Clinical Governance

January 31, 2014

???????????????What is Clinical Governance?

Clinical governance can be defined as a framework through which UK National Health Service (NHS) organisations and their staff are accountable for continuously improving the quality of patient care. NHS staff need to ensure that the appropriate systems and processes are in place to monitor clinical practice and safeguard high quality of care. Clinical governance is central to the UK Government’s agenda to ensure that quality of care becomes a key driver in the development of health services.

The five themes:

  1. Patient centred – Putting patients at the centre of care and strengthening the public and patient voice.
  2. Information focus – Access to good quality information helps people to understand their health situation, make informed decisions about their care and treatment, and manage their own health.
  3. Quality improvement – Meet standards developed by the National Institute for Health and Care Excellence (NICE).
  4. Staff focus – Important to support a skilled workforce who are able to adapt and respond to changes and the challenges required in sustaining the delivery of safe and effective care.
  5. Leadership – Senior healthcare staff should accept full managerial and professional accountability for high quality care.

Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system. It became particularly important after the Bristol heart scandal in 1995, during which anaesthetist Dr Stephen Bolsin exposed the high mortality rate for paediatric cardiac surgery at the Bristol Royal Infirmary.

Why do we need Clinical Governance?

Clinical governance is needed to reassure the public that the care received in the NHS is of the highest standard. It requires the development of a culture where healthcare professionals are motivated to routinely think: ‘Am I doing it right? How can I do better?’

Accountability is at the heart of the concept of clinical governance. Not only must health professionals strive to improve the quality of care, they must also be able to show that they are doing so. However the concept of accountability isn’t new, health care providers have been accountable to their professional regulatory bodies for a long time.

What are we accountable for?

We need to show that appropriate systems are being used to record to whom care is being delivered and the way in which it is delivered. Healthcare providers need to show that staff are delivering care in accordance with the standards in national service frameworks, and also that any locally developed standards are adhered to.

Clinical governance doesn’t impose any new legal obligations on individual health professionals. The only legal obligation, given in section 18(1) of the Health Act 1999, is that primary care trusts (along with health authorities and hospital trusts) must “put and keep in place arrangements for the purpose of monitoring and improving the quality of health care.” Since PCT’s no longer exist the responsibility now lies with the CQC and CCGs to monitor quality of care.

Best practice

The Royal College of Nursing (RCN) strongly believes that improving the patient’s experience of health care is also the central purpose of clinical governance. Good care means:

  • Getting good treatment – high quality, safe and effective treatment delivered by capable teams.
  • Being treated as a person – with respect, honesty and dignity.
  • Being safe and comfortable – confidence in the care environment.
  • Being informed and having a say in the care they receive.

These things should be present at every point of contact with health services. The journey includes health awareness, access to care, continuity of care and support for patients, families and carers. However, people can face additional challenges. For example, people whose first language is not English can have problems with information and accessing care. So equity, diversity and choice issues influence the patient experience as well.

All healthcare providers strive to provide safe and good quality health care; improve patient experience, tackle effectiveness and update practice in the light of evidence from research. Understanding what influences attitudes and behaviours has been given much greater attention in looking at what makes for higher quality and compassionate care.

Participating in Clinical Governance

Clinical governance is intended to improve standards of care and also to protect the public from unacceptable care. An underlying challenge for clinical governance in primary care is to move away from professional development based on individual disciplinary education towards multidisciplinary, team based learning. The emphasis on continuing professional development for all clinicians, be they doctors, dentists, nurses, or other healthcare professionals, will encourage clinicians to reflect on their educational needs and meet those needs. An active process can be met in a variety of ways, including through traditional lectures, but may be best met through peer discussion, discussing published literature, or consulting guidelines.

Clinical Governance in the future

In order for clinical governance to succeed, health organisations need to move away from a ‘blame culture’ to one of learning. It is important that quality in the NHS is maintained and that necessary changes are made to ensure that the patients become central to the healthcare agenda and that their voice is heard.

Tips for Clinical Governance


  • Have clinical and organisational leadership.
  • Conduct performance reviews including quality issues.
  • Undertake clinical audits.
  • Work together to improve performance.
  • Manage and learn from complaints.
  • Seek and respond to patients views.


  • Ignoring quality issues as part of core business.
  • Undervaluing individuals education, training and continuing professional development.
  • Ignoring problems, it’s important to be proactive and transparent.

The QCS Management System provides advice to Practices to support them in managing Clinical Governance for Health and Safety, Risk Management and Safe Guarding, and Practice Management.


The BMJ – Accountability for clinical governance: developing collective responsibility for quality in primary care

The Royal College of Nursing (RCN) – Clinical Governance


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Alison Lowerson

GP Specialist


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