Clinical governance
It was originally elaborated within the United Kingdom National Health Service (NHS), and its most widely cited formal definition describes it as: A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
The concept has some parallels with the more widely known corporate governance, in that it addresses those structures, systems and processes that assure the quality, accountability and proper management of an organisation's operation and delivery of service.
Prior to 1999, the principal statutory responsibilities of UK NHS Trust Boards were to ensure proper financial management of the organisation and an acceptable level of patient safety.
Clinical governance is composed of at least the following elements: It is no longer considered acceptable for any clinician to abstain from continuing education after qualification – too much of what is learned during training becomes quickly outdated.
In the modern health service, clinical practice needs to be refined in the light of emerging evidence of effectiveness but also has to consider aspects of efficiency and safety from the perspective of the individual patient and carers in the wider community.
In addition, patient risks can be minimised by ensuring that systems are regularly reviewed and questioned – for example, by critical event audit and learning from complaints.
Risks to practitioners: ensuring that healthcare professionals are immunised against infectious diseases, working in a safe environment (e.g. safety in acute mental health units, promoting an anti-harassment culture) and are kept up-to-date on important parts of quality assurance.
Furthermore, keeping healthcare professionals up to date with guidelines such as fire safety, basic life support (BLS) and local trust updates is also important, these can be annually or more frequent depending on risk stratification.
If clinical governance is to truly function effectively as a systematic approach to maintaining and improving the quality of patient care within a health system, it requires advocates.
