Clinical Governance: Definition, Importance, and Quality in Healthcare

This report provides a comprehensive overview of clinical governance, defining it as a system that ensures accountability for standardizing service quality and safeguarding proper healthcare within National Health Service (NHS) firms. It emphasizes the importance of clinical governance in delivering safe, effective, and high-quality services, highlighting accountability to patients and the community. The report details key elements such as clinical audits, risk management, patient involvement, and evidence-based practice, supported by attitudes like ownership, teamwork, leadership, communication, and systems awareness. It further explores how clinical governance promotes quality through continuous quality improvement, quality assurance, and clinical practice improvement. The report also examines the accountability of clinical governance to patients and the community, discussing the roles of individual healthcare professionals and healthcare groups. Finally, it concludes by emphasizing the importance of stakeholders prioritizing elements like horizontal accountability to ensure safe, effective, and high-quality services.

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THE IMPORTANCE OF CLINICAL GOVERNANCE
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Clinical governance is a system whereby National Health Service (NHS) firms are accountable
for standardizing the quality of the services and safeguarding proper healthcare by creating a
supportive environment in which there is proper clinical management (Brownson, 2017).The
system ensures that everyone is accountable to patients and the community for assuring the
delivery of safe, effective and high quality services (McSherry & Paddy, 2011). Being
accountable to members of the society means that clinical governance has an obligation to
provide justification and be held responsible for its actions. Accountability has three components
namely; professional accountability for the quality of work done, accountability of health
professionals within the organizations in which they work and accountability as senior members
of staff for organizations’ performance and more widely for provision of local services.
Clinical governance has various elements such as clinical audits, risk management, patient
involvement, lifelong learning and evidence-based practice (Burgess, 2011). The patient-
professional relationship is considered very important to high-quality healthcare. The above
elements are supported by attitudes shared by health care experts. Such elements were;
ownership, teamwork, leadership, communication and systems awareness. Their opinions were
centred on patient-professional relationship.
Ownership
Ownership is the activity of participating in design and implementation of health care by
professionals. Thereby the health professionals share an obligation of quality improvement. In
order to deliver quality, the health professionals need a free environment where they can share
their opinions without fear or favor. The 23 experts who conducted the Delphi study managed to
gather some perception on ownership. The panelists said that the role of health care professionals

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was very crucial for Clinical Governance. They advocated for innovation for each and every
professional but then another expert commented that teamwork was a core element and not
independence of the healthcare professionals (Makar, 2012).
Teamwork
Teamwork is working together among healthcare professionals. It is contributive towards high-
quality patient care through joint learning and more knowledge and skills. Delphi study panelists
perceived teamwork as a driver to organizational and cultural change. Aspects like sharing
responsibilities and maintaining good relationships were perceived as very important. Even if
teamwork was advocated for, it was not completely trusted to move Clinical Governance beyond
the quality improvement methods (David & Richard 2013). One expert commented that
teamwork was not a unique Clinical Governance aspect as there were other more quality
initiatives that emphasized on learning. For teamwork to be supported and a working
environment be enabled, leadership is necessary (White, 2010).
Leadership
The quality of healthcare is better of when leaders talk about it. The Delphi expertise were also
in support of leadership but said that the leaders needed knowledge on clinical practice. Leaders
were also advised to work towards creating an open and a participative environment. Leadership
was also perceived to bring about changes by facilitating professional development. According
to the experts, it was important for leaders to come together and share responsibilities among
healthcare experts, the board and the managers. The panelists did not approve the elements that
considered authoritarian approaches leadership (Haxby, Hunter & Jagger, 2010).

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Communication
Communicating information about a patient is important, such as when they are transferred to
other health care facilities to be taken care of by other healthcare professionals. Communication
also boosts the courage of other healthcare professionals to share their opinions. The freeness
among the professionals brings about a collective vision which in turn opens doors for the
creation of an open working environment. Communication also promotes patient involvement.
This is whereby the professional socializes with the patient and acts according to the patient’s
needs. It also is important in establishing correct diagnosis (Travagalia, 2011). When a clinical
error occurs and the healthcare professional is open about it, the chances of that error occurring
again since the other colleagues are aware of it and will work towards avoiding the error.
Communicating to patients openly makes them aware of advanced treatment techniques.
Systems awareness
Healthcare processes are interrelated and errors may occur in systems that a clinical professional
is working. The recognition of that fact is known as systems awareness. System awareness leads
to keenness among the practitioners thereby reducing the risk of occurrence of an error(Tingle &
Cribb,2014). The experts in the Delphi study perceived systems awareness as important. The
importance of learning from mistakes was illustrated by a comment from an expert who said that
they thought that clinical practice was difficult to standardize. Managerial approaches such as
systematic risk evaluation and continuous revision of guidelines were rejected by the experts in
Delphi (Wilkson & Powell, 2011).Clinical Governance was generally termed as a cultural
concept that was aimed at promoting quality improvement; that was according to the experts in
Delphi.

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How clinical governance promotes quality in clinical setting
Clinical governance is guided by elements such as Continuous Quality Improvement which is a
philosophy that guides clinical staff to be checking on patients and listen to their needs. It begins
with culture of improvement for the caring of patients. According to Australian Aged Quality
Agency (AACQA), the importance of continuous quality improvement includes; there is always
identification of changes in healthcare and service needs. Continuous Quality Improvement in
the clinical setting provides improved systems to check and track changes in patients. Another
importance of Continuous Quality Improvement is that it promotes stakeholders inputs in
healthcare. For CQI to be successful it must be understood and accepted by clinical staff and
management, its aim is to find ways to improve quality of care provided to patients. There must
be suitable planning, process, activities and proper evaluation for CQI to succeed.
Clinical governance also ensures there is always quality assurance in clinical setting. Quality
assurance is a technique designed to ensure that there is best standards of healthcare to patients
and ways made to point out and deal with those whose performance do not meet the
recommended standards. For a Primary Health Organization (PHO) to come up with best
assurance plan, performance checking aspect of clinical auditing needs to be developed
(Zwanenberg & Harrison, 2016).
Clinical governance is also important in ensuring quality in its services by checking on clinical
practice improvement which deals with improvement of care of patients in health service
organizations. It involves identifying, defining and diagnosing problems then coming up with the
best solutions and implementing those inventions that may solve the problems. Success of
Clinical Practice Improvement depends on the clinical staff which has a role to be accountable,

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both individually and collectively for it. The clinical staff should be ready to continually try to
improve clinical practices. Lastly, clinical staff should be aware of quality, efficiency and safety
of patients.
Various examples of quality improvement work in primary care were given in the international
setting. In New Zealand, there was peer review and individual feedback on clinical performance.
Independent healthcare professional associations volunteered to perform some clinical work.
They were then assessed through peer discussion groups to with an aim of reducing expenditure.
Germany on the other hand used lifelong learning. The state ran a diploma program for the
professional doctors who had been in the career for not less than five years. The study was a 200
hour programme which taught covering guidelines and best practice, health economics and
quality management. Norway opted for revalidation of doctors. They were recertified after each
interval of five years, based upon 200 hours of medical training accompanied by an internship of
three months in hospital. The revalidation had an added advantage of 10-15% salary increment.
Canada used public involvement in medical regulation and accountability to improve quality.
They organized projected representation by medical colleges, registration councils and
complaints and disciplinary councils. The last example was by European countries UK, Spain,
Netherlands amongst others in the continent. They assessed technological programmes and chose
the best which could ensure maximum quality improvement.
How is clinical governance accountable to patients and the community?
Clinical governance ensures that everyone is accountable to patients and the community for
assuring the delivery of safe, effective and high quality services. Clinicians have been
accountable to their professional bodies and it is a requirement for each and every clinician to be

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answerable to colleagues in their practices and their primary care groups. Clinical governance
has divided accountability in healthcare into two: individual healthcare professionals, such as
primary care groups and trusts. The duty for individual healthcare professionals is to provide
care of high quality to individual patients. This is mainly dealt by the law of negligence, under
which a patient can sue a health professional for failing to have provided care of reasonable
standard .In addition, obligations imposed on individual professionals by their professional
bodies such as the General Medical Council. The main goal of clinical governance is to hold
groups of professionals accountable for each and other’s performance. One of the agenda of
clinical governance is to encourage a sense of collective responsibility for the quality of care
provided by all practitioners (McLaughlin & Johnson 2012).
Primary care practitioners have a duty of ensuring that they are accountable to variety members
of the community: the local community in which the practice is situated, peers in the primary
care groups, actual patients, the regulatory organization of the profession and the NHS
organization. Within primary care the importance of clinical governance will lie in the
development of public involvement in quality improvement work characterized as downwards
accountability and use of annual accountability agreements between primary groups and trusts
and local health authority (CIRANAplus, 2013).
Accountability in clinical governance deals with issues like fiscal and programme. Fiscal is
concerned with finance thus the ability to follow up and explain all expenditure and programme
deals with activities undertaken and the need to show that appropriate systems are being used to
record to whom care is being delivered and the ways in which is delivered (Dhamija &
Keane,2012). All the dimensions are relevant to the activities of clinical staff working in primary
care.

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Finally, clinical governance ensures that everyone is accountable to patients and the community
for assuring the delivery of safe, effective and high quality services. However, issues have been
raised by individuals that doctors are engaging in dangerous clinical practices, this has limited
accountability of doctors in particular. These doctors who engage in clinical malpractices should
be answerable to the relevant authorities (Gauld & Horsburg, 2015). With the limited resources
available, stakeholders should prioritize some elements of accountability such as horizontal
accountability. Horizontal accountability is a key element for it is the foundation for effective
clinical governance and care groups. Accountability is essential for it can be used to measure the
quality of care. Primary care groups will also satisfy the requirements of clinical governance
because they know that they will be answerable to the authorities (NHS). Doctors, nurses and all
the practitioners should therefore understand the society attitudes towards clinical governance,
the various aspects for quality improvement and finally be accountable for their work. When all
that is considered then delivery of safe, effective and high quality services will be ensured
(Gottwald & Landsdown, 2014).

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