The term ‘clinical governance’ involves a mix of structures, systems and undertakings that relate to governance, management, and administration, as well as to clinical practice; it involves more than only clinical, and more than only governance.5 A more accurate way to describe it would be ‘governance, management and practice for quality and safety’.
Clinical governance can be defined as:
a whole-of-organisation approach to continuously improving the quality of services to protect safety and well being of, and outcomes for, the person, whānau, and staff, and enhance the quality of care provided and experienced. It involves systematically joining-up all safety, quality maintenance and improvement efforts within or across health care organisations.1,3,5,7,8,11
“Clinical governance is about the infrastructure that enables clinical excellence to manifest. It involves frameworks and processes for creating and supporting clinical excellence; and measuring, monitoring, and auditing the frameworks. … It places the patient at the centre of the equation.” (PNZ member, Martin Kidd)
But what exactly is clinical governance? Unpacking the definition
Clinical governance is a whole-of-organisation approach:1,3,8,11
- It involves everyone and all functions across an organisation: clinical, administrative, ancillary, management, governance. Everyone within the organisation has responsibility and a role to play.
- Critically, it involves clinicians providing leadership and oversight of service delivery.11
“Clinicians are not only responsible for the provision of high quality patient care; their leadership is also important at all levels of the system. Clinical participation in the management and governance of [health care] services is essential in creating the culture needed for high quality and safety.”4 HQSC (2016) p16
Clinical governance is about continuously improving the quality:1,3,8,11
- It is a continuous cycle that does not have an end-point. Quality improvement becomes part of business-as-usual of the organisation.
- It involves the provision of high-quality clinical care (and the continuous improvement of this), and improving the organisational system.
Services:
- That is, the services and care that the organisation provides—i.e., the work of the organisation. The quality of the services and care is influenced by the organisation and delivery of those services. Therefore, clinical governance is also concerned with the organisation and delivery of services.
Enhance the quality of care provided and experienced:1,2,8,12
- Enhancing the quality of care is about improving the services and care—as provided by the organisation and experienced by the person and whānau—so that it is high quality.
High quality care:
- is safe and appropriate (in a holistic sense, i.e., clinically, culturally, psychologically, other)
- is person and whānau centred
- is timely and efficient
- is equitable, including in terms of access, experience and outcomes
- results in the desired or expected clinical or other health outcomes. That is, it is effective.
“It encourages internal accountability within clinicians to lift the quality and outcomes from a clinical viewpoint.” (PNZ member, Karen Evison)
Systematically joining-up:
This means that efforts across the organisation are coordinated and integrated.1,3 For example,
- Establishing and using pathways through which to communicate relevant review findings or learnings into other areas and services
- Using findings from the review of individual services to inform other services and areas, as applicable
- Proactively collecting and sharing critical information1
- Coordinating or integrating clinical services and care (including interprofessionally), and ensuring effective communication and sharing of information between the services
This systematic joining-up is reflected through the organisational systems and processes that make up an organisation’s clinical governance framework (which cover the work of the organisation and improving the organisational systems and processes themselves).
Safety, quality maintenance and improvement efforts:
These are all actions, behaviours, initiatives and undertakings that protect, maintain, and enhance safety and quality. These include:
- adherence to regulated requirements,13-19
- adherence to all applicable legislation,20,22-26,29,37
- adherence to relevant certification requirements,
- implementation of organisational systems and processes that address the clinical governance domains, and any other existing or new initiatives that aim to protect or enhance safety and quality.
Note: superscript numerals in the above text denote references cited. Refer also to the glossary.