A clinical governance framework is a structure that guides how we think about, plan, and deliver services and care, so that safety, wellbeing and outcomes, and the quality of care and services, can be monitored and enhanced.1,3,5,7,27 The framework provides the whole-of-organisation approach.
“A good clinician will make consistently good clinical decisions, but having a system of effective clinical governance means there is a structure to ensure that this is not by chance, but follows from good recruitment, continuing professional education and clinical audit. Such a system will enable good performance to be sustainable and to be spread across the organisation.”28 Owens, 2005.
Conceptually, we can think of a clinical governance framework as a dome structure that houses—surrounds and protects—the services and care provided by the organisation. Wrapped in and surrounded by the services and care provided are the person and whānau, and their experience of those services and care.1,3,12
The underpinning principles1,3,7,8,11 form the floor of the structure. The person and whānau—surrounded by the services and care provided—rest on the floor.
The underpinning principles are that:
- Services and care are person and whānau centred
- Services and care are safe, effective and equitable
- Organisational culture is fair, just, open and transparent
- Everyone across the organisation has a role to play in clinical governance
- There is a shared commitment to continuous quality improvement
“If you don’t have trust, clinical governance won’t work. The culture and values of the organisation are critical to having successful clinical governance. Going hand-in-hand with setting up clinical governance, there needs to be a programme to build and improve the culture of the organisation within which you work. Everyone has responsibility. Everyone is accountable. Everyone matters. Everyone is valued. The patient is at the centre. Everyone strives for this. Everyone is in it together. When there’s trust and a good culture, you feel like you belong to an organisation that values you, and that the organisation wants to do the best by you. You want to do your best by the organisation and by the patient. That’s when clinical governance can really work.” (PNZ member, Jane Hamer)
“Communication is at the centre of good clinical governance. In essence, it is about honouring, respecting, valuing input. Then everyone feels ownership of the frameworks.” (PNZ member, Martin Kidd)
“With clinical governance there’s a greater degree of collegiality. You’re able to have discussions about difficult situations without fear of blame or finger-pointing.” (PNZ member, Karen Evison)
The clinical governance framework is a dome that sits over the floor, and protects the person, whanau, and services and care provided. The framework is made up of Organisational systems and processes (including policies, procedures, and associated activities) which address the four domains of clinical governance (represented as the four layers of the dome), that are in-place. The four domains of clinical governance are:1,3,7,8
- Person, whānau and staff safety
- Clinical effectiveness
- Engaged and effective workforce
- Person and whānau engagement and participation
“… People struggle with the phrase clinical governance, but really it’s about having a framework in place throughout the organisation, that supports you to be explicit about the standard of care delivered, about how you protect patients from harm, about how you listen to patients and about how you plan and measure improvement.”5 Project Manager, Hospital. Quoted in HSE (2014), p iv.
Why a dome?
We have chosen to use a dome to visually represent the clinical governance framework for several reasons. A dome is a strong structure29 that offers protective shelter—as a clinical governance framework should be and do. From pre-history to the current day, cultures from around the world have used domes in buildings within which they live, recreate, worship, and do business. Across these cultures and times, the materials from which the buildings were constructed varied enormously, as did the size and complexity of the buildings.30 A dome structure is adaptable: it can be built from the materials available and in whatever size is needed. Likewise, a clinical governance framework should be developed to suit the individual organisation, incorporating the systems and processes that are appropriate to that organisation.
Note: superscript numerals in the above text denote references cited. Refer also to the glossary.