There are four domains of clinical governance, all of which must be addressed by the organisational systems and processes (e.g., policies, procedures, associated activities) that make up an organisation’s clinical governance framework.1,3,7,8
The four domains of clinical governance are:
- Person, whānau and staff safety
- Clinical effectiveness
- Engaged and effective workforce
- Person and whānau engagement and participation
Although presented here as separate domains, there is crossover, overlap and interaction between them.
Person, whānau and staff safety
There is an ongoing, organisation-wide commitment to person, whānau and staff safety. This involves:
- proactively and reactively identifying and managing risks (including clinical, cultural, psychological, other)
- monitoring, reporting and evaluating performance of risk identification and management, and
- using this evaluation to inform improvements.
A fair, just and open organisational culture that takes a “no-blame” approach to risk identification and management, and repair of errors, and which has a continuous learning focus will help to realise this domain.
This domain contains distinct aspects of person and whānau safety and staff safety.
“The two most important aims of clinical governance are quality improvement and to ensure patient safety. … Clinical governance raises the standards of care. It means you have a safe bottom line.” (PNZ member, Jane Hamer)
Clinical effectiveness
There is an ongoing, organisation-wide commitment to clinical effectiveness, in order that the ‘right care’ is provided to the ‘right patient’ at the ‘right time’ by the ‘right clinician’ in the ‘right way’. This involves:
- using evidence-based practice (informed by person and whānau preference) to achieve the best possible care and outcomes for people
- monitoring, reporting on, and evaluating clinical and other health outcomes, and the use of evidence-based practice and guidelines, clinical pathways and models of care, and
- using these evaluations to inform improvements in service and care delivery.
Having systems in place for sharing learning and improvements will help to realise this domain.
This domain contains distinct aspects of the practice (i.e., the service and care provided by the organisation), and the outcomes (i.e., the clinical and other health outcomes for the person and whānau).
“Clinical governance brings everything back to clinical outcomes and what’s possible from a clinical perspective.” (PNZ member, Karen Evison)
Engaged and effective workforce
All staff have the appropriate expertise and qualifications for their roles, and are supported to maintain the roles by the organisation. All staff are aware of their roles and responsibilities regarding clinical governance, and actively participate in associated activities; i.e., everyone plays their role in clinical governance.
A culture in which staff partner in clinical governance initiatives will assist this domain to be realised.
An essential part of clinical governance is that health care professionals—clinicians—provide leadership for, and oversight of, the services and care provided.3,11
This domain contains distinct aspects relating to staff expertise (qualifications, knowledge for their roles) and their awareness and participation in clinical governance.
“Clinical governance helps to ensure the acceptability of decision-making processes because clinicians are involved. You must have clinicians really and truly involved in conversations and decisions, otherwise it won’t translate into practice; you won’t get genuine change in practice without this. …Clinical governance impacts on day-to-day practice, because it involves clinicians, and gives them a sense of belonging, and they feel valued and respected.” (PNZ member, Karen Evison)
Person and whānau engagement and participation
The organisation engages with people and whānau in culturally appropriate ways, and monitors, reports on, and evaluates their experiences of care, and uses these evaluations to inform improvements. The organisation actively seeks opportunities to understand the views, needs and perspectives of tangata whenua and the community it serves. These insights are used to inform service design, delivery, and evaluation, and where possible, design and evaluation processes are conducted in such a way as to enable and empower people, whānau and tangata whenua participation.
Establishing and maintaining meaningful relationships with people and whānau, and being responsive to their expectations in ways that enhance their outcomes and experience will help to realise this domain.
This domain entails inviting and enabling meaningful engagement by tangata whenua in decision-making, service design, implementation and evaluation.31
This domain contains distinct aspects relating to person and whānau experience of care, consultation with people, whānau and tangata whenua (in which their perspectives are collected and used to inform service design etc), and collaboration with people and whānau (i.e., in which they participate throughout the processes, e.g., co-design).
“True clinical governance involves everyone. It involves patient voice, and co-design. Because the main things at its heart are quality improvement and patient safety, true clinical governance has patients or consumers involved. Everyone is actively involved. Person and whānau engagement is a core part of true clinical governance.” (PNZ member, Jane Hamer)
Note: superscript numerals in the above text denote references cited. Refer also to the glossary.