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Clinical Governance

Clinical Governance and Leadership Guideline for Physiotherapy

Undertaken with support from ACC the Clinical Governance and Leadership Guideline for Physiotherapy (2020) provides a reference and resource for physiotherapists who want to develop their understanding of clinical governance and clinical leadership, particularly in relation to the Clinical Director requirement for the ACC Physiotherapy Services Contract. This has relevance to all physiotherapy services provided in an outpatient or community setting regardless of size and funding arrangements.

Part A of the guideline outlines legislation and standards relevant for guiding provision of safe and quality physiotherapy services. Part B presents the components and processes for appropriate and effective clinical governance for physiotherapy services with emphasis on the activities of a physiotherapist in various leadership roles including Business Owner, Service Manager, Clinical Leader, Clinical Director and/or physiotherapy role.

Clinical Governance Framework

People have the right to receive safe, high-quality healthcare. Robust systems and processes are necessary to enable the consistent provision of such care. Clinical governance is an organisation-wide approach that protects and continuously improves the safety and quality of services and care provided. It puts patient safety, outcomes and experience of care first for all decisions and actions. A clinical governance framework ensures that the organisational systems and environment necessary to deliver safe and high-quality services are in place.1-7

“The single most important obligation for any health system is patient safety and improving the quality of care.”5 HSE (2014) p v.

Clinical governance applies to all healthcare providers, including physiotherapy practices, regardless of size and irrespective of funding arrangements or certification status. The fundamentals of clinical governance—the concepts, approaches and underpinning principles—apply to all organisations, although the specific arrangements will be tailored for each.1,3,5,7,8

A clinical governance framework supports all staff—clinicians and others—in their endeavours to provide safe high-quality services and care by making it ‘easy to do the right thing’ and ‘difficult to do the wrong thing’.7 Clinical governance involves everyone: it is critical that everyone understands and embraces that “we are all responsible … and together we can create a safer and more effective health system.” Lack of clarity about the responsibility for the quality and safety of care, or the shifting of responsibility for this, can sometimes be an issue in healthcare organisations.5

“[A clinical governance framework] is the framework within which you operate [that] makes sure that patient safety is secure. It’s about making sure that standards of care and safety are able to be met. Without clinical governance, you would end up with people making decisions that aren’t robust and that place people at risk.” (PNZ member, Martin Kidd)

A clinical governance framework is made up of organisational systems and processes that address the four domains of clinical governance, all of which are supported by underpinning principles. The systems and processes included in a clinical governance framework should be appropriate for that organisation’s context and situation. For each organisation, the clinical governance framework should also be scaled to the organisation:1 large or complex organisations will have larger and more complex clinical governance frameworks, where smaller or simpler organisations will have smaller and simpler frameworks. For some, it might be appropriate to have a clinical governance framework that covers more than one organisation.

“The two primary drivers of clinical governance are quality improvement and patient safety. Falling out of that are heaps of other benefits: it can improve efficiency and save money; it can prevent things going wrong; it can improve service delivery to make it more efficient and more equitable; it can support developing staff to be the best that they can be; it provides a structure to provide care to the person and whānau. But the key is that the whole organisation buys into it: managers, clinical leaders, clinicians, consumers.” (PNZ member, Jane Hamer)

PNZ has developed this framework and associated guidance to support physiotherapy in New Zealand, and to support members to develop and implement clinical governance frameworks within their organisations. This information and guidance will assist members to introduce or refine a clinical governance framework in their practice, or to increase their focus on safety and quality of care. ACC has introduced the requirement for clinical governance and a nominated clinical director in their variation to the Physiotherapy Services Contract commencing May 2020.9,10 PNZ’s framework and guidance will support members to meet these requirements. Aspects of the framework will also assist practices to meet certification standard requirements.

The framework and guidance that PNZ has developed are based on current best practice, literature and international examples.

Information and resources provided:

Note: superscript numerals in the above text denote references cited.

Page updated September 2020

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