Clinical governance: applying theory to practice

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Summary

Although clinical governance is prominent in modern health care, it is often perceived as an abstract concept. This article explains the key components of clinical governance and relates these to nursing practice. The author emphasises that clinical governance should be viewed as an opportunity to improve care delivery.

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Keywords

Accountability; Audit; Clinical governance; Quality assurance

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Aim and intended learning outcomes

This article provides an overview of clinical governance by explaining the key components. It aims to increase readers' understanding of the concept and enable them to relate this knowledge to nursing practice. After reading this article you should be able to:

* Identify the key elements within the clinical governance framework.

* Understand how clinical governance relates to everyday nursing practice.

* Discuss the implications of clinical governance for practice.

* Review the role of the nurse within the context of clinical governance.

* Understand nurses' responsibilities in improving and maintaining quality care.

Introduction

Clinical governance was first introduced into the NHS in 1997 as a comprehensive framework to improve the quality of care (Department of Health (DH) 1997). Its origins date back to the aftermath of some highly publicised failures in the NHS in the 1990s. Perhaps the most notable of these was the Bristol Royal Infirmary Inquiry (2001 ), in which investigations of 23 deaths of cardiac surgical paediatric patients revealed unacceptable variations in clinical practices and outcomes. Other notable cases were: The Royal Liverpool Children's Inquiry (Alder Hey Inquiry) ( Redfern et al 2001 ), the case of the GP Harold Shipman (Smith 2005), and the trial of the nurse Beverly Allitt in 1993 (Clothier 1994); all caused widespread public and political concern and heightened a general awareness of the potential for harm. These cases also engendered a period of deep reflection and critical analysis among the health professions and fostered growing support for major changes in the way health services were managed (Smith 1998).

The present Labour government's focus on reforming the NHS, minimising risk and improving the quality of...