Definition – what is clinical and care governance?

Clinical governance is defined by the UK government for the NHS across the UK as:

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care by creating an environment in which excellence in clinical care will flourish.

The NHS gained a statutory duty for quality of care in 1998 (see Health Act 1999).

Clinical governance can be thought of in terms of seven pillars:

1. Service User/Patient Involvement.
2. Clinical Audit and Quality Improvement.
3. Staffing and Staff Management.
4. Clinical Effectiveness.
5. Risk Management and Safety.
6. Data and Information.
7. Education and Training.

In short, it's about doing the right thing, at the right time, by the right person—the application of the best evidence to a patient's problem, in the way the patient wishes, by an appropriately trained and resourced individual or team. This is essentially the aim of the Right Decision Service, so clinical governance sits at the heart of delivering RDS toolkits.

But this aim of clinical governance can only be fulfilled if it is underpinned by core values and ways of working within the organisation.  Individuals and teams need to work within an organisation that is accountable for the actions of its staff, values its staff (appraises and develops them), minimises risks, and learns from good practice, and mistakes. These elements of clinical governance are all reflected in the quality checklist (Request form part 3) for RDS toolkits.

NHS Scotland has defined a combined clinical and care governance framework to support integrated health and social care partnerships and integrated joint boards. This defines clinical and care governance as:

The process by which accountability for the quality of health and social care is monitored and assured…..it is the way by which structures and processes assure Integration Joint Boards, Health Boards and Local Authorities that this is happening.

This framework emphasises that:

• Organisations should foster a culture where clinical and care governance are the responsibility of everyone working in the organisation.
• Clinical and care governance depend on partnership and collaboration within teams and between health and social care professionals and managers.
• Organisations need to empower clinical and care staff to contribute to the improvement of quality.
• Clinical and care governance depend on creating and responding to a strong voice from the people and communities who use services.

Clinical and care governance are part of the bigger picture of good governance as a whole across the NHS. The NHS Scotland Blueprint for good governance defines governance as:

the means by which NHS Boards direct and control the healthcare system to deliver Scottish Government policies and strategies and ensure the long term success of the organisation. It is the ability to ask questions and make decisions to improve population health and address health inequalities, while delivering safe, effective and high quality healthcare services. It is to be distinguished from executive-led operational management.

Open up the quiz below to check your understanding of the definitions highlighted above.