Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system and is essential to improving the standards of health care itself.
Clinical governance was first described in a UK government white paper as a new system to ensure that clinical standards are met and that processes are in place to ensure continuous improvement of medical practice.
It is a framework through which the UK national health service organisations are held accountable for, and continuously improve the quality of their services and safeguard the high standard of care by creating an environment in which clinical care will flourish. Clinical governance is designed to ensure quality of patient care, and is the responsibility of doctors, nurses, health professionals, hospital authority and the government to make sure that high standards of clinical care are maintained throughout a health system and the quality of service is continuously improved.
Clinical governance is composed of education and training, clinical audit, clinical effectiveness, risk management, research and development and Openness.
Education and training
In the modern health service, it is no longer acceptable for any clinician to abstain from continuing education after qualification. Too much of what is learnt during training becomes outdated too quickly, and continuous professional development (CPD) for doctors is the responsibility of the authority that employ them and a professional duty of the doctors themselves.
Clinical audit
Clinical audit is the systematic critical analysis of the quality of health care, including procedures for diagnosis, treatment and care, use of resources, resulting outcomes and the quality of life for patients. It embraces the work of all health professionals.
Clinical audit is designed to improve patient care, enhance professionalism, efficient utilisation of resources and sense of accountability; eventually aiding professional development and management as a whole.
Clinical effectiveness
Clinical effectiveness is a measure of the extent to which a particular intervention works. The measure on its own is useful, but it is enhanced by considering whether the intervention is appropriate, and whether it represents value for money.
In the modern health service, clinical practice needs to be refined in the light of emerging evidence of effectiveness as well as consider aspects of efficiency and safety from the perspective of the individual patient and carer.
Clinical effectiveness has been promoted through the development of guidelines and protocols for particular diseases, and is based on evidence of effectiveness.
Risk management
There is inherent risk in providing health care to the patient, to the medical practitioner and to the provider Organisation. Risks need to be minimised by quality assurance that has to be one of the essential components and the strongest pillar of health care. Plans for risk management must cover patient-specific risks and be well documented; they must also be accessible to those working with patients. Many patient risks can be reduced by adequately training physicians and staff, encouraging strong communication among staff-members, providing counseling services for those working with patients, and conducting competency assessments.
Risk in health care is something that would pose a potential threat or opportunity to the achievement of objectives within the context of health care organisations; strategic, program or operational.
Risks and issues should not be confused. Risks are situations that might happen and stop us from achieving objectives, or otherwise impact on the success of the organisation in contrast. Issues are things that have happened, were not planned and require management action.
Once identified, the risk needs to be described clearly to ensure that there is a common understanding of the risk by the stakeholders. It will then go on the risk register to be assessed and scored, and an action plan will be instituted to eliminate, minimise, or maximise the risk.
Setting up of statutory regulations and compliance to such regulations will help to reduce risks and improve quality of patient care. In the UK health system, regulations such as the Data Protection Act, the Control of Substances Hazardous to Heath (COSHH) regulations, Medicines Control Agency approvals, Indemnity insurance and many other regulations are implemented and regularly reviewed to minimise risks.