Principles Of Clinical Governance

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What is clinical governance?

Clinical governance is defined as: ‘a framework through which NHS organisations are

accountable for continuously improving the quality of their services and safeguarding high

standards of care by creating an environment in which excellence in clinical care can

flourish’ (NHS Executive1999). A more succinct definition is offered by Lilley and Lambden

(1999) who state that clinical governance is ‘doing anything and everything to maximise

quality’ in the health service..

The main components of clinical governance

1. Accountability

As individuals we are accountable for our practice, but so are our colleagues and managers.

Concerns about the performance of colleagues should be raised with the appropriate
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Responsibility for it should be combined with the


Clinical governance requires us to have current systematic evidence of what is being done.

While clinical audit is effective, not all practice can be subject to constant audit. We therefore

need to build a portfolio of measures to help us. Complaints, incidents, accidents,

performance indicators, individual projects and peer review should be used together to

provide a complete picture. Any missing portions need to be investigated and the gaps filled.
Much of our ‘knowledge’ is based on custom and practice, or on evidence produced in

settings other than our own. Clinical governance requires us to review that knowledge with

an ever-questioning approach.

In nursing, is a team effort and judgements about best practice need to be made by teams,

not individuals, to avoid uneven approaches to care.

Absolutely, the ability to critically appraise research is an acquired skill, and employers

should be responsible for training. We are responsible for ensuring that there are sufficient

skilled people in our team. We need to be able to question the validity of evidence
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8. Staffing and staff management

Staffing and staff management is vital to our ability to provide high-quality care. We need to

have highly skilled, knowledgeable and competence staff will be working in an efficient team

and in a well-supported environment. For example, poorly performing healthcare staff are

not only a risk to patients, but also to colleagues and the organisation in which they work.

Clinical governance advocates a clear mechanism for identifying, reporting and dealing with

poor performance. This can be identified through the adverse incident reporting system and

complaints management. For example, reviewing complaints or adverse incidents can

identify areas of poor performance, prompt a review of current practice and identify areas for

further education and training to improve practice. In addition an open, supportive working

environment can also assist the reporting of poor performance and quality improvement

initiatives. Processes such as appraisals and regular review of personal development

planning are also ways of managing and improving individual

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