Nursing Law and Ethics

11.4 Elements of clinical governance

Clinical governance provides a framework or mechanism through which clinicians
and managers recognise their individual and collective responsibilities and
accountabilities in respect of quality of care, and by which the health care
organisation fulfils its statutory duty for the quality of care. It is a framework to co-
ordinate quality improvement and quality assurance efforts with a full range of
activities which aim to promote, maintain and improve the standards of patient
care. Figure 11.1 demonstrates the range of activities through patient-centred care
with a focus on accountability along a range of mechanisms to ensure imple-
mentation.

Most of the elements of clinical governance are not new to good clinicians
and managers, but the framework brings them together under one umbrella
providing a protective mechanism for both public and staff knowing that
their local health care organisations are actively developing structures to
improve quality and standards of patient care. It is about having efficient and
effective systems of communication with staff and patients where robust infra-
structures are established to proactively develop evidence based quality health
care.

4 Clinical governance

Executive

directors

Chief executive

Staff

3 CQI

Competencetraining Accreditation

Bench-

marking

Workforce

planning

Education

and training

Care

pathways

Standards

Audit

Complaints

Patient

involvement

R & D

2 Evidencebased

practice

Clinical

audit

Integrated

care

management

Clinical

guidelines

Complaints Clinicalrisk

developmentProfessional management

1 The patient

Patient

Clinical effectiveness

Continuous quality improvements (CQIs)

Clinical governance

Fig.11.1 The elements required for clinical governance.

228 Nursing Law and Ethics