BAnEthical Perspective ± Quality and Judgement
Lucy Frith
Clinical governance is the latest `big idea' for the NHS [1]. The main aim of clinical
governance is to improve the qualit yof care provided b ythe NHS. At first sight this
seems a common sense message ± we should aim to provide the best health care
that we can and always be seeking to improve the quality of that care. Surely, this is
what health providers have always done? The main new facet of clinical govern-
ance is that it makes health organisations legall yresponsible for the qualit yof the
health care the ydeliver, creating a statutor ydut yto improve the qualit yof health
care. With this legal responsibilit ycomes accountabilit y. The chief executive of
ever yTrust is responsible for the qualit yof care and individual practitioners are
held to be more accountable.
Clinical governance can be defined as:
`A framework through which NHS organisations are accountable for
continuousl yimproving the qualit yof their services and safeguarding high
standards of clinical care b ycreating an environment in which clinical care will
flourish.' [2]There are three main components of clinical governance:
,1) Setting standards:Bodies such as the National Institute for Clinical Excellence
and the National Service Frameworks will set standards and aim to ensure
equalit yof access and standardisation of health provision throughout the
NHS.
,2) Putting these standards into practice:Measures such as care-pathways and
clinical guidelines will implement these standards and recommendations for
care. Clinical governance aims to create a more open environment where
professionals will share good practice and participate in lifelong professional
learning.
,3) Monitoring these measures: Bodies such as the Commission for Health
Improvement, set up in September 1999, will publish information on the
performance of Trusts in terms of three dimensions of quality: effectiveness