Chapter 11
Clinical Governance
A The Legal Perspective
Jo Wilson
The main purpose of health care delivery is to secure, through the resources
available, the greatest possible improvement in the physical and mental health
of the population. Achieving clinical quality and effective risk management is
the aim of every clinician so it may seem surprising that there is apparently
so much variation in practice between hospitals, departments and even indivi-
duals, all trying to deliver the same service. Some local customisation is of
course desirable, but the variations in both quality of care and quality of deliv-
ery of care would suggest that many of the principles which should underpin
any quality service are not always addressed. The reasons for this are com-
plex, but may relate to a historic narrowness in the training of health care pro-
fessionals; an inability to implement change; fears of failure and threats to
clinical autonomy and clinical freedom due to lack of evidence based prac-
tice; and a poor record in effective team working. The concept of clinical gov-
ernance ensures that quality of care is central to the delivery of care for all
professional groups. It aims to ensure clear systems are in place to promote
and check that health care professionals are working towards quality
standards.
Clinical governance within health care organisation therefore provides a clear
framework for the achievement of quality improvement. Quality in this context
means clinical care as well as customer care and getting things right first time and
every time. Risk management is about avoiding the potential for unwanted out-
comes and getting things right every time. Clinical governance encompasses all the
processes needed to achieve the highest quality clinical practice possible, within
available resources. Clinical governance represents a major opportunity for health
professionals as it gives the professionals the authority they need to make the
health service work more effectively.
Since the early 1990s there has been strong support to develop the clinical
effectiveness agenda through robust arrangements for quality improvements,
clinical audit and clinical guidelines. In the 1997 UK Government White Paper
[1]The New NHS Modern Dependable,the systems of clinical governance mark a
fundamental and significant shift towards involving clinicians in the assurances
of both quality, security and accountability in health care delivery. The paper
states: