`The Government will require every NHS Trust to embrace the concept of
clinical governance, so that quality is at the core, both of their responsibilities as
organisations, and of each of their staff as individual professionals.'In order to achieve this the Government has legislated a new duty for the quality of
care and working in partnership. Under these arrangements chief executives now
carry ultimate responsibility for assuring the quality of the services provided by
their NHS Trust, just as they are already accountable for the proper use of
resources. InAFirst Class Service Quality in the NHS[2], clinical governance is
`defined as a framework through which the NHS organisations are accountable for
continuously improving the quality of their services and safeguarding high stan-
dards of care by creating an environment in which excellence in clinical care will
flourish'. The principles of clinical governance apply to all those who provide or
manage patient care services in the NHS. It requires staff to work in partnership
providing integrated care [3] within health and social care teams, between
practitioners and managers and between the NHS, patients and the public.
11.1 Principles of clinical governance
Clinical governance incorporates a number of processes, including:
. clinical audit;
. evidence based practice in daily use supported within the infrastructure;
. clinical effectiveness;
. clinical risk management with adverse events being detected, openly investi-
gated and lessons learned;
. lessons for improving practice are learned from complaints;
. outcomes of care;
. good quality clinical data to monitor clinical care with problems of poor clinical
practice being recognised early and dealt with;
. good practice systematically disseminated within and outside the organisation
and clinical risk reduction programmes of a high standard being in place.
There is an expectation for all clinicians to fully participate in audit programmes,
including speciality and subspeciality national external audit programmes and the
four confidential enquiries endorsed by the Commission for Health Improvement.
Clinical governance has placed a duty of responsibility on all health care
professionals to ensure that care is satisfactory, consistent and responsive; each
individual will be responsible for the quality of their clinical practice as part of
professional self-regulation. The aim will be to strengthen the current systems of
quality assurance based on evaluation of clinical standards, better utilisation of
evidence based practice and learning the lessons from poor performance. The
clinical governance framework builds upon professional self-regulation and per-
formance review; it takes account of existing systems of quality control and
includes all activity and information for quality improvements. It is based on
partnership and driven by performance based on efficiency, effectiveness and
excellence.
Clinical Governance 225