Any framework for clinical quality must be amenable to monitoring and
assurance of compliance with the policies of the health care organisation. An
excellent way to achieve this is through Multidisciplinary Pathways of Care#[4]
9MPCs#)which have utilised clinical guidelines, standards, outcomes and var-
iance analysis. MPCs can incorporate components of effective care, including
evidence based practice, clinical audit, change management, multidisciplinary
working and performance management. Multidisciplinary means that all members
of the team should have an equal say and, although teams require a leader, there is
little doubt that effective teams allow individuals to take leadership for particular
objectives or responsibilities of that team's performance. Effective teams who are
self-managed, self-directed and accountable will identify problems with variations
from their targets and will have responsibility for correcting those problems for
quality of care improvements.
11.2 Clinical governance processes
The main issues that health care organisations are addressing, and are producing
evidence about, are that these systems of clinical governance are in place and are
producing the right outcomes. These include the following:
. clinical quality improvements integrated with the overall organisational con-
tinuous quality improvement programmes to identify and build on good
practice;
. good practice systematically disseminated;
. clinical risk reduction programmes in place;
. professional self-regulation/assessment including the development of clinical
leadership skills;
. evidence based practice systems in place;
. adverse events, near misses and incidents detected, openly investigated and
lessons learned;
. complaints to be dealt with positively and the information used to improve the
organisation and care delivery;
. high quality and performance measurement data collected to monitor clinical
care and support professionals in delivering quality care;
. poor clinical performance dealt with appropriately to minimise harm to patients
and other staff;
. staff should be supported in their duty to report concerns about colleagues'
professional conduct and performance, and procedures developed for early
action to support the individual to remedy the situation;
. continuing professional development through lifelong learning aligned with
clinical governance principles.
11.3 Dimensions of clinical governance
There are three dimensions to clinical governance which are:
- Corporate accountability for clinical performance with the chief executive/
chair of the governing body with overall responsibility `accountable officer'
226 Nursing Law and Ethics