role. There may be a board sub-committee led by a clinical professional such
as the medical director or chief nurse and the expectation of monthly reports
to the board, and arrangements in the annual report. There will be clear lines
of responsibility and accountability for the overall quality of clinical care.
NHSTrusts were required to produce their first clinical governance external
reports by April 2000 and then on an annual basis.
92) Internal mechanisms for improving clinical performance including indivi-
dual accountability, self and professional regulation. Professional self-
regulation was aimed at giving health professionals the ability to set their
own standards of professional practice, conduct and discipline. The
emphasis will be on lifetime learning through continuing professional
development programmes as an integral part of quality improvement. With
total involvement of staff in shaping the health care delivery system and
planning change through open communication, collaboration and improving
patient care.
93) External mechanisms for improving clinical performance, e.g. Commission
for Health Improvement 9CHI), the watchdog with a smile and sharp teeth
[5]. The Commission for Health Improvement is a statutory body responsible
for reviewing the NHS to support those who are developing and monitoring
local systems and multidisciplinary standards for clinical quality. CH Ipro-
vides national leadership to develop and disseminate clinical governance
principles. CH Iindependently scutinises local clinical governance arrange-
ments to guarantee that local systems to monitor, assure and improve clinical
quality are in place, through a rolling programme of local reviews of service
providers. It has the capacity to offer specific support on request when local
organisations face particular clinical problems. It also investigates and
identifies the sources of problems and work by troubleshooting with orga-
nisations on lasting remedies to improve quality and standards of patient
care. CH Iassesses NHS progress in achieving the standards set in the
National Service Frameworks and the uptake of the National Institute of
Clinical Excellence 9NICE) guidance on the clinical and cost effectiveness of
different treatment options, and oversees critical incident enquiries to ensure
the best outcomes for patients and the service. CH Ialso identifies problems
and barriers to progress and makes recommendations to help overcome
them.
These three dimensions are to ensure that there are proper processes in place for
continually monitoring and improving clinical quality. Every health care
organisation has a clinical professional to take charge of quality issues, and the
legal duty of quality is imposed on every organisation. CH Iworks with and helps
organisations to develop quality criteria, monitoring, measurement and evaluation
as well as policing the adoption and operation of clinical governance. It helps the
NHS to identify and tackle serious or persistent clinical problems with the capacity
for rapid investigation and intervention to put these right. The core functions of
CH Iwill be discussed later in the chapter.
Clinical Governance 227