Implementing clinical governance

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7315.753a (Published 29 September 2001) Cite this as: BMJ 2001;323:753

Intellectual discussion would have been useful

  1. Neville W Goodman, consultant anaesthetist (Nev.W.Goodman{at}bris.ac.uk)
  1. Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB
  2. Princess Margaret Hospital, Okus Road, Swindon SN1 4UJ

    EDITOR—What is upsetting about clinical governance is the way in which political zeal has eclipsed intellectual honesty. Halligan and Donaldson have listened to audiences composed of healthcare professionals who believe that clinical governance is the right idea.1 From the response to my criticism of clinical governance,2 and of audiences that I have addressed on the basis of that criticism, I know there are many healthcare professionals who are not so convinced. Halligan has himself heard important criticisms because he spoke at a conference convened at the Royal College of Physicians in March 2000 to discuss some of its difficulties.3 So why is my critical reference, or any other, not cited in the article by Halligan and Donaldson? The article is little more than a restatement of the rhetoric of the original article by Scally and Donaldson,4 plus some anecdotal examples of how they claim clinical governance has improved the delivery of service.

    Anyone writing a review of a new medical treatment is expected to look for all the evidence. Halligan and Donaldson have ignored evidence that they knew was there—or does intellectual dissent not count as evidence? The BMJ has championed the rigorous searching for evidence that underlies evidence based medicine. Why did the assessors of this paper not point out Halligan and Donaldson's apparent blind spot? The paper appeared in the education and debate section of the journal, but should more rightly have been in a new section termed propaganda.


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    Medical training should include project management

    1. Sean W O'Kelly, consultant anaesthetist (swokelly{at}aol.com),
    2. Rachel Maxwell, senior sister
    1. Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB
    2. Princess Margaret Hospital, Okus Road, Swindon SN1 4UJ

      EDITOR—As one of the first teams to graduate from the national development programme for clinical governance, and having successfully used techniques of clinical governance to produce important changes in our hospital, we endorse the paper by Halligan and Donaldson.1

      The establishment of a project culture, as discussed in the paper, was a key event in the implementation of clinical governance in our organisation. This was also the most invigorating element of our trust's response to the challenge set by our involvement with the development programme. Project culture enables effective change to take place in many different areas of a service without requiring the whole service itself to be reformulated. Project teams are especially effective because they can reach across traditional professional barriers while also addressing areas of service with which they are entirely familiar. As a result, hurdles that blocked the process of change previously are overcome.

      It is also liberating to see how the quality of patient care can be improved substantially without resorting to grandiose schemes that seldom produce the desired result. Through project management, the ability to effect real change is placed within the grasp of those who see the need for it most.

      The best way to engender a project culture throughout the NHS, however, requires consideration. Although the NHS support team for clinical governance is expanding and aiming to reach many professionals, we believe that ultimately the implementation of clinical governance would be well served if early medical training included instruction in project management. If the quality of the provision of medical care is a priority for all, then the ability to manage change is a desirable skill for all healthcare professionals to master. Improved quality does not arrive by chance but by well reasoned and well founded intervention.

      The implementation of clinical governance is far too important a lesson to be taught at a relatively late stage in one's career. The NHS support team for clinical governance should consider visiting medical schools as well as trust boards.


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