Intended for healthcare professionals

The Nhs's 50th Anniversary Looking forward

Clinical governance and the drive for quality improvement in the new NHS in England

BMJ 1998; 317 doi: (Published 04 July 1998) Cite this as: BMJ 1998;317:61
  1. Gabriel Scally, regional director of public health (,
  2. Liam J Donaldson, regional director, NHS Executive (Northern and Yorkshire).b
  1. a NHS Executive (South and West), Westwood House, Lime Kiln Close, Stoke Gifford, Bristol BS34 8SR
  2. b John Snow House, Durham University Science Park, Durham DH1 3YG
  1. Correspondence to: Dr Scally

    A commitment to deliver high quality care should be at the heart of everyday clinical practice. In the past many health professionals have watched as board agendas and management meetings have become dominated by financial issues and activity targets. The government's white paper on the NHS in England outlines a new style of NHS that will redress this imbalance.1 For the first time, all health organisations will have a statutory duty to seek quality improvement through clinical governance. In the future, well managed organisations will be those in which financial control, service performance, and clinical quality are fully integrated at every level.

    Summary points

    Clinical governance is to be the main vehicle for continuously improving the quality of patient care and developing the capacity of the NHS in England to maintain high standards (including dealing with poor professional performance)

    It requires an organisation-wide transformation; clinical leadership and positive organisational cultures are particularly important

    Local professional self regulation will be the key to dealing with the complex problems of poor performance among clinicians

    New approaches are needed to enable the recognition and replication of good clinical practice to ensure that lessons are reliably learned from failures in standards of care

    The new concept has echoes of corporate governance, an initiative originally aimed at redressing failed standards in the business world through the Cadbury report2 and later extended to public services (including the NHS). The resonance of the two terms is important, for if clinical governance is to be successful it must be underpinned by the same strengths as corporate governance: it must be rigorous in its application, organisation-wide in its emphasis, accountable in its delivery, developmental in its thrust, and positive in its connotations. The introduction of clinical governance, aimed as it is at improving the quality of clinical care at …

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