Intended for healthcare professionals

Soundings Soundings

Clinical governance made simple

BMJ 1998; 317 doi: (Published 25 July 1998) Cite this as: BMJ 1998;317:287
  1. Colin Douglas, doctor and novelist
  1. Edinburgh

    The Auchendreich Medical Golf Society, for decades an all male bastion, has moved with the times and now brings together men and women in a spirit of equality and healthy outdoor competition. The weather could not have been more kind for our summer event and there were some truly surprising scores and results.

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    But, as so often in the past, the most interesting moments of the day came later, when a dozen or so survivors of the dinner convened once more beneath the stags' heads and trophy cabinets of the club's agreeably old fashioned bar.

    Though the business of this part of the evening is for obvious reasons normally confidential, the overwhelming importance to the whole of the NHS of the main topic discussed dictates some relaxation of the normal convention. Clinical governance, as the journals have been informing us for months, concerns us all.

    “Tell you what it is,” said a urologist. “It's crap. Jus' words. There's no money, they've lost the plot, and the last thing they can do is admit it. So they say, we've got this big, concept. Like in politics, see? Remember the guy with glasses? Back to basics. That was his. An' look at him now. So it's jus' words. Crap.”

    “There might a bit more to it than that,” said our haematologist sweetly. Her stamina through the evening had been impressive, her afternoon on the course even more so: an astonishing hole in one at the fifth—the notorious Dreichwood Canyon—for an awesome 66, the ladies' medal and a society record that had strong men weeping inwardly. “And there's probably some money on the way. So perhaps we should give clinical governance a chance.”

    “No problem,” said an orthopod. “Provided it means we're in charge.” A psychiatrist looked puzzled and a physician shook his head. “I meant just in charge of us,” the orthopod explained. “You should be in charge of yourselves. I mean, everybody should. Stands to reason. Budgets. Hire and fire. And probably social work too. Know what I mean? Really in charge. That's the answer. Show ‘em who's boss.”

    “Multidisciplinary,” said the psychiatrist with some difficulty. “That's the problem. Really is. You guys don't….” “Yes we do,” said the orthopod. “No problem. Key thing is… strong man in charge.”

    “It's a bit more subtle than that,” said the haematologist, smiling at the orthopod in a way no one had ever seen her smile before. “You see, John….” “Actually it's Joe.” “You see, Joe, I think they're trying to tell us they need our help. If you look at the things management can actually manage it comes down to the laundry, the porters, the cooks, and the crèche if they're lucky. They can't get near the real stuff, the things we do. They really need help, so it's an opportunity for us. A kind of partnership. We could do things our way—information, budgets, quality, strategy, everything. A real working relationship. It could be really terrific, Joe.” “Triffic,” said the orthopod. “Like another drink?”

    As they settled in a corner for what might turn out to be a lengthy session on clinical governance, Ecky Badenoch, our senior physician and medical director, cast an eye in their direction. “Remarkable woman,” he said. “Actually dropped in on me the other day to inquire gently about my retirement plans.”

    The eyes of various colleagues widened. “I think she'd make an excellent medical director—in due course.” Ecky nodded towards the corner of the bar. “All the necessary diplomatic skills. And of course there's no arguing with a hole in one at the Canyon.”

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