Intended for healthcare professionals

Career Focus

What is clinical governance?

BMJ 2005; 330 doi: (Published 25 June 2005) Cite this as: BMJ 2005;330:s254
  1. Carl Gray, consultant histopathologist and executive medical director
  1. Harrogate Health Care


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Clinical governance is defined as “A framework through which NHS organisations are accountable for continuously improving the quality of their services and safe-guarding high standards of care by creating an environment in which excellence in clinical care will flourish.”1 It's often thought of in terms of the seven pillars of clinical governance—clinical effectiveness, risk management, patient experience and involvement, communication, resource effectiveness, strategic effectiveness, and learning effectiveness.

In short, it's doing the right thing, at the right time, by the right person—the application of the best evidence to a patient's problem, in the way the patient wishes, by an appropriately trained and resourced individual or team. But that's not all—that individual or team must work within an organisation that is accountable for the actions of its staff, values its staff (appraises and develops them), minimises risks, and learns from good practice, and indeed mistakes.

Perhaps surprisingly the NHS only acquired a statutory duty of care for quality in 1998, unlike that of finance, which has been in existence for as long as the NHS has!

As with everything, times are changing, and in a lot of places clinical governance is being superseded by Healthcare Standards. Under this, there are seven domains—different to the seven pillars of clinical governance, but with the seven pillars buried within. Have a look at the clinical governance support team's website for more information ( ■


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