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Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance

C.V. Som (University of Durham, Durham, UK)

International Journal of Public Sector Management

ISSN: 0951-3558

Article publication date: 1 August 2005




The purpose of this paper is to contribute to the debate on the response of doctors to health policy initiatives in general and clinical governance in particular.


A qualitative approach has been adopted where the empirical data collection and the analysis are influenced by a phenomenological case study approach. An instrumental case study is undertaken and a heterogeneous group of 33 persons with important responsibilities for clinical governance was interviewed using a semi‐structured format.


The results indicate that doctors are not enthusiastic about clinical governance and it is not receiving wholehearted support from doctors because they feel that clinical governance is a management‐led initiative imposed without adequate consultations. The real reasons for lack of enthusiasm, indifference and sometimes resistance of doctors to clinical governance are examined. This paper points out the tension between an organisation (wishing to bring clinical care within a management framework) and doctors (who are resisting managerial efforts to replace the old framework of bureau professionalism).

Research limitations/implications

Further research is required to develop a better understanding of the influence of clinical governance on power and conflict in NHS organisations.

Practical implications

This paper has practical implications for policy makers as well as NHS managers. Policy makers may consider suitable amendments in clinical governance to minimise resistance and seek the support of clinicians. A better understanding of this issue would perhaps enable NHS management to develop better management practices that will make it possible to seek the support of doctors for clinical governance.


Limited attention has been paid to understanding the response of doctors to clinical governance. This empirical research makes a valuable contribution by focusing on this important aspect of clinical governance.



Som, C.V. (2005), "Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance", International Journal of Public Sector Management, Vol. 18 No. 5, pp. 463-477.



Emerald Group Publishing Limited

Copyright © 2005, Emerald Group Publishing Limited

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