Harrop, N. and Gillies, A. (2014), "Editorial: clinical governance, an environment for excellence", Clinical Governance: An International Journal, Vol. 19 No. 4. https://doi.org/10.1108/CGIJ-09-2014-0030Download as .RIS
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Editorial: clinical governance, an environment for excellence
Article Type: Editorial From: Clinical Governance: An International Journal, Volume 19, Issue 4
Healthcare institutions have two sets of goals: they have to maintain their own integrity and they have to fulfil their duty of care towards patients.
Maintaining integrity means keeping the institution viable, especially in relation to its financial and legal position. Fulfilling a duty of care towards patients involves nurturing professionalism and clinical practice, maintaining an equitable relationship between clinical services and patients who, in the past, took the role of client in the gift relationship between paternalistic institutions and the destitute sick.
In a previous editorial (Harrop and Gillies, 2014), we identified four environments in which these two sets of goals are fostered. We focused, then and now, on the duty of care because, although we do not want our healthcare providers to go to the wall, we are more interested in clinical than corporate aspects of governance.
The environments we listed were: first, the immediate clinical environment, where patients encounter doctors and nurses; second, the managed environment, where professional staff set operational policies, define local clinical practice and norms of good professional behaviour, exert local professional discipline and organise themselves for clinical activity; third, the regulatory and performance managed environment, which is the interface between the institution and its professional staff on the one hand, and between the institution and the public and political environment on the other; and fourth, the public and political environment where the public and their elected representatives set expectations and hold institutions and professional groups to account.
That model of four nested environments deserves further refinement and investigation, and we welcome contributions that respond to it critically. In this present issue, we have assembled perspectives on clinical governance from countries beyond the UK. The broad question we put to authors in our call for papers was, “what does clinical governance mean in your country?”. We asked a list of subsidiary questions:
Has clinical governance in your country fulfilled the broad goals its proponents intended?
What has been achieved and what remains to be done?
Has clinical governance been implemented successfully?
Could it have been implemented in a different way?
Does anything need to be changed?
What major challenges remain?
Are there any special characteristics of your own health system that (a) might not be replicated elsewhere; and (b) have strongly influenced the form and maturation rate of clinical governance in your own health system?
Are there useful lessons from your country's own experience for other health systems?
The author of the first paper in this issue (McAuliffe) has addressed these questions in detail. The second paper (Black and Berg) directs institutional boards to complement their focus on corporate governance with an equal concentration on clinical governance and a willingness to translate lessons from other safety-critical industries into direction for healthcare providers. The third paper (Botje et al.) has focused a contribution which we locate to the third of the environments we have listed. The authors are concerned with the transparent sharing of performance information by different institutions within the system of healthcare provision. Such information is the vehicle used by institutions to assess the capability of their professional staff and their own boards. It is also the vehicle for dialogue between the institution and its external social and political environment. The fourth paper (Rahman and Al-Khatlan) presents the terms of this dialogue in social rather than technical terms, emphasising the multiple “social constructions” of health, illness and healthcare and the various forms of disparity which need to be eradicated through government and political action before universal health and healthcare quality can becomes realities. On the other hand, O’Neill (2014) place the importance of protecting patients’ privacy and data on a near-equal level with protection of their person. This is a regulated activity which resides within the third of our environments.
We conclude this editorial by saying that the people and institutions who promote health and provide healthcare do not do this in isolation from “an environment in which excellence in clinical care will flourish” (Scally and Donaldson, 1998). Creating that environment is a hugely important and complex activity, not restricted to regulation and performance management.
Nick Harrop and Alan Gillies
Harrop, N. and Gillies, A. (2014), “An inspector calls clinical governance”, An International Journal, Vol. 19 No. 3, pp. 186-190
O'Neill, A. (2014), “An action framework for compliance and governance”, Clinical Governance: An International Journal, Vol. 19 No. 4, pp. 342-359
Scally, G. and Donaldson, L. (1998), “Clinical governance and the drive for quality improvement in the new NHS in England”, BMJ, Vol. 317 No. 7150, pp. 61-65