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Is clinical governance a black box?
Is clinical governance a black box?
Article Type: Editorial From: Clinical Governance: An International Journal, Volume 18, Issue 2
Is clinical governance a black box? This term usually identifies an entity whilst disclosing nothing about its internal workings or contents. Travaglia et al. (2011) have previously shown that, as a concept, clinical governance has evolved substantially since the term was coined by Scally and Donaldson (1998). Greenfield et al. (2011) have previously published in this journal a revision of their own useful and succinct summary of clinical governance. We have previously expressed antipathy towards competitive attempts to produce a universal definition of the topic for which our journal is named.
In this issue, we welcome a paper by Brennan, questioning whether definitions of clinical governance adequately distinguish between governance, management and practice. The other papers in this issue fall under these three headings.
Under the heading, governance, LUU questions whether, in Viet Nam, corporate social responsibility strongly influences clinical governance.
Corporate social responsibility is an ethos which considers the corporate entity in relation to a wider organisational or societal whole. The issue is relevant elsewhere. In the UK, our National Health Service is seeking, through commissioning arrangements, to expand the range of healthcare providers and services, so that patients can enjoy bespoke arrangements that are highly congruent with their healthcare needs. A more exciting healthcare menu will be offered a la carte, alongside the traditional plat du jour. The clinical commissioning groups of general practitioners, to whom the UK government has delegated the commissioning task, will soon have to decide how each new service proposal is to fit into a broader systemic healthcare whole. The public inquiry into failings at a hospital in Stafford (Francis, 2010) has taught the UK that aggressive performance management against quantified targets cannot be allowed to compromise the ethical clinical management of patients. LUU’s paper emphasises the ethical aspects of corporate social responsibility.
Concerning management, commissioners of clinical services are expected to decide which services they can decline to commission. SONI-JAISWAL and colleagues make a case for the incorporation of patient reported outcome measures (PROM) within the evidence base for commissioning decisions and the economic evaluations conducted in the UK by the National Institute for Clinical Excellence.
Managers of commissioned services also make resource allocation decisions in order to ensure that basic administrative processes such as the prompt production of imaging results meet the standards necessary for the continuity and pace of clinical management. RAO shows how the adoption of voice recognition software took days off the interval between a particular imaging modality and the production of a report during a complete clinical audit cycle.
Concerning practice, managers need to consider what contextually conditioned mechanisms allow management interventions achieve their impact on practice (Pawson and Tilley, 1997). In this issue, Philips considers clinical supervision and find that the literature on this topic is relatively what constitutes best practice in specifying the content of clinical supervision. Clinical supervision programmes will not achieve benefits if they are not carefully planned to address currently salient issues. The tendency to reduce clinical practice to a set of codified competencies, to be demonstrated and periodically re-certified, sits ill with the findings from the Stafford inquiry, that nurses there lacked empathy and compassion for their patients. In order to meet patients’ minimum and prosaic requirements, effective supervision will not only ensure that staff can perform tasks correctly but also understand in explicit rather than generic terms why, at the most basic level, they are needed at work by patients that day. That is a question that can be answered through continual awareness of present deficiencies and the channelling of a constantly introspective appraisal into the planning of supervision is proposed in this editorial as a candidate context-aware mechanism to fill the gap between a black-box intervention and its intended quality and safety outcomes.
In the last of this issue’s papers to be discussed, Edozien makes a substantial contribution to safer clinical practice and organisational learning through his proposed RADICAL framework. RADICAL is an acronym whose meaning will be discovered by those who read his paper. This paper is worth reading in conjunction with that of Greenfield et al. (2011).
Finally, to answer the rhetorical question, posed at the beginning of this editorial, Brennan has helped provide a useful categorisation of the contents of the clinical governance black box. It is less a black box by virtue of our enhanced capacity to sift through its contents.
Nick Harrop, Alan Gillies
Francis, R. (2010), Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust January 2005-March 2009: Volume I, HC375-1, The Stationery Office, London
Greenfield, D., Nugus, P., Fairbrother, G., Milne, J. and Debono, D. (2011), “Applying and developing health service theory: an empirical study into clinical governance”, Clinical Governance: An International Journal, Vol. 16 No. 1, pp. 8–19
Pawson, R. and Tilley, N. (1997), Realistic Evaluation, Sage, Thousand Oaks, CA
Travaglia, J.F., Debono, D., Spigelman, A.D. and Braithwaite, J. (2011), “Clinical governance: a review of key concepts in the literature”, Clinical Governance: An International Journal, Vol. 16 No. 1, pp. 62–77