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The purpose of this paper is to consider organisational climate as the vehicle to get an understanding, map and enhance the appropriate organisational culture for good clinical governance (CG). Based on this assertion, the purpose of this research is fourfold: to investigate CG attributes embedded in Greek hospitals' climate; to test the validity and reliability of the Clinical Governance Climate Questionnaire (CGCQ) and highlight the dimensions of CG climate in the Greek context; to illuminate the “red flag” aspects of hospital's climate and areas shaping the perceptions of the quality of the provided services; and to explore the influence of hospital's legal status on CG climate and service quality.

Empirical research using the CGCQ was conducted in three Greek NHS hospitals. A total of 214 usable questionnaires completed by the hospitals' personnel were gathered.

The validity and reliability tests proved that the study's five‐dimension structure of CGCQ is capable of conceptualising the basic elements of CG climate in the Greek context. Hospital's climate was found to be not supportive to successful CG implementation, and areas that demand attention were illuminated. Hospital's legal status seems to mediate CG climate and service quality.

CGCQ proved to be a useful tool for managers and policymakers to trace “problematic” areas of hospital's climate and develop strategies for successful CG initiatives.

The paper contributes to the field of health care management, since it demonstrates that CG climate can be used as a “gauge” of the prevailing CG culture. CGCQ is revealed as a valid, reliable and flexible tool.

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).

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

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.

The purpose of this paper is to explore the dilemma facing the health staff regarding the achievement of targets (waiting list reduction, etc.), on the one hand, and, on the other hand, the responsibility of continuously improving the healthcare quality in NHS organisations.

In‐depth interviews were conducted using a semi‐structured interview method with a heterogeneous group of 33 key persons who have important responsibilities in an NHS Hospital Trust. The case study method was adopted to understand how the health staff are coping with the dilemma of meeting targets, on the one hand, and, on the other hand, continuously improving the quality of care (a statutory duty imposed on every member of health staff under clinical governance framework).

The findings of the research suggest that clinical governance has increased the dilemma of health staff on how to meet targets while continuously improving the quality of clinical care. The departments get additional funds only when it is clearly demonstrated that funds will be used to meet targets, whereas such additional funding is not available for quality improvement activities. Consequently, meeting targets becomes a priority, while achieving continuous quality improvement takes a backseat.

In view of the mounting pressure on health staff to deliver the highest quality of clinical care more speedily, more research on a wider scale is necessary to understand what could be a practical solution for reducing the tensions of health staff and delivering the highest quality of care.

The research points out that it is almost impossible to continuously improve service quality to higher standards while meeting quantitative targets, because improving quality of healthcare would require allocation of more time to each patient and subsequent quality improvement activities. Putting too many patients through the system may reduce waiting lists but it may increase the risk of clinical errors because less time is available for individual patients.

The current literature provides little information on the above issue. The paper makes a valuable contribution by highlighting the failure of clinical governance to address some of the fundamental issues facing the NHS organisations. The managerial concepts of improving both quality and quantity at the same time may not be workable in healthcare organisations, because of the unique characteristics (i.e. the human dimension of clinical decision making) of healthcare management.

This research aims to look through the data of Nhan Dan Gia Dinh Hospital, a state‐owned hospital in Vietnam, for evidence on whether a clinical governance initiative cultivates ethical leadership, market‐ or innovation‐oriented culture, knowledge sharing, and knowledge‐ or identity‐based trust.

Data were collected through a case study approach with hospital document collection, field observations, and in‐depth interviews conducted between April 2009 and April 2011.

The findings demonstrated that a clinical governance initiative, when effectively implemented, can function as a lever for behavioural transformations in the hospital towards ethical leadership, market‐ or innovation‐oriented culture, knowledge sharing, and knowledge‐ or identity‐based trust.

The current research provides a portrayal of an effective clinical governance initiative with its proactive hospital outcomes such as ethical leadership, market‐ or innovation‐oriented culture, knowledge sharing, and knowledge‐ or identity‐based trust on the hospital journey of sustainable health creation. This paper also highlights the necessity for research that examines other organizational outcomes of clinical governance in Vietnamese hospitals of other ownerships.

This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model.

The research site was a large organisation within an autonomous jurisdiction. The study focused on one organisational division. There were nine interviews and 15 focus groups (118 participants). Ethnographic observations totalled 60.5 hours. Document analysis was conducted with organisational reports and website. Data were examined against the model's four attributes and 24 elements, and used to conduct an organisational culture analysis.

Analysis showed that a majority of elements, 17 of 24, were strongly identifiable. The remainder were identifiable but not strongly so. Analysis suggested two additions to the model: the inclusion of two elements to an existing attribute and a new attribute and defining elements. This showed that the organisation was working towards, but not yet having achieved, a positive quality and safety culture. In particular, a schism in understanding between managers and frontline staff was noted.

The study empirically applied and refined a health service theory. The new model, the “clinical governance practice model”, can be broadly applied, and can continue to be developed to expand the evidence base for the field.

Substantively, the study accounts for differences in managerial and frontline staff actions in applying clinical governance. Investigations to understand and identify strategies to bridge the differences are required.

The study is an original application and refinement of a health service theory. The study identifies that the interpretation of clinical governance, whilst different in different places, gives rise to similar disagreements.

The purpose of this paper is to contribute to the current debate on the implementation of clinical governance by exploring the understanding of clinical governance at different levels in an NHS organisation.

A case study method has been adopted with in‐depth interviews to understand how organisational actors make sense of the term “clinical governance”. Semi‐structured interviews were conducted with a heterogeneous group of 33 persons in an NHS hospital trust handling important responsibilities for clinical governance. In‐depth analysis of the data revealed the understanding of clinical governance at different levels in an NHS organisation.

The results indicate that clinical governance creates more confusion, debate and disagreement on quality of care, making it more a contentious issue than one promoting unanimity, uniformity and consistency. This could become a major obstacle in achieving continuous quality improvement in healthcare.

Further research on a wider scale is required to develop a better understanding of how people make sense of clinical governance for improving the quality of care.

To look into implications of clinical governance in NHS organisations, it is necessary to understand how people at different levels in the NHS understand clinical governance. The paper makes a valuable contribution by bringing out the practical implications which will be useful for policy makers and practitioners. A better understanding of how health staff make sense of clinical governance would enable policy makers to know the problems of implementing clinical governance.

From the current literature very little information is available on the above topic. This empirical research makes a valuable contribution by focusing on how stakeholders at different levels in an NHS organisation make sense of clinical governance.

This study aims to explore how leadership, management practices and organisational cultures have changed in low and high-performing mental health (MH) providers between 2015 and 2020 in the English National Health Service.

The authors used a qualitative case study design comprising a purposeful sample of two low-performing and two high-performing MH providers, based on semi-structured interviews with 60 key informants (mostly internal to the organisation with some external informants from local Clinical Commissioning Groups).

The authors found major differences regarding leadership, management and organisational culture between low and high performing MH providers in 2015/2016, and that the differences had diminished considerably by 2019/20. In 2015/16, low performing providers were characterised by a “top-down” style of leadership, centralised decision-making and “blame cultures”. In contrast, the high performing providers were characterised as having more distributed, collaborative and inclusive styles of leadership/management, with open and supportive cultures. As the low performing providers changed and adapted their styles of leadership and management and organisational culture over the five-year period, they more closely resembled those of the high performing trusts.

To the best of the authors’ knowledge, this is the first study to explore the relationship between changing organisational factors and the performance of MH care providers. It provides evidence that it is possible for radical changes in leadership, management and organisational culture to be enacted over a relatively short period of time and that such changes may help low performing providers to turnaround their underperformance.

The purpose of this paper is to explore how the clinical governance policy and its main component, patient satisfaction, turned into practice and what they look like on the ground in the centralised health system of Iran.

A qualitative research stance was adopted incorporating three main sources of information: face to face in‐depth interviews and focus groups conducted with hospital senior managers at the teaching hospitals in Kerman city, Iran, as well as documentary analysis of key policy texts. Nine hospital senior managers were purposefully selected for face‐to‐face interviews as well as a purposeful sample of 15 hospital senior managers for focus groups.

The documentary analysis revealed how clinical policy has been put into practice. The interview and focus group data analysis also disclosed four key themes with respect to how policy implementers in the Iranian centralised health system perceive nationally developed policies towards clinical governance and patient satisfaction. These include: a paper exercise; opaque, ambiguous policies; unstable policies; and separation of policy making from policy implementation.

The study revealed a perceived mismatch between the official proposals for clinical governance and their application in practice. The findings of this research lend support to the idea that there should be no separation between policy making process and its implementation; they are inseparable and should be treated in parallel, rather than in sequence. The study further suggests more accountability of the state towards its policies and public alike as a better governance of the health system. State‐level sustainability followed by allocating proper resources to implementation fields and empowering policy implementers coupled with good systems of performance control are the keys to keep patient focus a top priority.

In the context of budget constraints and the current quality crisis facing UK healthcare, the purpose of this paper is to examine the use of trans-disciplinary community groups (TCG) – an innovative and inexpensive initiative for improving patient care.

Using an action research study, TCG was implemented within a private healthcare firm for vulnerable adults. Qualitative data were gathered over 12 months from 33 participants using depth interviews and focus groups.

TCG led to improved patient activities and increased patient decision-making and confidence in self-advocacy. Key prerequisites were top management commitment, democratic leadership and employee empowerment. However, staff nurses resisted TCG because they were inclined to using managerial control and their own independent clinical judgements.

Whilst the findings from this study should not be generalized across all healthcare sectors, its results could be replicated in contexts where there is wide commitment to TCG and where managers adopt a democratic style of leadership. Researchers could take this study further by exploring the applicability of TCG in public healthcare organizations or other multi-disciplinary service contexts.

The findings of this research paper provide policy makers and healthcare managers with practical insights on TCG and the factors that are likely to obstruct and facilitate its implementation.

Adopting TCG could enable healthcare managers to ameliorate their services with little or no extra cost, which is especially important in a budget constraint context and the current quality crisis facing UK healthcare.