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Article

Matthew Peak, Rebecca Burke, Steven Ryan, Karen Wratten, Rick Turnock and Christopher Vellenoweth

To provide an overview of a model for clinical governance in the National Health Service that incorporates continuous improvement and innovation as a core theme.

Abstract

Purpose

To provide an overview of a model for clinical governance in the National Health Service that incorporates continuous improvement and innovation as a core theme.

Design/methodology/approach

The paper considers the core functions of clinical governance and how these are related to established structures and roles within the modern NHS. A case study approach is used to describe the implementation of a theoretical model in a large teaching NHS Trust.

Findings

A clinical governance cycle is described that comprises three functional domains: accountability, assurance, and innovation. For each domain there is a definable outcome and a key role. Critical success factors for implementation of the model are described.

Originality/value

This paper introduces a new model for clinical governance that focuses on continuous improvement. The paper will be of particular interest to managers and lead clinicians responsible for the development of robust systems for clinical governance and modernisation in the NHS.

Details

Clinical Governance: An International Journal, vol. 10 no. 2
Type: Research Article
ISSN: 1477-7274

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Article

L. Mynors‐Wallis, D. Cope and S. Suliman

Clinical governance is at the heart of the drive to improve the quality of patient care in the National Health Service. National targets, the National Service Frameworks…

Abstract

Clinical governance is at the heart of the drive to improve the quality of patient care in the National Health Service. National targets, the National Service Frameworks and NICE Guidance are providing a top‐down mechanism to deliver this improved care. Improved patient care will not happen, however, without the active and enthusiastic participation of clinicians and clinical teams. This article sets out the mechanism that Dorset Healthcare NHS Trust, a specialist mental health and learning disability trust, has established to foster and develop the involvement of clinical teams in clinical governance. The article describes the development of team‐based clinical governance portfolios and sets out how they have been used to focus clinical teams on clinical governance activities.

Details

Clinical Governance: An International Journal, vol. 9 no. 3
Type: Research Article
ISSN: 1477-7274

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Article

James Murray, Hazel Fell‐Rayner, Howard Fine, Nisha Karia and Rachel Sweetingham

Clinical governance has been an important issue in the British National Health Service for several years. This study looks to see how this has filtered down to front‐line…

Abstract

Clinical governance has been an important issue in the British National Health Service for several years. This study looks to see how this has filtered down to front‐line staff, in terms of their knowledge about clinical governance, their attitude to it, and their implementation of it. A total of 539 participants across three NHS trusts in the South of England completed the Staff Clinical Governance Survey. The results showed generally positive attitudes and varying levels of knowledge and implementation. The use of this questionnaire enables services to audit their implementation of clinical governance, and highlights specific training needs for staff and their managers.

Details

Clinical Governance: An International Journal, vol. 9 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

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Article

Maureen Alice Flynn and Niamh M. Brennan

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly…

Abstract

Purpose

While clinical governance is assumed to be part of organisational structures and policies, implementation of clinical governance in practice (the praxis) can be markedly different. This paper draws on insights from hospital clinicians, managers and governors on how they interpret the term “clinical governance”. The influence of best-practice and roles and responsibilities on their interpretations is considered.

Design/methodology/approach

The research is based on 40 in-depth, semi-structured interviews with hospital clinicians, managers and governors from two large academic hospitals in Ireland. The analytical lens for the research is practice theory. Interview transcripts are analysed for practitioners' spoken keywords/terms to explore how practitioners interpret the term “clinical governance”. The practice of clinical governance is mapped to front line, management and governance roles and responsibilities.

Findings

The research finds that interpretation of clinical governance in praxis is quite different from best-practice definitions. Practitioner roles and responsibilities held influence practitioners' interpretation.

Originality/value

The research examines interpretations of clinical governance in praxis by clinicians, managers and governors and highlights the adverse consequence of the absence of clear mapping of roles and responsibilities to clinical, management and governance practice.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

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Article

Nick Harrop and Alan Gillies

The purpose of this paper is to summarise key concepts within clinical governance by reference to literature, and to present the topic of statutory clinical governance

Abstract

Purpose

The purpose of this paper is to summarise key concepts within clinical governance by reference to literature, and to present the topic of statutory clinical governance inspections of hospitals.

Design/methodology/approach

Conceptual paper in form of extended editorial; rapid, non-systematic review of basic clinical governance literature from UK, Republic of Ireland and Australia.

Findings

The Mid-Staffordshire Hospitals report (Francis, 2013) is evidence that, more than 15 years after its inception, clinical governance in the UK has not yet fulfilled its mission. This report has stimulated the subjection of all NHS provider institutions to a statutory inspection regime. Two different yet complementary, authoritative perspectives on clinical governance are identified and discussed. Whilst the inspection regimes methodology is under review, the object of inspection is not. The object of inspection could usefully be broadened to bring the arms length planning and funding bodies associated with provision under closer scrutiny for their obligation to engage constructively and collaboratively with providers in difficulty.

Research limitations/implications

A more extensive, systematic study of international literature will provide a foundation for international comparison studies which will enable participants in clinical governance to learn from each other.

Practical implications

The information contained in this brief review will assist practices of governance inspection and local self-governance.

Originality/value

Other studies (e.g. Brennan and Flynn 2013) have garnered definitions of clinical governance from other health systems, which tend to emphasise accountability as the key concept. Inspired by Halligan (2006), the present contribution stresses leadership and empowerment alongside accountability (in the sense of enabling “every clinical team to put quality at the heart of their moment-to moment care of patients”. It implies that accountability to “create an environment in which excellence in clinical care will flourish” should lie not only with individual clinical departments and healthcare provider institutions but also with funding and planning bodies such as the Clinical Commissioning Groups, recently introduced in the UK. The latter are not subject to the same inspection regime as providers but could usefully be made more accountable to engage constructively and collaboratively with providers in difficulty (Colin-Thomé, 2013).

Details

Clinical Governance: An International Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1477-7274

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Article

Luu Trong Tuan and Luu Thi Bich Ngoc

Clinical governance effectiveness is built on the responsibility of clinical members towards other stakeholders inside and outside the hospital. Through the testing of the…

Abstract

Purpose

Clinical governance effectiveness is built on the responsibility of clinical members towards other stakeholders inside and outside the hospital. Through the testing of the hypotheses on the relationships between clinical governance and its antecedents, this paper aims to corroborate that emotional intelligence is the first layer of bricks, ethics and trust the second layer, and corporate social responsibility (CSR) the third layer of the entire architecture of clinical governance.

Design/methodology/approach

A total of 409 responses in completed form returned from self-administered structured questionnaires dispatched to 705 clinical staff members underwent the structural equation modeling (SEM)-based analysis.

Findings

Emotional intelligence among clinicians, as the data reveals, is the lever for ethics of care and knowledge-based or identity-based trust to thrive in hospitals, which in turn activate ethical CSR in clinical activities. Ethical CSR in clinical deeds will heighten clinical governance effectiveness in hospitals.

Originality/value

The journey to test research hypotheses has built layer-by-layer of CSR-based model of clinical governance in which high concentration of emotional intelligence among clinical members in the hospital catalyzes ethics of care and knowledge-based or identity-based trust, without which, CSR initiatives to cultivate ethical values cannot be successfully implemented to optimize clinical governance effectiveness in Vietnam-based hospitals.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 8 no. 1
Type: Research Article
ISSN: 1750-6123

Keywords

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Article

David Greenfield, Peter Nugus, Greg Fairbrother, Jacqueline Milne and Deborah Debono

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

Abstract

Purpose

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

Design/methodology/approach

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.

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Originality/value

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.

Details

Clinical Governance: An International Journal, vol. 16 no. 1
Type: Research Article
ISSN: 1477-7274

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Article

Luu Trong Tuan

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…

Abstract

Purpose

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.

Design/methodology/approach

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.

Findings

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.

Originality/value

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.

Details

Clinical Governance: An International Journal, vol. 17 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

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Article

Robin Gauld and Simon Horsburgh

Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this…

Abstract

Purpose

Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this paper is to describe and reflect upon the approach taken in New Zealand.

Design/methodology/approach

New Zealand’s clinical governance policy of 2009 and its implementation through its public health care system are outlined. The authors’ assessments, in 2010 and 2012, of this policy are described and key findings summarised.

Findings

The implementation of the policy was swift, with considerable commitment across the public health care system to this. The quantitative assessments found reasonable developmental progress between 2010 and 2012. Case studies undertaken in 2012 indicated various areas that policy makers should attend to or build upon in order to better support clinical governance development.

Research limitations/implications

Key lessons from New Zealand’s clinical governance experience, based on the assessments, include the need for: a well-defined definition of clinical governance; resource materials that can be used by those involved in clinical governance development; recognition that clinical governance development is complicated and takes time; and commitment to new leadership and organisational arrangements.

Originality/value

This paper provides useful lessons for policy makers pursuing clinical governance development, derived from two rounds of assessment in New Zealand.

Details

Clinical Governance: An International Journal, vol. 20 no. 1
Type: Research Article
ISSN: 1477-7274

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Article

Karen Staniland

This study aims to give an account of how stakeholders in one NHS Hospital Trust responded to the clinical governance initiative, the effects on quality improvement and…

Abstract

Purpose

This study aims to give an account of how stakeholders in one NHS Hospital Trust responded to the clinical governance initiative, the effects on quality improvement and the practical accomplishment of legitimacy.

Design/methodology/approach

Sociological new institutionalism theory was utilised to explain the political and ceremonial conformity that marked the clinical governance process. A case study was employed using ethnographic methods. The qualitative data were obtained by documentary analysis, observation of meetings and ward activity and 28 semi‐structured interviews. A grounded theory approach was adopted in the analysis of the interviews.

Findings

Errors and inconsistencies were found in Trust documentation and reporting systems were poor. In practice clinical governance was inadequately understood and the corporate goals not shared. Nevertheless, during the same period the Trust obtained recognition for having appropriate structures and systems in place resulting in external legitimacy.

Research limitations/implications

The results only relate to the Trust considered but the study has identified that, although the organization responded to isomorphic governmental pressures in the production of appropriate institutional documentation, the impact of clinical governance to improve the quality in practice was found to be inconsistent.

Practical implications

The Trust promoted and endorsed clinical governance success but the lack of organizational processes and knowledge management equally promoted its failure by denying the resources to implement the desired actions.

Originality/value

Whilst the study identified that clinical governance had been a “ceremonial success”, it is argued that the practical accomplishment in the improvement of quality of care for patients will remain a paper exercise until organizational and practice issues are addressed.

Details

Clinical Governance: An International Journal, vol. 14 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

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