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With the increased need for quantitative measures of accountability and effectiveness in the therapeutic setting, standardised outcome measures have come to the fore. This study aimed to assess the psychometric quality of the Clinical Outcomes in Routine Evaluation (CORE‐OM) used with an Irish population of adult victims of childhood abuse. The study indicated that the outcome measure was a useful tool in a forensic therapeutic setting, despite issues regarding the CORE's factor structure. The study also found that the service assessed matched the benchmarks laid down by the CORE systems group regarding levels of change brought about by therapeutic interventions, further indicating the benefits of CORE. The study discusses these issues and possible recommendations for aiding better integration of CORE's findings within therapy and broader clinical practice.

Clinical governance and leadership concepts can lead to more or less successful implementations of new clinical practice. The purpose of this paper is to examine how Fiery Spirits, as institutional entrepreneurs can, working in a team, implement sustained change in hospital clinical practice.

This paper describes two case studies, conducted at two Swedish hospitals over a period of two years, in which changes in clinical practice were implemented. In both cases, key-actors, termed Fiery Spirits, played critical roles in these changes. The authors use a qualitative approach and take an intra-organizational perspective with semi-structured in-depth interviews and document analysis.

The new clinical practices were successfully implemented with a considerable influence of the Fiery Spirits who played a pivotal role in the change efforts. The Fiery Spirits persuasively, based on their structural and normative legitimacy and the adoption of learning processes, advocated, and supported change.

Fiery Spirits, given flexibility and opportunity, can be powerful forces for change outside the trajectory of management-inspired and management-directed change. Team members, when inspired and encouraged by Fiery Spirits, are less resistant to change and more willing to test new clinical practices.

The paper complements literature on how the Fiery Spirit concept aligns with concepts of clinical governance and leadership and how change can be achieved. Additionally, the findings show the effects of legitimacy and learning processes on change in clinical practice.

The purpose of this paper is to discuss the lessons learnt from the process of implementing a new model of governance within Living Well, a New Zealand statutory mental health agency.

It presents the findings from an organisational case study that involved qualitative interviews, meeting observations and document analysis. Archetype theory provided the analytical framework for the research enabling an analysis of both the formal structures and informal value systems that influenced the implementation of the governance model.

The research found that the move to a new governance model did not proceed as planned. It highlighted the importance of staff commitment, the complexity of adopting a new philosophical approach and the undue influence of key personalities as key determining factors in the implementation process. The findings suggest that planners and managers within statutory mental health agencies need to consider the implications of any proposed governance change on existing roles and relationships, thinking strategically about how to secure professional commitment to change.

There are ongoing pressures within statutory mental health agencies to improve the efficiency and effectiveness of organisational structures and systems. This paper has implications for how planners and managers think about the process of implementing new governance models within the statutory mental health environment in order to increase the likelihood of sustaining and embedding new approaches to service delivery.

The paper presents insights into the process of implementing new governance models within a statutory mental health agency in New Zealand that has relevance for other jurisdictions.

The way change occurred at a strategic level and in four clinical services in three hospitals was examined. The purpose of this paper is to report how the hospitals designed and delivered change at organisational and clinical service level to improve services for patients, and the role of clinical leadership in this process.

A comparative case study involving semi-structured interviews was undertaken. These involved a range of senior managers in 2009 (n=77), 2011 (n=21) and 2012 (n=29). Interviews with staff involved directly in service delivery were also carried out in 2011 (n=92). The interviews were recorded digitally, transcribed verbatim, and analysed thematically using the Framework Method.

The value of, and approach taken to clinical leadership varied across the hospitals and over time. This was affected by the culture and priorities of the organisation. Some strategies for developing clinical leadership were developed, however they were limited. It was expected that capable clinical leaders would emerge, and be supported. Effective clinical leadership during organisational and service change required direct executive or managerial support and relied on clinical “champions”.

The paper demonstrates that despite the importance of clinical leadership being widely recognized in policy and research, there were no established programmes in place at the hospitals that were studied to support it. Rather there was a reliance on clinical staff coming forward to take on leadership roles as part of organizational efforts to bring about change.

There is widespread recognition that simply publishing research findings is not enough to ensure that they are carried into clinical practice. One response to this has been the burgeoning “guidelines movement” of recent years, which has now reached the stage of generating guidelines for the production of guidelines. Argues that guidelines, and other forms of intervention to change clinical practice in an evidence‐based direction, will succeed only to the extent that they engage actively with the real world of clinical decision making. This world is more complex than guidelines writers acknowledge, and includes economic, administrative, professional and personal incentives as well as those provided by research evidence. Engaging with this real world may be difficult, but it opens up new possibilities for understanding how clinicians act and how evidence may be used to inform clinical practice. Such possibilities include social influences, educational outreach, providing information to patients, negotiating local coalitions on specific issues and changing the administrative environment.

Aim: To assess the potential for improved clinical effectiveness through the use of research‐based evidence in obstetric care. Design: A questionnaire survey to obtain evidence about (i) the usage of reviews of controlled perinatal trials, and (ii) the attitudes of professionals towards the reviews and their practice, relating to 27 areas of clinical care addressed by the reviews. Subjects and setting: All doctors and midwives working in two teaching hospital maternity units (Units X and Y). Main outcome measures: The use of the reviews. For each of the 27 areas of clinical care, (i) whether a majority of professionals were in agreement with research‐based evidence, and (ii) how perceived current practice compared with research‐based evidence. Results: For most areas of clinical care (21/27 in unit X, 20/27 in unit Y) a majority of professionals agreed with the research‐based evidence. However, for a large proportion of these areas (16/21 in unit X, 12/20 in unit Y), practice appeared to be inconsistent with research‐based evidence. Conclusion: There is a considerable opportunity to improve clinical effectiveness, as in many of the areas of care examined professionals agree with research‐based evidence, but clinical practice appears to be inconsistent. The approach used in this study could be used to help develop practices for promoting clinical effectiveness.

This paper seeks to explore critical factors that may obstruct or advance integration efforts initiated by the clinical management following a hospital merger. The aim is to increase the understanding of why clinical integration succeeds or fails.

The authors compare two cases of clinical integration efforts following the Karolinska University Hospital merger in Sweden. Each case represents two merged clinical departments of the same specialty from each hospital site. In total, 53 interviews were conducted with individuals representing various staff categories and documents were collected to check data consistency.

The study identifies three critical factors that seem to be instrumental for the process and outcome of integration efforts and these are clinical management's interpretation of the mandate; design of the management constellation; and approach to integration. Obstructive factors are: a sole focus on the formal assignment from the top; individual leadership; and the use of a classic, planned, top‐down management approach. Supportive factors are: paying attention to multiple stakeholders; shared leadership; and the use of an emergent, bottom‐up management approach within planned boundaries. These findings are basically consistent with the literature's prescriptions for managing professional organisations.

Managers need to understand that public healthcare organisations are based on competing institutional logics that need to be handled in a balanced way if clinical integration is to be achieved – especially the tension between managerialism and professionalism.

By focusing on the merger consequences for clinical units, this paper addresses an important gap in the healthcare merger literature.

To describe the methodology used to introduce Clinical Governance into the NHS and to review progress.

The RAID (Review, Agreement, Implementation, Demonstration) process and its use in introducing the Clinical Governance Development Programme into the NHS are described.

The NHS Clinical Governance Programme employs RAID, a modification of an accepted “bottom‐up” approach to achieving successful organisational change, as the means of effecting service improvement. The “Review” stage involves analysis and understanding of the service; “Agreement” ensures that all staff, the organisation and stakeholders are committed to recommended changes; the “Implementation” phase tests effects that the changes have made to the service and “Demonstration” allows evaluation and monitoring. Lessons learned from the process can lead to further improvements. Initially staff from the Clinical Governance Support Team introduced the Programme but thereafter the process can be run internally. Specialised programmes, e.g. The Stroke Programme, have developed out of the general programme and the RAID process has been disseminated to other public sector services. Over half of NHS organisations have participated.

RAID is described in the context of the NHS and its implementation is summarised.

This paper describes one trust's approach to the clinical effectiveness initiative. Staff at the Luton and Dunstable Hospital NHS Trust have risen to the challenge of enhancing their clinical practice by developing and implementing a tri‐partite strategy that focuses on providing practitioners and managers with information about effective clinical practice, facilitating changes in clinical behaviour, and monitoring those changes.

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.