Search results

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.

To investigate the association between implementation of clinical governance and patient safety.

A pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.

There was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.

Given that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.

The findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

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.

In 2012, Headquarters 17 Combat Service Support Brigade (HQ 17 CSS Bde) implemented a clinical governance framework. The framework is intended as a quality improvement tool through which excellence in deployed healthcare is achieved. The purpose of this paper is to describe the implementation of this clinical governance framework to 17 CSS Bde and present feedback provided by users on their application of the clinical governance framework.

An electronic survey was disseminated to the four 17 CSS Bde deployable health battalions (n=1,061). Qualitative data were analysed using descriptive statistics and qualitative data using thematic analysis.

In total, there were 105 responses providing valid data for analysis. The data identified mixed understanding and awareness of clinical governance amongst participants, and pinpointed aspects of the framework that needed refinement.

The results highlight important challenges implementing a clinical governance framework for deployable health units. The authors propose embedding clinical governance education in all army soldier and officer health courses to remedy deficits in knowledge and understanding. Recommendations for further development of the clinical governance framework are also made with particular emphasis on education, clinical risk and clinical evaluation.

This paper offers unique insight into the implementation of a clinical governance framework to the 17 CSS Bde, Australian Army. The results suggest that levels of understanding and awareness of clinical governance are stalling its translation through the military hierarchy. The data identify that implementation of a clinical governance framework is not easy, even within a military environment where the culture is to follow orders and obey the chain of command.

The implementation of clinical governance presents a major challenge for NHS Trusts. The article provides a summary of the background to implementing governance; the results of locally organised research in an NHS Trust reveals clinicians’ perceptions and attitudes to implementing clinical governance and the lessons for NHS chief executives. The research provides a valuable insight into the implementation issues which Trusts need to address and the basis for trying to address these in their own organisation.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

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.