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The introduction of clinical governance in the “new NHS” means that National Health Service (NHS) organisations are now accountable for the quality of the services they provide to their local communities. As part of the implementation of clinical governance in the NHS, Trusts and health authorities had to complete a baseline assessment of their capability and capacity by September 1999. Describes one Trust’s approach to developing and implementing its baseline assessment tool, based upon its existing use of the European Foundation for Quality Management (EFQM) Excellence Model. An initial review of the process suggests that the model provides an adaptable framework for the development of a comprehensive and practical assessment tool and that self‐assessment ensures ownership of action plans at service level.

Providers of health and social care services aim to deliver personalised care that is safe, effective, caring, responsive and well led. Multidisciplinary teams often have to work together, either within or across multiple provider organisations in order to achieve this aim. It is valuable to have a framework of clinical governance for such circumstances that enables a shared assurance of quality. To achieve these aims, the purpose of this paper is to present a clinical governance matrix framework developed by the author’s experiences in clinical practice, in service change and in management and leadership.

There are seven pillars of clinical governance; patient and public involvement, staffing and staff management, clinical effectiveness and research, using information and IT, education and training, risk management and audit. These seven pillars of clinical governance can be mapped against the five quality domains of safe, effective, caring, responsive and well led to create a matrix that in turn describes the framework we need for quality assurance.

The matrix is populated with outcome measures and these are monitored to achieve balance across the framework. The tool can be used at the level of an individual practitioner all the way up to multiple organisations in collaboration. The detail in each cell of the matrix will change accordingly and critically should be developed and owned by the subject of the framework.

This clinical governance matrix is presented as a methodology to monitor quality assurance in the settings of health and social care.

Risk management is an essential cornerstone of any effective unit. The maternity dashboard has been found to be an efficient governance tool, but there is no such scorecard in gynaecology. The paper aims to conceptualise and implement an acute gynaecology dashboard in a teaching hospital over a period of two years and review the changes brought in practice as a result of the dashboard.

This acute gynaecology dashboard was designed in line with the existing maternity dashboard. Goals and benchmarks were determined on the basis of available national guidelines, expert opinions and local policies. The dashboard was prospectively implemented, updated monthly and presented in the relevant forums. A retrospective overview of the changes brought in the practice is presented in this paper.

Through the use of the dashboard significant problems related to workforce, training and clinical activity were identified. A number of changes were subsequently executed to improve patient management, service provision and training. This paper provides empirical insights about how positive changes in clinical practice could be brought in by the implementation of the acute gynaecology dashboard. The acute gynaecology dashboard was found to be a valuable governance tool to monitor performance and improve training and patient care.

The acute gynaecology dashboard can be used as an effective clinical governance tool to monitor performance and leads to improvement in clinical practice in other acute gynaecology units.

Though the maternity dashboard is widely in use, there has been no previous description of an acute gynaecology dashboard and this is the first paper in this area. With the increasing demand of acute gynaecology services, the dashboard becomes an essential tool for clinical governance.

This qualitative study examined the views of clinical governance leads in South West England on the development of clinical governance, and its relationship to education in primary care. Information was obtained from semi‐structured interviews with clinical governance leads, and supplementary methods were used to confirm key findings. Four principal themes emerged: education, support, barriers, and evolution. Education is central to achieving the clinical governance agenda. There is a range of educational needs within primary care and these must be integrated into practice professional development plans, which will be shaped by national and local priorities. A need for PCG clinical governance tutors to support this process emerged. A range of supporting mechanisms was identified, as were barriers: principally inadequate resources and a rigid agenda imposed from above. Existing educationalists will need to change their role within the new structures, and this should be an evolutionary rather than a revolutionary process.

There is a strong drive within the UK's National Health Service (NHS) towards ensuring quality and reducing adverse events. This incorporates clinical governance, which applies to clinical activities, and information governance, which applies to preserving the confidentiality, availability and integrity of patient information. The purpose of this paper is to consider why humans make errors, how the current governance tools can minimise the incidence of such errors and the causatives that can increase the likelihood of an error. Errors sometimes lead to adverse events, which have to be reported. The latest adverse event reports from NHS Scotland, recently published on the BBC website, were analysed to identify major themes that emerged from the recommendations made by the investigative teams. These themes are then discussed in terms of how the current clinical governance tools should be applied to further reduce the incidence of adverse events. A revised clinical governance diagram that more clearly depicts the cross-cutting nature of the themes that emerged from the analysis is proposed. Finally some opportunities for future research are identified.

Qualitative analysis of adverse incidence reports in order to identify causatives. Used the insights delivered by this analysis in order to propose a change to Scally and Donaldson's clinical governance diagram.

A clear reliance on education and training by adverse event review teams was found, which suggests that they do not really understand what causes error, and they do not acknowledge the impact of the situation on the actors. Also – a tendency to define processes to cover all eventualities, even though some situations cannot be encoded as processes. The main insight is that there are a number of cross-cutting concerns which means that the original clinical governance diagram would benefit from a level of integration which is not currently present.

The analysed reports were severely redacted which meant that nuances of the situation could have been missed by the researcher. However, the recommendations were never redacted so the researcher focused on these.

The paper, in general, highlights the need for a more nuanced approach to clinical governance and less reliance on education and training as the universal panacea.

Over reliance on education and training puts the blame on the person, and does not acknowledge the causatives in the situation. Acknowledging the more complex nature of the problem makes adverse events less blame-worthy and more likely to lead to real learning and effective mitigation.

The author is not aware of anyone else having analysed these reports.

To report on the clinical governance work of the NHS Clinical Governance Support Team's, Primary Care Team.

The review describes the formation of the NHS Clinical Governance Support Team's Primary Care Team and the development of a range of national clinical governance activities, drawing on a case study example.

The Team have been developing appraisal, and revalidation for general practitioners across the UK, supporting front‐line staff in primary care to improve patient experience by embedding principles of clinical governance into day‐to‐day practice, and are providing an online education and training programme to develop primary care managers. It has established links, and worked collaboratively with a range of partners in its activities.

The article provides a summary of the activities of the Primary Care Team and its activities to date. An example of supporting clinical governance in primary care is given in a case study of facilitating an influenza vaccination campaign.

Clinical risks can be contained through risk management initiatives, and can also be used to demonstrate effective clinical governance. The purpose of this paper is to outline a new risk assessment tool that monitors the risk factors of sudden unexpected death in epilepsy (SUDEP).

A systematic review of the literature was undertaken to determine the contributory risk factors of SUDEP. A total of 18 factors were identified, of which 11 were modifiable and therefore have the potential to influence the risk of SUDEP.

The factors identified from the literature review have been populated into a Microsoft Excel® spreadsheet with drop-down boxes for the responses to each factor. No attempt has been made to rank these risk factors. Neuropsychiatrists piloting the tool in clinical practice have found the tool simple and quick to use. A printout of the checklist is placed in the patient's medical notes as evidence. Where an overall SUDEP risk rating is increasing, the clinical team can intervene to mitigate the risks.

The checklist brings together factors identified in a systematic review of the literature in order to inform clinical practice in mental health. In parallel with using the checklist in practice, a broader team is undertaking an explorative retrospective case-control research study to determine whether it is possible to rank the risk factors; this will inform a more sophisticated risk assessment tool.

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 article is to provide a viewpoint on a controversial aspect of evidence‐based medicine (EBM) and its application to clinical decision making and healthcare policy. To draw attention to the potential for using EBM as a rationalising tool, as opposed to rationalising treatment options, and to discuss how legitimacy in the decision‐making process may be secured.

A range of academic commentary and case law is reviewed. A model for the legitimacy of due process is suggested through the application of the framework for the “accountability for reasonableness”.

Provides information about sources indicating their relevance and where they can be found. Emphasises that NHS organisations and trusts need to enhance the legitimacy of due process through clinical governance.

Presents a viewpoint designed to stimulate debate, which is based on a critical evaluation of the literature as well as contemporary quality initiative issues in the context of clinical governance.

A useful source of guidance for NHS Trust decision makers, healthcare practitioners and those involved with patient support initiatives.

This paper provides an original viewpoint on a topical and important issue and develops the concept of legitimacy and decision making that is delivered by the application of legal principles through clinical governance.