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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 study investigates the role of leadership and cultural transformation in facilitating Lean Six Sigma (LSS) practices in clinical pharmacy settings to reduce medicine waste within the UK National Health Services (NHS).

A systematic literature review on Lean Six Sigma in health care was conducted to develop an analytical framework. This was followed by a qualitative case study of an English NHS trust to test the framework, exploring pharmacists' adoption of LSS practices and their impact on staff behaviour, focussing on leadership decisions and organisational culture.

The research highlights the significance of leadership’s prioritisation in waste reduction efforts and its influence on staff engagement. It also examines the intricate relationship between leadership decisions, education and training, resource allocation, and the prevailing clinical culture, which shapes pharmacists' behaviours and attitudes towards LSS practices and waste reduction.

The study’s focus on a single NHS trust limits the generalisability of the findings, suggesting the need for further research across different healthcare settings.

The study recommends a cultural transformation, earlier training, and reformation in service strategy to enhance the adoption of LSS practices and contribute to a more sustainable future for the wider health services.

Effective medicine waste management prevents harm and helps address the current NHS medicine shortage. The NHS can allocate resources efficiently, ensure timely treatment, and prepare for future disruptions by implementing the proposed framework.

We developed a leadership model for the NHS to reduce medicine waste, offering a novel approach to addressing the challenge of medicine waste through leadership and cultural transformation.

The new NHS White Paper (DoH, 1997) provides for a new legal duty of quality for chief executives in Trusts. Clinical governance is seen as a central tenant of this legal duty which is designed to raise clinical quality to the same level of importance as corporate governance.

The purpose of this paper is to explore how multi-professional approved clinicians (MPACs), responsible for the care of patients detained under the Mental Health Act (2007), can enable clinical leadership in mental health settings.

A questionnaire was completed by clinical psychology and mental health nursing practitioners in a mental health trust in the UK working towards or having gained approved clinician (AC) status, identifying barriers to implementation of the roles and enablers. Qualitative interview data were also gathered with psychiatrists, clinical psychologist and Mental Health Nurse ACs (three in each group).

There are a number of barriers and enablers of distributed leadership promoted by the MPAC role. Themes identified focused on enabling person-centred care, clinical leadership and culture change more broadly within mental health care. The AC role is supporting clinical leadership by a range of professionals, promoting patient choice by enabling access to clinicians with the appropriate skills to meet needs. Clinical leadership roles are promoting links between organisational priorities, teams and patient care, fostering distributed leadership in practice.

This project reflects the views of a limited number of practitioners within one organisation which limits generalisabilty.

Organisations need clear strategies linked to workforce development and implementation of the roles to capitalise on their potential to support clinical leadership and person-centred care.

This study provides initial qualitative data on potential benefits and challenges of implementing the role.

Clinical leadership, researcher capacity and a culture of clinical inquiry are needed in the clinical workforce. The purpose of this paper is to report on a program which was used to develop and support clinicians to explore practice, implement innovation, translate evidence and build researcher capacity.

This pragmatic paper presents a case study of a nursing and midwifery clinician-researcher development program. The multi-site, multi-modal program focused on education, mentoring and support, communication networks, and clinician-university partnerships strategies to build workforce capacity and leadership.

Over 2,000 staff have been involved in the program representing a range of health disciplines. The study day program has been delivered to 500 participants with master classes having over 1,500 attendees. The research mentor program has demonstrated that participants increased their confidence for research leadership roles and are pursuing research and quality assurance projects. Communication strategies improved the visibility of nursing and midwifery.

This case study was conducted in one health district, which may not have relevance to other geographical areas. The small numbers involved in the research mentor program need to be considered when reviewing the findings.

The program has been a catalyst for developing a research culture, clinical leadership and research networks that strengthen workforce capacity. Building researcher skills in the workforce will better support quality healthcare and the examination of everyday practice.

Building a culture of healthcare that is based on inquiry and evidence-based practice will lead to more appropriate and consistent healthcare delivery. Consumers have the right to expect health clinicians will challenge everyday practice and have the skills and capability to translate or generate best evidence to underpin professional and service delivery.

This paper provides strategies for building workforce researcher capacity and capability. The program provides opportunity for building research networks and role modeling the value and importance of research to practice and quality improvement.

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 investigate the clinical communication using Tamale Teaching Hospital as a case.

The paper is based on the Reassure, Explain, Listen, Answer, Take Action and Express Appreciation (RELATE) model and the Four Habits models of Clinical Communication.

The results of the study indicate that leadership conducted staff meetings with some of the components of the RELATE model. These include staff meetings, employee rounding and communication/notice boards. The results of the study also suggest that much as some parts of the Four Habits model was used in provider–patient communication, certain aspects of the model were absent. The study identified some communication challenges including poor dissemination, lack of unity among some health workers, poor attendance in meetings and, with respect to patients, language barrier, patients’ reluctance to disclose their actual health problems to health providers, lack of privacy and lack of a friendly environment.

Providers, especially physicians, should be given training on the local languages in areas where they perform their services. Health service providers should receive as part of their learning in-depth training on the Four Habits model of Clinical Communication, especially the Medical Officers.

It is imperative to embrace evidence-based practices/models aimed at securing proper communication in all hospitals but most especially teaching hospitals.

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.

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

Recent changes in the National Health Service in the UK have included a drive towards better quality health care through enhanced professional regulation, clinical governance and lifelong learning. It has been stated that the successful adoption of programmes of clinical governance is dependent on the right culture prevailing within the NHS. Progress and problems in the implementation of clinical governance to date are discussed.