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To hammer home that clinical governance is the defining heart and inspiration of quality in the NHS and to expand on its implementation by all concerned.

Lists the ideal aspects and attributes of clinical governance.

Finds that clinical governance is a sine qua non and mandatory lever for achieving quality in the NHS and that whatever changes are necessary must be fully carried out.

Arguably, coming as it does from the top of the hierarchy, this posits the most soul‐searching advocacy of clinical governance's importance for the NHS so far presented.

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 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 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.

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 purpose of this paper is to enable busy health care professionals to gain a quick overview of the current articles in CGIJ.

The paper takes the form of a review.

Clinical governance continues to be an important issue in contemporary healthcare and the concept is being applied to many different facets of healthcare provision.

The papers in the issue recommend changes to: knowledge sharing, risk management, defining low value/high value treatments, use of voice recognition software and clinical supervision.

Knowledge sharing and considering patient quality of life (QOL) rather than basing treatment decisions on cost alone are considered.

The paper provides an overview of current subjects.

Clinical governance was introduced in 1997 as a comprehensive framework to improve the healthcare quality in the National Health Service. Since then, the proliferation of various definitions and models of clinical governance illustrates that different perceptions are emerging on clinical governance. However, none of these definitions captures the essence of clinical governance in terms of its organisation‐wide implications for continuous quality improvement. Although there is discrete mention of structure, process and outcomes in the literature on clinical governance, it is hard to find any clear explanation on how clinical governance influences organisational elements. This paper therefore analyses clinical governance in terms of the inputs, processes, structure and the outcomes of healthcare organisations. The fact that the introduction of any new governance framework will have much wider implications for the management of healthcare organisations is illustrated through a refined definition of clinical governance presented in this paper.

Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation.

The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario’s cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations.

From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives.

To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers.

This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.

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.

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.

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.

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.

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.