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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.

For most people, especially those with fixed incomes, household budgets have to be balanced and sometimes the balance is precarious. With price rises of foods, there is a switch to a cheaper substitute within the group, or if it is a food for which there is no real substitute, reduced purchases follow. The annual and quarterly reviews of the National Food Survey over the years have shown this to be so; with carcase meat, where one meat is highly priced, housewives switch to a cheaper joint, and this is mainly the reason for the great increase in consumption of poultry; when recently the price of butter rose sharply, there was a switch to margarine. NFS statistics did not show any lessening of consumer preference for butter, but in most households, with budgets on a tight string, margarine had to be used for many purposes for which butter had previously been used. With those foods which have no substitute, and bread (also milk) is a classic example, to keep the sum spent on the food each week about the same, the amount purchased is correspondingly reduced. Again, NFS statistics show this to be the case, a practice which has been responsible for the small annual reductions in the amount of bread consumed per person per week over the last fifteen years or so; very small, a matter of an ounce or two, but adequate to maintain the balance of price/quantity since price rises have been relatively small, if fairly frequent. This artifice to absorb small price rises will not work, however, when price rises follow on one another rapidly and together are large. Bread is a case in point.