What is clinical governance?

Clinical governance is an overarching framework which covers activities that help sustain and improve high standards of patient care in the NHS. 

In the 1998 publication ‘Clinical governance and the drive for quality improvement in the new NHS in England’, Scally and Donaldson defined clinical governance as ‘a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’.

Central to the UK Government’s agenda since the late 1990s, clinical governance requires healthcare organisations and the NHS staff within them to maintain standards through structures and processes, and be able to evidence those structures and processes.

What are the seven pillars of clinical governance?

There are seven pillars of clinical governance which form the framework, and which healthcare organisations are accountable for.

1. Evidence based care and effectiveness 

This pillar ensures healthcare organisations use the best evidence and research for optimum outcomes for patients. This includes:

• Following evidence-based practice when deciding on treatment options
• Sticking to standards and guidelines to help inform care
• Carrying out new research to inform new guidelines, papers, and standards
• Implementing new standards and guidelines into practice as they are developed

2. Risk management

This pillar includes methods to understand, monitor, and minimise risks to both patients and staff. It ensures any past mistakes or accidents are learned from, so the quality of patient care is improved. This includes:

• Carrying out risk assessments and reporting any incidents or near misses
• Identifying any problem areas in treatments
• Ensuring risk systems are in place and protocols are followed

3. Patient and public involvement (PPI)

This pillar requires communication with patients and the public to gain insights into the quality of care given and to address any issues. This includes:

• Carrying out patient questionnaires
• Implementing patient forums
• Including representatives for patients on practice and hospital boards

4. Clinical Audit

This pillar requires audits to be carried out to evaluate the standard of existing care against the gold standard. It ensures any shortcomings are identified, enabling staff to develop methods to improve outcomes. This includes:

• Carrying out an audit and researching a standard to compare it to
• Collecting data from the audit and the comparison standard and analysing it to identify shortcomings
• Implementing any methods of change
• Re-auditing after a certain time has passed to assess the improvements

5. Staffing and staff management

This pillar ensures the right staff are employed for the right jobs, professional development is encouraged, and a good work environment is in place. This includes:

• Under performing staff being highlighted and helped to improve
• Encouraging staff to actively participate in the work environment
• Ensuring the employer has an open attitude to improve working conditions and appropriate staff management where necessary

6. Education and training

This pillar highlights the importance of ongoing education and training of staff to ensure their knowledge and practice is both up-to-date and evolving as new developments in healthcare are identified, so the best possible care is given at all times. This includes:

• Creating pathways into further education for staff through degrees or diplomas
• Encouraging staff to attend events, lectures, webinars, or courses
• Carrying out work appraisals with staff to assess competency and identify areas of improvement

7. Information & IT

This pillar ensures patient information is safe, correct, and up-to-date on all systems. This includes:

• Implementing the correct storage and management of data
• Keeping patient data confidential

In order to ensure high standards of care, many health and social care organisations are inspected and rated by the Care Quality Commission (CQC) – the independent regulator of health and social care in England.

The five CQC standards

There are five CQC standards which are followed during inspections, which assess the quality of care provided by a health or social care organisation. Inspected organisations are then rated as one of the following: outstanding; good; requires improvement; or inadequate.

1. Are they safe?

This standard measures if patients are protected from abuse and avoidable harm. It asks:

• How does the organisation safeguard people from abuse?
• How are risks and safety monitored to ensure people’s freedom is respected?
• How does the organisation ensure the proper and safe use of medicines?
• How well are people protected by the prevention and control of infection?
• Are lessons learned and improvements made when something goes wrong?

2. Are they effective?

This standard measures if care, treatment, and support achieves good outcomes, how an organisation helps to maintain quality of life, and is based on the best available evidence. It asks:

• Is care delivered in line with legislation and evidence-based guidelines?
• How does the organisation ensure staff has the knowledge to deliver effective care?
• How well does the organisation work together as a whole to deliver effective care?

3. Are they caring?

This standard measures whether patients are treated with compassion, kindness, dignity, and respect. It asks:

• How does the organisation ensure people are treated kindly and provided with emotional support?
• How does the organisation support people to be actively involved in making decisions about their care?

4. Are they responsive to people’s needs?

This standard measures whether services are organised to meet the needs of individuals. It asks:

• How does the organisation handle concerns and complaints to improve the quality of care?

5. Are they well-led?

This standard measures how well the leadership, management, and governance of an organisation ensures it’s providing high quality care based around the needs of individuals, that it encourages learning and innovation, and that it promotes an open and fair culture. It asks:

• Does the organisation promote a positive culture?
• Are responsibilities clear, and are quality performance, risk, and regulatory requirements managed?
• How are people engaged and involved with the service?
• How does the organisation continuously learn, improve, and innovate?

Learn how to take the lead in clinical governance

If you’re a registered nurse currently working in a health or social care organisation and have ambitions to move into a leadership position, the University of Sunderland’s 100% online MSc Nursing Studies will equip you with the skills and knowledge you need to become an effective leader.

Designed to build capacity in education, research, clinical practice, and leadership, this master’s degree will also teach you how to deliver high quality care under the pressure of rising demand, limited funding, and the increasing need for innovation and transformation to improve both quality and safety.

As clinical governance requires continuous education and training amongst NHS staff, you will study this degree part-time and apply what you learn to your current role.