Realising the developmental potential of Clinical Governance
-
Peter Degeling
Abstract
To be effective, Clinical Governance should reach all levels of a healthcare organisation. It requires structures and processes that integrate financial control, service performance, and clinical quality in ways that will engage clinicians and generate service improvements. The Clinical Governance arrangements of many Trusts, however, present several flaws. In particular, the “silos” organisational structure of Clinical Governance is based on generic issues such as risk management, clinical audit, clinical effectiveness and staff development, and it tends to treat clinical work as an undifferentiated aggregate. An alternative model focused on clinical pathways and on a balance between professional autonomy and accountability (responsible autonomy) should be promoted to make Clinical Governance work.
References
1. Scally G, Donaldson LJ. Looking forward: clinical governance and the drive for quality improvement in the new NHS in England. Br Med J 1998; 317:61–5.10.1136/bmj.317.7150.61Suche in Google Scholar
2. Leatherman S, Sutherland K. The quest for quality in the NHS: a mid-term evaluation of the ten-year quality agenda. London: Nuffield Trust, 2003.Suche in Google Scholar
3. Degeling P, Kennedy J, Macbeth F, Telfer B, Maxwell S, Coyle B. Practitioner perspectives on the objectives and outcomes of Clinical Governance: some evidence from Wales. In: Gray A, Harrison S, editors. Governing medicine: theory and practice. Maidenhead: Open University Press, 2004.Suche in Google Scholar
4. Gregory C, Pope S, Werry D, Dobek P. Reduced length of stay and improved appropriateness of care with a clinical path for total knee or hip arthroplasty. J Qual Improvement 1996; 22:617–27.10.1016/S1070-3241(16)30269-3Suche in Google Scholar
5. Johnson S. Pathways of care: what and how? J Managed Care 1997; 1:15–7.10.1177/136395959700100106Suche in Google Scholar
6. Flynn AM, Kilgallen ME. Case management: a multidisciplinary approach to the evaluation of cost and quality standards. J Nurs Care Qual 1993; 8:58–66.10.1097/00001786-199310000-00008Suche in Google Scholar
7. Guiliano KK, Poirier CE. Nursing care management: critical pathways to desirable outcomes. Nurs Manage 1991; 22:52–5.10.1097/00006247-199103000-00015Suche in Google Scholar
8. Poole DL. Care profiles, pathways and protocols. Physiotherapy 1994; 80:256–66.Suche in Google Scholar
9. Degeling P, Kennedy J. What is the work? An analysis of activity in fifteen NHS Trusts. Durham: Centre for Clinical Management Development, University of Durham (forthcoming).Suche in Google Scholar
10. Degeling P. Reconsidering clinical accountability. An examination of some dilemmas inherent in efforts to bolster clinician accountability. Int J Health Plann Manage 2000; 15:3–16.10.1002/(SICI)1099-1751(200001/03)15:1<3::AID-HPM568>3.0.CO;2-RSuche in Google Scholar
11. Degeling P, Kennedy J, Hill M. Mediating the cultural boundaries between medicine, nursing and management – the central challenge in hospital reform. Health Serv Manage Res 2001; 14:36–48.Suche in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Artikel in diesem Heft
- Foreword
- Evidence-based policy-making
- Clinical Governance – from rhetoric to reality?
- Realising the developmental potential of Clinical Governance
- Re-energising Clinical Governance through Integrated Governance
- Clinical Governance: from clinical risk management to continuous quality improvement
- Involvement of patients in Clinical Governance
- Teaching and Continuing Professional Development: an Italian experience
- New National Healthcare Information System
- Clinical Governance and Laboratory Medicine: is the Electronic Medical Record our best friend or sworn enemy?
- Technology to improve quality and accountability
- Clinical Governance and evidence-based laboratory medicine
- ISO 15189:2003 – Quality management, evaluation and continual improvement
- External Quality Assessment: an effective tool for Clinical Governance in Laboratory Medicine
- Errors in clinical laboratories or errors in laboratory medicine?
- Laboratory request appropriateness in emergency: impact on hospital organization
- Point-of-care-testing and Clinical Governance
- Integration between the Tele-Cardiology Unit and the central laboratory: methodological and clinical evaluation of point-of-care testing cardiac marker in the ambulance
Artikel in diesem Heft
- Foreword
- Evidence-based policy-making
- Clinical Governance – from rhetoric to reality?
- Realising the developmental potential of Clinical Governance
- Re-energising Clinical Governance through Integrated Governance
- Clinical Governance: from clinical risk management to continuous quality improvement
- Involvement of patients in Clinical Governance
- Teaching and Continuing Professional Development: an Italian experience
- New National Healthcare Information System
- Clinical Governance and Laboratory Medicine: is the Electronic Medical Record our best friend or sworn enemy?
- Technology to improve quality and accountability
- Clinical Governance and evidence-based laboratory medicine
- ISO 15189:2003 – Quality management, evaluation and continual improvement
- External Quality Assessment: an effective tool for Clinical Governance in Laboratory Medicine
- Errors in clinical laboratories or errors in laboratory medicine?
- Laboratory request appropriateness in emergency: impact on hospital organization
- Point-of-care-testing and Clinical Governance
- Integration between the Tele-Cardiology Unit and the central laboratory: methodological and clinical evaluation of point-of-care testing cardiac marker in the ambulance
