CLINICAL GOVERNANCE/ˈklɪnɪkəl ˈɡʌvənəns/

The phrase clinical governance has been the hot topic among members of the medical professions in England and Wales over the past year or so; it is now beginning to be seen in newspapers and other non-technical writing, though it will probably continue to be viewed as jargon. It encapsulates a systematic attempt by the Labour government in Britain to improve standards of care in the National Health Service (NHS). These have come under threat through financial constraints, especially a competitive system introduced by the last Conservative government that was based on an internal market. There have also been several recent much-publicised cases of medical incompetence. From April 1999, all British hospital administrators will have a statutory responsibility for standards and the quality of patient care, which will require them to keep a firm eye on how well surgeons, doctors, nurses and support staff do their jobs. They will have to ensure that doctors who are identified as performing poorly either retrain, change their caseloads or leave their jobs. Many doctors are unsure how well monitoring can work, but within at least some hospital departments it already seems to be leading to a more alert and questioning view of methods. The term echoes the older term corporate governance for proposals to improve standards in British business life following the Cadbury Report.

While the proposal to improve “clinical governance” in the NHS should be universally welcomed ... the mechanisms for monitoring and managing clinical performance will almost certainly prove more controversial.

British Medical Journal, Jan. 1998

There is no doubt in many people’s minds that clinical governance could become a bureaucratic extravaganza ... without much effect on the quality of patient care.

Report, Clinical Governance in North Thames, Jun. 1998

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