Clinical governance is essential for creating a framework in which healthcare organisations can align their efforts to enhance outcomes for patients and service users. It provides a lens through which healthcare boards must view their decision-making to ensure their organisations deliver high-quality care as a matter of course.
However, in order to break down the concept of clinical governance into manageable and actionable elements, there are the 7 pillars of clinical governance on which organisations must focus their efforts. Each of these pillars plays a role in improving patient safety, improving care, maintaining transparency and creating an efficient and effective governance process.
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This article explores each of these seven pillars to explain what they are and how they help healthcare providers meet their obligations and desired outcomes.
What are the 7 pillars of clinical governance?
Pillar 1: Clinical effectiveness
The UK’s NHS describes clinical effectiveness as “the application of best knowledge, derived from research, clinical experience and patient preferences to achieve optimum processes and outcomes of care for patients. The process involves a framework of informing, changing and monitoring practice.”
This means providing evidence-based care that leads to improved outcomes, building on established studies and engaging with new research and medical and technological advances.
By ensuring all clinical staff are aware of the current developments and actively integrate this learning into their daily duties, you can create a service that is best equipped to meet the needs of patients and the most pressing challenges. Boards should also take this same approach to their decision-making, ensuring they are up-to-date with the latest developments.
To improve clinical effectiveness, your teams should:
- Set clear goals for clinical activities, such as patient outcomes and service quality.
- Conduct a continuous improvement programme, detailing the latest research and best practice.
- Use real-time data analytics to identify trends and act accordingly.
- Implement standardised procedures and protocols to create a consistent approach to healthcare.
- Monitor key performance indicators (KPIs) to track achievement in areas such as:
- Mortality rates
- Readmission rates
- Length of stay (LOS)
- Recovery times
- Infection rates
- Surgical error rates
- Bed occupancy
- A&E waiting times
- Time to treatment
- Staff-to-patient ratios.
Pillar 2: Risk management
This involves the process by which you identify, assess and mitigate risks relating to patient safety, healthcare quality and operational effectiveness. It helps you reduce incidences of medical errors, equipment failures, data breaches, compliance violations and other potential issues that could affect the ability of the organisation to provide high standards of care and governance.
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Carrying out effective clinical risk management includes:
- Identifying risks by monitoring incidents that occur within your organisation, adverse events and near misses to build a profile of the kinds of issues that you are exposed to.
- Assessing risks by evaluating the likelihood of these risks occurring and the potential severity of the consequences if they were to come to fruition. This risk matrix helps you prioritise your approach to mitigation, starting with those risks that are most likely to occur and which would cause the greatest damage.
- Implementing controls, including policies, procedures, training programmes and safe working practices to prevent harm to the organisation, its employees or service users.
- Monitoring and reviewing these risks and the effectiveness of your mitigation efforts, as well as analysing risk data to help you refine your strategies and improve the care your organisation provides.
Pillar 3: Patient and public involvement
As good clinical governance revolves around patient-led care, involving patients and the wider community in the way the organisation runs its services is essential. This allows you to develop programmes that meet the needs of these stakeholders more effectively and embeds accountability into the way you run your healthcare organisation.
Creating effective two-way communication lines between the provider and the public allows you to view your services through the eyes of a patient and tailor your offering in such a way that you deliver better quality provision that achieves greater outcomes.
Here are some ways to engage patients so that you can effectively integrate patient voices into your service design:
- Define objectives for your outreach, whether it is to improve your service quality, enhance patient experience or something else.
- Start by engaging patients at the beginning of the process, rather than starting new projects and then asking them once the foundations are established. This will help engrain public participation, rather than adding it on as an afterthought.
- Allow patients to contribute in a range of different formats to reflect the wide range of perspectives available. This includes in-person meetings, focus groups, in-person surveys, online feedback forms, social media outreach and more.
- As well as asking the public for insights, offer educational materials to help them understand healthcare processes, their rights and other opportunities to involve themselves with shaping your services.
Pillar 4: Clinical audit
All healthcare professionals should audit their practice on a regular basis to monitor their performance. But clinical audit is not just about collecting data; it is about viewing the clinical care data in context against clinical benchmarks and with the understanding that each person or department audited will improve between each audit.
The process for clinical audit includes:
- Selecting a topic for audit
- Agreeing the standards of best practice for that topic (audit criteria)
- Collecting data on performance regarding this topic areas
- Analysing data against clinical standards
- Feeding back results
- Discussing possible changes to improve performance
- Implementing the agreed changes
- Allowing time for these changes to embed before re-auditing
- Collecting a second set of clinical care data relating to the topic
- Analysing the re-audit data
- Feeding back the re-audit results
- Discussing whether practice has improved.
The audit not only checks on the progress of the subject being audited, but also helps to raise questions about how they can be supported to improve in the future. This might include having access to new technology or ways of working.
Pillar 5: Education and training
Personal development through lifelong learning is key to clinical governance in the NHS and other healthcare organisations. It ensures that staff are able to carry out their duties to the best of their ability and can upskill to meet the developing needs of their patients.
This means running education programmes within your organisation and ensuring that all internal stakeholders have access to materials they need for continuous professional development, as well as providing the opportunities to attend courses and conferences.
Staff should also be able to take professional exams, undergo regular assessments to ensure they receive the most appropriate training and take on appraisals to identify areas that require improvement and the steps to achieving that improvement.
Pillar 6: Information management
Information management within clinical governance relates to the manner in which organisations acquire and store data. However, it is increasingly related to how they can use that data in an appropriate manner to create evidence-based decisions that improve the experience and outcomes for patients.
Within clinical governance, information management can include:
- Monitoring patient safety data, including incident reports, outcomes and other related factors to help improve processes and reduce or eliminate risks.
- Gathering the responses to patient and community surveys, analysing the input provided and using that to find effective pathways towards positive changes to services.
- Supporting staff development by monitoring performance and sharing insights, knowledge and best practice across your organisation and partner organisations.
- Ensuring that patient data is accurate and up-to-date.
- Maintaining that data in a secure manner, accessible only to authorised personnel and stored in accordance with privacy regulations.
- Keeping your information protected from cyberattacks at all stages of the clinical process, including, for example, when discussing patient care in a multidisciplinary team meeting.
Pillar 7: Staffing and staff management
To be able to deliver quality service and achieve the necessary outcomes, organisations need to have an appropriate level of staffing and expertise on hand. This requires strategic recruitment to ensure there are enough employees and that there are no skill gaps that could lead to an inferior experience for patients.
It is also essential that management teams are able to motivate and develop their staff to achieve continuous improvement and meet the challenges they face on a daily basis. This includes recognising underperformance and being able to put in place measures to successfully mitigate its impact and address the issues accordingly.
Improving staff retention is key in a challenging sector such as healthcare, and it is an important part of clinical governance. Management teams are responsible for creating good working conditions so that employees feel comfortable and valued in their work.
Best practices to strengthen your clinical governance framework
| Best practice | Explanation |
| Clear governance policies | Clarity of message is key throughout clinical governance. Ambiguity makes it difficult to understand what success looks like and how to achieve it. By being clear from the start, teams can focus on a direction that will bring results. |
| Review and update | Clinical governance does not stand still. Make sure that your governance practices are still working, still driving improvement and still relevant to your patients and the local community. |
| Benchmark | Collaborate with other healthcare organisations to understand and analyse best practice across the sector, benchmarking appropriate policies and procedures to help you create your own governance strategy. |
| Cross-departmental collaboration | Also collaborate internally to share learning within your organisation and across departments. Align your efforts to make more effective governance policies. |
| External assessments | Engage external parties to provide an unbiased, outside view on the performance within your organisation. |
| Monitor regulatory changes | Any adjustments to regulations surrounding healthcare can have a significant bearing on the effectiveness of your clinical governance, so ensure you stay ahead of the game on forthcoming regulatory changes, enabling you to adapt as soon as possible. |
FAQ
What is clinical governance?
Clinical governance is a framework that ensures healthcare organisations maintain high standards of care, patient safety and continuous quality improvement through accountability and structured processes.
Why is clinical governance critical in modern healthcare?
Clinical governance is essential for safeguarding patient well-being, enhancing service quality, reducing medical errors and ensuring compliance with regulatory standards.
What challenges might arise in maintaining clinical governance?
The most common challenges include resistance to change from staff, resource limitations, data security concerns, inconsistent compliance with policies and difficulties in sustaining continuous improvement.
What role does culture play in clinical governance success?
A strong organisational culture that prioritises transparency, accountability and learning encourages staff engagement, adherence to best practices, and continuous improvement of patient care.
Conclusion
The 7 pillars of clinical governance help healthcare organisations create top-down policies that drive accountability and support continuous improvement to achieve the best outcomes for patients. Leaders can create a strong culture by displaying good governance within board meetings.
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