This notion of clinical governance has become part of a more comprehensive approach to quality. Today it is widely agreed that clinical governance should not be divorced from overall governance in hospitals, diagnostic centres or general practice. Accordingly it is now perceived that integrated governance ¹ combines all auspices of clinical and fiscal governance in one coherent structure.
A useful definition of integrated governance is:
“Systems, processes and behaviors by which organisations lead, direct and control their functions in order to achieve their objectives, safety and quality of service and in which they relate to patients and carers, the wider community and partner organisations.”
The term ‘clinical governance’ could be misunderstood to imply that clinical governance is the sole responsibility of clinicians and not part of the mainstream of any organisation. In the wake of problems in recent years in the health system such as the public inquiry into the Mid Staffordshire NHS Foundation Trust, it is clear that clinical governance is the responsibility of all but especially of those who run organisations. In the case of NHS hospitals the Board would have overall responsibility for integrated governance; in GP practices it will be the responsibility of the principals in that practice following the abolition of PCTs. The review of failings by the Mid-Staffordshire Trust included the following recommendations which are applicable to all types of healthcare institutions, including hospitals, GP practices and investigation centres:
1. Develop and promote an open, learning culture;
2. Collect and report information accurately, both internally and externally, and in sufficient detail;
3. Identify and mitigate risks to the safety of its patients;
4. Identify serious incidents and unexpected deaths correctly, and then report, investigate adequately and learns from such incidents;
5. Learn from and ensure that necessary improvements are made following incidents, near misses and complaints;
6. Engage clinicians and develops effective clinical audit;
7. Consider and act on the views and experiences of patients who use the Trust’s services.
The concept of integrated governance has been introduced accordingly to widen the scope of governance and assign responsibility to those tasked to run organisations.