Team Member Role(s) Profile
Paul Banaszkiewicz Paul Banaszkiewicz Section Editor
Mark Mark Sohatee Segment Author
  • Clinical governance is 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.1
  • It is often described in terms of seven pillars,2 which include:3
    • Patient and public involvement
    • Information and information technology
    • Risk management
    • Clinical audit and quality improvement
    • Teaching and training
    • Clinical effectiveness
    • Staffing management

Patient and public involvement

  • Patient and public involvement, sometimes referred to as patient and public participation, is a process that is aimed at guaranteeing that services delivered meet the needs of the patient. This is done by collating feedback from patients and can be done in a variety of ways:
    • Feedback surveys and questionnaires at local and national levels
    • Local involvement networks (LINk)
    • Patient advice and liaison services

Information and information technology

  • This ensures that information held and information technology is used appropriately and in a way to maximise patient outcomes. It may be utilised in a number of ways. This may be through the use of specialist systems and programmes directly to facilitate the day to day treatment of patients and to store results and data safely over a prolonged period of time.
  • Information technology may also be used as an adjunct to systems in place for monitoring services and allowing for quality improvement.
  • Alongside the practical uses of information technology, there is also a focus on using it correctly. This involves it being applied in lines with information governance and having robust systems and staff training to ensure the confidentiality of patient data.

Risk management

  • This is about having protocols and systems in place to reduce risk to patients and staff members.
  • It also includes having mechanisms to report and investigate adverse events (i.e. Datix). This should also ensure that staff members can learn from adverse events to prevent future risk.
  • It is important to have risk management procedures in place that are progressive and look to improve overall patient and staff safety. They should also facilitate staff learning from adverse events and may be closely linked with aspects of quality improvement such as root cause analysis.

Clinical audit and quality improvement

  • Clinical audit is a mechanism by which practice is measured against existing standards, and deficiencies are identified and addressed with the intention of re-audit to ensure that this best practice continues. Quality improvement looks at systems in place within healthcare, and through a number of strategies aims to ensure that these are as efficient and effective as possible.

Teaching and training

  • This involves ensuring that staff members have adequate education and training to be able to do their job effectively. This requires continuing professional development (CPD) courses, etc., undertaking professional examinations and undertaking regular appraisal and assessment to ensure that learning needs are being met. This teaching and training can be delivered via a number of different roots and can include:
    • Local and regional – including mandatory training and induction, moving and handling, etc.
    • National organisations – e.g. royal colleges, resuscitation council.
    • International organisations – e.g. ATLS.

Clinical effectiveness

  • Clinical effectiveness ensures that the care delivered results in the best clinical outcomes for patients.
  • This is done by adopting evidence-based practices and having strategies to ensure that this knowledge and evidence base is kept up to date. This process is facilitated by turning clinical problems into questions and then systematically locating, appraising and using contemporaneous research findings as the basis for clinical decisions.4

Staffing management

  • An integral part of making sure that all the other pillars of clinical governance are implemented is having adequate staffing. This requires organisations to have:
    • Satisfactory recruitment policies in place. This should ensure that there are sufficient numbers of staff employed of satisfactory quality to meet requirements.
    • Systems to assess and appraise existing staff. This is important alongside other aspects of clinical governance, including teaching and training and clinical effectiveness, to ensure that staff get adequate education and remain up to date with best practice.
  • It is the responsibility of all NHS organisations to be actively involved with the components of clinical governance, and they must each have a nominated clinician with lead responsibility who reports directly to the chief executive.5 According to information from the national audit office, trusts have made good progress in implementing the clinical governance programme but it recognises that it must maintain this momentum to achieve the intended benefits.6


  • 1. Scally G, Donaldson LJ. The NHS's 50 anniversary. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998; 317(7150): 61–65.
  • 2. Gray C. What is clinical governance?, 2005.
  • 3. Patricia Day RK. The NHS improvers: A study of the commision for health improvement., 2004 (last accessed 07/2016).
  • 4. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995; 310(6987): 1122–1126.
  • 5. Starey N. What is clinical governance?, (last accessed 07/2016).
  • 6. National Audit Office. Acheiving improvements through clinical governance: A progress report on implementation by NHS trusts., 2003 (last accessed 07/2016).