Healthcare professionals’ perceptions of clinical governance implementation: a qualitative New Zealand study of 3205 open-ended survey comments

OBJECTIVES To investigate healthcare professional perceptions of local implementation of a national clinical governance policy in New Zealand. DESIGN Respondent comments written at the end of a national healthcare professional survey designed to assess implementation of core components of the clinical governance policy. SETTING The written comments were provided by respondents to a survey distributed to over 41 000 registered healthcare professionals employed in 19 of New Zealand's government-funded District Health Boards. Comments were analysed and categorised within emerging themes. RESULTS 3205 written comments were received. Five key themes illustrating barriers to clinical governance implementation were found, representing problems with: developing management-clinical relations; clinicians stepping up into clinical governance and leadership activities; interprofessional relations; training needs for governance and leadership; and having insufficient time to get involved. CONCLUSIONS Despite a national policy on clinical governance which New Zealand's government launched in 2009, this study found that considerable effort is required to build clinical governance at the local level. This finding parallels with other studies in the field. Two areas demand attention: building systems for organisational governance and leadership; and building professional governance arrangements.