Clinical governance--a new label for old ingredients: quality or quantity?

HE title 'clinical governance' is now part of our vocabulary, although it is not clear to many what it entails. 1 It is stated to be a famework to enable clinicians to continuously improve quality and safeguard standards of care. 2,3 In fact, it is a new label for old ingredients. These ingredients include clinical audit, guidelines, complaint procedures, clinical supervision, risk management , evidence-based practice, continuing professional education , and reflective practice. 4-6 Despite being comprised of old ingredients, 1 it is believed to be a helpful label to concentrate the minds of professionals and managers on the interrelationships between the ingredients, disciplines, and care sectors. Clinical governance (CG) will make clinicians, together with managers, accountable for the quality of patient care. 7 This may result in decisions on health care provision being more, or less, based on clinical effectiveness and not just on cost effectiveness. Clinical governance should be patient focused, universally applicable, and encompass a partnership between clinicians, managers, and the public. 5,8,9 There is a danger, however, that the management agenda of CG will overtake the professional agenda. The management agenda is concerned with making sure that uniform, minimum standards are met, procedures and checks are in place, and that budgets are adhered to. The professional agenda is concerned with the development of individuals and their teams, the educational requirements that they may have, and the quality of care that patients receive. 4,5 Monitoring frameworks will be appropriate for both agendas to improve existing care and to anticipate, prevent, and recognize poor performance , 10 although details may be problematic. 3 There must be a key relationship between CG and education, both uni-disciplinary and inter-disciplinary. 11,12 Clinical governance activity may highlight three types of problem areas: clinical competence, organization of care, or lack of resources. These will each require a different solution. Educational innovation is needed, with doctors and nurses learning from each other's strengths. Clinical supervision, 13 mentor-ship, 14 tutors, and focused education will be required where clinical competence is poor. GP tutors should have a key role. New comparable nurse tutors could work in tandem with an expanded number of GP tutors. All should be appointed through the university system, have similar standing to existing GP tutors, and be primary care based. The ideal would be generic trained tutors who would assess the educational needs of all disciplines within their primary care group (PCG). …