The Government has published proposals to set up two new structures ‐ one for the regulation of social services and one for independently provided health care. This article argues…
Abstract
The Government has published proposals to set up two new structures ‐ one for the regulation of social services and one for independently provided health care. This article argues that a single regulator for all categories of health care, including that provided in social care settings, would be more cost‐effective. It proposes the creation of functionally ring‐fenced divisions of health care regulation, structured within and answerable to the proposed commissions for care standards.
The report of the Royal Commission on Long Term Care, published in March 1999, is to be subject to further consultation, thus delaying any progress on its recommendations which…
Abstract
The report of the Royal Commission on Long Term Care, published in March 1999, is to be subject to further consultation, thus delaying any progress on its recommendations which include important links to other Government initiatives in health and social care. The paper argues that its proposal for a National Care Commission could be the missing link to equity of care provision and care standards for older people, and early implementation should not be lost.
This research aims to look through the data of Nhan Dan Gia Dinh Hospital, a state‐owned hospital in Vietnam, for evidence on whether a clinical governance initiative cultivates…
Abstract
Purpose
This research aims to look through the data of Nhan Dan Gia Dinh Hospital, a state‐owned hospital in Vietnam, for evidence on whether a clinical governance initiative cultivates ethical leadership, market‐ or innovation‐oriented culture, knowledge sharing, and knowledge‐ or identity‐based trust.
Design/methodology/approach
Data were collected through a case study approach with hospital document collection, field observations, and in‐depth interviews conducted between April 2009 and April 2011.
Findings
The findings demonstrated that a clinical governance initiative, when effectively implemented, can function as a lever for behavioural transformations in the hospital towards ethical leadership, market‐ or innovation‐oriented culture, knowledge sharing, and knowledge‐ or identity‐based trust.
Originality/value
The current research provides a portrayal of an effective clinical governance initiative with its proactive hospital outcomes such as ethical leadership, market‐ or innovation‐oriented culture, knowledge sharing, and knowledge‐ or identity‐based trust on the hospital journey of sustainable health creation. This paper also highlights the necessity for research that examines other organizational outcomes of clinical governance in Vietnamese hospitals of other ownerships.
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Niamh M. Brennan and Maureen A. Flynn
This paper seeks to review prior definitions of the umbrella term “clinical governance”. The research question is: do clinical governance definitions adequately distinguish…
Abstract
Purpose
This paper seeks to review prior definitions of the umbrella term “clinical governance”. The research question is: do clinical governance definitions adequately distinguish between governance, management and practice functions? Three definitions are introduced to replace that umbrella term.
Design/methodology/approach
Content analysis is applied to analyse 29 definitions of clinical governance from the perspective of the roles and responsibilities of those charged with governance, management and practice.
Findings
The analysis indicates that definitions of the umbrella term “clinical governance” comprise a mixture of activities relating to governance, management and practice which is confusing for those expected to execute those roles.
Practical implications
Consistent with concepts from corporate governance, the paper distinguishes between governance, management and practice. For effective governance, it is important that there be division of duties between governance roles and management and practice roles. These distinctions will help to clarify roles and responsibilities in the execution of clinical activities.
Originality/value
Drawing on insights from corporate governance, in particular, the importance of a division of functions between governance roles, and management and practice roles, the paper proposes three new definitions to replace the umbrella term “clinical governance”.
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Maureen A. Flynn, Thora Burgess and Philip Crowley
The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of…
Abstract
Purpose
The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.
Design/methodology/approach
A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.
Findings
Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations
Research limitations/implications
The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.
Practical implications
The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.
Originality/value
Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.
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David Greenfield, Peter Nugus, Greg Fairbrother, Jacqueline Milne and Deborah Debono
This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model.
Abstract
Purpose
This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model.
Design/methodology/approach
The research site was a large organisation within an autonomous jurisdiction. The study focused on one organisational division. There were nine interviews and 15 focus groups (118 participants). Ethnographic observations totalled 60.5 hours. Document analysis was conducted with organisational reports and website. Data were examined against the model's four attributes and 24 elements, and used to conduct an organisational culture analysis.
Findings
Analysis showed that a majority of elements, 17 of 24, were strongly identifiable. The remainder were identifiable but not strongly so. Analysis suggested two additions to the model: the inclusion of two elements to an existing attribute and a new attribute and defining elements. This showed that the organisation was working towards, but not yet having achieved, a positive quality and safety culture. In particular, a schism in understanding between managers and frontline staff was noted.
Research limitations/implications
The study empirically applied and refined a health service theory. The new model, the “clinical governance practice model”, can be broadly applied, and can continue to be developed to expand the evidence base for the field.
Practical implications
Substantively, the study accounts for differences in managerial and frontline staff actions in applying clinical governance. Investigations to understand and identify strategies to bridge the differences are required.
Originality/value
The study is an original application and refinement of a health service theory. The study identifies that the interpretation of clinical governance, whilst different in different places, gives rise to similar disagreements.
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Eleonora Karassavidou, Niki Glaveli and Kostas Zafiropoulos
The purpose of this paper is to consider organisational climate as the vehicle to get an understanding, map and enhance the appropriate organisational culture for good clinical…
Abstract
Purpose
The purpose of this paper is to consider organisational climate as the vehicle to get an understanding, map and enhance the appropriate organisational culture for good clinical governance (CG). Based on this assertion, the purpose of this research is fourfold: to investigate CG attributes embedded in Greek hospitals' climate; to test the validity and reliability of the Clinical Governance Climate Questionnaire (CGCQ) and highlight the dimensions of CG climate in the Greek context; to illuminate the “red flag” aspects of hospital's climate and areas shaping the perceptions of the quality of the provided services; and to explore the influence of hospital's legal status on CG climate and service quality.
Design/methodology/approach
Empirical research using the CGCQ was conducted in three Greek NHS hospitals. A total of 214 usable questionnaires completed by the hospitals' personnel were gathered.
Findings
The validity and reliability tests proved that the study's five‐dimension structure of CGCQ is capable of conceptualising the basic elements of CG climate in the Greek context. Hospital's climate was found to be not supportive to successful CG implementation, and areas that demand attention were illuminated. Hospital's legal status seems to mediate CG climate and service quality.
Practical implications
CGCQ proved to be a useful tool for managers and policymakers to trace “problematic” areas of hospital's climate and develop strategies for successful CG initiatives.
Originality/value
The paper contributes to the field of health care management, since it demonstrates that CG climate can be used as a “gauge” of the prevailing CG culture. CGCQ is revealed as a valid, reliable and flexible tool.
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John Pickles, Elaine Hide and Lynne Maher
The purpose of this paper is to describe a study which aims to provide an alternative approach to clinical governance. This involves patients in redesigning services based on…
Abstract
Purpose
The purpose of this paper is to describe a study which aims to provide an alternative approach to clinical governance. This involves patients in redesigning services based on their actual experiences of health services. This will be of interest to front line health care staff and public and patient involvement leads.
Design/methodology/approach
The paper illustrates Experience Based Design (EBD) as a structured, formal methodology with clearly defined roles, actions and timescales. A case study approach is used to describe the implementation of this model in a District General Hospital.
Findings
This study demonstrates how three theoretical components of good design: functionality, engineering and aesthetics can be used as a framework to improve performance, safety and governance and in addition, actual experience of the service for patients and staff.
Research limitations/implications
The case study approach used has provided a good range of learning and transferable information; however, the results are currently based on a single site.
Practical implications
The use of the EBD approach will ensure that healthcare services truly reflect the needs of patients and carers based on their specific experience. It provides a mechanism whereby patients' views contribute fully to the change process leading to safer, more effective and reliable care. This approach will require the application of the non‐clinical competencies included in the Medical Leadership Competency Framework and specific health and wellbeing dimensions in the Knowledge and Skills Framework.
Originality/value
This paper offers a new model that can be incorporated into service redesign. The model enables greater understanding of clinical governance as described by patients through narrative of their actual experiences.
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The NHS Plan incorporates the long‐awaited response of the Government to the report of the Royal Commission on the Costs of Long‐Term Care. This article argues that the risk of…
Abstract
The NHS Plan incorporates the long‐awaited response of the Government to the report of the Royal Commission on the Costs of Long‐Term Care. This article argues that the risk of cost shunt between funding agencies is perpetuated, and that new forms of care will need to be included within the standards assurance of the newly established National Care Standards Commission.
Although Presented AS evolutionary, the White Paper on the NHS could prove revolutionary in its impact. The ‘third way’ approach to the service, based on partnership and driven by…
Abstract
Although Presented AS evolutionary, the White Paper on the NHS could prove revolutionary in its impact. The ‘third way’ approach to the service, based on partnership and driven by performance, is not without potential problems over structures and boundaries at both local and national levels. The delivery of seamless service is a very positive goal, but it is too early to predict how far it will be achieved.