Clinical governance and governmentality

The introduction of Clinical Governance into the National Health Service in England represents a fundamental shift in the regulatory relationship between the state and medical professionals. This paper critically examines the underlying assumptions of Clinical Governance, and discusses them in relation to Foucauldian concepts of 'governmentality'. First, official definitions of Clinical Governance are reviewed in the context of other policies to apply increased control and surveillance to medical professionals and linkages between this and wider tends in public sector managerialism and governance. The paper then briefly considers these developments in relation to theoretical accounts of bureaucracy, professionalism, risk and trust. It is argued that at the organisational level, Clinical Governance can be usefully analysed as involving a move towards 'encoded knowledge' through the use of 'soft bureaucracy'.     

Clinical governance and revalidation

The quality agenda in the NHS has many parts. For the medical profession the means of enhancing standards and consistency will be revalidation. This article outlines progress to date in defining how doctors will demonstrate they are 'up to date' and 'fit to practice'.     

Clinical trials finance and operations

The National Coverage Decision of 2000 was designed to enhance the participation in clinical trials for both patients and physicians by mandating the governmental coverage for services in a clinical trial that are considered "routine" regardless of the trial. Participation in clinical trials can be a practice builder as well as a contribution to the betterment of medical science. Without proper coverage analysis, study budgeting, accurate time estimates, and effective negotiation prior to signing the contract, participation in clinical trials can cost a practice rather than benefit it.     

Patient-reported outcomes measurement and management with innovative methodologies and technologies

Successful integration of modern psychometrics and advanced informatics in patient-reported outcomes (PRO) measurement and management can potentially maximize the value of health outcomes research and optimize the delivery of quality patient care. Unlike the traditional labor-intensive paper-and-pencil data collection method, item response theory-based computerized adaptive testing methodologies coupled with novel technologies provide an integrated environment to collect, analyze and present ready-to-use PRO data for informed and shared decision-making. This article describes the needs, challenges and solutions for accurate, efficient and cost-effective PRO data acquisition and dissemination means in order to provide critical and timely PRO information necessary to actively support and enhance routine patient care in busy clinical settings.     

Clinical governance in primary care

The government's stated top priority for the NHS is the quality of care of patients and there now exists a new duty of quality on all those providing care, accompanied by a drive for greater accountability to the public of clinical decision making. The process which governs these initiatives is termed clinical governance.     

Clinical governance, litigation and human rights

Explores the relationship between doctors, lawyers and the government in the context of the explosion in clinical negligence litigation, clinical governance and the introduction of the Human Rights Act 1998. Examines these issues from a legal perspective. Concludes that successful risk management, careful monitoring and the implementation of authoritative guidelines hold the key to legal change.     

Clinical governance in accident and emergency services

Owing to NHS managers' preponderance with financial issues, the present Government made improving the quality of health services a statutory requirement in 1997. In this article, one means of improving the quality of health services, clinical governance, is examined in detail before some issues related to its implementation are described. The Trust's A&E services, the context for interpreting and applying clinical governance, are briefly described before introducing a force-field analysis that demonstrates the different elements when changing services broadly and clinical governance specifically. The final section concentrates on implementing and improving clinical governance in A&E departments.     

Clinical governance. Scope to improve

A survey of all 47 trusts in the West Midlands found that clinical governance had not been advanced beyond the production of strategies, establishing committees and appointing leads. There is little evidence of the cultural change clinical governance requires. Clinical governance has yet to make a real difference at the clinical workface.     

Clinical governance in action: radiology

Articles and conferences on clinical governance abound, but much of the content is theoretical. This article describes how clinical governance may be introduced in a busy radiology department in a straightforward and practical way, with benefits to both the radiologist and patient.     

Clinical governance: principles into practice

This paper describes the early development of clinical governance in an acute NHS Trust. Three Trust-wide workshops and 17 individual departmental workshops were held between 1998-1999. The discussions in these workshops were used to define the key founding principles of clinical governance and the operational structure. The philosophy behind clinical governance, to improve quality of services, was recognised as being part of mainstream trust business, not an optional add-on. The authors found that teamwork and multidisciplinary collaboration are essential components of future quality improvement. Effective leadership skills need to be supported and developed, with responsibilities shared between a core group within each department rather than one individual. Contributions should be recognised and rewarded. Collaboration with primary care and involvement of patients are prerequisites. Specific objectives should be agreed by each department and used to monitor progress. More effective use of existing resources (staff, time, IT and training) can be made.     

Clinical governance: setting the scene

The concept of clinical governance was first introduced to the NHS in late 1997. Since then, it has become a commonly used term, but there is still a great deal of uncertainty about what it means and how it should be implemented. This paper places clinical governance in the context of previous quality initiatives, and considers the roles of both managers and clinicians.     

Clinical governance for public health professionals

This paper examines the issues specific to clinical governance for public health professionals. It highlights three levels at which public health is capable of promoting clinical governance: within the specialty of public health, across other National Health Service (NHS) organizations and as part of the public health responsibilities of health authorities. Current work is reviewed, and its focus on hospital and community NHS Trusts is noted. Current thinking on the introduction of clinical governance into clinical practice is interpreted to provide a framework for its development in public health professional practice.     

Clinical governance: an educational perspective

Clinical governance is a novel concept with potentially profound implications for the practice of medicine in the next millennium. What the term might mean from the perspective of patients, and doctors in the health service of the future is explored in this article. All this has significant educational implications and these are considered.