O&G · Professional practice — clinical governance, quality and patient safety
Clinical governance
Also known as Clinical governance · Quality and safety · Patient safety · Risk management · Clinical audit · Open disclosure · Root cause analysis · Morbidity and mortality
Exam-exhaustive FRANZCOG fellowship reference on clinical governance — Scally and Donaldson's definition, the four pillars (clinical effectiveness, risk management, patient experience, staff and education), Donabedian's structure–process–outcome triad, Reason's Swiss cheese and the system approach, incident reporting and classification, root cause analysis (London Protocol), the clinical audit cycle, open disclosure, the mortality and morbidity meeting, the second victim, and the ACSQHC framework. RANZCOG-primary, globally tagged to MRCOG and ABOG.
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Red flags
- A serious adverse event followed by silence, delay, or scapegoating of the junior — the surest sign of a weak governance culture
- Root cause analysis that stops at 'human error' and never reaches the system — the commonest RCA failure
- Incident reports filed by the same handful of nurses while doctors never report — reporting is the pulse, and a flat line is alarming
- Open disclosure postponed until the facts are perfect — patients want honesty early, not a polished statement later
- Action plans from M&M that sit in a drawer and are never re-audited — governance without the re-audit loop is theatre
- A second-victim clinician left unsupported after a harmful error — blame culture suppresses reporting and breeds the next event
It is 06:00 and the night registrar is crying in the tea room. A baby was born in poor condition overnight after a missed CTG concern, and the family is in shock. Your job as the consultant is not to find the person to blame — it is to hold the system to the light, support everyone harmed (and that includes the registrar), and make sure the same hole in the cheese never lines up again. Clinical governance is the machinery that lets you do that deliberately rather than by accident.[1][6]
Definition and the pillars
Clinical governance was coined by Scally and Donaldson in 1998 as the system through which the new NHS would be accountable for continuously improving the quality of services and safeguarding high standards of care. The definition is the exam answer, word for word: a framework through which organisations are accountable for continually improving quality and maintaining standards.[1]
The model taught and examined rests on four pillars, with the supporting architecture running underneath them: [9]
- Clinical effectiveness — care that works, delivered to standard evidence supports: evidence-based practice, guidelines, and the audit cycle that tests reality against the standard.[9]
- Risk management — identifying, assessing and mitigating clinical risk: incident reporting, the risk register, root cause analysis, and the controls layered across the system.[9]
- Patient experience — partnership with patients and families: communication, consent, complaints as data, and open disclosure when things go wrong.[10]
- Staff and education — the trained, supported, supervised workforce that delivers the care: credentialing, continuing professional development, and a culture that is safe to speak up in.[9]
References12ShowHide
- [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.PMID 9651278
- [2]Donabedian A Evaluating the quality of medical care Milbank Mem Fund Q, 1966.PMID 5338568
- [3]Reason J Human error: models and management BMJ, 2000.PMID 10720363
- [4]Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population N Engl J Med, 2009.PMID 19144931
- [5]Taylor MJ, McNicholas C, Nicolay C, et al. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare BMJ Qual Saf, 2014.PMID 24025320
- [6]Coughlan B, Powell D, Higgins MF The Second Victim: a Review Eur J Obstet Gynecol Reprod Biol, 2017.PMID 28526169
- [7]Wu AW, Shapiro J, Harrison R, et al. The Impact of Adverse Events on Clinicians: What's in a Name? J Patient Saf, 2020.PMID 29112025
- [8]Mira JJ, Lorenzo S, Carrillo I, et al. Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations Int J Qual Health Care, 2017.PMID 28934401
- [9]Australian Commission on Safety and Quality in Health Care National Model Clinical Governance Framework ACSQHC, 2017.Source
- [10]Australian Commission on Safety and Quality in Health Care Australian Open Disclosure Framework ACSQHC, 2013.Source
- [11]Braithwaite J, Travaglia JF An overview of clinical governance policies, practices and initiatives Aust Health Rev, 2008.PMID 18241145
- [12]Australian Commission on Safety and Quality in Health Care National Safety and Quality Health Service (NSQHS) Standards ACSQHC, 2021.Source