Psych · Professional — leadership and clinical governance
Leadership and clinical governance
Also known as Clinical governance · Patient safety culture · Quality improvement psychiatry · Just culture · Open disclosure · Clinical audit · Transformational leadership healthcare · High reliability organisation · Systems approach to error · Psychological safety teams
Exam-exhaustive fellowship reference on clinical governance (Scally–Donaldson), Donabedian quality, systems vs person approaches to error, just culture, leadership behaviours, clinical audit and PDSA, serious incident response, open disclosure, second victim support, high-reliability concepts, and regional governance frames for psychiatry. FRANZCP-primary, globally tagged.
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Red flags
- Punitive blame culture suppressing incident reporting and speaking up
- Serious harm followed by cover-up, delayed open disclosure, or scapegoating of juniors
- KPI theatre and target-gaming that displace clinical safety (Mid Staffordshire-type lessons)
- Root-cause analysis that ends at 'human error' with no system redesign
- Leadership that ignores psychological safety, second-victim harm, or consumer voice
- Inventing universal statute section numbers for duty of candour or mandatory notification
Meet the patient
A 19-year-old with first-episode psychosis is discharged on a Friday after a brief admission. Three days later he is dead. The review finds: a risk form signed at admission and never updated after a missed depot; the night-shift nurse who noticed rising agitation did not feel able to wake the consultant; the family received a brief phone call, no meeting, no apology.[4][17]
On Tuesday morning the consultant asks you: where did the system fail, and what do we do today? That question — not the recitation of committee names — is the fellowship exam in clinical governance.[3][12]
References20ShowHide
- [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 The quality of care. How can it be assessed? JAMA, 1988.PMID 3045356
- [3]Reason J Human error: models and management BMJ, 2000.PMID 10720363
- [4]Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW The "To Err is Human" report and the patient safety literature Qual Saf Health Care, 2006.PMID 16751466
- [5]Leape LL Error in medicine JAMA, 1994.PMID 7503827
- [6]Berwick DM Continuous improvement as an ideal in health care N Engl J Med, 1989.PMID 2909878
- [7]Vincent C, Taylor-Adams S, Stanhope N Framework for analysing risk and safety in clinical medicine BMJ, 1998.PMID 9552960
- [8]Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU N Engl J Med, 2006.PMID 17192537
- [9]Chassin MR, Loeb JM High-reliability health care: getting there from here Milbank Q, 2013.PMID 24028696
- [10]Firth-Cozens J, Mowbray D Leadership and the quality of care Qual Health Care, 2001.PMID 11700372
- [11]Firth-Cozens J Cultures for improving patient safety through learning: the role of teamwork Qual Health Care, 2001.PMID 11700376
- [12]Vincent CA Analysis of clinical incidents: a window on the system not a search for root causes Qual Saf Health Care, 2004.PMID 15289620
- [13]West THR, Daher P, Dawson JF, et al. The relationship between leader support, staff influence over decision making, work pressure and patient satisfaction: a cross-sectional analysis of NHS datasets in England BMJ Open, 2022.PMID 35105577
- [14]Ree E, Wiig S Linking transformational leadership, patient safety culture and work engagement in home care services Nurs Open, 2020.PMID 31871709
- [15]Tawfik DS, Profit J, Morgenthaler TI, et al. Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors Mayo Clin Proc, 2018.PMID 30001832
- [16]Dekker SW, Hugh TB A just culture after Mid Staffordshire BMJ Qual Saf, 2014.PMID 24505113
- [17]Wu AW Medical error: the second victim. The doctor who makes the mistake needs help too BMJ, 2000.PMID 10720336
- [18]Iedema R, Allen S, Britton K, et al. Patients' and family members' views on how clinicians enact and how they should enact incident disclosure: the IIPDS study BMJ Qual Saf, 2011.PMID 21788260
- [19]Dixon-Woods M, Baker R, Charles K, et al. Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study BMJ Qual Saf, 2014.PMID 24019507
- [20]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