Leadership and clinical governance — structured clinical viva

This viva tests whether the candidate can lead after harm with systems thinking, candour, and fair accountability — not slogans or pure blame.^[1][2]

Definitions. State Scally–Donaldson clinical governance. Name Donabedian structure–process–outcome if asked. Separate governance from corporate finance and from medical-board regulation.^[1]

Error model. Person vs system; active failures and latent conditions; Swiss cheese alignment; incident analysis as a window on the system.^[2]

Culture. Falling near-miss reports plus public humiliation = fear culture. Learning cultures need trust and teamwork; Mid Staffordshire-type lessons warn against target/fear displacement of care.^[3][7]

After the depot error. Care for patient; open disclosure (honesty, apology, plan); support second victim; just-culture classification; redesign medication processes; leadership conversation with the consultant about psychological safety.^[3][4][5][6]

Improvement. Audit seclusion; iterative PDSA on medication safety; speak-up mechanisms; consumer involvement; board assurance with owners/dates.^[6]