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Global Policy Institute

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Publication details

Degeling, P.J., Maxwell, S., Iedema, R. & Hunter, D.J. (2004). Making clinical governance work. British Medical Journal 329(7467): 679-681.

Author(s) from Durham


Clinical governance has been described as "by far the most high-profile vehicle for securing culture change in the new NHS."1 However, the government's past preoccupation with delivery and top down performance management has undermined its developmental potential.2 To be effective, clinical governance should reach every level of a healthcare organisation. It requires structures and processes that integrate financial control, service performance, and clinical quality in ways that will engage clinicians and generate service improvements.3 We strongly endorse this view. Because clinicians are at the core of clinical work, they must be at the heart of clinical governance. Recognition of this fact by clinicians, managers, and policy makers is central to re-establishing "responsible autonomy" as a foundation principle in the performance and organisation of clinical work. We look at problems with the prevailing model of clinical governance and describe an alternative approach.