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Advancing Clinical Governance.
  1. Rory Shaw
  1. Medical Director & Professor of Respiratory Medicine, Hammersmith Hospitals NHS Trust, Hammersmith Hospital, London W12 0HS UK

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    Myriam Lugon, Jonathan Secker-Walker, Editors. (Pp 215; £18.50). London: Royal Society of Medicine, 2000. ISBN 1 85315 471 7.

    The contents of this book update and extend the material covered in the authors' previous and very successful book “Clinical Governance—Making it Happen”. The current book provides a very good review of many of the issues in the area of clinical governance and associated recent Government initiatives. The editors and most of the contributors have a healthy realism and touch on many of the contradictions inherent in trying to modernise and assure quality of all aspects of the NHS, while meeting patient expectation and budgetary constraints.

    For those setting up clinical governance arrangements or wishing to check their arrangements against a standard model, chapter 3 on “Organisation and clinical governance” will provide a very useful resource. This chapter contains a clear blueprint for a workable set of arrangements and includes a number of charts and templates for quality reporting documents. This very practical chapter follows a review of the more difficult area of the role of the patient in clinical governance, in which numerous ways of introducing a broad range of different categories of patients and those outside the healthcare professions into the clinical governance process are discussed. It will be interesting, with time, to see how these different models will work in actual practice.

    This contrast between didactic factual chapters and aspirational reviews are a feature of many other parts of the book. There is a very clear and accurate account of the role of the National Institute for Clinical Excellence by its Chief Executive, Andrew Dhillon, and a chapter giving a brief review of the NHS complaints procedure. Some co-authors are clearly more evangelical than others. The chapter on “Nursing and midwifery contribution to clinical governance” was very positive. The review of the controls assurance process was similarly upbeat, very theoretical, and clearly not written by anyone who has had to go through this very complex and detailed bureaucratic process. An interesting way to write about clinical governance is to use case studies. This was exhibited in the chapter by Jenny Simpson, the Chief Executive of the British Association of Medical Managers, in her excellent review of the role of the Medical Director.

    My favourite lines in the book come from the chapter on the “Myth of accurate clinical information”: “Usually, there is a failure to understand how difficult it is to collect the even relatively simple data contained in the standard minimum data sets accurately.” The section on “Clinical governance in primary care trusts” attempts to provide some useful guidance on an area very much in its infancy. This section contains the very wise words: “... none of the clinical governance work can proceed without proper resources, protected time and adequate infrastructure”.

    My experience of clinical governance is that, if clinicians have data on the clinical quality of their work, they will change behaviour to improve their results. The challenge is to find ways of obtaining and sharing accurate data in a cost effective and non-threatening way.

    This book offers a useful guide to many of the dimensions of clinical governance. There are a wealth of references in many of the chapters and a useful resource section at the end. Notable omissions were a section on the Commission for Health Improvement and, in particular, the criteria the Commission will use to evaluate healthcare organisations. The appendix could have provided a guide to the useful Government documentation and guidance available on the world wide web. I hope these will be added in future editions.