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The relationship between external and local governance systems: the case of Health Care Associated Infections and medication errors in one NHS trust
  1. Angus Ramsay,
  2. Carin Magnusson,
  3. Naomi Fulop
  1. NIHR King's Patient Safety and Service Quality Research Centre, King's College London, London, UK
  1. Correspondence to Professor Naomi Fulop, Department of Management, School of Social Science and Public Policy, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK; naomi.fulop{at}


Background ‘Organisational governance’—the systems, processes, behaviours and cultures by which an organisation leads and controls its functions to achieve its objectives—is seen as an important influence on patient safety. The features of ‘good’ governance remain to be established, partly because the relationship between governance and safety requires more investigation.

Aims To describe external governance systems—for example, national targets and regulatory bodies—and an NHS Trust's formal governance systems for Health Care Associated Infections (HCAIs) and medication errors; to consider the relationships between these systems.

Methods External governance systems and formal internal governance systems for both medication errors and HCAIs were analysed based on documentary analysis and interviews with relevant hospital staff.

Results Nationally, HCAIs appeared to be a higher priority than medication errors, reflected in national targets and the focus of regulatory bodies. Locally, HCAIs were found to be the focus of committees at all levels of the organisation and, unlike medication errors, a central component of the Trust's performance management system; medication errors were discussed in appropriate governance committees, but most governance of medication errors took place at divisional or ward level.

Discussion The data suggest a relationship between national and local prioritisation of the safety issues examined: national targets on HCAIs influence the behaviour of regulators and professional organisations; and these, in turn, have a significant impact on Trust activity. A contributory factor might be that HCAIs are more amenable to measurement than medication errors, meaning HCAIs lend themselves better to target-setting.

  • Organisational governance
  • governance
  • patient safety
  • healthcare associated infections
  • medication errors
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  • Funding National Institute for Health Research (

  • Competing interests None.

  • Ethics approval Ethics approval was provided by King's College London Education and Management Research Ethics Panel (Health Care Associated Infections—ref REM(EM)0708-84; medication errors—ref REPSSPP(W)-0708-207, June 2008).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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