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Clinical governance: making it happen.
  1. Elizabeth J Gaminara
  1. Consultant Haematologist, Hemel Hempstead General Hospital

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    Edited by Myriam Lugon, Jonathan Secker-Walker. (£17.50). London: Royal Society of Medicine Press, 1999. ISBN 1 85315 383 4.

    Busy clinicians, by and large, do not have time even to sample the many courses currently on offer that discuss clinical governance. The subject is one which divides doctors firmly into two groups. The minority believe that clinical governance will prove to be a useful tool for introducing quality improvements into health care, whereas the majority consists of those cynics who believe the topic is another “flavour of the month” which will go away if ignored. A comprehensive and up-to-date book on this rapidly developing subject will be welcome and should go some way towards converting the disbelievers while providing new ideas and inspiration to the converted.

    The authors of Clinical Governance: Making it Happen focus on problems of implementation in secondary care. They acknowledge the fact that there is no right way to do this and describe lessons learnt from personal experience.

    Some of the chapters do not make easy reading, but without exception each contains a useful idea or new perspective and it is likely that there is something of interest for everyone. An excellent second chapter reminds us firmly that everything we do should be assessed from the patients' viewpoint, while the rest of the book concentrates on those positive aspects of clinical governance most likely to bring about change and hence quality improvement. Thankfully, little space is afforded to areas on which the professional bodies are concentrating—namely, monitoring and inspecting poor performers, be they individuals or institutions. The chapter on evidence-based medicine is particularly stimulating. It is approached from the angle of organisation behaviour and examines some of the barriers to implementation of what must be one of the most important tenets of clinical governance. It contains much food for thought in addition to helpful and pragmatic suggestions as to how these barriers can be overcome.

    The description of the emerging legal implications of clinical governance should allay any doubts that it is here to stay while the tantalising potential described in the chapter on information and data quality should stimulate even the most cynical critic. The book ends with a valuable guide to sources. A problem apparent in several chapters is that of terminology, particularly when referring to the plethora of committees and posts which have sprung up. This is not the fault of the authors, rather is inherent in the subject matter and it is clearly going to be important to identify these new groupings by the roles they fulfil rather than the names attached to them.

    There are many useful and positive messages in this book, but neither the difficulties involved nor the time required for implementation of clinical governance are underestimated. If we are serious about improving quality in health care, then the way forward is becoming clearer.