The 7 Pillars of Clinical Governance

What is Clinical Governance?

Clinical governance is more and more involved in healthcare. It is something which is commonly asked about in interview scenarios for Dental Core Training and Specialty Training. The most frequently published definition is that from the NHS:

“A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish” (1)

Essentially, a simpler way to consider clinical governance is that it is a quality assurance process to maintain and improve standards of care for patients, with full accountability of the system towards patients. 

The 7 Pillars of Clinical Governance

We can divide clinical governance into 7 main areas. However, the first 4 are the most important to consider when answering interview questions.

1) Clinical Effectiveness and Research

This is ensuring that we use the best available evidence and research to provide the best possible outcomes for patients. We should always work in the best interests of the patient and this aspect ensures we provide the best care. Examples of this include:

• Carrying out evidence-based practice when deciding treatments and decision-making
• Using standards and guidelines to help inform care e.g. FGDP radiograph guidelines, NICE guidelines on wisdom tooth extraction. These are all backed by evidence.
• Conducting new research to inform new guidelines, papers and standards to continually improve care
• Implementation of new standards and guidelines as they are developed (this also links into clinicians requirements to carry out Continuing Professional Development (CPD))

2) Audit

Auditing evaluates existing practice against the gold standard of practice. Through this, we try to identify any shortcomings and develop methods to improve our outcomes. Ultimately, this aims to improve the quality of care we provide. An example of this would be auditing radiographs using the FGDP standards of Grade 1, 2 and 3.

Carrying out an audit involves identifying a particular area of interest/concern; researching a standard to compare it to; collecting the data to compare; analysing the data and identifying shortcomings; implementing methods of change and, finally, re-auditing after a time period to close the loop and assess improvements.

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3) Risk Management

This involves methods to understand, monitor and minimise risks to patients and staff. Additionally, it involves learning from any mistakes/accidents that have happened in the past. By doing so, we can improve the quality of care patients receive. Examples of this include:

• Reporting of incidents/near-misses (e.g. critical incident form) and learning from them. Often these involve implementing change or methods of limitation
• Following protocols e.g. hand washing, IRMER and IRR legislation
• Conducting risk assessments to identify and mitigate risks where possible

4) Education and Training

A dental career is a career of continual learning. In the UK, the GDC requires dental professionals to carry out CPD. For a dentist, this is 100 hours of verifiable CPD over a 5 year period. This ensures that practitioners remain up-to-date with the latest skills, knowledge and research – linking into Clinical Effectiveness and Research. This may involve:

• Work appraisals with colleagues to assess competency and areas of improvement/further training
• Completing further training e.g. certificates, diplomas or degrees
• Attending courses, conferences and lectures to help further knowledge and skills

5) Patient and Public Involvement

Through this, patient involvement in clinical governance is achieved. We are able to assess the quality of services from a patient’s point of view and address any issues. Methods through which this is implemented include:

• Patient feedback questions e.g. Friends and Family questionnaires
• Patient representatives on practice and hospital boards
• Patient Forums to discuss healthcare matters

6) Information and IT

Here we ensure data protection and confidentiality for patients as well as appropriate storage and management of patient data e.g. including use for audits.

7) Staff Management

This ensures correct staff are employed for the correct jobs. Any staffing issues, e.g. performance, are addressed as well as encouraging staff to actively participate in the environment. Additionally, it requires the employer to provide an open attitude with good working conditions and appropriate management of staff members.

Conclusion

Clinical Governance is crucial in improving standards of care that patients receive. Hopefully, this post has covered the basic aspects of clinical governance and why they are important.

(1) G Scally and L J Donaldson ‘Clinical governance and the drive for quality improvement in the new NHS in England’ BMJ (4 July 1998): 61-65