Governance, leadership and culture

Clinical governance is fundamental to ensuring your healthcare service delivers safe, high-quality health care to patients. It involves your healthcare service establishing, using and continuously improving the quality of their services and minimising risks to patient safety.^[i]

Clinical governance is the set of relationships and responsibilities established by a healthcare service between regulators and funders, owners and managers, healthcare providers, patients, consumers and other stakeholders to ensure good clinical outcomes. It ensures:

• The community can be confident systems are in place to deliver safe and high-quality health care
• There is a commitment to continuously improve services 
• The healthcare service and its workforce are accountable to patients and the community for ensuring the delivery of safe, effective and high-quality health care.

Clinical governance framework 

Your healthcare service’s clinical governance framework describes the safety and quality systems and processes, which, when they are in place, ensure the delivery of safe, high-quality health care. 

By implementing the actions in the Clinical Governance Standard and the Partnering with Consumers Standard, your healthcare service will develop its own clinical governance framework. Clinical governance consists of five key components:

• A culture of safety and quality 
• Safety and quality improvement systems 
• Clinical performance and effectiveness; from a workforce with the right skills and qualifications to deliver high-quality patient care 
• Safe environment for the delivery of health care
• Partnering with patients and consumers.

A ‘system’ is a way of describing all the components that together make up an approach to managing an issue. A system includes resources, policies, processes and procedures that are organised, integrated, regulated and administered to achieve an outcome.

Governance, leadership and culture 

Governance, leadership and culture form a central driver of clinical governance. Healthcare services that demonstrate a culture of safety and quality improvement have strong leadership that prioritises safety and quality. Commitment from leaders is key; their actions and attitudes influence the perceptions, attitudes and behaviours of everyone in the healthcare service. Other important aspects include:

• Shared perceptions of the importance of safety
• Accountability 
• Constructive communication
• Mutual trust
• A workforce that is engaged and always aware that things can go wrong
• Acknowledgement at all levels that mistakes can occur
• Ability to recognise, respond to, give feedback about and learn from adverse events, compliments, complaints, data and new models of care.^[i]

• How are continuous improvement opportunities identified, prioritised, reported and actioned? 
• How do you involve the workforce in your healthcare service’s safety and quality improvement processes?

• By understanding the safety and quality risks and performance of your healthcare service, identify the priority areas for safety and quality and the time required for the change to occur. Communicate these priorities to others in your healthcare service. 
• Establish mechanisms for incorporating safety and quality of health care into the healthcare service’s business decision-making.
• For the people in your healthcare service, describe their safety and quality roles and responsibilities. 

Note: the way responsibilities are assigned depends on the size of your healthcare service, whether your healthcare service is in a rural or remote area and the safety and quality risks involved. 

The type and comprehensiveness of evidence used is dependent on each healthcare service context. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Description of safety and quality roles and responsibilities of members of the workforce in your healthcare service 
• Summary of safety and quality improvement priorities 
• Communications with your workforce about safety and quality priorities, such as emails, entries in a staff communications book, pin-board notice
• Position descriptions describing the safety and quality roles and responsibilities for each member of the workforce
• Policies, protocols or documented process that detail how healthcare providers work together in a patient’s care, within or between another service
• Minutes of meetings, notes on business decisions that consider where patient safety and quality can be improved
• Documented clinical governance framework
• Demonstration of shared leadership and collaborative teamwork in multidisciplinary healthcare teams in rural and remote settings
• Annual declaration confirming compliance to the Primary and Community Healthcare Standards. 

Commission resource

• National Model Clinical Governance Framework provides guidance on roles and responsibilities, based on the NSQHS Standards. The principles and strategies outlined are broadly applicable. 

Other resource

• BMC Primary care: Patient safety and safety culture in primary health care: a systematic review – a study reviewing the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care.