Clinical Governance

Clinical governance is a system that helps healthcare organisations make sure the care they provide is safe, consistent, and continually improving. It sets out how staff should check the quality of their work, learn from mistakes, and use evidence to guide decisions. Most importantly, it creates a culture where everyone — from frontline clinicians to senior leaders — is responsible for maintaining high standards and improving patient outcomes.

Definition

"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."

Scally G, Donaldson LJ. BMJ. 1998

Clinical governance is often described as having seven pillars, which break down the key concepts that underpin the overall approach to delivering safe, effective, and accountable healthcare. These pillars provide a clear structure that helps organisations understand what good quality care involves and how it should be maintained. Together, they form the foundation for a system that supports continuous improvement and ensures patients consistently receive a high‑standard of care.

Pillar 1 : Clinical Effectiveness

Clinical effectiveness means doing the right thing, for the right patient, at the right time, using the best available evidence to achieve optimal outcomes. This involves delivering evidence-based care, implementing national guidance, conducting research, and continually evaluating clinical practice to improve patient outcomes.

Clinical effectiveness is achieved by

NICE guidance – implementing national evidence-based recommendations.
Evidence-based medicine – combining research evidence, clinical expertise, and patient preferences.
Research and innovation – adopting new evidence to improve patient care.
Clinical pathways and protocols – standardising care to reduce unwarranted variation.
Monitoring key performance indicators (KPIs) – tracking measures such as mortality rates, readmission rates, infection rates, surgical error rates, bed occupancy, A&E waiting times, time to treatment and staff-to-patient ratios

Pillar 1

Pillar 2

Pillar 2 : Risk Management

Patient Safety & Risk Management focuses on creating a culture that prioritises patient safety by proactively identifying and managing risks, learning from incidents and near misses, and implementing systems to reduce the likelihood of harm. It promotes openness, continuous learning, and a just culture, ensuring that patient safety incidents are investigated, lessons are shared, and improvements are embedded into everyday clinical practice to deliver safer, higher-quality care.

This is achieved through embedding practices listed below within the clinical setting

Incident reporting (Datix/LFPSE) – reporting safety incidents and near misses to facilitate learning.
Root Cause Analysis (RCA) – identifying underlying system factors that contributed to an incident.
Risk assessments – proactively identifying and mitigating potential patient safety risks.
Human factors – recognising how teamwork, communication, environment, and systems influence safety
Duty of Candour – being open and transparent with patients following safety incidents.

Pillar 3 : Patient and Public Involvement

Healthcare should be centred around patients by involving them in decisions about their own care and in the design and development of healthcare services. Engaging patients from the outset helps ensure that services are built around the needs of the people who use them, rather than relying on feedback after changes have already been made. This leads to better patient experiences, more effective services, and greater accountability within healthcare organisations.

Patient and public involvement can be achieved through:

Shared decision-making – involving patients in choosing investigations and treatment options.
Patient feedback surveys – using patient experience to identify areas for improvement.
Complaints and compliments – learning from patient feedback to improve services.
Patient participation groups – involving patients in service development and quality improvement.
Engaging patients at the inception of projects – ensuring patient perspectives help shape new pathways and service redesign from the outset.

Pillar 3

Pillar 4 : Clinical Audit

Clinical audit and quality improvement are key components of clinical governance that ensure healthcare services continually improve. Clinical audit measures current practice against agreed standards to identify areas where care can be improved, while quality improvement focuses on implementing and evaluating changes to enhance patient outcomes, safety, and efficiency. Re-auditing then confirms whether these improvements have been successfully embedded into routine practice.

This is achieved through:

Clinical audit – comparing current practice against national or local standards to identify areas for improvement.
Quality Improvement (QI) – using structured improvement methods, such as Plan–Do–Study–Act (PDSA) cycles, to test and implement changes.
Benchmarking – comparing departmental or organisational performance with regional or national data to identify unwarranted variation and share best practice.
Re-audit – repeating the audit after changes have been introduced to ensure improvements are sustained and standards continue to be met.
Re-audit – assessing whether implemented changes have resulted in sustained improvement.

Pillar 4

Pillar 5 : Education and Training

Education and training ensure that healthcare professionals remain competent, up to date, and equipped to deliver safe, high-quality care. This involves providing education programmes within the organisation, supporting continuous professional development, and enabling staff to access courses, conferences, simulation training, and other learning opportunities throughout their careers.

Education and training opportunities can be facilitated through -

Continuous Professional Development (CPD) – maintaining and updating professional knowledge and skills.
Appraisal and revalidation – demonstrating ongoing competence and reflective practice.
Teaching and simulation – developing individual and team performance in a safe learning environment.
Courses and conferences – keeping up to date with advances in clinical practice.
Workplace-based assessments – providing structured feedback to support learning and progression.

Pillar 5

Pillar 6 : Information Governance

Information management ensures that patient information is accurate, secure and confidential in accordance with GDPR information governance, and used appropriately to support safe, effective healthcare. It also involves collecting, analysing, and applying clinical data to monitor outcomes, support quality improvement, and inform evidence-based decision-making, ultimately improving patient care and service delivery.

Information management in practice includes:

Electronic patient records – maintaining accurate, accessible clinical documentation.
Clinical coding – ensuring diagnoses and procedures are recorded accurately for audit, benchmarking, and funding.
Patient safety data – analysing incident reports and clinical outcomes to identify risks and improve safety.
Audit and outcome data – using routinely collected data to evaluate performance and drive quality improvement.
Patient feedback – using surveys and complaints to inform service redesign and improve patient experience.
Performance monitoring – using data to monitor service performance, support staff development, and share best practice.
Data security – protecting confidential information and ensuring secure access to patient records.

Pillar 6

Effective leadership and workforce management ensure that organisations have the right people, with the right skills, working in an environment that promotes safe, high-quality care. This includes recruiting and retaining staff, supporting professional development, identifying and addressing underperformance, and fostering a culture of openness, wellbeing, and continuous improvement.

Clinical leadership – leading teams to deliver safe, high-quality patient care.
Workforce planning – ensuring appropriate staffing levels and skill mix.
Recruitment and retention – attracting, developing, and retaining a skilled workforce.
Managing performance – identifying underperformance early and providing appropriate support and remediation.
Staff wellbeing – promoting a supportive working environment that encourages staff retention and professional development.
Freedom to Speak Up culture – encouraging staff to raise concerns safely without fear of reprisal.

Pillar 7 : Leadership and Workforce

Pillar 7

Associated
Sample
Questions

What is Clinical Governance and what is its role?
As a clinician how do you contribute to Clinical Governance?
Tell us about a Quality Improvement project you’ve done that you found challenging – how did you overcome these challenges?
How do you keep up to date?
Tell us about a recent literature paper that has changed your clinic practice?
How do you measure quality of care in your specialty?
How do you assess the quality of your practice?
How do you keep your skills up to date?
What do you understand about appraisal?
Describe a situation where you have involved service users/ Stakeholders? What did you learn from this?