CLINICAL AUDIT AND GOVERNANCE

Clinical Audit and Governance

Clinical Audit and Governance

Introduction

Clinical governance is a term first used within the National Health Service (NHS)—the United Kingdom's state-funded health system—to describe a process for maintenance, improvement, monitoring, and accountability for clinical standards. The responsibility for clinical governance rests with the chief executive of all NHS bodies. The development of clinical governance is important because it made chief executives responsible and accountable for clinical quality in their organisation alongside business goals and budgetary control. Clinical governance also challenged the “clinical freedom” of doctors (Smagghe, 2005, 17).

Up to its inception, a doctor only needed to justify their actions in terms that would be seen reasonable by a group of peers. The onus has now changed to one where a clinician is expected to deliver best practice, usually as defined in evidence-based guidelines; and persistent deviation from guidelines or being an outlier in audit might be cause for review.

Both evaluation and performance auditing share an interest in establishing their independence and in warranting the credibility of their professional judgments. Furthermore, both practices are broadly concerned with assessing performance. However, some observers have argued that evaluation and performance auditing differ in the ways they conceive of and accomplish that aim. Some of the differences between the two practices include the following: Auditors address normative questions (questions of what is, in light of what should be), and evaluators are more concerned with descriptive and impact questions (Scally, 1998, 61).

Discussion

Clinical auditors work more independently of the auditee than evaluators do with their clients. Auditors are more exclusively focused on management objectives, performance, and controls than are evaluators. Auditors work with techniques for generating evidence and analysing data that make it possible to provide quick feedback to auditees; evaluations often (though not always) have a longer time frame (Kohn, 2000, 74).

Although both auditors and evaluators base their judgments on evidence, not on impressions, and both rely on an extensive kit of tools and techniques for generating evidence, they often make use of those tools in different ways. For example, auditors plan the steps in an audit, but an evaluator is more likely to establish a study design that may well take into account examining related evaluation studies and their results.

Although the implementation of clinical governance is formalised within UK legislation, this conceptual approach is also found internationally. It is similar to the mechanism for quality assurance discussed over two decades ago by the World Health Organisation (WHO).

There is an established clinical governance process in place in Australia, and the Institute for Healthcare Improvement (IHI) in the United Kingdom provides an example of an organisation that promotes a similar agenda for quality improvement. The use of information systems to reduce errors and implement clinical governance has been recognised in France.

Although they did not use the term clinical governance, the importance of best practice protocols and the use of information systems to reduce medical errors and improve patient safety were important components of the Institute of Medicine (IOM) reports ...