Topics related to clinical governance feature in all ST interviews & consultant interviews.
On this page we explain what clinical governance is about and how you can discuss it knowledgeably at an interview.
The most widely used definition of clinical governance is as follows:
"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."
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
Although you should of course familiarise yourself with this definition, there is no need to memorise it. Under pressure, most candidates remember the beginning and the end, and mess us the middle part. Even if you remembered it perfectly, you would only demonstrate that you have a good memory and not that you understand the concept.
Instead, you should derive you own practical and down-to-earth definition.
Anything which avoids the word “flourish” and can be delivered in your own natural words will do, provided it addresses the concepts of quality and accountability. Here are a few examples:
Clinical Governance is a quality assurance process designed to ensure that standards of care are maintained and improved and that the NHS is accountable to the public.
Clinical Governance is an umbrella term which encompasses a range of activities in which clinicians should become involved in order to maintain and improve the quality of the care they provide to patients and to ensure full accountability of the system to patients.
Traditionally, clinical governance has been described using 7 key pillars. Although it has been refined over the past few years, this approach remains the easiest to remember and to describe at a trainee interview level. It is also the approach that your interviewers are most likely to expect from you since this is what they would have learnt too. The 7 pillars are as follows:
Clinical Effectiveness & Research
Clinical effectiveness means ensuring that everything you do is designed to provide the best outcomes for patients i.e. that you do "the right thing to the right person at the right time in the right place”.
In practice, it means:
The aim of the audit process is to ensure that clinical practice is continuously monitored and that deficiencies in relation to set standards of care are remedied.
Risk Management involves having robust systems in place to understand, monitor and minimise the risks to patients and staff and to learn from mistakes. When things go wrong in the delivery of care, doctors and other clinical staff should feel safe admitting it and be able to learn and share what they have learnt.
Education and Training
This entails providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date. Professional development needs to continue through lifelong learning.
In practice, for doctors, this involves:
Patient and Public Involvement (PPI)
PPI is about ensuring that the services provided suit patients, that patient and public feedback is used to improve services into day-to-day practice to ensure an increased level of quality and suitability, and that patients and the public are involved in the development of services and the monitoring of treatment outcomes.
This is being implemented through a number of initiatives and organisations, including:
Using Information & IT
This aspect of clinical governance is about ensuring that:
Staffing & Staff Management
This relates to need for
From the above explanations, you may have noted that some of the pillars are more directly related to the day to day responsibilities of a junior doctor:
Whenever you discuss Clinical Governance in an answer, you may prefer to discuss these in more depth and simply mention the other three. You can remember these 4 key pillars with the mnemonics CARE
Other (less useful) mnemonics
If you are the type of person who likes to remember information through the use of mnemonics, here are a couple which will enable you to remember the all the components of clinical governance (though not necessarily in the most useful order):
eCommerce by Xanthos
My Account | Basket | About Us | Contact Us | FAQ | Blog | Terms | Privacy | Sitemap