Clinical governance lies at the heart of our health service.  Each NHSScotland board uses clinical governance to drive:

• quality assurance
• quality improvement
• patient safety.

Within your healthcare team, clinical governance will ensure everyday routines and practices are providing patients with care that is:

• safe
• effective
• focused on their needs.

Clinical governance is a statutory requirement of NHS Boards; it’s how health services are held accountable for the safety, quality and effectiveness of clinical care delivered to patients.  It is achieved by co-ordinating three interlinking strands of work:

• Robust national and local systems and structures that help identify, implement and report on quality improvement
• Quality improvement work involving health care staff, patients and the public
• Establishing a supportive, inclusive learning culture for improvement

Clinical governance is a concept developed as a quality improvement system to enable accountability for the quality of clinical care.

Clinical governance brings together NHS staff with the systems and structures that account for and report on clinical quality. It involves everyone who works for, and with, the health service, from non-executive directors to GP practice staff and hospital porters.

Clinical governance supports effective clinical practice and minimises risks to patients. It is:

• Thinking critically about what you do in your job
• Using the evidence to improve what you do
• Involving patients in decisions about their care
• Developing your skills
• Working as a team to make improvements
• Preventing that error from happening again
• Learning lessons from experience and good practice elsewhere and not reinventing the wheel
• Knowing how to use quality improvement processes and structures to achieve results
• Involving patients and carers in improving services
• Taking an active part in improving the health service for patients

Clinical governance has been interpreted and implemented in different ways throughout the UK via a wide range of systems, structures, components and strands. This has resulted in exciting and innovative work such as service redesign and patient safety initiatives.

All NHS Boards provide clinical governance assistance to staff.  It may be a team or network of staff based in a hospital or community setting who have a responsibility to promote and assist the implementation of quality improvement.  They can include:

• Clinical governance manager/support staff
• Risk manager/support
• Clinical effectiveness manager and/or support officers
• Clinical audit managers and/ clinical audit officers
• Public partnership, patient involvement officers
• Improvement/redesign specialists
• Managed clinical network support staff

As well as these specific roles, clinical and professional staff may have time allocated to take forward clinical governance or clinical effectiveness work in a hospital or community setting.  This work may involve supporting others as part of a team to work on or take forward an improvement idea.  These staff will usually link with a local or national initiative involving a team including:

• Clinical effectiveness projects leads
• Specialist clinical audit
• Service redesign/patient safety initiatives

Teams, departments and directorates have (or should be supported to have) a quality improvement programme that links the local priorities with the wider divisional and NHS Board priorities and programme.  
It is important that national priorities are clearly linked to improving the quality of care in your team. Local priorities also need to be communicated through the NHS organisation particularly when they raise issues relevant to national priorities.