Clinical governance as a restructuring of quality assurance processes: shifting the focus from corporate to clinical action

Presents a model for clinical governance developed from the work of Sutherland, Dawson and Mintzberg. The model relates existing quality assurance processes to three key components of quality maintenance, namely skills, outcomes and processes. Argues that from such a model the relevant actions for clinicians are easier to identify and the respective needs for corporate and clinical service level actions become easier to understand. In addition four generic questions are presented which allow detailed examination of a clinical service while addressing broad principles of clinician behaviour, continuous improvement of services, patient expectations and appropriateness of interventions. This approach of using simple generic models which can be easily adapted to a specific setting provides usable tools for understanding, enquiry and change, and encourages the continuing appropriate exercise of well‐maintained skills.