Organisational change through clinical governance: the West Midlands three years on

Clinical governance is an organisational approach to improving the quality of clinical services. A survey was conducted of 33/40 NHS trusts 2.5 to three years after a baseline survey of the 46 trusts was conducted in the West Midlands region. Reported outcomes were achieved more often than expected at baseline. Patient outcomes and documented changes in clinical behaviour were both expected and reported in over three quarters at both periods. A more open culture was expected in 65 per cent at baseline and achieved in 84 per cent at time 2. Strategies for change continued to rely on both periods in optional, educative, audit and protocol procedures. The new approaches of critical incident review and consultant appraisal were welcomed. External review and league tables had adverse impacts where results were poor, but minimal impact if results were positive. Conclusions are drawn about more effective means of catalysing change.