Clinical governance: a key, but under-researched, health system foundation

This special issue of the JHOM covers a topic of increasing and critical importance to health systems. It has now been some years since the introduction of the concept of clinical governance (CG) in the UK NHS, as described by Scally and Donaldson (1998), and many countries and health systems have since had CG firmly on the policy agenda (Gauld, 2014; Halligan and Donaldson, 2001; Nicholls et al., 2000; Shiwani, 2006). This is for several reasons. First, are concerns about health care quality improvement and patient safety, driven by various lapses in professional standards and the monitoring and promotion of these. These concerns have also been propelled by obvious gaps in the systems of care – gaps in the way in which professionals work together, and between the different professionals involved in patient care (Scally and Donaldson, 1998). Second, because of the so-called “management-clinician divide” which exists in many health systems and hospitals, especially in countries such as the UK and New Zealand where there has been a strong influence of “managerialism” in recent years (Gauld, 2000; Klein, 1995). A third reason relates to the obvious knowledge of front-line service delivery that health professionals can bring to the decision-making arena. This means decisions in a CG environment are derived from a knowledge base that encompasses more than just strategic and financial considerations.