Rethinking Australia’s approach to clinical governance: what it means for clinicians

As clinicians work harder than ever to deliver the best possible care in hospitals under stress, our ability to provide care is deeply influenced by the organisational systems, processes and culture in which we work. 

For example, decisions made by the board and executive around resourcing, workforce support, use of data and risk management all profoundly affect our daily work at the point of care. 

The Australian Commission on Safety and Quality in Health Care (the Commission) has released new national guidance on clinical governance for public and private acute health services. The model emphasises that boards and executives are accountable for the organisational systems that enable the workforce to provide high-quality care.

Our new National Model for Clinical Governance (national model) signals a strategic shift in how clinical governance is understood, led and embedded in all health services. The aim is to elevate clinical governance to the highest level of organisational leadership and oversight as a way of driving better outcomes in Australian hospitals. 

A new national approach to clinical governance

Clinical governance is the combination of organisational culture, systems and structures that enables everyone in a health service to deliver care that is consistently high quality and improving.

When done well, clinical governance builds trust across a health service and gives the workforce confidence that their organisation values them and backs them to deliver the highest quality of care possible, every day. 

However, National Safety and Quality Health Service (NSQHS) Standards accreditation outcomes data highlight there are ongoing challenges in clinical governance across many health services.

Ineffective clinical governance often features in inquiries into safety and quality failures, and state and territory governments have all called for a unified national approach to clinical governance in Australia.

The national model repositions clinical governance from being an end in itself, to supporting clinicians, managers and the rest of the workforce to deliver high-quality care. It emphasises the importance of effective team functioning as an essential part of a healthy workplace culture, and provides the key principles and role clarity to achieve this.

The national model describes how everybody in a health service is responsible for clinical governance. For example, this means that all doctors have a responsibility to participate in clinical and performance review, and that the meetings and systems they use to review quality — such as morbidity and mortality meetings, and clinical quality registries — are fully incorporated into the organisation’s formal clinical governance system. 

Recognising the need to strengthen clinical governance in public and private hospitals, all Australian health ministers have urged hospitals to implement the national model.

The six foundations of clinical governance in the national model (refer to Box 1) will form the structure of the Clinical Governance Standard in the third edition of the NSQHS Standards, soon to be released for consultation. The updated NSQHS Standards will apply to all hospitals and day procedure services in Australia from 2030.

Box 1: Six foundations of clinical governance

How can effective clinical governance support clinicians?

To inform the development of our new guidance, the Commission conducted in-depth interviews with board chairs, chief executives and health system leaders across Australia.

We found that in high-performing health services, systems and culture are designed to support rather than impede clinicians, with high-quality care the end goal across the entire organisation.

These health services have effective processes for using evidence-informed clinical guidance and standards at the point of care. There are systems for sharing information seamlessly and communicating with patients. 

In high-performing health services:

• clinicians are represented at all levels of governance throughout the organisation;
• there is investment in training clinical leaders in leadership, teamwork and communication skills, and
• clinical quality systems are integrated into organisation-wide clinical governance.

Crucially, in these health services the board and executive engage closely with clinical issues, even if individual board members do not have clinical backgrounds. They use comparative data on clinical performance and take action to manage risk and improve performance. 

How can clinicians support an organisational approach to high-quality care?

Evidence shows that people deliver better care if they are working in an environment in which they feel supported and valued, and in which there is an organisational culture focused on patient care.

The national model recognises the importance of clinical leadership in achieving this culture. Clinicians have dual roles as healthcare professionals and stewards of system improvement, and we would like to see them involved in their organisation’s clinical governance systems at every level.

For example, to support the board and executive to engage with clinical issues, clinicians can think practically about how they can translate complex clinical indicators into meaningful information that management can understand and act on. They can form a conduit between the ward and the board, highlighting issues and suggesting practical solutions for a more effective organisational approach.

Clinical leaders can model good practice in their own teams, including provision of culturally safe and environmentally sustainable care, partnering with patients, and creating a safe workplace environment with effective supervision of junior staff. They can show others how to communicate clearly and respectfully, and how to work truly collaboratively.

To support an organisation that values safety and quality, clinicians can listen closely, respect a diversity of views, and empower others to speak up for safety. They can champion an environment at work where there is accountability without blame, problems are dealt with transparently, and everyone learns from mistakes.

The national model presents an opportunity for the acute health sector to lay the foundations for high-quality and improving care amid evolving challenges such as workforce shortages, growing demand for health care, the need for environmentally sustainable care, changing patterns of disease, and constrained resources.

But it cannot happen without the involvement of clinicians. It has never been more important for us all to get the foundations of good clinical governance right. 

Professor Christine Kilpatrick AO, is Chair of the Australian Commission for Safety and Quality in Health Care, and a neurologist.

Conjoint Professor Anne Duggan is the Commission’s CEO and a gastroenterologist.