I mean, this clinical governance stuff has nothing to do with me – I’m just a staff nurse; I show up, I do as I am told and I go home. Governance is something for the people in suits who tell people like me what to do … (band 5 staff nurse)
In this chapter, we will look at clinical governance, its impact on the care nurses like you (and the nurse above) give every day and the organisations that can give you information about clinical governance and the issues it raises.
Although the principles of clinical governance apply across the world, the different countries of the UK have different specific bodies and policies involved in clinical governance. However, the basic information is applicable no matter where you live.
Just to make sure you understand the importance of clinical governance, I am going to try to put this to you in a different way:
Imagine that you have just bought a new car. You get home and the key will not come out of the ignition. You ring the dealership and speak to a secretary but she won’t help you because she doesn’t sell cars herself. She puts you through to the person who sold you the car but he says it’s not his problem because he is not a mechanic. You write to the people who made the car and they say it’s not their problem because they didn’t put the key in the ignition, you did. Everywhere you turn someone says it’s somebody else’s problem: but all you want is a car that works, that’s what you paid for and that’s what you need.
How is it different from the care you give as a nurse under the NHS? You might not be the person who made the problem or who can fix the problem, in fact you might not know anything about the problem at all, but none of those things change the fact that the patient needs help and to the patient you are at the NHS.
Your nursing profession is like a treasure: it’s a piece of property, it is something very valuable, and it’s something you could potentially lose if you don’t take care of it. Whenever you go to work you should be thinking about how well you are taking care of this treasure. Even if you don’t care about your patients, even if you don’t care about the hospital or organisation you work for, you must at least care about yourself: you need to prove you have maintained the skill and knowledge to work as a nurse, and then to use that skill and knowledge appropriately on every shift you work. If you fail to do these things, then get used to asking ‘do you want fries with that?’ because you are going to be serving burgers instead of doing medication rounds. Is that what you want?
You have to tell someone if you are not maintaining that standard so that they can help you, because if you don’t, and something bad happens, you could wind up not only losing your profession but going to jail as well. If a patient is seriously injured or dies because you didn’t keep up to date, then you are to blame.
You also have to tell someone if the organisation you work for is not doing things the way it should, because if you know but don’t say anything, you are just as guilty as the rest of the organisation.
Clinical governance is making sure that the right people do the right things in the right way, every time.
WHERE DOES CLINICAL GOVERNANCE COME FROM?
Shortly after the general election in 1997, the Department of Health published The new NHS, modern and dependable, which promised that the NHS was to be reborn as an organisation with quality, professionalism and high standards at its core. Partly, this was in response to a number of stories in the media that exposed serious problems within the NHS, partly because – in the years leading up to the election – the NHS as an organisation hadn’t seemed very trustworthy. Mistakes were made but instead of facing them openly, they were hidden and people suffered. Poorly performing professionals were shuffled around, and their lack of skills and their competence were never addressed. Leadership wasn’t by clinicians but by business-people, who were more concerned about money than care, which meant that care often suffered.
In The new NHS, modern and dependable, the incoming government recognised that people wanted the highest level of care to be available where they lived, and began the discussion about how the NHS could be made to focus on patients and on patient care: clinical governance was chosen as the way forward. People wanted clinicians – not business-people – to make decisions about the best equipment, the best types of care and the right kinds of medication. The concept of clinical governance was new and fresh. It didn’t involve blaming anyone but instead examined existing problems to see how things could be made better for patients, how care could be improved and how the number of people being cared for by the NHS could be increased.
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