Unlike these individual accountability mechanisms, the central goal of clinical governance is to hold professional groups accountable for each other`s performance. One of the goals of clinical governance in primary care is to promote a new sense of collective responsibility for the quality of care provided by all primary care physicians. This article will focus on the collective notion of accountability in clinical governance. In 1997, six principles of clinical governance were outlined to make the NHS modern and reliable: clinical governance can be studied through 7 different pillars, all of which together form the framework. Essentially, a simpler way to look at clinical governance is that it is a quality assurance process aimed at maintaining and improving standards of patient care, with full system accountability to patients. The key to clinical governance is trust; Individuals and teams need to be able to trust the orhanization systems they work with, trusting that other individuals and teams will make their stated contribution to patient care. Clinical governance cannot be successfully implemented without supporting the non-clinical aspects of health care. Health care is complex in nature and depends on good teamwork, effective leadership and sound management. Organizations and individuals are therefore compelled to embrace the concept of clinical governance as a journey in the pursuit of clinical excellence. The great opportunity that clinical governance offers is the ability to change systems to bring together different components and components of the clinical world and management to make things better for patients. These components must be available and accessible throughout the organization. An innovative healthcare organization that involves employees at all levels of the organization and patients/caregivers is an ideal foundation for the implementation of clinical governance.
Maintaining the NHS`s declining accountability to local communities has generally proved difficult.11 Primary care groups and trusts are required to have some secular representation in their main bodies; This is to strengthen their local accountability.12 Some primary care groups and trusts (including the one used as a case study in this article) are also represented by laymen in their clinical governance subgroups. This is not where the most effort is currently being made to establish accountability. Nevertheless, in existing examples of good practice, individual practices have involved their patients in decisions about the services provided13; Primary care groups and trusts need to build on that. The notion of accountability is not new – clinicians have long been accountable to their professional regulatory bodies. However, recent scandals regarding physicians` unsafe practices have undermined confidence in the current peer-led self-regulation system and, in particular, have raised concerns about the limited liability of physicians.1,2 The new requirement for primary care clinicians to be accountable to or trust their colleagues for their practice and gp group. can be seen as one of the many responses to these concerns and is at the heart of the notion of clinical governance. Clinical governance is a framework through which NHS organisations are responsible for continuously improving the quality of their services and maintaining high standards of care by creating an environment in which clinical excellence will thrive (DH 2009) But primary care groups and trusts will not be able to fulfil their obligations under their liability agreements. unless they are able to maintain horizontal accountability between the practices that make up the group or trust.
This should be achieved through a mix of persuasion and peer pressure and, where possible, through financial incentives. Data collected by independent medical associations in New Zealand show that collective responsibility for the quality of care can be successfully promoted with the financial incentive of collective responsibility for a common and limited budget through which savings can be used to improve services.15 These last two groups are not the main concern of clinical governance, because they are mainly motivated by the law of negligence. or the disciplinary powers of the profession concerned are covered. In primary care, the novelty of clinical governance will lie in the development of public participation in quality improvement work (marked as a downward responsibility) and the use of annual accountability agreements between primary care groups and trusts and the local health authority (labeled as an obligation of responsibility on the rise). Comparing these developments with the quality assurance systems of general practice in other European countries, it is striking that in Germany, for example, the focus remains mainly on legal liability to individual patients and professional self-regulation and has not extended to other forms of liability provided for by clinical governance in the United Kingdom.3 Quality is indicated in the At the Heart of the NHS: User experience clearly measures the patient experience, while quality and safety, as well as operational standards and goals, are about both patient safety and the efficiency of care. Each domain is supported by a set of indicators, mainly from existing sources, and a scoring system to determine performance thresholds. In cases where data are not currently available, the Department will continue to work with key stakeholders to develop indicators to assess performance. Organizational performance areas measured under the framework include management and clinical priorities and are approved by clinicians and managers. This article explains how to understand and operationalize the concept of accountability in clinical governance in primary care. It will use the clinical governance work of a London primary care group as a case study to illustrate accountability mechanisms and show how there are different forms of accountability between health professionals and others that relate to different aspects of performance. The document will also take into account obstacles to improving accountability and highlight tensions that may arise.
The introduction of bottom-up primary care accountability to the NHS hierarchy is, to some extent, a new element of accountability introduced with primary care groups and trusts. Until recently, the NHS performance management system focused on hospital and community services rather than primary care.14 An annual accountability agreement must now be reached between each primary care group and its local health authority. The box (above) presents the two clinical governance objectives agreed to by a London primary care group for its 1999-2000 accountability agreement with the Health Authority. Audits are conducted to monitor the quality of clinical care performed. They are measured against established guidelines and any deviations are studied and improved. After some time, audits are repeated to ensure that the measures taken to improve have worked and that organizations are assured of quality. Scally and Donaldson wrote «Clinical governance and the drive for quality improvement in the new NHS in England» in 1998 and addressed a definition of clinical governance: Clinical governance ensures an ongoing effort to improve the standards of health and social organisations. A cycle of control, monitoring and improvement through the 7 pillars ensures a better quality of care for patients.