Clinical governance: the ethical dimension

The main thrust of the Government's White Paper 'A First Class Service: Quality in the new NHS' (DOH, 1998) was to tackle the issues of quality and modernization in health services. While in part, clinical governance was aligned with positive, developmental and collaborative approaches to quality improvement, it was also designed to protect service users from risks associated with poor performance. Certainly there was more than a suggestion that the implementation of clinical governance would help restore public confidence in health professionals and care delivery. In essence clinical governance for Trusts was intended as a single, coherent local programme for quality improvement. Quality was to infuse all aspects of service delivery and unite fragmented policies and approaches. Clinical governance was also to challenge indifferent organizational cultures and connect grass roots staff to the quality agenda, so encouraging the widespread adoption of the principles and methods of continuous quality improvement.