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Clinical Governance, Audits and Research

Hi, my name is Dr. Siddharth Sunil. I am an IMG, graduated from Charles University in Prague and about to start my first job in the National Health Service (NHS) as a Foundation Year 2 doctor. Having had the clinical experience in the NHS and partaken in multiple clinical audits and research works, I have realised the importance of clinical governance. In this article, I will hence be discussing about clinical governance and also the core differences between clinical audit and research.

Clinical Governance

Clinical governance in the NHS of the United Kingdom is an umbrella-term describing a system through which the NHS is accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. It encompasses a range of measures, policies, and practices that are aimed at maintaining and improving the standards of clinical care, fostering a culture of learning, and minimizing risks associated with healthcare delivery.

At its core, clinical governance involves various components that collectively contribute to the overall management of clinical services, also called as the pillars of clinical governance. The 7 pillars of clinical governance are:

1. Clinical Audit

Clinical governance places significant emphasis on the use of clinical audit as a tool to assess and improve the quality of care provided. Clinical audit is a quality improvement process which seeks to improve patient care and outcomes through systematic review of care against an explicit criteria/ pre-defined ideal standard. Regular audits in clinical practices, procedures, and outcomes enable healthcare professionals to identify areas for improvement, measure progress over time, and ensure that gold standard practises are followed.

2. Risk Management

Ensuring patient safety is paramount within clinical governance. NHS organisations must learn from mistakes and develop a culture that allows the admittance of errors and mitigation of risks, so that those organisations can improve their quality of care. This is called risk management.. This includes reporting and analyzing incidents, near-misses, and adverse events to implement corrective actions and prevent recurrences.

3. Clinical Effectiveness

The NHS prioritizes evidence-based practice to ensure that interventions and treatments are grounded in the latest research and clinical knowledge. Clinical effectiveness focuses on providing the right care, at the right time, and in the most appropriate manner, leading to better patient outcomes. In practice this includes:

- Embracing an evidence-based methodology to patient management.

- Adapting practice and expanding new protocols learning from experience if current practice needs improvement.

- Ensuring National Service, NICE and other guidelines are implemented.

- Pushing research to develop further evidence to enhance patient care in the future.

What is evidence-based medicine?

It is the approach to medicine and patient care using best possible research, data and evidences in your current system and practicing according to what is available and safest for use. It is a very important entity of clinical effectiveness within the NHS.

4. Education and Training

Continuous professional development (CPD) is an integral part of clinical governance. Healthcare professionals are encouraged to engage in ongoing education, training, and skill enhancement to stay up-to-date with the latest advancements and best practices in their respective fields.

5. Patient and Public Involvement

Clinical governance acknowledges the importance of involving patients in their own care and decision-making processes. Engaging patients and their families in shared decision-making and incorporating their feedback by taking patient surveys and questionnaires, contributes to patient-centres care and enhances overall satisfaction.

6. Leadership, Accountability and Staff Management

Strong leadership at all levels of the healthcare system is essential for the successful implementation of clinical governance. Leaders are held accountable for promoting a culture of safety, ensuring compliance with standards, and driving continuous improvement. Staff management is about recruitment, staff retention, and performance monitoring. The point is to ensure the best people are in the right roles.

7. Information and IT

Clinical governance involves monitoring and measuring key performance indicators to track the quality of care being delivered. This data-driven approach allows for the identification of trends, comparisons with benchmarks, and the implementation of necessary interventions. Patient information must be accurate and up to date and always adhere to confidentiality standards. An NHS organisation might upgrade how they store data to improve this area of clinical governance.

In conclusion, clinical governance in the NHS is a multifaceted approach that aims to uphold and enhance the quality of patient care. It emphasizes patient safety and continuous improvement. By incorporating the mentioned 7 pillars or elements, clinical governance ensures that the healthcare system remains responsive, adaptable, and focused on delivering the best possible outcomes for patients.

Clinical Audit and Research

Clinical audit and research are terms which are easily confused but they have very important core differences and are of utmost importance when it comes to working of clinical governance, evidence-based medicine and even asked extensively during NHS job interviews. Hence, establishing the basic differences between research and audit is crucial.

What is Clinical Audit?

Clinical audit is a review comparing current practises against said guidelines or standards to improve quality of care or correct any shortcomings in the system. Clinical audit operates in a loop called the audit cycle, which are the major stages which a successful audit had to go through. The Audit Cycle is:

What is Research?

Research is the process of creating a new understanding and to derive new generalizable knowledge; and is yet to be introduced properly into the system by way of experiments, retrospective studies or monitoring patterns.

Main Differences between a Clinical Audit and Research


How TrewLink can help?

If you have any further questions, I would be happy to answer them at You can register using the following link. Find me as an ambassador and follow my profile- Siddharth Sunil – to receive regular support and advice.

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