Clinical governance is an important first step and certainly a natural next step from heightened concern over clinical efficacy and reduction of practice variance.
I remain concerned that we are not fully addressing the organisational dimension of clinical, aka medical, practice. The structure of medical specialist practice in hospitals continues to advantage the doctors and not the patients.
This means that junior doctors continue to revolve through a system which fragments their clinical learning, and may actually hamper their ability to adopt current practice. After all, the younger, new doctors are more likely to be the most up to date on current practices, but are at the whim of individual consultants when it comes to rewards for their learning. Where, after all, are the bad habits learned?
I am still convinced that we should investigate further the US/Canada system of hospital privileges (approved areas of clinical practice) for hospital-based consultants, with appropriate reviews of clinical practice, including the clinical supervision of specialists in the first year of appointment at a hospital, regardless of how many years they have been practising. This general approach has the additional advantage of ensuring that post-graduate education is the reponsibility of the clinical service area more generally, not individual consultants.
More widely, responsibility for clinical and service quality is opened up to scrutiny at the board level, with wider managerial responsibility to manage the distribution of the patient case load. (There are areas which have adopted this pooled approach and been very successful in reducing waiting; its a pity though, that waiting is seen as the important quality variable....)
Important steps have been take through clinical governance, and as we all know, what gets measured gets done. However, clinical governance as an idea to reduce variance and enhance better/best practice will still require more than measured good intentions. I for one am still waiting for the "governance" to be developed further.
Competing interests: No competing interests