What Are The 7 Pillars of Clinical Governance (2023)

Clinical governance is “a system through which healthcare organisations are 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."

Clinical Governance is an Umbrella Term.

The scope of clinical governance is quite broad and covers many activities that help to support, improve and advance the standards of care delivery. You may already be familiar with some of these such as clinical audit and risk management.

Clinical Governance works by trying to link all of these activities together to make them more effective. Whatever structures, systems and processes you may have in place currently, you must be able to evidence that high standards of care are being advocated within your organisation. Seven key themes appear repeatedly in evidence reviews on clinical governance which include:

  • Service User/Patient Involvement
  • Clinical Audit & Quality Improvement
  • Staffing & Staff Management
  • Clinical Effectiveness
  • Risk Management & Safety
  • Data & Information
  • Education & Training

These themes are inter-related. They provide a foundation and framework to look at your overall systems and the quality of care provided in your organisation. This resource describes some of the key themes of clinical governance, so you can gain a better understanding of what clinical governance is along with some hints and tips of how to put it into practice

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It is fundamental that staff caring for service users and patients have the knowledge and skills they need to do a great job. For this reason, staff should be given ample opportunity to update their skills and to keep up to date with the latest developments. Alongside this, healthcare staff should be able to learn any new skills that may be needed to fulfil their role fully. Staff should always have the skills they need to provide the best care for service users and patients. As well as mandatory and statutory training there are wider healthcare and management related skills to consider.

Clinical audit is a way healthcare organisations can measure and benchmark the quality of the care provided. It is a cycle process that allows you to compare where you are now (against a set of standards-criteria) with where you should be and how you are doing against current standards.

Doing a clinical audit is a great way to identify opportunities to improve. Changes can then be made, followed by follow up audits to see if these changes have been positive. Clinical Audit is often confused with clinical research or a simpler service review/evaluation. We have seen countless organisations who think they are performing clinical audits, when in fact they are performing a service review by following a checklist or tick box.

Clinical Auditing is not always a skill that is taught to healthcare professionals and often you are just expected to know how to audit. Advanced Clinical Solutions are experts in their fields and can provide you with a range of quality,evidence-based clinical audit services and action plans, which align nicely with the current KLOE's and up-to date clinical evidence. As well as providing training on how to clinical audit correctly, our team provides an on-site audit service. This is usually completed within a day or two and includes focused clinical audits on theme

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Care for service users and patients should be based on good quality evidence from research. The National Institute for Health and Care Excellence (NICE) provides a wealth of national guidance on the promotion of good health ,prevention measures and treatment of illness.

Alongside NICE ,there are many professional and regulatory bodies (e.g. NMC,GMC ,CQC ) producing clinical guidance and standards. It’s hard to keep up with current thinking and evidence ,let alone trying to read a new clinical paper without loosing the will to live. Systematic reviews, p-values , meta-analysis, case studies .Where do you even begin ?

Just like clinical auditing , critiquing and understanding clinical evidence is a skill that is often not routinely taught or a skill that is regularly updated for healthcare professionals. We hear of so many barriers in the industry to keeping evidence-based practice up to date such as, time restraints, low staffing levels and increased demand on services.

Change is happening constantly within healthcare and finding time to introduce new guidance can be challenging. It is our job to stay ahead of current evidence and we regularly set aside time each month to horizon scan and discuss new evidence , perhaps you could introduce ‘Evidence Hour’ once a month.

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Risk management is about minimising risks to service users or patients by:

  • Identifying what can and does go wrong during care
  • Understanding what factors influence this
  • Learning lessons from any adverse events, accidents or incidents
  • Ensuring action is taken to prevent it reoccurring
  • Putting effective systems in place to reduce risks


It is likely that you have heard of or performed a risk assessment. Risk assessing is a way of trying to identify the potential dangers involved with care delivery . It also looks at who may be harmed and how you can minimise hazards (a hazard is anything that has the potential to cause harm) and risks (a risk is the likelihood that harm will occur). Think outside of the box , risk can come from anywhere including your processes , equipment, procedures or even the environment.

For any risk assessment to be really effective it must go through a set number of stages .There are 6 stages in total, and they should be performed in the correct order. The steps are outlined below.

  1. Identify the hazard
  2. Decide who may be harmed by the hazards and how this will occur
  3. Assess the risk of the hazard causing the harm
  4. Decide what precautions could reduce or remove the chance of the hazard causing
  5. Record your findings and implement any changes needed
  6. Review the assessment regularly and update if required


If your aim is to offer the highest quality care, it is important to work in partnership with service users and patients. This means gaining a better understanding of the priorities and concerns of those who use your service by involving them in your work, including planning, feedback and new service provision.

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One way to gain the views of service users and patients is by holding regular meetings or forums with the people who use your service. Monitoring and recording the views of service users and patients through complaints and compliments is hugely beneficial. Some key questions ask yourself are:

  • What ways do you currently receive feedback from service users or patients ?
  • When you do receive feedback , what do you do with that information ?
  • Can you give specific example of change that has happened in your organisation due to service user input ?
  • What additional external access or support is available to you and you service users or patients?

Are you looking to improve the quality and safety of your healthcare organization? Our clinical governance consultancy can help. With a team of experienced professionals, we offer a range of services to help you establish and maintain best practices in clinical governance.

From developing policies and procedures to conducting risk assessments, we can help you ensure that your organisation is meeting all necessary regulatory requirements.

But it's not just about compliance - our team can also help you improve the overall quality of care you provide to your patients. By working with us, you'll have access to the latest research and best practices in clinical governance, allowing you to stay at the forefront of the industry.

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Don't wait - take the first step towards improved clinical governance and contact us today to learn more about how we can help your organisation succeed and BOOK A FREE CONSULTATION TODAY


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