Clinical governance : a review of key concepts in the literature

Purpose - This paper aims to explore the development of the concept of clinical governance as an international approach to addressing quality and safety issues in healthcare. Design/methodology/approach - The authors reviewed and analysed published clinical governance abstracts from 1966 to 2009. Citations were identified through a systematic search of Medline, Embase and CINAHL databases. A time series analysis was undertaken on the citations. The contents of the abstracts were then examined using an automated data-mining software package in order to identify underlying concepts. Findings - A total of 2,000 publications which made direct mention of clinical governance were identified across the 43-year search period. All were produced after 1998. This was when the concept was first seriously mobilised. Of the 2,000 citations, 2.3 per cent were published in 1998 and 6.3 per cent in 2008 (the last complete year available). The peak was reached in 2003, when 12.7 per cent of all clinical governance citations were published. The years 1998 to 2003 accounted for 59.2 per cent of all citations (to September 2009). There has been a steady decrease in the number of citations making direct reference to clinical governance since 2003. Originality/value - This paper maps the development and peak of clinical governance as a mobilising concept in healthcare in the late twentieth and early twenty-first centuries and shows how its conceptual underpinnings have been taken up by wider quality and safety agendas. Fads and fashions rise and fall in healthcare, as in other areas of life.16 page(s