How do trusts intend to measure progress in clinical governance?

Background: Clinical governance places a new statutory responsibility on NHS organisations to put in place a framework for quality improvement, in which high standards are safeguarded, continuous improvement promoted and excellence encouraged. This definition contains elements of both assurance and continuous improvement approaches to quality, and poses a challenge to organisations in measuring progress. Objective: To examine how directors of NHS trusts with a lead role in clinical governance intend to measure progress. Method: Semi-structured face-to-face interviews with up to four directors from all 47 trusts in the West Midlands region, as part of a larger study. Of 151 interviews, 134 contained material related to how the progress of clinical governance might or would be measured in the organisation. This paper presents an analysis of those components of the interview data. Results: Areas identified as potential indicators include the adoption and use of care protocols, integration with business planning, the operation and integration of structures and processes, clinical outcomes, reflective practice, learning from mistakes and openness. Measurement intentions reveal differences between those who see clinical governance as a performance management and assurance system, and those who view it more as a vehicle for promoting continuous quality improvement. In total, 86 (64) interviewees described their measurement intentions solely in terms of quality assurance. Discussion: Where trusts measure progress in clinical governance exclusively in terms of quality assurance, they will have little indication of progress in continuous quality improvement. An extensive literature on assurance-based performance indicator systems provides cautionary reading against exclusive reliance on such systems. Conclusion: Those responsible for implementing clinical governance need to ensure that arrangements are in place to gather and use information on both assurance and improvement elements