Clinical governance, organisational culture and change management in the new NHS

A study is reported that examined leadership of executives and non-executives in NHS trusts in implementing organisational interventions to support clinical governance. Structured interviews were conducted face to face on site with up to four respondents per trust fulfilling the roles of chief executive, clinical governance lead and non-executive director with a lead role in clinical governance. This yielded 151 interviews with staff in all 47 trusts in the West Midlands. Respondents were asked their views on the vision for cultural change and the objectives for achieving change locally, the impact of clinical governance in the trusts, particularly on clinicians' attitudes and behaviour, the types of organisational interventions and external support for change used. Results showed a more open culture was seen as a desirable outcome, but trust leaders do not explicitly take responsibility for leadership action to achieve change. While clinical staff were reported in some trusts as having overwhelmingly either positive or negative attitudes, perceived ambivalence by clinical staff towards clinical governance was most commonly reported. Education interventions and facilitative interventions predominate, with few examples of managerial interventions, such as performance review, at directorate or team level being used. External sources of advice were used by few trusts, where reliance was most often upon individuals seeking education or advice from others, with very few involving external others in the trusts' clinical governance processes on a systematic basis. Trust leaders are failing to take a systematic approach to the design and implementation of organisational interventions that could impact on the culture change goals of clinical governance