Sense making of clinical governance at different levels in NHS hospital trusts

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Abstract
Purpose – The purpose of this paper is to contribute to the current debate on the implementation of clinical governance by exploring the understanding of clinical governance at different levels in an NHS organisation. Design/methodology/approach – A case study method has been adopted with in-depth interviews to understand how organisational actors make sense of the term “clinical governance”. Semi-structured interviews were conducted with a heterogeneous group of 33 persons in an NHS hospital trust handling important responsibilities for clinical governance. In-depth analysis of the data revealed the understanding of clinical governance at different levels in an NHS organisation. Findings – The results indicate that clinical governance creates more confusion, debate and disagreement on quality of care, making it more a contentious issue than one promoting unanimity, uniformity and consistency. This could become a major obstacle in achieving continuous quality improvement in healthcare. Research limitations/implications – Further research on a wider scale is required to develop a better understanding of how people make sense of clinical governance for improving the quality of care. Practical implications – To look into implications of clinical governance in NHS organisations, it is necessary to understand how people at different levels in the NHS understand clinical governance. The paper makes a valuable contribution by bringing out the practical implications which will be useful for policy makers and practitioners. A better understanding of how health staff make sense of clinical governance would enable policy makers to know the problems of implementing clinical governance. Originality/value – From the current literature very little information is available on the above topic. This empirical research makes a valuable contribution by focusing on how stakeholders at different levels in an NHS organisation make sense of clinical governance.

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