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Clinical governance was launched in 1998 as part of the NHS reforms. It is a framework used by healthcare professionals to continuously improve the quality of care provided. Its intention is to pool together all the activities that have an impact upon patient care into a single strategy. Clinical governance is an umbrella term for everything that helps to maintain and improve high standards of patient care. In Northern Ireland it is referred to as ‘health and social care governance’.

Clinical governance covers a range of quality improvement activities that include clinical audit and practice development.

Risk management is a process that raises the quality and safety of services provided to patients. It includes identifying, evaluating and reporting of risks. A risk management strategy contains systems for:

• incident reporting and investigation
• learning from complaints
• minimising negligence claims
• all aspects of patient safety
• infection, prevention and control.

Clinical audit is the regular review of patient care against clear standards and making changes where needed. In most NHS Trusts, support is available to undertake clinical audit projects. By reviewing areas of clinical practice against set standards, practitioners can identify priorities for action planning and improvement.

Audit can measure the structure (resources and available staff), the process (how you use the resources) and the outcome (results of a service). It is important to remember that audit is not the same as research but they have things in common, such as a rigorous approach to developing a methodology.

A term commonly associated with audit is the audit cycle; this includes:

• reflecting on current performance
• observing current practice
• comparing practice with standard
• implementing change.

The audit cycle is an ongoing process and is about the application of knowledge to practice. It involves negotiating what level of quality is wanted, recording the actual level of quality given, putting into practice changes then evaluating those changes by re-audit.