Clinical governance is a quality assurance framework through which NHS organisations are accountable for continually improving the quality of their services. It is asked about in virtually every NHS interview, and the panel expects you to understand both the definition and how it applies to your daily practice as a junior doctor.
The Seven Pillars
1. Clinical Effectiveness: Ensuring that everything you do is designed to provide the best outcomes for patients, based on the best available evidence. In practice: following NICE guidelines, using evidence-based protocols, keeping up with current best practice.
2. Clinical Audit: A systematic process of reviewing clinical practice against agreed standards to ensure patients receive high-quality care. The audit cycle: set standards → collect data → compare against standards → identify gaps → implement changes → re-audit. You should have at least one audit you can discuss in detail.
3. Risk Management: Having robust systems to understand, monitor, and minimise risks to patients and staff. Includes incident reporting (Datix), Serious Incident investigations, Root Cause Analysis, learning from near-misses, and a no-blame/just culture. The panel wants to hear that you understand reporting systems and actively participate in them.
4. Education & Training: Ongoing professional development through CPD, appraisal (annual), revalidation (every 5 years), and supporting the education of others. Includes both formal teaching and informal supervision of juniors and students.
5. Patient & Public Involvement: Involving patients and the public in healthcare decisions and service design. Includes patient surveys, PALS (Patient Advice and Liaison Service), patient representatives on governance committees, and complaints management.
6. Information & IT: Ensuring patient information is accurate, up-to-date, and stored securely in accordance with data protection regulations. Includes electronic health records, Caldicott Guardian role, and clinical coding.
7. Staffing & Staff Management: Appropriate recruitment, retention, and management of staff. Ensuring underperformance is identified and addressed, providing good working conditions, and supporting staff wellbeing.
Mnemonic: The four pillars most relevant to junior doctors can be remembered as CARE — Clinical effectiveness, Audit, Risk management, Education. Discuss these in depth and mention the other three briefly.
How to answer “What is clinical governance?”: Do NOT recite the official definition word-for-word. Explain it in your own words: “Clinical governance is the framework through which the NHS ensures and continuously improves the quality of patient care. It includes activities like clinical audit, risk management, education and training, and using evidence-based practice. In my own work, I’ve been involved in clinical governance through [specific example].” Always link to a personal example.