Free article: Clinical governance: a seven-point approach

Published: Monday, 20 July 2015

Dr Alun Rees offers a practical seven-point approach to clinical governance and how it can be used to improve dental practices.


  • Clinical governance should not be a cause for concern; it can lead to happier patients and a team committed to continuous improvement and transparency.
  • Dental practices should have a clear statement of vision and mission.
  • Involving patients and staff in your systems is key to overall improvement.
  • Healthy organisations are ones that are constantly learning and pursuing improvement.

The phrase ‘clinical governance’ can be a cause for confusion and concern in the dental profession. It brings with it the spectre of judgement and the notion of somehow being marked down and therefore compared unfavourably with colleagues.

In this article I will seek to remove the myths that may surround the subject and to encourage the reader to introduce a system of clinical governance that will improve the quality of patient care. This will lead to patients who are happier with the care they receive, a team that is committed to a cycle of continuous improvement, and transparency to any outside organisation that examines the workings of the practice or department. The accompanying toolkit provides a checklist for a clearly identified process of governance in your workplace.

What is clinical governance?

The following definition of clinical governance reflects the tenets of corporate governance from which the concept is derived:

‘A framework through which an organisation is accountable for continually improving the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.’

My own interest in clinical governance arose during the 1990s, primarily from the observation of my uncle’s engineering factory which required, and gained, BS 5750 (later ISO 9000). This led me to the work of W. Edwards Deming, and I became interested in applying the basic principles of quality assurance and total quality management to my dental practice. As a result I defined what I now call the ‘seven pillars of successful dental clinical governance’, which are:

  1. Vision and leadership
  2. Your patients
  3. Your people
  4. Continuous improvement
  5. Risk assessment
  6. Decision-making
  7. Systems

Examining these individually will bring clinical governance into clearer focus.

1. Vision and leadership

It is essential that everyone understands what the organisation needs to do. This requires the owners of the business to define, share and follow statements of vision and mission. The vision must take into account the values of all involved. The statements do not need to be lengthy but will provide a definition of your primary customers and the services you provide. The difference between the two statements is that the ‘vision’ concerns the future direction of the business and the ‘mission’ states what is being done today to move towards that future.

Leadership is a key part of governance. Business leaders have to demonstrate a commitment to openness, transparency and candour. They must also show that the highest quality of patient care is the bedrock of their professional work.

2. Your patients

A focus on the needs, wants and development of your patients is central to your systems. You have to listen to them, involve them in every aspect of their care, and identify and address any and all concerns they may have about that care. You must provide a system that is committed to them becoming more knowledgeable and sophisticated consumers. Your responsibility extends to ensuring their safety through cross-infection control and the appropriate safeguarding processes for children and vulnerable adults.

3. Your people

Each and every individual needs to fully understand what the practice is supposed to do and what their role is in providing the highest possible patient care.

In order to do this, there must be a robust system of introduction to the practice (induction), a regular review of training needs and plans for implementation (appraisal) and a commitment to become a learning organisation.

4. Continuous improvement

The learning organisation is one that encourages personal mastery through individual self-improvement. This concept is allied with a determination to become a community to which everyone has a commitment. The synergy from such a situation produces a business that is more agile and flexible, acknowledges changes that are required both for short-term expedience and long-term success and is able to respond to challenges.

Within this comes clinical audit and peer review. Under some systems ‘just enough’ has been the order of the day, where the bare minimum is achieved with a blind eye being turned by the supervising authorities. This does neither patient nor clinician any good whatsoever. So a truly robust system of clinical audit is needed, built on personal honesty and commitment and a willingness to change one’s practice to reflect what has been learned.

Similarly, peer review requires the individual to be willing to move themselves out of their comfort zone and to expose themselves to the opinions of their fellow clinicians. This has to be done in a non-judgemental way and all participants must be prepared to support their colleagues, share their good and bad experiences, and be willing to accept that they will never know everything. This does not come easily to most people, so junior members of staff in particular must be encouraged and shown that this is a positive exercise.

5. Risk assessment

Risk assessment is a fundamental cornerstone of your clinical governance and encompasses all aspects of health and safety, including radiation protection. You must learn from past experiences and be able to demonstrate what you have learned, sharing the outcomes with all colleagues.

6. Decision-making

All decisions, whether clinical or non-clinical, must reflect the core values, vision and mission of the practice. There should be consideration given to all parties involved and, where necessary, records must be kept of the thought processes involved and the evidence used to reach a decision.

7. Systems

A practice manual is essential. This is not a digital or paper file full of dry policies and tickbox documents, but rather a living thing that reflects the ever changing and evolving systems of your practice. It is something to which all team members contribute, with any updates or amendments shared during regular team meetings.

There is, of course, an elephant in the room when it comes to dealing with anything in UK dentistry and that is the NHS. If you have an NHS contract then be quite clear about what the contract demands of you and ensure that you exceed those requirements. If you do not have an NHS commitment then your arrangements should be as high as the clinical standards to which you aspire.

Further information


Use the following item to put the ideas in this article into practice:

About the author


Dr Alun Rees BDS graduated from Newcastle University and started his career as an oral surgery resident, before working as an associate in a range of different practices. Alun went on to launch two practices in the space of 15 months. A CTI trained coach and Kolbe consultant, Alun now works as the Dental Business Coach, offering specific and specialised support for dentists and their teams on all matters related to the business of dentistry.


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