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Title: Clinical governance in mental health services : a study of a quality system
Author: Worrall, Adrian
ISNI:       0000 0004 2701 2589
Awarding Body: University of East London
Current Institution: University of East London
Date of Award: 2009
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Clinical governance is the most ambitious quality initiative in the history of the National Health Service. It is a comprehensive system of steps and procedures to ensure patients receive high quality care and, like most quality systems, it attempts to do this by influencing the behaviour of staff members. This study evaluates the implementation of clinical governance in 30 mental health trusts in England and Wales. It is set broadly within the action research paradigm and uses a participative research method to engage staff and help them learn from each other. Trusts were evaluated against a set of standards and using open questions in two annual cycles of self- and external peer-review. The first cycle focused on clinical governance structures and strategy; the second focused on how managers enabled front-line staff - a topic chosen in response to the findings of the first cycle. By the beginning of 2002, 5 years after clinical governance was introduced and when clinical governance was probably at its peak, this study found that only half the key strategies and structures were in place. Most managers view clinical governance as useful, but struggle to implement it under pressure from the government and without sufficient resources. It is of great concern that their clinical governance work is disconnected from the work of front-line staff and hence probably has little impact on patient outcomes. There are 3 main themes from both cycles: there is a hierarchical rather than enabling management style; there are poor resources, e.g. not enough skilled staff; and there are problems with support for front-line staff, e.g. risk management training needs to be provided to more staff. There was no statistically significant association between trust performance in both cycles and whether there had been a recent merger. Organisational theory was found weak and a tentative developmental model is offered. Clinical governance standards may have declined since the study was conducted because it is no longer the focus of statutory regulator's programme of reviews and because there are new policy priorities. Services need slow reforms with a staged pace and need enabling rather than hierarchical management styles. They also need better resources and to develop beyond a basic survival level to one where they are able to focus on growth and investment before embarking on ambitious policy initiatives.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Occ.Psych.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available