Josie Winter • 13 July 2021

What Are The 7 Pillars of Clinical Governance

Clinical governance is “a system through which healthcare organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish."

7 Pillars of Clinical Governance


Clinical Governance is an Umbrella Term.


The scope of clinical governance is quite broad and covers many activities that help to support, improve and advance the standards of care delivery. You may already be familiar with some of these such as clinical audit and risk management.


Clinical Governance works by trying to link all of these activities together to make them more effective. Whatever structures, systems and processes you may have in place currently, you must be able to evidence that high standards of care are being advocated within your organisation. Seven key themes appear repeatedly in evidence reviews on clinical governance which include:



  • Service User/Patient Involvement
  • Clinical Audit & Quality Improvement
  • Staffing & Staff Management
  • Clinical Effectiveness
  • Risk Management & Safety
  • Data & Information
  • Education & Training


These themes are inter-related. They provide a foundation and framework to look at your overall systems and the quality of care provided in your organisation. This resource describes some of the key themes of clinical governance, so you can gain a better understanding of what clinical governance is  along with some hints and tips of how to put it into practice


EDUCATION & TRAINING


It is fundamental that staff caring for service users and patients have the knowledge and skills they need to do a great job. For this reason, staff should be given ample opportunity to update their skills and to keep up to date with the latest developments. Alongside this, healthcare staff should be able to learn any new skills that may be needed to fulfil their role fully. Staff should always have the skills they need to provide the best care for service users and patients. As well as mandatory and statutory training there are wider healthcare and management related skills to consider.




CLINICAL AUDIT & QUALITY IMPROVEMENT


Clinical audit is a way healthcare organisations can measure and benchmark the quality of the care provided. It is a cycle process that allows you to compare where you are now (against a set of standards-criteria) with where you should be and how you are doing against current standards.


Doing a clinical audit is a great way to identify opportunities to improve. Changes can then be made, followed by follow up audits to see if these changes have been positive. Clinical Audit is often confused with clinical research or a simpler service review/evaluation. We have seen countless organisations who think they are performing clinical audits, when in fact they are performing a service review by following a checklist or tick box.


Clinical Auditing is not always a skill that is taught to healthcare professionals and often you are just expected to know how to audit. Advanced Clinical Solutions are experts in their fields and can provide you with a range of quality,evidence-based clinical audit services and action plans, which align nicely with the current KLOE's and up-to date clinical evidence. As well as providing training on how to clinical audit correctly, our team provides an on-site audit service. This is usually completed within a day or two and includes focused clinical audits on theme



CLINICAL EFFECTIVENESS


Care for service users and patients should be based on good quality evidence from research. The National Institute for Health and Care Excellence (NICE) provides a wealth of national guidance on the promotion of good health ,prevention measures and treatment of illness.


Alongside NICE ,there are many professional and regulatory bodies (e.g. NMC,GMC ,CQC ) producing clinical guidance and standards. It’s hard to keep up with  current thinking and evidence ,let alone trying to read a new clinical paper without loosing the will to live. Systematic reviews, p-values , meta-analysis, case studies .Where do you even begin ?


Just like clinical auditing , critiquing and understanding clinical evidence is a skill that is often not routinely taught or a skill that is regularly updated for healthcare professionals. We hear of so many barriers in the industry to keeping evidence-based practice up to date such as, time restraints, low staffing levels and increased demand on services.


Change is happening constantly within healthcare and finding time to introduce new guidance can be challenging. It is our job to stay ahead of current evidence and we regularly set aside time each month to horizon scan and discuss new evidence , perhaps you could introduce ‘Evidence Hour’ once a month.


RISK MANAGEMENT


Risk management is about minimising risks to service users or patients by:


  • Identifying what can and does go wrong during care
  • Understanding what factors influence this
  • Learning lessons from any adverse events, accidents or incidents
  • Ensuring action is taken to prevent it reoccurring
  • Putting effective systems in place to reduce risks




RISK ASSESSING


It is likely that you have heard of or performed a risk assessment. Risk assessing is a way of trying to identify the potential dangers involved with care delivery . It also looks at who may be harmed and how you can minimise hazards (a hazard is anything that has the potential to cause harm) and risks (a risk is the likelihood that harm will occur). Think outside of the box , risk can come from anywhere including your processes , equipment, procedures or even the environment.


For any risk assessment to be really effective it must go through a set number of stages .There are 6 stages in total, and they should be performed in the correct order. The steps are outlined below.



  1. Identify the hazard
  2. Decide who may be harmed by the hazards and how this will occur
  3. Assess the risk of the hazard causing the harm
  4. Decide what precautions could reduce or remove the chance of the hazard causing
  5. Record your findings and implement any changes needed
  6. Review the assessment regularly and update if required





PATIENT/ SERVICE USER INVOLVEMENT


If your aim is to offer the highest quality care, it is important to work in partnership with service users and patients. This means gaining a better understanding of the priorities and concerns of those who use your service by involving them in your work, including planning, feedback and new service provision.


One way to gain the views of service users and patients is by holding regular meetings or forums with the people who use your service. Monitoring and recording the views of service users and patients through complaints and compliments is hugely beneficial. Some key questions ask yourself are:


  • What ways do you currently receive feedback from service users or patients ?
  • When you do receive feedback , what do you do with that information ?
  • Can you give specific example of change that has happened in your organisation due to service user input ?
  • What additional external access or support is available to you and you service users or patients?



Are you looking to improve the quality and safety of your healthcare organization? Our clinical governance consultancy can help. With a team of experienced professionals, we offer a range of services to help you establish and maintain best practices in clinical governance.


From developing policies and procedures to conducting risk assessments, we can help you ensure that your organisation is meeting all necessary regulatory requirements.


But it's not just about compliance - our team can also help you improve the overall quality of care you provide to your patients. By working with us, you'll have access to the latest research and best practices in clinical governance, allowing you to stay at the forefront of the industry.


Don't wait - take the first step towards improved clinical governance and contact us today to learn more about how we can help your organisation succeed and BOOK A FREE CONSULTATION TODAY





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by Josie Winter 4 June 2026
Introduction Over the last year, I have been quieter than usual on LinkedIn and social media. It wasn't because I had lost interest in healthcare, governance, patient safety, or leadership. Quite the opposite. I was doing something I should probably have done years ago. I was working on myself. Like many people working in healthcare, I spent years focusing on everyone else's needs. Patients. Staff. Organisations. Services. Improvement projects. Regulatory requirements. Governance systems. Risk registers. Incident investigations. What I rarely stopped to consider was how my own experiences, beliefs, coping mechanisms, and unresolved trauma influenced the way I led. Through therapy and self-reflection, I began to understand something that has fundamentally changed how I view leadership. The systems we build are often a reflection of the people leading them. And if we want safer organisations, stronger cultures, and better patient outcomes, we need to be willing to look beyond policies and procedures and explore the human beings behind them. The Leadership Conversation We Rarely Have Healthcare leadership is often discussed in terms of strategy, governance, performance, finance, and regulation. We talk about: Staffing shortages Quality indicators Patient safety metrics Inspection outcomes Workforce challenges Organisational performance All of these things matter. But there is a question we rarely ask: Who are the people leading these systems? Every leader arrives with a lifetime of experiences. Some arrive having grown up in stable environments where they learned trust, confidence, and emotional security. Others arrive carrying experiences of adversity, trauma, neglect, instability, loss, or chronic stress. Those experiences do not disappear when we step into leadership roles. They influence how we communicate, how we manage conflict, how we respond to pressure, and how we make decisions. In healthcare, where decisions can affect patient outcomes, this matters more than we often realise. Trauma Doesn't Stay at Home When people hear the word trauma, they often think of major life events. But trauma is not defined solely by what happened to us. It is often defined by how our nervous system learned to adapt in order to survive. Many of the traits that help people become successful healthcare leaders can also be rooted in coping mechanisms developed much earlier in life. For example: Hyper-Responsibility Many healthcare leaders carry an overwhelming sense of responsibility. They struggle to switch off. They feel personally accountable for everything. They take on too much and find it difficult to ask for help. On the surface, this can look like commitment.But beneath it may be a deeply ingrained belief that they must hold everything together because nobody else will. Perfectionism Healthcare attracts perfectionists. Attention to detail is important. But perfectionism can also create fear. Fear of failure. Fear of criticism. Fear of making mistakes. When leaders cannot tolerate imperfection in themselves, they often struggle to tolerate it in others.This can undermine learning cultures and psychological safety. Avoidance Some leaders avoid difficult conversations. Others delay decisions. Others become overwhelmed by conflict. These responses are rarely about capability. They are often about emotional survival strategies developed long before leadership positions were ever considered. Control Many leaders find delegation difficult. They feel safer when they maintain direct oversight. The challenge is that organisations become dependent on them, teams lose autonomy, and growth becomes limited. What Does This Have to Do With Patient Safety? Everything. Patient safety is often viewed through the lens of systems, processes, and governance. Those things are essential. But patient safety is also influenced by culture. And culture is heavily influenced by leadership. Consider the following: Psychological Safety If staff fear criticism, blame, or humiliation, they are less likely to speak up. Concerns remain hidden. Near misses go unreported. Learning opportunities are lost. Incident Reporting If leaders react defensively when incidents occur, staff quickly learn that reporting is risky. The result is under-reporting, reduced transparency, and missed opportunities for improvement. Duty of Candour Being open about mistakes requires emotional maturity and self-awareness. Leaders who struggle with shame or fear may unintentionally create environments where openness becomes difficult. Risk Management Leaders who avoid discomfort may avoid difficult risks. Leaders who fear conflict may tolerate poor performance. Leaders who need control may struggle to empower others. These behaviours can directly affect organisational safety. What Therapy Taught Me About Governance For much of my career, I believed good governance was primarily about systems. Risk registers. Policies. Audits. Committees. Performance reports. These things remain important. But what I have learned is that governance is also about people. You can have the best policies in the world. You can have comprehensive audits. You can have sophisticated reporting systems. But if leaders are unable to receive challenge, admit mistakes, or create psychological safety, governance will always be limited. The most effective governance systems are supported by leaders who are willing to reflect on themselves. Leaders who understand their strengths. Leaders who recognise their triggers. Leaders who are curious about their own behaviours. Leaders who understand that self-awareness is not a weakness but a governance asset. Trauma-Informed Leadership Is Not Soft Leadership This is one of the biggest misconceptions. Trauma-informed leadership is often misunderstood as being less accountable or less demanding. In reality, the opposite is true. Trauma-informed leaders still: Hold people accountable Address performance concerns Make difficult decisions Manage risk Maintain standards The difference is how they do it. They understand that people perform best when they feel psychologically safe. They recognise that curiosity often produces better outcomes than judgement. They understand that learning is more powerful than blame. And they appreciate that culture is built through everyday interactions rather than policies alone. Building Trauma-Informed Healthcare Organisations Trauma-informed leadership is not simply about individual leaders. It also influences how organisations operate. Healthcare organisations can become more trauma-informed by: Creating Psychological Safety Encouraging staff to speak openly about concerns, incidents, and mistakes without fear. Supporting Reflective Practice Giving staff and leaders opportunities to learn from experiences. Moving Beyond Blame Focusing on systems and contributing factors rather than individual fault. Investing in Leadership Development Developing emotional intelligence alongside technical and operational skills. Prioritising Wellbeing Recognising that workforce wellbeing and patient safety are closely connected. The Future of Healthcare Leadership Healthcare is becoming increasingly complex. Leaders face unprecedented pressures. Financial challenges. Regulatory scrutiny. Workforce shortages. Growing patient demand. Traditional leadership models focused solely on performance and compliance are no longer enough. The healthcare leaders of the future will need: Governance expertise Patient safety knowledge Emotional intelligence Self-awareness Systems thinking Compassionate leadership skills These are not competing priorities. They are complementary capabilities. The strongest leaders will be those who understand both organisations and themselves. Conclusion Over the last year, I have learned that leadership is not just about understanding organisations. It is also about understanding ourselves. The systems we create. The cultures we build. The decisions we make. The way we respond to challenge. The way we treat people. All of these things are influenced by the stories we carry. As healthcare leaders, we spend considerable time asking organisations to learn from incidents. Perhaps we should spend more time learning from ourselves too. Because one of the most important patient safety interventions we can make may not be a new policy, audit programme, or governance framework. 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