Perspectives of rural and remote primary healthcare services on the meaning and goals of clinical governance
Ruyamuro K. Kwedza A E , Sarah Larkins B , Julie K. Johnson C and Nicholas Zwar A DA School of Public Health and Community Medicine, UNSW Medicine, NSW 2052, Australia.
B College of Medicine and Dentistry and Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Douglas, Qld 4811, Australia.
C Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 North St Clair, 20th Floor, Chicago, IL 60611, USA.
D Present address: School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
E Corresponding author. Email: r.kwedza@unswalumni.com
Australian Journal of Primary Health 23(5) 451-457 https://doi.org/10.1071/PY16168
Submitted: 23 December 2016 Accepted: 14 June 2017 Published: 21 August 2017
Abstract
Definitions of clinical governance are varied and there is no one agreed model. This paper explored the perspectives of rural and remote primary healthcare services, located in North Queensland, Australia, on the meaning and goals of clinical governance. The study followed an embedded multiple case study design with semi-structured interviews, document analysis and non-participant observation. Participants included clinicians, non-clinical support staff, managers and executives. Similarities and differences in the understanding of clinical governance between health centre and committee case studies were evident. Almost one-third of participants were unfamiliar with the term or were unsure of its meaning; alongside limited documentation of a definition. Although most cases linked the concept of clinical governance to key terms, many lacked a comprehensive understanding. Similarities between cases included viewing clinical governance as a management and administrative function. Differences included committee members’ alignment of clinical governance with corporate governance and frontline staff associating clinical governance with staff safety. Document analysis offered further insight into these perspectives. Clinical governance is well-documented as an expected organisational requirement, including in rural and remote areas where geographic, workforce and demographic factors pose additional challenges to quality and safety. However, in reality, it is not clearly, similarly or comprehensively understood by all participants.
Additional keywords: Australia, case study, quality of health care, rural health, safety.
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