Clinical governance in primary care: Organisational development for clinical governance

This is the third in a series of five articles Underpinning contemporary theories of quality improvement is the axiom that poor individual performance usually reflects wider “system failure” or the absence of an organisation-wide system of quality assurance.1 In healthcare organisations, critical incidents can lead to death, disability, or permanent discomfort. This, together with clinicians' tendency to protect their individual autonomy and reputation, can promote a culture of blame and secrecy that inhibits the organisational learning necessary to prevent such incidents in future. Introducing clinical governance to primary care, the government stated that it “must be seen as a systematic approach to quality assurance and improvement within a health organisation … Above all clinical governance is about changing organisational culture … away from a culture of blame to one of learning so that quality infuses all aspects of the organisation's work.”2 This paper seeks to identify the contribution of organisational development to the effective establishment of clinical governance. #### Summary points Organisational development is a field of applied behavioural science focused on managing change and improving effectiveness in organisations Four aspects of organisational development are particularly important: cultural change, the development of technical skills, structural change, and the development of effective leadership Developing the necessary culture for clinical governance will be difficult given the variability of general practices and practitioners An agenda of control and risk management could jeopardise the inventiveness and innovation that secures continuous improvement The idea of organisation-wide quality improvement poses challenges in a primary care setting. Much care is still provided by relatively isolated professionals based in small practices, which are not typically thought of as “organisations.” Newly formed primary care groups and trusts are easier to conceptualise as organisations, but many have yet to develop the sense of cohesion and “organisational belonging” among …