Quality Indicators as Tools for Clinical Governance in Healthcare: A Narrative Review

Quality indicators are widely used to assess healthcare performance, yet their contribution to clinical governance depends on how measurement is translated into action.Clinical governance provides a framework through which healthcare organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care.This narrative review examines the conceptual foundations, methodological requirements, organizational applications, and evidence of effectiveness of quality indicators within clinical governance.PubMed and Scopus records published from January 2022 through June 2026 were searched and supplemented with foundational literature on clinical governance, indicator development, and performance measurement.Sources were selected purposively and synthesized thematically.The Donabedian structureprocess-outcome framework remains a useful basis for classifying indicators, but no single domain adequately captures quality.Meaningful indicators require validity, reliability, relevance to clinicians and patients, feasibility, actionability, and interpretability with appropriate comparability.Within clinical governance, indicators can support accountability, clinical audit, risk management, benchmarking, and continuous quality improvement when they are linked to contextual review, designated responsibility, corrective action, and remeasurement.Evidence of effectiveness is mixed.Audit and feedback produce small to moderate improvements in professional practice; public reporting has been associated with lower mortality in heterogeneous studies; and pay-for-performance has shown limited effects on patient outcomes.Target-driven use of indicators can also produce gaming and unintended consequences.Effectiveness further depends on leadership, workforce engagement, patient participation, and trustworthy data infrastructure, which may be limited in health systems with low digital maturity.Quality indicators should therefore be treated as signals for investigation and learning rather than as stand-alone judgments of care quality.