6.5.2 Clinical governance and nursing - A sociological analysis (410)

Karen Staniland, Senior Lecturer Nursing, School of Nursing, University of Salford, Manchester, United Kingdom k.staniland@salford.ac.uk

Abstract:

Clinical governance involves demonstrating that quality assurance and patient safety is routine practice within every organization that provides healthcare. This ethnographic study presentation is an account of the degree to which nurses and other stakeholders in one NHS hospital Trust responded to the clinical governance initiative, the effects on quality improvement and professional regulation and the practical accomplishment of legitimacy. A case study was employed using broadly ethnographic methods. The qualitative data were obtained by documentary analysis, observation of meetings and ward activity and twenty-eight semi-structured interviews. Sociological new institutionalism theory as explained by Powell and DiMaggio (1991) served as a useful tool for understanding the political and ceremonial conformity that marked the clinical governance process. Errors and inconsistencies were found in documentation and the Trust’s reporting systems. Nevertheless, during the same period the Trust obtained a three star status and recognition for having appropriate structures and systems in place for the NHS Litigation Authority. A grounded theory approach was adopted in the analysis of the interviews using methods described by Straus and Corbin (1998) and Charmaz (2006). Identified themes included: Making Sense’ ‘Knowledge Construction’ ‘Somebody Else’s Job’ and ‘Real Work’. It was concluded that at a practice level clinical governance was poorly understood and seen as unrealistic and that corporate organizational goals were ambiguous and not shared. The study concludes that what is happening is not a ‘failure’ but an unintended consequence that results from an inadequate understanding of how organizations work. It is suggested that the organization and professionals are taking on legitimate forms to gain legitimacy, but that the impact of clinical governance to improve quality in practice is inconsistent.

Biography:

Karen Staniland has been involved in healthcare practice for many years and in teaching health related subjects since 1980. She has practical experience in Nursing, Health Education and Management. She is particularly interested in flexible methods of learning, including the use of eLearning in Nursing. She is currently working as Flexible Learning Co-ordinator within the School of Nursing at the University of Salford.