Clinical governance views on culture and quality improvement

Purpose - The purpose of this paper, based on a nation-wide survey, is to explore how clinical governance managers in the English NHS are seeking to engage with the culture(s) of their organisation to support quality improvement. Design/methodology/approach - All English NHS primary and acute trusts, a total of 325, were contacted for R&D approval between March and September 2006. Clinical governance leads of organisations which gave their approval, 276 (or 85%), were targeted in a nation-wide postal survey between October 2006 and February 2007. A response rate of 77% was obtained. The questionnaire contained mostly closed questions about the role and importance of culture in clinical governance and the use of tools for culture assessment. The questionnaire was piloted with eight respondents, seven in clinical governance from both primary care and acute trusts, and one from the National Patient Safety Agency. Useful feedback was received from five of the respondents, which was used to revise and refine the questionnaire. Confidence in the reliability and validity of the results is based on a high degree of consistency and similarity in the responses, both with respect to a few questions which were closely related and the two categories of respondents from primary care trusts and acute trusts. Findings - There was found to be clear interest among clinical governance managers in culture renewal and management, in line with the growing national policy interest in promoting culture change as a lever for health system reform. Nearly, all clinical governance managers (98%) saw the need to measure local culture in order to foster change for improved performance; 85 %, indicated that culture assessment should satisfy a formative purpose, whereas 64% believed that it should serve summative ends. While nearly all clinical governance managers (99%) acknowledge the importance of understanding and shaping local cultures, the majority are also conscious that there are many challenges to overcome in their efforts to implement and sustain beneficial culture change. Originality/value - This research highlights the widespread practical interest in assessing and managing local health care cultures to support clinical governance and quality improvement activities. It also highlights the need for culture assessment tools that better reflect the needs and interests of clinical governance managers.