Clinical governance: A customisation of corporate principles. Will it work?

The introduction of clinical governance in the NHS is designed to increase the quality of care within trusts. Its structure is loosely adapted from commerce, where corporate governance is a well recognised managerial concept. Corporate governance is the concern of senior management, and imbedded in it are the concepts of strategy, direction, and control. Transferring governance structures to the NHS, however, may not be as simple as originally anticipated. Firstly, there is the issue of stakeholdership: whereas corporations give priority to the shareholders' interests, the NHS has patients, tax payers, and the government, each with different instincts, payoffs, and methods for evaluating success. Secondly, line management: where corporations have definite lines of authority, the health service has complex collegiate interrelationships and peer assessment procedures. Thirdly, in corporations where control over quality follows a hierarchical and pyramidal framework, clinical audit does not. The role of clinical audit will have to be revised such that the setting of clinical standards becomes a joint task for clinicians and management. Finally, in all organisations, management should aim to achieve a degree of specialisation which is aligned with the goals of that organisation. In the context of the NHS this is simply not possible. Until all sides accept major compromises, the chance of success for clinical governance, as a public sector equivalent of the more comprehensive corporate governance, is small.