History and evolution of Corporate and Clinical governance

Dhana Sekaran

Manager, Clinical Governance, Kauvery Group of Hospitals

Introduction

Clinical and corporate governance have been ongoing concern in the National Health Service (NHS). Since the Bristol Royal Infirmary scandal of the 1990s

Clinical and corporate governance are closely related as the two of them share similar processes such as openness, performance review, striving for effective end results, and accountability in the use of resources and power within healthcare management. [1]

Corporate Governance

The corporate governance structure specifies the distribution of rights and responsibilities among different participants in the corporation, such as the Board, managers, shareholders, and other stakeholders, and spells out the rules and procedures for making decisions on corporate affairs.

-Economic Co-operation and Development (OECD)

Corporate governance in India has evolved significantly over the years, spurred by changing market dynamics, regulatory reforms, and the need to improve transparency and accountability in business practices.

In the wake of corporate scandals and frauds in India, such as the Satyam scandal in 2009, the government and regulatory authorities have implemented various measures to strengthen corporate governance practices in India.

Principles of Corporate Governance

Accountability

  • In the context of corporate governance, accountability implies the responsibility of chairman, Board of Directors and the chief executive for the use of company resources (over which they have authority) in the best interest of the company and its stakeholders.

Transparency

  • Timely, accurate and adequate disclosure of all relevant information on matters, including the financial situation and performance of the company, to the stakeholders of the company.
  • High quality annual reports are published to make sure that all investors are given clear and factual information that precisely reflects the financial and environmental position of the organization.

Fairness

  • Fairness refers merely to the way companies and their officers treat stakeholders, employees and investors against the dominant players as majority shareholders.

Independence

  • Good corporate governance requires independence on the part of the top management of the corporation,that is the Board of Directors, who must be a strong and nonpartisan body, so that it can take all corporate decisions based on business prudence. [2]

Clinical governance

Clinical governance in India, on the other hand, has been a relatively recent development compared to corporate governance. With the growth of the healthcare sector and increasing concerns about patient safety, quality of care, and regulatory compliance, there has been a growing emphasis on clinical governance in India.

Clinical governance is a system of management and assurance that ensures healthcare providers deliver safe, effective, and high-quality care to patients. It involves the continuous monitoring, evaluation, and improvement of healthcare services to maintain high standards of clinical practice and patient safety.

Elements of clinical governance include risk management, clinical audit, education and training, performance management, and patient feedback. By implementing clinical governance, healthcare organizations aim to reduce medical errors, enhance patient outcomes, and foster a culture of learning and improvement within the healthcare system. [3]

Methods of clinical governance

  • Clinical audit: Regular review of clinical practices to ensure compliance with best practices and identify areas for improvement.
  • Risk management: Identifying and managing potential risks to patient safety, such as through incident reporting and root cause analysis.
  • Education and training: Ensuring that healthcare professionals have access to ongoing education and training to stay up-to-date on best practices and guidelines.
  • Performance monitoring: Regularly monitoring the performance of clinicians and healthcare teams to identify areas needing improvement.
  • Patient feedback: Collecting and incorporating feedback from patients to improve the quality of care and enhance patient satisfaction.
  • Clinical guidelines and protocols: Implementing evidence-based guidelines and protocols to standardize care delivery and improve patient outcomes.
  • Peer review: Engaging in peer review processes to evaluate the quality of care provided by healthcare professionals and identify areas for improvement.

History of Clinical Governance in India

  • Clinical governance in India can be traced back to the 1990s when healthcare organizations started to adopt quality improvement and assurance measures to ensure patient safety and improve the quality of care.
  • The concept of clinical governance was introduced in India as a part of the broader health sector reforms aimed at improving healthcare delivery and outcomes.
  • The Medical Council of India (MCI) introduced guidelines on clinical governance in 2002, emphasizing the need for healthcare organizations to establish systems and processes to ensure quality and safety in patient care.
  • These guidelines focused on various aspects of clinical governance, including clinical audit, risk management, patient feedback, and continuous professional development for healthcare providers.
  • Over the years, clinical governance has gained momentum in India, with healthcare organizations increasingly recognizing its importance in enhancing patient outcomes and building public trust in the healthcare system.
  • In recent years, the government of India has also taken steps to promote clinical governance in the country.
  • The National Accreditation Board for Hospitals and Healthcare Providers (NABH) was established in 2005 to set standards for quality healthcare delivery and accreditation of healthcare organizations.
  • In addition, the government has introduced various initiatives and programs to promote clinical governance and quality improvement in healthcare facilities across the country.

Clinical governance plays a vital role in ensuring high-quality care for patients by implementing processes and systems to continuously monitor and improve clinical practices within healthcare organizations.

Clinical governance in India has evolved over the years, with a focus on improving the quality and safety of healthcare services. The concept of clinical governance was first introduced in the United Kingdom in the late 1990s, and subsequently, the Indian healthcare system also adopted similar principles. [4]

The Government of India has taken several initiatives to promote clinical governance in healthcare facilities across the country. The National Health Policy 2017 emphasizes the need for better governance and quality of care in healthcare delivery. The policy emphasizes the integration of clinical governance in the healthcare system to improve patient outcomes and ensure accountability.

Conclusion

Overall, both corporate and clinical governance in India have undergone significant transformations in recent years, driven by a recognition of the importance of good governance practices in fostering trust, transparency, and accountability in both the corporate and healthcare sectors. Continued efforts are needed to further strengthen and institutionalize these governance frameworks to ensure sustainable growth and ethical practices in India.

Reference

Dhana Sekaran
Manager Clinical Governance

Nightingale Journals

Kauvery Hospital
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