Buetow S A, Roland M
Department of General Practice and Primary Health Care, University of Auckland, New Zealand.
Qual Health Care. 1999 Sep;8(3):184-90. doi: 10.1136/qshc.8.3.184.
Clinical governance has been introduced as a new approach to quality improvement in the UK national health service. This article maps clinical governance against a discussion of the four main approaches to measuring and improving quality of care: quality assessment, quality assurance, clinical audit, and quality improvement (including continuous quality improvement). Quality assessment underpins each approach. Whereas clinical audit has, in general, been professionally led, managers have driven quality improvement initiatives. Quality assurance approaches have been perceived to be externally driven by managers or to involve professional inspection. It is discussed how clinical governance seeks to bridge these approaches. Clinical governance allows clinicians in the UK to lead a comprehensive strategy to improve quality within provider organisations, although with an expectation of greatly increased external accountability. Clinical governance aims to bring together managerial, organisational, and clinical approaches to improving quality of care. If successful, it will define a new type of professionalism for the next century. Failure by the professions to seize the opportunity is likely to result in increasingly detailed external control of clinical activity in the UK, as has occurred in some other countries.
临床治理已作为英国国民医疗服务体系中提高质量的一种新方法被引入。本文将临床治理与对衡量和改善医疗质量的四种主要方法的讨论相结合：质量评估、质量保证、临床审计和质量改进（包括持续质量改进）。质量评估是每种方法的基础。一般而言，临床审计由专业人员主导，而质量改进举措则由管理人员推动。质量保证方法被认为是由管理人员外部推动的，或者涉及专业检查。文中讨论了临床治理如何寻求弥合这些方法之间的差距。临床治理使英国的临床医生能够在医疗机构内领导一项全面的质量改进战略，尽管预计外部问责制将大大加强。临床治理旨在将管理、组织和临床方法结合起来以提高医疗质量。如果成功，它将为下个世纪定义一种新型的专业精神。如果专业人员未能抓住这个机会，英国临床活动可能会像其他一些国家那样受到越来越详细的外部控制。
