Freeman T, Walshe K
Health Services Management Centre, University of Birmingham, Birmingham B15 2RT, UK.
Qual Saf Health Care. 2004 Oct;13(5):335-43. doi: 10.1136/qhc.13.5.335.
A national cross sectional study was undertaken to explore the perceptions concerning the importance of, and progress in, aspects of clinical governance among board level and directorate managers in English acute, ambulance, and mental health/learning disabilities (MH/LD) trusts.
A stratified sample of acute, ambulance, and mental health/learning disabilities trusts in England (n = 100), from each of which up to 10 board level and 10 directorate level managers were randomly sampled.
Fieldwork was undertaken between April and July 2002 using the Organisational Progress in Clinical Governance (OPCG) schedule to explore managers' perceptions of the importance of, and organisational achievement in, 54 clinical governance competency items in five aggregated domains: improving quality; managing risks; improving staff performance; corporate accountability; and leadership and collaboration. The difference between ratings of importance and achievement was termed a shortfall.
Of 1916 individuals surveyed, 1177 (61.4%) responded. The competency items considered most important and recording highest perceived achievement related to corporate accountability structures and clinical risks. The highest shortfalls between perceived importance and perceived achievement were reported in joint working across local health communities, feedback of performance data, and user involvement. When aggregated into domains, greatest achievement was perceived in the assurance related areas of corporate accountability and risk management, with considerably less perceived achievement and consequently higher shortfalls in quality improvement and leadership and collaboration. Directorate level managers' perceptions of achievement were found to be significantly lower than those of their board level colleagues on all domains other than improving performance. No differences were found in perceptions of achievement between different types of trusts, or between trusts at different stages in the Commission for Health Improvement (CHI) review cycle.
While structures and systems for clinical governance seem well established, there is more perceived progress in areas concerned with quality assurance than quality improvement. This study raises some uncomfortable questions about the impact of CHI review visits.
开展了一项全国性横断面研究，以探究英国急症、救护及精神健康/学习障碍（MH/LD）信托机构中董事会层面和部门经理对临床治理各方面重要性及进展情况的看法。
从英国的急症、救护及精神健康/学习障碍信托机构中抽取了一个分层样本（n = 100），每个信托机构随机抽取多达10名董事会层面和10名部门层面的经理。
2002年4月至7月进行了实地调查，使用临床治理组织进展（OPCG）调查表来探究经理们对五个汇总领域中54项临床治理能力项目的重要性及组织成就的看法，这五个领域分别是：提高质量；管理风险；提高员工绩效；企业问责；领导与协作。重要性评级与成就评级之间的差异被称为差距。
在接受调查的1916人中，1177人（61.4%）做出了回应。被认为最重要且感知成就最高的能力项目与企业问责结构和临床风险有关。在跨地方卫生社区的联合工作、绩效数据反馈以及用户参与方面，报告的感知重要性与感知成就之间的差距最大。汇总到各个领域时，在企业问责和风险管理等与保证相关的领域中感知成就最大，而在质量改进以及领导与协作方面，感知成就明显较少，因此差距更大。除了提高绩效领域外，部门层面经理对成就的看法在所有其他领域均显著低于其董事会层面的同事。在不同类型的信托机构之间，或在健康改善委员会（CHI）审查周期不同阶段的信托机构之间，在成就看法上未发现差异。
虽然临床治理的结构和系统似乎已确立，但在与质量保证相关的领域中，人们感知到的进展比质量改进方面更多。这项研究对CHI审查访问的影响提出了一些令人不安的问题。
