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Objective. This study aimed to evaluate the impact of the shared governance model application on the level of perceived professional governance among clinical nurses in a tertiary hospital in Riyadh. Background. Professional governance continues traditional governance, shared governance, and self-governance. Shared governance (SG) is the engagement of clinical nurses in decision-making at different levels. This empowers nurses, increases job satisfaction, improves clinical outcomes, and enhances patient satisfaction. Methods. This randomised control trial in which researchers distributed the Index of Professional Nursing Governance (IPNG) to a random sample of 440 nurses working in a 1200-bed tertiary hospital in Riyadh and divided into experimental and control groups. The intervention included designing and implementing a nursing shared governance model at the hospital level; professional governance was measured before and eight months after implementation. The IPNG was used to measure nurses’ perceived level of professional governance before and after the intervention. The sample was divided into experimental and control groups. Results. By comparing experimental and control groups, there was no statistically significant difference between them regarding professional governance subscales and the total IPNG scores before the intervention. At the same time, there was a considerable difference between them after the intervention. Moreover, the scores of the six professional governance subscales and the overall IPNG scores significantly increased after the intervention in the experimental group. They showed no significant difference in the control group. Conclusion. Designing and implementing specific shared governance structures and processes effectively enhanced nurses’ perceived level of shared governance at the hospital, as evidenced by significantly higher postintervention IPNG scores. Elements of the shared governance model that proved effective included engaging nurses in decision-making at various organizational levels and empowering their involvement.

Introduction Partnering with Consumers in healthcare systems is now widely accepted and mandated in many countries. Despite this acceptance, there is minimal information regarding the best practice of how to successfully establish systems to embed this practice into healthcare systems. Methods This evaluation used the RE‐AIM implementation framework to retrospectively analyse data from a 3‐year timeline to review the events relating to the transition of Consumer Partnering into a Clinical Governance Unit. Data was sourced via Phase 1 – a focus group to establish a 3‐year timeline of events, enablers and barriers, and Phase 2 – a quantitative and qualitative semi‐structured interview to review systems that had been developed to support embedding partnering with consumers into Clinical Governance. Results Five primary enablers and five barriers to successfully embedding a Consumer Partnering Team into a Clinical Governance Unit were identified. Enablers included Executive sponsorship and ownership of the value of partnering with consumers, Executive leadership influence on local area uptake, an organization‐wide network, valuing via remuneration, and a centralized orientation and onboarding programme for Consumer Partners. Barriers included skills and attitudes of committee chairs, the size of the Directorate (smaller local areas can be easier to influence change), patient feedback data requires interpretation to be useful, staff turnover can reduce the relationships with Consumer Partners, and financial insecurity is a barrier to implementation and maintenance. Conclusions This article described how an Australian Health Service embedded a Consumer Partnering Team into a Clinical Governance Unit to ensure that partnering became business as usual practice. Enablers, barriers, and unintended consequences can be used as learnings for other organizations to develop a similar approach. Patient or Public Contribution Two Consumer Partners with lived experience of the health service, and members of the organizations committee structures are part of the evaluation team. As team members, the consumers participated as equal contributors in evaluation design, analysis of the focus group and interview data, and contribution to the writing and review of the manuscript. Two Consumer Partners with lived experience of the health service, and members of the committee structures participated in the focus groups and the interviews.

Background: Since the enactment of the universal health insurance law in 2018, Egypt has undertaken major health system reforms. In 2021, the Egypt Healthcare Authority introduced a clinical governance framework to improve the quality and safety of health care services. Aim: To describe the implementation, early outcomes and lessons learned from introducing a clinical governance framework in Egypt between 2021 and 2024. Methods: We implemented the clinical governance framework in 29 hospitals and 301 family health units across 6 governorates, serving approximately 5 million beneficiaries. Activities included training and on-site technical support. Key performance indicators were monitored and analysed to assess implementation outcomes. Results: A total of 494 treatment protocols were developed across 28 medical specialties and more than 5000 physicians were trained to apply the protocols. There was an increase in the detection and timely correction of adverse events in the majority of cases. In Port Said Governorate, 82% of medication errors were detected and corrected in 2023, 84% in Ismailia Governorate and 70% in South Sinai Governorate. In 2024, the percentage of medication errors decreased by 27% in Port Said Governorate and 11% in Luxor Governorate. Hand hygiene compliance increased to 85% in 2024 from 78% in 2023, and surgical site infections decreased to 0.83 from 5 per 100 surgeries. Conclusion: Despite certain challenges the introduction of a clinical governance framework contributed to improved safety and clinical outcomes in selected facilities. Political commitment and integration within existing structures were crucial to success.

The aim of this study was to develop a valid, reliable instrument to measure the effectiveness of shared governance councils BACKGROUND: The work of shared governance, that is, the decisions, takes place in its structures, notably, the councils. A literature search yielded no formal instrument for evaluating how these councils function. A 4-phase process was used to generate valid items to measure shared governance council effectiveness, including content validity by experts, a pilot for feasibility, a larger pilot for internal consistency, and an exploratory factor analysis to delineate a final instrument. More than a dozen experts and participants from nearly 30 healthcare organizations contributed to the final development of the 25-item Council Health Survey instrument. Items for measuring council effectiveness at either the unit or division level were grouped in areas of structure, activities, and membership. When evaluating shared governance, nurses should focus on councils themselves, in which much of the work of shared governance occurs.

PurposeThis viewpoint introduces a “Readiness Self-Assessment Guide” that can be used as a diagnostic tool to help health service governors and managers, particularly in Low-Middle Income Countries, or those in the early stages of developing their governance program.Design/methodology/approachThe approach uses the conceptual framework for governance developed by Barbazza and Tello (2014).FindingsThe Guide is based on five foundational elements or components of governance that frame the actual governance activities. The self-assessment process uses a sequence of real-world examples to help users of the Guide assess their organization’s “readiness” or current capacity to strengthen quality. A simple scoring process allows users to rate their organization’s progress through potential evolutionary steps. The resulting analysis is intended to be the starting point of a structured discussion among team members about priorities, enabling factors and constraints.Practical implicationsAssessment of the institutional context is a fundamental step that will enable quality teams to select the appropriate tools for their priority concerns. This Readiness Self-Assessment Guide can be used as part of that diagnostic assessment.Originality/valueThis paper is empirically derived from the author’s experience as a consultant helping health service organizations and governing authorities to develop health governance programs in several countries.

PurposeIn this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.Design/methodology/approachOur recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.FindingsROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.Practical implicationsThis article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.Originality/valueThe article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

PurposeTo investigate the association between implementation of clinical governance and patient safety.Design/methodology/approachA pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.FindingsThere was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.Practical implicationsGiven that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.Originality/valueThe findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

In resource-constrained healthcare settings, clinical governance and risk management are critical to improving patient outcomes and efficiently using limited resources. This article describes an innovative strategy implemented at a South African district hospital led by family physicians to optimise admissions and care prioritisation. The protocol established a designated high-care unit and admissions ward, ensuring that all new admissions were seen by a family physician, allowing family physicians to focus on the sickest patients requiring immediate intervention. This structured approach improved clinical oversight, reduced medical errors, and decreased morbidity and mortality. By efficiently allocating the expertise of family physicians, the intervention demonstrated measurable improvements in care delivery and patient safety. This model highlights the leadership role of family physicians in clinical governance and presents a scalable solution for similar resource-limited healthcare settings.

This commentary article responds to the research into development of medical specialist enterprises (MSEs) in the Netherlands conducted by Ubels and van Raaij. The MSEs are a relatively new phenomenon in the Netherlands and similar conceptually to medically-led developments in other health systems. With the foundation for medical specialist organisation in place this provides several opportunities for further development. This commentary considers these opportunities, drawing from the example of New Zealand. This is because New Zealand has had considerable experience with clinically-led organisation which provides useful lessons for the MSEs. The lessons include building strong clinical governance with a focus on collaboration with other health professionals and management, working with primary care to support community service delivery, building integrated care, developing whole of system planning and service delivery approaches and population health management.