Clinical governance in primary care. Second edition
International Journal of Integrated Care, 19 January 2005 - ISSN 1568-4156
Book review
Clinical governance in primary care. Second edition
Edited by Tim van Zwanenberg and Jamie Harrison
Radcliffe Medical Press, 2004, pp 253,
ISBN 1 85775 8617
Han van Oosterbos, former CEO of the Almere Health Care Organisation, The Netherlands

Although the Dutch health-system and probably most health-systems in the world differ widely from the National Health Service (NHS) in England, clinical governance as stated in the book is “everybody's business”. The editors have succeeded in making this book useful for everyone who's involved in primary care (clinician, manager and policymaker) and who's interested in developing the quality of their own professional actions as well of improving the quality of the primary care team and primary care system they are part of, regardless of the particular national health-system they are functioning within.

Clinical governance as viewed by the authors is seen as a comprehensive approach rather than an addition sum of methods and measures. Clinical governance is seen as the means whereby the issues of quality in primary care can be addressed. Starting point: the clinician and his relation with his patients.

The book is divided into three parts. The first part (Chapter 1–4) outlines the conceptual and political origins of clinical governance in England. The second part (Chapter 5–17) describes a range of processes that support the development of clinical governance. The third part (Chapter 18–20) cast a glance at the future of professionalism against the background of increasing expectation.

What is making this book so readable, especially for health professionals and managers, are the many examples of clinical governance in action at practice level. Each chapter also contains a lot of practical information: guidelines, methods, indicators, useful websites, and practical points.

From the start of the book it becomes clear that the importance of clinical governance in primary care cannot be underestimated. First of all from the patient's point of view but also from the increasingly pivotal position of primary care in the NHS. However, with the recognition of the influence of primary care comes the responsibility of primary care practitioners and managers to constantly improve the quality of their work and be accountable for it.

As for the responsibility and accountability, 12 components of clinical governance are laid out in the second part of the book. The components are divided into 4 domains: patient's point of view, clinical effectiveness, risk manangent, personal and professional development. The authors stress that the significant point is that each of the components on its own will not suffice but that they need to be linked into ‘a systematic joining up of activities to improve quality’ and in doing so develop the organisation as a whole.

Success will depend upon the interaction between each level of primary care: individual, practice, team and primary care organisation.

What appealed to me is the attention to the human factor in relation to the described processes. Part and condition of this process is the individual practitioner and individual manager. The role and development of professionalism, teamwork and leadership as stated in the book in relation to the principal aim of clinical governance—the improvement of the quality of care—cannot be enough emphasised.

The book ends with an exploration of the future, of the necessary evolvements in the education of the generation of health professionals to come and the development in professionalism in relation to the ‘bargain’ between practitioner and patient.

In conclusion and referring to the pivotal position of primary health care—not only in the UK but almost everywhere in the world—this book is of high value to all who are daily struggling to improve the quality of their own work as part of a primary health organisation. This book offers the opportunity—having high regard to the role of all who are involved in primary care—to improve their actions and to celebrate success.

Though the book focuses on primary care it is also of importance for all those who daily strive to a greater integration of their care provision. In the first place because the writers explicitly approach primary care as coherent and coordinated system in order to fulfil the need of the their patients and not as a playing field of individual professionals.

In the second place the whole book expires that to achieve a better quality in the care of the patient, a comprehensive and integrated approach is necessary. What is more important is that working towards clinical government as seen by the writers in my opinion in the end will automatically lead to a more integrated care system.

The authors artistically compare clinical governance with a stained glass window, set into place, all the different coloured panes of glass form a coherent whole, while the message of the whole can change with the light and the place of the observer. From my point of view I would rate this book in the category of the stained glass windows of mediaeval cathedrals: warm, deep colours and craftsmanship.