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Clinical Governance.
  1. R Baker
  1. University of Leicester, Department of General Practice and Primary Health Care, Leicester General Hospital, UK;

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    John Wright and Peter Hill. (Pp 219; £19.99.) Churchill Livingstone, 2003. ISBN 0-443-07126-8.

    Clinical governance first arrived in the NHS in 1999, and it would be reasonable to say that initially there was some uncertainty about what it was, although general agreement that it would take some years before it was fully operational. Four years later, reflection is called for on what clinical governance has become, and what it is achieving. In publishing their overview of clinical governance, John Wright and Peter Hill have provided a helpful resource for reflection that will assist the maturation of clinical governance into the all-embracing and reliably effective quality system that health care requires.

    The book is intended for medical students, junior doctors, and also senior doctors who are seeking an outline of the methods and some ideas on worthwhile activities. After a description of the principles underlying clinical governance and discussion of the core values in medicine, there are eight chapters dealing with different components, including evidence based practice, lifelong learning, reducing errors, clinical guidelines, audit and changing practice, communication and complaints, outcomes and monitoring performance, team work, and working in a managed health service. Clinical governance, then, clearly covers a vast agenda.

    This is not an edited, multiauthor publication, and consequently the book presents a coherent picture of clinical governance, and has a consistent style. Each chapter includes several examples that both enliven the text and highlight key messages. There are also numerous figures and tables that ensure that every facet is covered somewhere, and consequently the book offers the novice comprehensive guidance in a digestible format. The book will not, nor is intended to, provide the in-depth analysis that a practitioner already familiar with, or with responsibility for leading, clinical governance would require. It is also firmly intended for doctors, and other health professionals should seek alternative publications.

    The authors are to be commended for discussing core values in medicine early in the book and showing them to be the foundation for much that is involved in clinical governance. Of course, some values are open to debate, as the authors make clear in their discussion of rationing. However, although both sides of the argument should be presented, the tone sometimes became rather negative, as in the initial mention of appraisal in the first chapter that rather undermines the more detailed discussion later in the book, or in the chapter dealing with performance monitoring.

    Finally, what insight does the book give into the progress of clinical governance? Much appears to have happened—structures have been set up in all NHS organisations, a wide variety of activities to improve quality and reduce error is underway, various national agencies have been created, and an image is beginning to emerge of the big idea that underpins them all. Clinical governance is both a system to improve quality and a strategy to change the way the NHS behaves towards the people who use it.