title: Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance.
abstract: OBJECTIVE
  To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care.
  
  
  METHODS
  Qualitative case studies using semi-structured interviews and documentation review.
  
  
  METHODS
  Twelve purposively sampled PCG/Ts in England.
  
  
  METHODS
  Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members.
  
  
  METHODS
  Participants' perceptions of the role of clinical governance in PCG/Ts.
  
  
  RESULTS
  PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment).
  
  
  CONCLUSIONS
  PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance.
authors.affiliation: National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, UK. stephen.campbell@man.ac.uk
authors.forename: S M
authors.initials: SM
authors.lastname: Campbell
authors.forename: R
authors.initials: R
authors.lastname: Sheaff
authors.forename: B
authors.initials: B
authors.lastname: Sibbald
authors.forename: M N
authors.initials: MN
authors.lastname: Marshall
authors.forename: S
authors.initials: S
authors.lastname: Pickard
authors.forename: L
authors.initials: L
authors.lastname: Gask
authors.forename: S
authors.initials: S
authors.lastname: Halliwell
authors.forename: A
authors.initials: A
authors.lastname: Rogers
authors.forename: M O
authors.initials: MO
authors.lastname: Roland
mesh_terms: D001291:Attitude of Health Personnel; D004739:England; D006123:Group Practice / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008485:Medical Audit / Q000458:organization & administration*; D015279:Organizational Culture; D009936:Organizational Innovation; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013222:State Medicine / Q000592:standards; D018511:Systems Integration