Clinical governance and the learning organization.
OBJECTIVE
This paper compares and contrasts clinical governance and organizational learning.


BACKGROUND
Clinical governance represents one of the most significant policy developments in recent years. It places on all health care delivery organizations a statutory duty to develop the systems, standards and processes necessary to improve health care quality and manage risk. At the same time, many health care organizations are seeking new ways in which learning can be retained and deployed more widely within the organization (organizational learning).


RESULTS
Both approaches emphasize cultural changes as essential underpinnings to quality improvement. However, the two approaches also differ fundamentally in their logic of action. Clinical governance is essentially 'top down', being built around formal standards, established procedures, and regular monitoring and reporting. In contrast, organizational learning emphasizes 'bottom up' changes in values, beliefs and motivations in such a way that learning and change are prioritized. The challenge for managers and practitioners lies in seeking a creative tension between these two contrasting styles of organizational change.
Wilkinson
Joyce E
JE
Centre for Public Policy and Management, University of St Andrews, St Andrews, UK. jew5@st-and.ac.uk
Rushmer
Rosemary K
RK
Davies
Huw T O
HT
D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007858:Learning; D009042:Motivation; D015279:Organizational Culture; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010686:Philosophy, Medical; D011588:Psychology, Educational; D012308:Risk Management / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration; D013597:Systems Analysis; D017749:Total Quality Management / Q000458:organization & administration*; D006113:United Kingdom