title: Is medical perspective on clinical governance practices associated with clinical units' performance and mortality? A cross-sectional study through a record-linkage procedure.
abstract: OBJECTIVE
  Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units' performance measured through mortality rates and efficiency indicators.
  
  
  METHODS
  This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors' knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units' performance indicators which include patients' mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators.
  
  
  RESULTS
  The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units' efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units' mortality rates (odds ratio, -8.677; 95% confidence interval, -16.654, -0.700).
  
  
  CONCLUSIONS
  The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.
authors: Department of Psychology, University of Bologna, Bologna, Italy.
authors: Guido
authors: G
authors: Sarchielli
authors: Department of Psychology, University of Bologna, Bologna, Italy.
authors: Giovanni
authors: G
authors: De Plato
authors: University Hospital St. Orsola-Malpighi Polyclinic, Bologna, Italy.
authors: Mario
authors: M
authors: Cavalli
authors: University Hospital St. Orsola-Malpighi Polyclinic, Bologna, Italy.
authors: Stefano
authors: S
authors: Albertini
authors: University Hospital St. Orsola-Malpighi Polyclinic, Bologna, Italy.
authors: Ilaria
authors: I
authors: Nonni
authors: Local Health Authority (AUSL), Ravenna, Italy.
authors: Lucia
authors: L
authors: Bencivenni
authors: University Hospital St. Orsola-Malpighi Polyclinic, Bologna, Italy.
authors: Arianna
authors: A
authors: Montali
authors: University Hospital of Parma, Parma, Italy.
authors: Antonio
authors: A
authors: Ventura
authors: University Hospital St. Orsola-Malpighi Polyclinic, Bologna, Italy.
authors: Francesca
authors: F
authors: Montali
keywords: Clinical governance; attitude of medical staff; efficiency; mortality; survey