title: Rethinking clinical governance: healthcare professionals' views: a Delphi study.
abstract: Although the guiding principle of clinical governance states that healthcare professionals are the leading contributors to quality and safety in healthcare, little is known about what healthcare professionals perceive as important for clinical governance. The aim of this study is to clarify this by exploring healthcare professionals' views on clinical governance.
  
  
  
  Based on a literature search, a list of 99 elements related to clinical governance was constructed. This list was refined, extended and restricted during a three-round Delphi study.
  
  
  
  The panel of experts was formed of 24 healthcare professionals from an academic hospital that is seen as a leader in terms of its clinical governance expertise in the Netherlands.
  
  
  
  Rated importance of each element on a four-point scale.
  
  
  
  The 50 elements that the panel perceived as most important related to adopting a bottom-up approach to clinical governance, ownership, teamwork, learning from mistakes and feedback. The panel did not reach a consensus concerning elements that referred to patient involvement. Elements that referred to a managerial approach to clinical governance and standardisation of work were rejected by the panel.
  
  
  
  In the views of the panel of experts, clinical governance is a practice-based, value-driven approach that has the goal of delivering the highest possible quality care and ensuring the safety of patients. Bottom-up approaches and effective teamwork are seen as crucial for high quality and safe healthcare. Striving for high quality and safe healthcare is underpinned by continuous learning, shared responsibility and good relationships and collaboration between healthcare professionals, managers and patients.
authors.affiliation: Centre of Expertise on Quality and Safety, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Gepke L
authors.initials: GL
authors.lastname: Veenstra
authors.affiliation: Centre of Expertise on Quality and Safety, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Faculty of Economics and Business, Department Operations, University of Groningen, Groningen, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Ahaus
authors.affiliation: Centre of Expertise on Quality and Safety, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Gera A
authors.initials: GA
authors.lastname: Welker
authors.affiliation: Centre of Expertise on Quality and Safety, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.|Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Heineman
authors.affiliation: Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: van der Laan
authors.affiliation: Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Friso L H
authors.initials: FL
authors.lastname: Muntinghe
mesh_terms: D001291:Attitude of Health Personnel; D054976:Clinical Governance; D003299:Cooperative Behavior; D003697:Delphi Technique; D006075:Governing Board; D006291:Health Policy; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011787:Quality of Health Care / Q000592:standards*
keywords: Delphi-method; Healthcare professionals; QUALITATIVE RESEARCH