Applying and developing health service theory: an empirical study into clinical governance

Purpose – This paper aims to examine an organisation's enactment of clinical governance through applying and advancing a theoretical model. Design/methodology/approach – The research site was a large organisation within an autonomous jurisdiction. The study focused on one organisational division. There were nine interviews and 15 focus groups (118 participants). Ethnographic observations totalled 60.5 hours. Document analysis was conducted with organisational reports and website. Data were examined against the model's four attributes and 24 elements, and used to conduct an organisational culture analysis. Findings – Analysis showed that a majority of elements, 17 of 24, were strongly identifiable. The remainder were identifiable but not strongly so. Analysis suggested two additions to the model: the inclusion of two elements to an existing attribute and a new attribute and defining elements. This showed that the organisation was working towards, but not yet having achieved, a positive quality and safety culture. In particular, a schism in understanding between managers and frontline staff was noted. Research limitations/implications – The study empirically applied and refined a health service theory. The new model, the “clinical governance practice model”, can be broadly applied, and can continue to be developed to expand the evidence base for the field. Practical implications – Substantively, the study accounts for differences in managerial and frontline staff actions in applying clinical governance. Investigations to understand and identify strategies to bridge the differences are required. Originality/value – The study is an original application and refinement of a health service theory. The study identifies that the interpretation of clinical governance, whilst different in different places, gives rise to similar disagreements.