Primary health care clinical governance – “who are the leaders?” — YRD
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Primary health care clinical governance – “who are the leaders?” (453)

Ru Karen Kwedza 1 , Sarah Larkins 2 , Nicholas Zwar 3 , Julie Johnson 4
  1. Australian Institute of Health Innovation , University of New South Wales, Sydney , NSW , Australia
  2. School of Medicine and Dentistry, James Cook University , Townsville , QLD , Australia
  3. School of Public Health and Community Medicine, University of New South Wales , Sydney , NSW , Australia
  4. Centre for Clinical Governance Research, University of New South Wales , Sydney , NSW , Australia

Introduction

Clinical governance is widely accepted as a framework and system to improve quality and safety, and leadership is a recognized key enabler. While the term has been adopted in Australia, most strategies to optimize clinical governance were operating before the introduction of the term. This study explores clinical governance in rural and remote primary health care (PHC) in north Queensland, Australia, including the identification of leaders.

Method

Semi-structured interviews were conducted in four study sites and in two overarching regional clinical governance committees. Interviews aimed to understand the articulation and implementation of clinical governance. Each interview lasted between 30 and 60 minutes and were transcribed verbatim. Content and thematic analysis were conducted with the support of NVIVO10.

Results

Over 50 interviews were conducted with staff from multiple disciplines. Key findings on leadership included impact of reforms, the views that leadership responsibility increased with hierarchy and that leadership and management responsibility were synonymous, discipline specific delivery, shared responsibility and the absence of leaders. In addition, in multi-organizational settings the concept of leadership became more complex.

Conclusion

Key areas to develop and strengthen leadership in clinical governance are:

· Identifying and recognizing formal and informal leaders

· Reviewing resource and development needs of leaders

· Articulating leadership at all levels of the organization.

The results of this study contribute to clinical governance development in complex PHC settings by exploring the impression of leadership in supporting organizational change to improve quality and safety.