The impact of CHI: evidence from Wales

Degeling, P., Maxwell, S., Kennedy, J., Coyle, B. and MacBeth, F. (2003) The impact of CHI: evidence from Wales. Quality in Primary Care, 11 (2), 147-154.

Abstract

The Commission for Health Improvement (CHI) recently published an overview of 175 clinical governance reviews that suggests that it is having little impact on the NHS. This paper overviews the content and context of CHI's message to trusts in an attempt to shed some light on why this may be so. Content is examined through an overview of policy documents. We deduce that CHI's message is strong on the individual elements of clinical governance but lacks a framework to integrate these elements where it matters most, the individual clinical unit. Context is examined using survey and focus group data from six Welsh trusts in 2000. The data indicate that the various professional groups in Welsh trusts have very different experience with, understandings of, and evaluations of, clinical governance. Further, each professional group's evaluation is influenced by its professional culture and stances on key issues of the modernisation agenda. The paper argues that, to be more effective, CHI needs to increase its awareness of how staff perceive and evaluate clinical governance and be clearer about the specific changes in practices and cultures it is seeking to promote.

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