April, 2011 - SUPPORT Summary of a systematic review | print this article |

Can clinical governance improve the quality of general practice and primary care?

Clinical governance is a systematic and integrated approach to ensuring that service providers are accountable for delivering quality healthcare.

Key messages

  • The current evidence base for clinical governance is limited, and focuses mainly on process rather than outcomes
  • Most of the evidence originates from high-income countries and support governance models that use targeted, peer-led feedback on clinician practice
  • There is limited information on the impact of clinical governance on chronic disease management, care of the elderly, and mental healthcare


Clinical governance is seen as a systematic, integrated approach to ensuring safe, good quality healthcare. It is a systematic and multi-faceted approach to quality improvement using a range of locally implemented strategies, instead of single strategies. Clinical governance is delivered through a combination of strategies. These include: ensuring clinical competence, clinical audits, patient involvement, education and training, risk management, the [better?] use of information, and [improved?] staff management. A wide range of resources and guidelines are used for clinical governance in primary care. Therefore, there is a need to clarify models of clinical governance and to evaluate evidence relating to their impact on quality improvement. Clinical governance models operate on a number of different levels, including the national level, regional level, service level or multiple combinations of these.

About the systematic review underlying this summary

Review Objectives: To explore the relevance of different models of clinical governance to Australian primary healthcare, and their potential contributions on quality and safety
/ What the review authors searched for What the review authors found
Interventions Clinical governance operating at any level
19 studies exploring the outcomes of clinical governance were included
Participants Not specified

Settings In hospital settings globall In hospital setting. The location of the trial was not stated in the Systematic review.

Capability, safety, continuity, appropriateness of care, responsiveness, accessibility, safety, efficiency and effectiveness

The included studies addressed capability (16 studies); safety (4 studies); responsiveness (6); accessibility (5); efficiency (4); effectiveness (8); and sustainability (1 study)

Date of most recent search: Not mentioned
Limitations: This is a good quality systematic review with only minor limitations

Phillips CB, Pearce CM, Hall S, Travaglia J, de Lusignan S, Love T, Kljakovic M. Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence. Med J Aust. 2010 Nov 15;193(10):602-7. See in Medical Journal of Australia

Summary of findings

The review summarised 19 studies: 7 randomised controlled studies, 11 longitudinal observational studies, and 1 case study. Most of the studies were conducted in high-income countries, including the United Kingdom (UK), the United States of America (USA), Australia, New Zealand, Spain, Belgium, Holland and Germany. One study was conducted in the Philippines. The included studies addressed capability (16 studies); safety (4 studies); responsiveness (6); accessibility (5); efficiency (4); effectiveness (8); and sustainability (1 study).


Type of model

May improve

Conflicting evidence on impact

May worsen

National Level

National benchmarking with regional level development support


Accessibility, capability



National external benchmarking with no regional support


responsiveness, capability


Regional Level

Collaboration with other GPs with targeted feedback to improve practice

Capability, safety

Effectiveness, capability,


Collaboration with other GPs without targeted feedback to improve practice


Capability, accessibility,


Collaboration with community to set
clinical priorities and/or monitor services




Service Level

Practice-determined organisation of quality management, using targeted feedback to healthcare workers with supported reflection

Effectiveness, safety,
responsiveness, efficiency,


Capability, effectiveness,



National level benchmarking and incentive-setting, regional network support, and support for practice-level organisation using targeted feedback

Efficiency, capability


Effectiveness, safety


Relevance of the review for low-income countries

Findings Interpretation*
  • Only 1 out of the 19 studies included was conducted in a low-income setting. The rest were conducted in high-income countries using different strategies and models of clinical governance  
  • There is limited evidence on the impact of clinical governance from low- and middle-income countries. The findings of the review may not be applicable in such settings


  • There was no information in the included studies on the differential effects of the interventions in resource-limited settings


  • The degree to which clinical governnance strategies are effective will determine the extent to which they are able to improve the quality of care in general practice and primary healthcare settings and reduce inequities in access to quality care, especially in resource-constrained settings
  • The review provided insufficient data to determine the cost of the different models and strategies of clinical governance
  • There is a need for research to identify the most cost-effective strategies used in models of clinical governance
  • There is little or no evidence on the impact of clinical governance on quality of care in low- and middle-income countries


  • There is a need for studies of strategies and models of clinical governance in low- and middle-income settings. There is also a need for the careful monitoring of strategies of clinical governance on quality of care in such settings

*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low- and middle-income countries. For additional details about how these judgements were made see: http://supportsummaries.org/support-summaries/how-support-summaries-are-prepared/

Additional information

Related literature

Tait AR. Clinical governance in primary care: a literature review. Journal of Clinical Nursing 2004; 13:723-30. 

This summary was prepared by

Charles I. Okwundu, South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa

Conflict of interest

None. For details, see: Conflicts of interest


This summary has been peer reviewed by: Christine Phillips, Australia; Nyokabi Musila, Kenya

 This summary should be cited as

Okwundu CI. Can clinical governance improve the quality of general practice and primary care? A SUPPORT Summary of a systematic review. April 2011.