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What is clinical governance? 

All aged care organisations have a commitment to provide safe, quality care that protects and promotes the person-centred health and wellbeing of their care recipients. [1] Clinical governance describes the approach an organisation takes to ensure good clinical outcomes. [2] Positive leadership ensures that relationships and responsibilities are established between the organisation’s key stakeholders including the governing body (which may include a board of directors), executives, clinicians, care workers, care recipients and their families. [1, 3] High-quality, safe clinical and care outcomes are supported by the policies, procedures, and ongoing monitoring and improvement mechanisms that the organisation must implement to achieve its clinical care goals. [4]  

The Australian Aged Care Quality and Safety Commission (ACQSC) describes the role of clinical governance to be ‘to provide safe, quality clinical care as part of a holistic approach to aged care that is based on the needs, goals and preferences of consumers.’ [1 p3] The ACQSC suggests six core elements that form the pillars of good clinical governance which can be mapped against the Aged Care Quality Standards. [5] These elements are: 

  • Leadership and culture 
  • Consumer partnerships 
  • Organisational systems 
  • Monitoring and reporting 
  • Effective workforce  
  • Communication and relationships. [1, 6]  

The role and significance of each of these elements are covered in detail in our clinical governance themes.

The role and significance of clinical governance in aged care 

The role of clinical governance in aged care is to assure that all clinical aspects of care for older people are holistic and person-centred, recognising individuality and context. [7, 8] Good clinical governance supports regulatory responsibilities and duty of care to provide organisations with a structure that achieves minimum care standards. [9] All stakeholders, including older people, should therefore be involved in the planning, development, and assessment of care, to design a functioning framework that accommodates the needs of care recipients and the organisation. This process should consider that ‘a safe experience may not be a person-centred one and a good experience might not be a safe one.’ [8, p10]

A clinical governance framework is now a regulatory requirement for all aged care organisations (Outcome 5.1 of the Revised Aged Care Quality Standards). [10] It is the governing body’s responsibility to develop this single overarching framework, [10, 11] which reflects the aged care service as well as the specific characteristics and needs of the population it serves. [1, 12] There is no ‘one size fits all’ approach to clinical governance for aged care providers [2, 13] and clinical governance frameworks should be personalised to fit the organisation. [14] 

The organisation’s clinical governance framework should be comprehensive to cover all relevant areas of oversight and flexible to be inclusive of all people receiving care, including those with different needs, physical or cognitive abilities, and levels of social connectedness. [15] Such frameworks should bring together clinical governance systems and relevant activities already delivered across the organisation. [12] The framework document might describe all roles across the organisation that provide care and their associated responsibilities while mapping the relationships between these roles alongside lines of accountability within the organisational structure. [4, 5] It will also address core elements of clinical governance set forward by the ACQSC. [16] 

The effective development and delivery of clinical governance frameworks in aged care have not been widely researched and reported, however, an integrated approach to clinical governance is needed. [2] In developing the clinical governance framework, the governing body should recognise the importance of: 

  • Setting a clear vision with a strategic direction, incorporating strong leadership and culture that delivers safe, quality, and consistent care 
  • Leading the organisational culture to be visibly engaging and accessible to the workforce to support communication and relationships 
  • Acknowledging that leaders can include frontline workers and care recipients at all levels 
  • Ensuring organisational culture is open and transparent by communicating the organisation’s core goals and values to build consumer partnerships  
  • Ensuring implementation of robust organisational systems to effectively support and empower the workforce and visiting practitioners, to provide safe, quality clinical care 
  • Understanding key clinical risks for the organisation and ensuring that controls and mitigation strategies are in place by implementing and following clear monitoring and reporting standards 
  • Ensuring that all controls and mitigation strategies are reviewed regularly to ensure they remain effective 
  • Continuous improvement of any part of the clinical governance framework, suggested by any of the organisation’s stakeholders. [2, 4] 

Clinical governance provides a framework that supports aged care providers to meet regulated standards of care.  [2] From this framework, the organisation develops and implements the policies, processes, procedures, and systems it needs to drive the delivery of high-quality, safe care in line with regulatory requirements. These should cover:

  • clinical risk areas, e.g., infection control [1, 3, 17]  
  • clinical practice, e.g., assessment and planning [1]  
  • medication management, e.g., antimicrobial stewardship [3, 17]  
  • effective delivery and continuity of clinical care, e.g., risk management and record keeping [1]  
  • data governance [18]  
  • the rapid implementation of assessment tools. [19] 

A framework offers an integrated system to manage the safety and quality of clinical care, to define clear roles, responsibilities, and accountability, [13] and to facilitate regulatory compliance to the Aged Care Quality Standards, [20] Code of Conduct for Aged Care, [21] funding arrangement compliances, and accreditation standards. [3] 

Good clinical governance supports the workforce and visiting practitioners to provide safe and quality clinical care. A well-defined clinical governance framework provides clear guidelines to support care providers to deliver care in a way that meets the organisation’s duty of care responsibilities, relevant professional standards, regulations, and guidelines. [1, 14] In turn, the governing body’s responsibility extends to ensuring the highest level of care is provided by all staff working in the organisation, including visiting health practitioners who deliver clinical care to the organisation. [2] The whole workforce needs to be adequately qualified and have sufficient skills to undertake their clinical roles. They also need to be adequately supported to feel safe to speak out when they have concerns. [2] Everyone in the organisation must ‘own’ the goals and values of the organisation and strive towards the common practice of safe, clinical care. [2]  

The clinical governance framework should define what the organisation means by ‘quality care’ to ensure everyone, including care recipients, understands the goals of care.  It might also explain how clinical governance supports staff to deliver care that meets the threshold of ‘quality’. This may help to reframe compliance requirements in terms of positive outcomes for care recipients and support and protection for staff, rather than ‘extra work’ with no rewards and recognition.  [24] Where this works well, staff often demonstrate a commitment to partnering with care recipients in the ongoing assessment, planning, and delivery of person-centred care and the regular evaluation of performance to identify areas for improvement. [14] 

Finally, an important role of organisational governance is to have mechanisms in place to identify and mitigate risks to care recipients, family carers, and the workforce. [25] People in aged care can have complex needs and, as such, are vulnerable to harm. Being aware of their individual needs and managing any associated risks (e.g., harm due to a fall, physical restraint, or unplanned weight loss) is a core purpose of clinical governance. [23] 

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  1. Aged Care Quality and Safety Commission. Fact sheet 1: Introduction to clinical governance. Canberra, ACT: ACQSC; 2019 [cited 2023 Apr 14]. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/Fact_sheet_1_Introduction_to_clinical_governance.pdf  
  2. Tan M. Clinical governance in changing times: Balancing risk, regulation and duty of care in aged care. Australian Health Law Bulletin. 2020 Nov 1;28(9):150-155.  
  3. Flannigan AC. Governance in practice: Corporate and clinical governance update for health and aged care providers. Governance Directions. 2018 Jul 13;70(5):235-241.  
  4. Aged Care Quality and Safety Commission. Fact sheet 4: Roles and responsibilities for clinical governance. Canberra, ACT: ACQSC; 2019 [cited 2023 Apr 14]. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/Fact_sheet_4_Roles_and_responsibilities_for_clinical_governance.pdf  
  5. Tan M. Aged care regulation through the looking glass of clinical governance: A framework for aged care providers. Australian Health Law Bulletin. 2022 Jul 1;30(5/6):116-126.  
  6. Aged Care Quality and Safety Commission. Quality and safety in home services – 5 key areas of risk. Guidance for governing bodies of home service providers. Canberra, ACT: ACQSC; 2022 [cited 2023 Apr 20]. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/quality-and-safety-in-home-services-5-key-areas_0.pdf  
  7. Meaningful Ageing Australia. Clinical governance as a support for spiritual health. Australia: Meaningful Ageing Australia; 2021 [cited 2023 Apr 20]. Available from: https://meaningfulageing.org.au/clinical-governance-as-a-support-for-spiritual-health  
  8. Tan M. Clinical governance and the serious incident response scheme in home and community aged care. Australian Health Law Bulletin. 2023 Feb 1;31(1):10-15.  
  9. Miller AC. Clinical governance in residential aged care facilities. Australian Medicine. 2019 Aug 5;31(14):16-17.  
  10. Department of Health and Aged Care (Australia). Revised Aged Care Quality Standards: Draft for Pilot [Internet]. Canberra, ACT: Department of Health and Aged Care; 2023 [cited 2023 Jun 6]. Available from: https://www.health.gov.au/sites/default/files/2023-05/strengthened-aged-care-quality-standards-pilot-program.pdf 
  11. Aged Care Quality and Safety Commission. Fact sheet 2: Clinical governance and the Aged Care Quality Standards [Internet]. Canberra, ACT: ACQSC; 2019 [cited 2023 Apr 14]. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/Fact_sheet_2_Clinical_governance_and_the_Aged_Care_Quality_Standards.pdf  
  12. Aged Care Quality and Safety Commission. Toolkit: Developing and implementing a clinical governance framework. Canberra, ACT: ACQSC; 2019. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/Developing_and_implementing_a_clinical_governance_framework.pdf  
  13. Australian Institute of Company Directors. Clinical governance for boards in the aged care sector [Internet]. Australia: AICD; 2021 [cited 2023 Apr 20]. Available from: https://www.aicd.com.au/corporate-governance-sectors/clinical/best-practice/clinical-governance-for-boards-in-the-aged-care-sector.html
  14. Riverview Lutheran Rest Home Inc. Clinical governance framework. Australia: Riverview Lutheran Rest Home; 2020 [cited 2023 Apr 20]. Available from: http://www.riverviewresthome.com.au/application/files/2215/8071/1875/Clinical_Governance_Framework.pdf
  15. Australian Institute of Company Directors. Board governance in the aged care sector [Internet]. Australia: AICD; 2020 [cited 2023 Apr 20]. Available from: https://www.aicd.com.au/regulatory-compliance/royal-commission-updates/aged-care/board-governance-in-the-aged-care-sector.html
  16. Aged Care Quality and Safety Commission. Fact sheet 3: Core elements of clinical governance [Internet]. Canberra, ACT: ACQSC; 2019 [cited 2023 Apr 14]. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/Fact_sheet_3_Core_elements_of_clinical_governance.pdf
  17. Shaban RZ, Sotomayor-Castillo C, Macbeth D, Russo PL, Mitchell BG. Scope of practice and educational needs of infection prevention and control professionals in Australian residential aged care facilities. Infect Dis Health. 2020 Jun 11;25(4):286-293.  
  18. Wieland-Jorna Y, Verheij RA, Francke AL, Tomassen M, Houtzager M, Joling KJ, et al. Setting up a governance framework for secondary use of routine health data in nursing homes: Development study using qualitative interviews. J Med Internet Res. 2023;25:e38929.  
  19. Martin A, Boyle N, Cooke J, Kennelly SP, Martin R, Mulroy M, et al. Responding to needs of residents in long term care in Ireland. Ir Med J. 2020;113(9):1-7.  
  20. Aged Care Quality and Safety Commission. Quality Standards. Canberra, ACT: ACQSC; 2022 [cited 2023 Apr 14]. Available from: https://www.agedcarequality.gov.au/providers/standards
  21. Aged Care Quality and Safety Commission. Code of Conduct for Aged Care: Guidance for aged care workers and governing bodies. Canberra, ACT: ACQSC; 2022. Available from: https://www.agedcarequality.gov.au/sites/default/files/media/code-of-conduct-for-aged-care-worker-guidance.pdf
  22. McDonald A, Frazer K, Warters A. Irish public health nursing services and home support services: Governance of older persons' home care. Public Health Nurs. 2022;39(1):96-102.  
  23. AgeWorks. Clinical governance in aged care [Internet]. Camberwell, Vic: AgeWorks; 2023 [cited 2023 Apr 22]. Available from: https://ageworks.com.au/clinical-governance-in-aged-care/#:~:text
  24. Balding C. Cathy Balding Qualityworks [Internet]. Melbourne, Vic: Qualityworks; 2018 [cited 2023 Apr 14]. Available from: www.cathybalding.com.au
  25. Anglicare South Queensland. Clinical and care governance framework. QLD: Anglicare; 2021. Available from: https://anglicaresq.org.au/wp-content/uploads/2021/11/GRA0118-Clinical-Care-Governance-Framework-A4-Brochure-2021-v05.pdf
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Selected resources

Information Sheet
Fact sheet 1: Introduction to clinical governance

The first in a series of Aged Care Quality and Safety Commission information sheets about clinical governance in aged care. This fact sheet introduces core concepts about clinical governance that aged care providers need to apply to their own services.

Clinical governance
 Updated 11 Apr 2023
Information Sheet
Fact sheet 2: Clinical governance and the Aged Care Quality Standards

The second in a series of Aged Care Quality and Safety Commission information sheets that describes the links between clinical governance and the Aged Care Quality Standards. This fact sheet discusses the quality assessment and compliance monitoring processes as they relate to clinical governance and clinical quality and safety.

Clinical governance
 Updated 11 Apr 2023
Information Sheet
Fact sheet 3: Core elements of clinical governance

The third in a series of Aged Care Quality and Safety Commission information sheets about clinical governance in aged care that aim to help aged care providers meet their responsibilities for ensuring the quality and safety of clinical care. This fact sheet describes the six core elements of clinical governance where action is needed.

Clinical governance
 Updated 11 Apr 2023
Information Sheet
Fact sheet 4: Roles and responsibilities for clinical governance

The fourth and last in a series of Aged Care Quality and Safety Commission information sheets about clinical governance in aged care. This fact sheet describes the main roles and responsibilities for clinical governance for different people working in an aged care service.

Clinical governance
 Updated 11 Apr 2023