What we did
We carried out a narrative review to understand the role and importance of clinical governance for aged care organisations and to identify facilitators and barriers to its implementation in aged care settings. Our approach to finding relevant information that might help in this research objective was twofold. We first identified relevant international literature indexed within databases. For this, we developed and tested a broad search strategy in Ovid Medline and then translated it for seven additional databases, including several business databases. These comprehensive searches were restricted to literature in English published between 2013 and 2023. We then used Google Advanced web searches to find information on clinical governance in aged care from 2019 onwards. These searches were restricted to countries whose aged care systems were comparable to the Australian system.
Eligible articles described clinical governance in the aged care context, either separate from or as part of corporate governance. Relevant resources found through Google web searches were saved in a folder as PDF files while database search results were uploaded to the Covidence systematic review management system where two reviewers checked them against the eligibility criteria. For each included article, reviewers extracted all information relevant to the review questions.
The review team then analysed the extracted information to identify the predominant issues discussed across the full set of resources. These issues were then constructed into ‘themes’ reflecting the way aged care clinical governance is conceptualised and discussed by aged care researchers and commentators.
What we found
Database searches retrieved 1,100 articles, of which 15 were relevant to clinical governance in the context of aged care. Google Advanced web searches identified an additional 25 resources providing relevant information. Most of these were in the form of organisational reports, clinical governance frameworks and guidance documents for establishing strong clinical governance in aged care settings.
After identifying the key topics of interest across the full research set, we determined that these topics were fully encompassed within the six core elements of clinical governance set out by the Aged Care Quality and Safety Commission (ACQSC). We, therefore, used the following elements as a framework for constructing our ‘themes’:
- Leadership and culture
- Consumer partnerships
- Organisational systems
- Monitoring and reporting
- Effective workforce
- Communication and relationships
To help put this into context we have also created a theme on the role and significance of clinical governance in aged care.
The resources on which we drew the content for these themes focus on what effective clinical governance should entail and what it might achieve within an aged care organisation. Few resources, including published research studies, link specific clinical governance models or their elements to actual quality and safety outcomes for care recipients. Most resources describe what good clinical governance looks like and what is needed to achieve it with some practical advice on how it might be implemented and operationalised. Few resources report empirical data on the factors known to facilitate or impede the process. Our themes, therefore, summarise what aged care regulatory bodies such as ACQSC and sector stakeholders consider the aspirations of clinical governance, describing how each of its core elements contributes to overall success.
Conclusion
We found a limited number of resources on clinical governance in the aged care context. Over time, as regulatory requirements to strengthen clinical governance become an entrenched part of organisational activities, we expect the evidence base for clinical governance models and their associated outcomes to develop. This evidence is needed to guide the sector on best practices in establishing effective clinical care oversight systems and processes.