S16 Australian Health Review April 2007 Vol 31 Suppl 1 System Observations Aust Health Rev ISSN: 0156-5788 1 April 2007 31 Suppl 1 16-19 ©Aust Health Rev 2007 www.aushealthre- view.com.au System Observations Abstract Clinical governance approaches in Queensland health were trenchantly criticised in 2005 by two external reviews. In designing the new approach to clinical governance it was recognised that clinical governance should not be seen as only being about traditional safety and quality policies. A range of levers and policy instruments have been used in Queensland health to effect a new Aust Health Rev 2007: 31 Suppl 1: S16–S19 approach to clinical governance. QUEENSLAND HEALTH IS AN INTEGRATED service delivery organisation which at the time of writing was organised into 37 Health Service Districts overseen by three Area Health Services. Queens- land is a highly decentralised state, and services range from isolated nursing posts to major teach- ing hospitals. Queensland Health employs around 60000 staff directly, and public health services are managed without independent boards of directors. Following the eruption of a high profile scandal about safety of hospital care at Bundaberg Hospi- tal, 1 Queensland Health was subjected to two external reviews which were highly critical of its approach to clinical governance and its culture. 2,3 In response, the government announced a “health action plan” 4 which committed to a substantial increase in funding and a culture change process within Queensland Health. In addition, a new Minister and Director General were appointed, followed by an almost entirely new Executive Management Team. I was appointed to head the reform team of Queensland Health, with one of the major tasks being to establish a new clinical governance approach in Queensland. This article describes the key elements of the new clinical governance approach. Importantly, the new approach is not simply a document, but is multi-faceted. Indeed, the Queensland Health clinical governance framework is described as a “web of policies, processes and accountabilities”, 5 (p. 1) emphasising the interrelated and interact- ing nature of the various policies. Methods The first step in the new clinical governance framework was the development and release of a discussion paper 5 which canvassed the new approach. Policies and implementation standards were developed based on the discussion paper, as modified by the consultation process. A number of key elements were identified to underpin the policies and processes: ■ Line management responsibility for patient safety and quality ■ Clinician and patient involvement ■ A just and open approach to managing adverse events ■ Responsibilities articulated for all levels of Queensland Health ■ Measurement of outcomes and performance ■ Transparency and accountability ■ Emphasis on the need for Queensland Health to improve its performance in patient safety, quality and effectiveness. These key elements were implemented through a range of different policy instruments, using a range of policy levers. The overall aim of the new approach is summarised as: “In a culture which supports improvement in patient safety and qual- ity, to have the right person, doing the right job, with the right skills, working in high performance Stephen J Duckett, PhD, DSc, FCHSE, FASSA, Executive Director, Reform and Development Queensland Health, Brisbane, QLD. Correspondence: Dr Stephen J Duckett, Queensland Health, 147-163 Charlotte St, Brisbane, QLD 4000. stephen_duckett@health.qld.gov.au A new approach to clinical governance in Queensland Stephen J Duckett