"What can you tell us about clinical governance?" is one of the most frequently asked questions in NHS interviews, and it is asked more often of doctors joining from abroad because panels want to know whether you understand how safety and quality are managed in the NHS. Many candidates can recite a definition and few can give an example of each part from their own practice, which is what scores. This guide explains it and shows how to answer.
What it is
Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of care and keeping patients safe. The definition panels recognise is that it is the framework through which organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. In plain terms: it is everything a hospital does to make sure care is safe, effective and improving, and the structures that hold people accountable for it.
The parts
Panels usually expect you to name the components and give an example of each. A workable list:
- Clinical audit: measuring practice against a standard and improving it. Your example: the audit you did, the standard, the result and what changed.
- Risk management and incident reporting: the Datix system, the review of incidents and near misses, the learning. Your example: an incident you reported and what came of it.
- Clinical effectiveness and evidence based practice: guidelines, NICE, local protocols. Your example: a guideline you applied or helped introduce.
- Education and training: keeping staff competent and up to date. Your example: training you attended or delivered.
- Patient and public involvement: feedback, complaints, the friends and family test. Your example: a complaint you handled or feedback that changed something.
- Staffing and staff management: appraisal, revalidation, supervision, the handling of poor performance. Your example: your own appraisal, or supervising a junior.
- Information and data: using the trust's data to see where care is poor. Your example: a measure you looked at and acted on.
You will not be asked for all seven; three or four with examples is a strong answer. Choose the ones you can evidence.
Answering the question
A structure that scores: define it in one sentence in your own words; say why it matters, which is that it turns individual good intentions into a system that catches failures; name three or four components with a short example of each from your own practice; and close with the consultant's or junior doctor's role in it, which is to report, to take part in audit, to follow guidelines and to speak up.
Keep it under two minutes. The panel will probe the examples, so make sure each is real and you can go deeper.
The follow up questions
- What is the difference between audit and research? Audit measures practice against a standard to improve care; research creates new knowledge and needs ethical approval. Say which yours was.
- What is a Datix and when would you complete one? The incident reporting system, for any incident or near miss, as soon as possible, with the facts and no blame.
- What is a never event? A serious, largely preventable incident that should not occur if guidance is followed, such as wrong site surgery.
- What is the duty of candour? The duty to be open with patients when something has gone wrong: to tell them, apologise, explain and say what will be done.
- Describe your last audit. The problem, the standard, the measure, the change, the result and whether you re audited.
Where the NHS differs
If you trained in a system with a weaker reporting culture, say so honestly and say that you understand reporting in the NHS is expected and protected. Panels respect candour about the difference more than a pretence of familiarity. Mention that you know reporting is not about blame.
Preparing
Write your definition in a sentence. Pick four components and write a two line example for each from your own practice. Learn the follow up definitions. Then practise the whole answer aloud in under two minutes with someone who asks "tell me more about that audit". The question is almost certain to come, and a prepared answer with real examples is one of the easiest marks in the interview.