The term ‘clinical governance’ was first introduced by Scally and Donaldson in 1998, as a way for NHS organisations to be accountable for the quality of the services they provide and for ensuring high standards of care. It aimed to create environments in which excellence could thrive.

This definition has since been expanded by the Healthcare Quality Improvement Partnership (HQIP), which refers more broadly to the term ‘governance,’ describing it as “the culture, vision, values, structures, policies, processes and over-arching assurance framework that support an organisation to take decisions and meet agreed strategic objectives”. This encompasses all elements of governance, not just clinical governance.

Clinical governance, more specifically, is an umbrella term encompassing an array of activities that help to support, improve and advance the standards of care delivery across health and social care.

Robust governance approaches provide the foundation for assuring clinical and care standards, strengthening accountability, decision-making and ensuring the best use of resources.

Together, these elements create safe environments for delivering high‑quality care. Effective governance also enables the early identification of incidents and service or system failures, ensuring that appropriate actions, communication processes and improvement plans are put in place.

Quality and safety in health and social care across the UK is prioritised through:

• Regulatory oversight: Each country has an independent regulatory body—such as the Care Quality Commission (CQC) in England, Regulation and Quality Improvement Authority (RQIA) in Northern Ireland, Care Inspectorate Scotland and Healthcare Improvement Scotland (HIS) in Scotland, and the Care Inspectorate Wales (CIW) in Wales - that inspects, evaluates and enforces quality standards.
• Person-centred care models: All four countries emphasise person-centred, co-produced care, enabling individuals to take an active role in decisions about their health and well-being.
• Integrated care initiatives: Integration of health and social care seeks to improve continuity of care, especially for vulnerable populations, ensuring smoother transitions across care settings and reducing risks.
• Accountability and transparency: National standards and regular reporting systems aimed at ensuring quality and safety remain central, with mechanisms for public accountability.

Each UK country—England, Northern Ireland, Scotland and Wales—has its own approach and priorities shaped by the specific needs of its health and social care system. Their respective legislative frameworks reflect these unique policy contexts. However, despite these differences, all four nations share overarching goals: to deliver safe, effective and high-quality health and social care services.

The seven pillars of clinical governance are key components that, together, ensure high standards of care and accountability in health and care services. A variety of frameworks exist that support clinical governance activities; however, the key principles include:

1. Clinical effectiveness: Using the best available evidence and guidance to provide safe, high‑quality care and achieve the best outcomes for people.
2. Risk management: Identifying, assessing and managing risks to protect patients, staff, and the organisation and putting systems in place to reduce harm.
3. Patient and public involvement: Engaging patients and the public in decisions, service planning, and policy development and using their feedback to improve care.
4. Clinical audit/quality improvement: Regularly checking care against agreed standards, identifying areas for improvement, making changes and reviewing progress.
5. Education and continuous professional development (CPD): Ensuring staff receive ongoing training and development so they stay competent, confident and up to date with best practice.
6. Information management: Using accurate and meaningful information to guide decisions, improve care and support clear communication.
7. Staff management: Recruiting, supporting and developing staff so they can work effectively, maintain high standards and provide excellent care.

Whatever structures, systems and processes an organisation puts in place, it must be able to show evidence that standards are upheld.

The Care Quality Commission (CQC)—the independent regulator of health and social care in England—asks five fundamental questions during inspections.

Regardless of where you work, you may find these questions provide a useful prompt when considering the quality and safety in your workplace:

1. Are they (we) safe?
2. Are they (we) effective?
3. Are they (we) caring?
4. Are they (we) responsive to people’s needs?
5. Are they (we) well-led?

The RCN Nursing Workforce Standards, along with guidance from the Nursing and Midwifery Council (NMC), make explicit the actions necessary to ensure the registered nurse lead receives sufficient, dedicated time and resources to deliver safe and effective care.

It also includes the contributions nurses make to continuous monitoring and quality improvement to enhance health outcomes and people’s experience of their care and treatment.

The standards have been created to support you in your workplace and explain what must happen within workplaces to ensure the delivery of safe and effective patient care.

The standards work alongside each nation’s legislation and can be used by the whole nursing workforce, along with those responsible for funding, planning or commissioning services that require a nursing workforce.

We encourage you to work through the standards to identify any improvement work that you can undertake in your workplace.

Once you have done this work, tell us by completing the self-nomination form and be formally endorsed as a Nursing Workforce Standards Champion.