ABSTRACT
‘Clinical indicators should be used to learn, not to judge.’ The fact that this needs stating shows how fragile the learning culture of the NHS really is. Medical and dental students were traditionally humiliated if they were unable to come up with the right answer, in front of other students, patients and nursing staff. Clinical audit has sometimes been used to identify and expose people’s shortcomings rather than to provide opportunities for learning and improvement. Clinical governance will only achieve health gains and improvements in the quality of healthcare if team members are not penalised for admitting mistakes and calling for more resources. Such a culture would help everyone, professionals and managers alike, to work together to achieve the highest standards of care. The application of clinical governance in practice will require a learning culture that encourages a sustained quality improvement culture, motivated staff and an evaluation of changes in practice.
