ABSTRACT
For patients to benefit from our increasingly comprehensive understanding of the pathophysiology of disease and its treatment, people need to be able to apply correct therapies to appropriate patients in a timely fashion guided by the results of clinical trials and observational studies. Clinical governance is composed of six service improvement processes that work together to improve patient care. The process of clinical audit has been described as a loop or spiral. An area of interest is selected and standards that define optimal care are identified from the literature. Clinical practice is then measured against these standards using either prospectively or retrospectively collected data. Centres treating fewer cases towards the left of the plot may have a larger range of time delays by random statistical variation than those treating large numbers. The audit process is dependent on the standards selected to define optimal care, and yet, these 'standards' may be elusive.
