The 7 pillars of clinical governance: practical examples and records

Clinical governance is the way a healthcare organisation takes responsibility for the quality of its care and works to improve it. In practice, it connects standards, staff, information and learning with decisions that someone owns and follows through.

NHS England’s governance overview describes this responsibility for quality and the role of reviewing experience, taking action and reassessing progress.

What are the seven pillars of clinical governance?

The seven pillars are a traditional way to explain connected areas of clinical governance: patient involvement, clinical effectiveness, audit, risk management, education, staffing and information. NHS training material uses this teaching model. Terminology and groupings vary; the examples below turn these areas into practical questions for a team.

This is an explanatory framework, rather than a claim that every regulator uses seven identical headings. In England, CQC’s assessment framework uses five key questions and quality statements. Keep the applicable regulatory requirements alongside your organisation’s own governance arrangements.

1. Patient and public involvement

Include the experience of people receiving care when assessing and improving services.

Practical example: a team receives feedback that people cannot tell who will respond to a concern. Record the issue, agree who will review the communication process and return to the people involved to find out whether the change helped. A count of feedback forms would not answer that final question.

2. Clinical effectiveness

Connect care with relevant evidence and professional standards.

Practical example: the responsible clinical lead reviews updated guidance and records the decision about local practice. An administrator can maintain the document version, decision reference and review date. The clinical judgement remains with the appropriately qualified team.

3. Clinical audit and improvement

Compare practice with agreed standards and use the findings to guide change.

Practical example: an audit identifies a recurring documentation gap. Keep the finding linked to its action, then record the result of the agreed follow-up review. Marking the first audit “finished” should not conceal an unresolved action.

4. Risk management

Identify and manage risks, and learn from concerns and incidents.

Practical example: an equipment-record check reveals an unresolved inspection question. Assign verification and escalation to the responsible person. Retain the outcome and supporting evidence so another manager can understand the decision. Our healthcare risk-management guide gives a worked administrative record.

5. Education and training

Support the knowledge and skills people need for their roles.

Practical example: separate evidence awaiting review from evidence that is missing. For each gap, record who will resolve it. A course attendance record can contribute to the picture without being treated as a complete judgement of competence.

6. Staffing and staff management

Consider the people, responsibilities and support needed to deliver care.

Practical example: a manager reviews a changed shift pattern alongside availability and relevant staff records. The recorded decision should make the responsibility clear. Counting names on a rota cannot by itself establish whether the team is suitable for the work.

7. Information and its use

Use reliable information to understand performance and support decisions.

Practical example: when two reports disagree, check their dates, definitions and populations before drawing a conclusion. Keep the record supporting a decision accessible to those who need it, under the organisation’s access arrangements.

Worked example: from feedback to a checked action

Suppose staff say that a revised procedure is difficult to find. This fictional example involves information, staff involvement and education. It shows why the pillars overlap.

1. Describe the problem. Record which procedure, which team and what people could not find.
2. Assign the review. Name the person responsible for confirming the current approved version and its location.
3. Record the change. Note what was corrected and how the affected team was told.
4. Check the experience. Ask the team to locate the procedure again and record any remaining difficulty.
5. Review the outcome. Keep the action open if the original problem persists.

This is an administrative example of follow-through, not evidence that a particular care outcome improved. Use measures relevant to the actual concern when evaluating a real change.

Questions for a governance review

Pick one open action and trace it from the original finding to the latest decision. Can the team identify its owner, the next step and the evidence still needed? If it is closed, can someone explain what was checked and why closure was justified?

CQC’s good-governance guidance links oversight with reliable records and improvement. Meeting minutes and dashboards are useful when the team can follow the decisions behind them.

How Synergy supports the administrative work

Synergy includes staff training records, policies, incident and complaint records, a corporate risk register and governance reporting. These can support the information around a governance process.

Explore HR and training records or rota planning using one of your existing workflows. Ask to see the specific records and reports your team needs. Clinical decisions, governance responsibilities and judgement about the quality of care remain with the appropriate professionals.