What are different types of governances in nurse and doctors?
The term “governance” in healthcare refers to the systems, structures, and processes through which nurses, doctors, and other health professionals are guided, held accountable, and supported in delivering safe and effective care.
There are different types or models of governance for nurses and doctors, depending on the level of autonomy, leadership structure, and organizational policy. Let’s go through them clearly and comparatively:
🩺 1. Clinical Governance (for both doctors & nurses)
Definition:
A system through which healthcare organizations are accountable for continuously improving the quality of services and safeguarding high standards of care.
Key Components (7 Pillars):
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Clinical effectiveness
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Risk management
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Patient involvement
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Education and training
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Clinical audit
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Information management
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Staffing and staff management
Purpose: Ensures that all clinical staff (nurses, doctors, allied health professionals) maintain quality and safety in patient care.
👩⚕️ 2. Nursing Governance (Professional Nursing Governance)
Definition:
A framework that empowers nurses to have control, autonomy, and accountability over their professional practice and decision-making.
Types/Models:
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Shared Governance Model
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Nurses share decision-making authority with management.
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Encourages participation in policy development, practice standards, and quality improvement.
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Example: Unit-based councils or nursing practice councils.
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Self-Governance
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Nurses manage their own professional practice independently.
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Used in highly professionalized settings (e.g., advanced practice nurses).
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Administrative Governance
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Decision-making is centralized with nursing leaders or administrators.
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Limited autonomy at the staff level.
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Goal: To enhance professional accountability, autonomy, and collaboration in nursing care.
🩺 3. Medical Governance (or Clinical/Professional Governance for Doctors)
Definition:
Structures and processes ensuring doctors maintain competence, ethics, and accountability in medical practice.
Key Types:
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Corporate/Administrative Governance
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Hospital management or governing board sets the policies and monitors compliance.
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Doctors follow institutional standards.
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Professional Self-Governance (Medical Council)
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Medical professionals regulate themselves through licensing and disciplinary boards.
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Example: Nepal Medical Council (NMC) ensures registration, ethics, and discipline.
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Shared or Collaborative Governance
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Doctors work in multidisciplinary teams, sharing responsibility for quality improvement and decision-making.
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Common in hospitals promoting team-based care.
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⚖️ 4. Corporate Governance in Healthcare Institutions
Definition:
The overall organizational system of accountability, transparency, and performance that includes both medical and nursing governance under one institutional framework.
Includes:
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Board of directors or hospital management committee
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Financial accountability
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Ethical and legal compliance
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Quality assurance programs
🔍 Summary Table:
| Type of Governance | Focus Group | Main Goal | Example/Feature |
|---|---|---|---|
| Clinical Governance | Both doctors & nurses | Quality and safety of care | Audit, training, patient feedback |
| Nursing Governance | Nurses | Empowerment and accountability | Shared governance councils |
| Medical Governance | Doctors | Professional accountability and ethics | Licensing by Medical Council |
| Corporate Governance | Whole institution | Organizational accountability | Hospital board oversight |
🏥 In Nepalese Context
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Nepal Nursing Council (NNC) → Regulates nursing practice (nursing governance).
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Nepal Medical Council (NMC) → Regulates medical practice (medical governance).
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Hospital Quality Assurance Committee / Clinical Governance Committee → Oversees overall clinical governance.
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Hospital Management Committee → Responsible for corporate governance.
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