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Qual Health Care 2001;10:40-48 doi:10.1136/qhc.10.1.40 * Viewpoint
Management matters: the link between hospital organisation and quality of patient care 1. Elizabeth West, senior research fellow
+ Author Affiliations 1. Royal College of Nursing, Radcliffe Infirmary, Woodstock Road, Oxford OX1 6HE, UK 1. Dr E West elizabeth.west@rcn.org.uk * Accepted 21 December 2000 Next Section
Abstract
Some hospital trusts and health authorities consistently outperform others on different dimensions of performance. Why? There is some evidence that “management matters”, as well as the combined efforts of individual clinicians and teams. However, studies that have been conducted on the link between the organisation …show more content…

Some of the main policy documents relating to quality of care in the UK National Health Service are described in table 1. Within the quality initiative there is a clear recognition that only so much can be achieved by appealing to individual practitioners, and that more effort needs to be expended on understanding how the organisation and management of care affects outcomes. Many of the goals of the new NHS—including clearer lines of accountability and responsibility, better communication, and improved conditions for staff—require interventions at the level of the organisation.
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Table 1
Quality initiatives for the NHS in England introduced since 1997 (excluding documents relating to the development and regulation of the professions)
One of the most important planks in the quality platform is the policy of clinical governance. Clinical governance has been defined as “a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care can flourish”.7 Buetow and Roland8 noted that the “duty of quality” relates to the organisation, not just to individuals within the organisation. Although a named individual, most often the Chief Executive, will assume statutory responsibility for quality, many trusts have already implemented structural