Learning from regulatory interventions in healthcare. The Commission for Health Improvement and its clinical governance review process

Lawrence A. Benson, A. Boyd, K. Walshe

Research output: Contribution to journalArticlepeer-review


Purpose - This paper aims to present the findings from research commissioned by the Commission for Health Improvement (CHI), which set out to examine the impact of CHI's clinical governance reviews on NHS trusts in England. Design/methodology/approach - This paper, giving a stratified random sample of 30 NHS trusts, was taken from a set of 75 trusts reviewed by CHI during a period from 2001 to 2003. Documents from these trusts' reviews were analysed. A postal questionnaire was sent to key stakeholders with an involvement or direct interest in each trust's review. Semi- structured telephone interviews were held with five to six people from each of four trusts selected as case studies. Findings - In this paper the clinical governance review process was characterized by wide variability in methods, application and effects, in the initial CHI visit and report, and the subsequent NHS trust action plan and SHA progress review. The recommendations made by reviews for change in an NHS trust were often of a nature or expressed in terms, which made measuring their subsequent implementation and impact problematic. CHI recommendations concentrated on management and support processes rather than on direct patient care and outcomes. Trusts were generally willing to accept and then enact CHI review recommendations. Practical implications - The paper concluded that a more focused and controlled review process would support greater change and improvement. There was evidence to suggest that this kind of regulatory intervention can have largely positive impacts on the organisational performance of NHS trusts, although these positive effects were mainly indirectly related to the delivery of patient care and health improvement. Any future review or inspection processes should place a greater focus upon patient outcomes if such reviews are to demonstrate their value in making a contribution to improving health. Originality/value - The paper shows that, internationally, there have been few empirical studies analysing the work of health care regulators and their impact on the organisations they regulate. While the work of CHI has been examined by others, this study is the first empirical and largely quantitative analysis of CHI's regulatory regime and its impact within the English NHS. The article is also published at a time when there is much debate about regulatory functions and forms for health and social care.
Original languageEnglish
Pages (from-to)213-224
Number of pages11
JournalClinical Governance
Issue number3
Publication statusPublished - 2006


  • Clinical governance
  • Inspection
  • Regulation


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