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Book Review   |    
Richard E. Kellogg
Psychiatric Services 2006; doi:
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edited by Adrian James, M.D., Adrian Corral, and Tim Kendall; London, Gaskell Press, 2004, 360 pages, $60

Mr. Kellogg is the director of Mental Health Services, Department of Social and Health Services, State of Washington.

The goal of a comprehensive system of quality assurance and improvement has been elusive in the exercise of public policy. Stops and starts in the field of publicly paid mental health and learning disability services appear to reflect changes of executive administrations at the state and federal levels rather than a reliance on consistency, investment, and common sense. In Clinical Governance in Mental Health and Learning Disability Services the Royal College of Psychiatrists effectively acquits the search for a comprehensive system of quality assurance and improvement in a single-pay public model.

The book describes the efforts of the Royal College of Psychiatrists to implement the processes of a comprehensive quality assurance and improvement system—clinical governance, within the relevant trusts of the National Health Services (NHS).

The values and structure of the NHS model of clinical governance are explained and illustrated through the prism of an operational guide. Attention is given to the concerns of implementing administrative and operational culture change. The book is structured into four main categories: background, history, and philosophy of clinical governance; foundations and organizational structure; the building blocks and key elements of clinical governance; and translating clinical governance into the clinical context. The sections on foundations and organizational structure section discusses the NHS model, the role of trust boards, a labyrinth of inspectorates and cross-audits, program guidance by the National Institute for Clinical Excellence, support for the clinical governance model, and the National Service Framework for Mental Health. The chapter concerning the role of trust boards in clinical governance is of particular interest to citizens, consumers, and professionals involved with the nonprofit community mental health provider model.

The section about building blocks and key elements explores several current and vital topics relevant in this country. The chapter concerning the role and involvement of service users and their relatives includes a cogent discussion about user and family involvement with organizational change and service delivery. The authors suggest that what counts the most is a belief in the value of such involvement, not the model. The two chapters concerning evidence-based practice are especially noteworthy. John Geddes discusses a pointed taxonomy for the selection and review of articles about evidence-based practice in the journal Evidence-Based Mental Health that federal and state policy makers would benefit from reading. Mary Lindsay provides an excellent exploration of good and bad organizational practice relative to policies and procedures. Her discussion of the need for policies and procedures as a foundation for clinical governance and a well-functioning system is fertile ground for administrators and staff who often feel overburdened by internal and external policy and procedural requirements.

The final section covers a broad array of topics that support the integration of clinical governance into the clinical context. Information systems, monitoring and improvement, and the importance of leadership by clinicians and nurses in the management of change of mental health services delivery are discussed from the perspective of quality improvement through the system of clinical governance. The chapter concerning vulnerable people in care and person-centered values is recommended to all readers concerned with human dignity and provider integrity.

This book does not present as an easy read despite flourishes of English wit. It took this reviewer some time to understand the context of the clinical governance philosophy and how it is embedded in the NHS. American readers might find the book more accessible if the introduction included information concerning the structure of the NHS, the purpose and role of trusts, and the operational meaning of some terms. A trip to the Web sites of the NHS and Royal College of Psychiatrists is recommended. Federal and state policy makers interested in comparative systems of clinical practice improvement, evidence-based practice, consumer involvement, and culture change within organizations providing mental health services would find merit with this work. Academic programs in psychiatry could derive benefit from reviewing this book from the perspective of physician-related quality standards and improvement based on external review.

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