Clinical governance in internal medicine: the challenge of length of stay

Abstract

Clinical governance highlights the relevance of the combination of “quality” and “safety” with “excellence” and “improvement”. In hospitals, as highly complex organizations, the principles and practices of clinical governance are key elements for success. Several angles would be pertinent in the application of clinical governance to the hospital context, and specifically to internal medicine. The length of stay of patients in hospital is frequently used as a quality indicator of clinical activity. Ideally the patient should remain in the hospital during the time in which he has benefit, minimizing inherent risks. With its centrality in the patient, clinical governance, interpreted in the light of the Seven Pillars Model, can provide a comprehensive framework for addressing the management of length of stay. We should try to bring to the day-to-day of our organizations the aggregating vision of clinical governance, whose foundational values need to be reinforced and deepened.