understanding the problems and aspirations of the community requires the cooperation between NHS organisations, public health department. Legislations contribute to this. The system of clinical governance brings together all the elements which seek to promote quality of care. Risk management Risk management involves consideration of the following components: Risks to patients: compliance with statutory regulations can help to minimise risks to patients. In addition, patient risks can be minimised by ensuring that systems are regularly reviewed and questioned – for example, by critical event audit and learning from complaints. Medical ethical standards are also a key factor in maintaining patient and public safety and well-being. Risks to practitioners: ensuring that healthcare professionals are immunised against infectious diseases, working in a safe environment (e.g. safety in acute mental health units, promoting an anti-harassment culture) and are kept up-to-date on important parts of quality assurance. Furthermore, keeping healthcare professionals up to date with guidelines such as fire safety, basic life support (BLS) and local trust updates is also important, these can be annually or more frequent depending on risk stratification. Risks to the organisation: poor quality is a threat to any organisation. In addition to reducing risks to patients and practitioners, organisations need to reduce their own risks by ensuring high quality employment practice (including locum procedures and reviews of individual and team performance), a safe environment (including estates and privacy), and well designed policies on public involvement. Balancing these risk components may be an ideal that is difficult to achieve in practice. Recent research by Fischer and colleagues at the University of Oxford finds that tensions between 'first order' risks (based on clinical care) and 'second order' risks (based on organisational reputation) can produce unintended contradictions, conflict, and may even precipitate organisational crisis. Information management Information management in health: Patient records (demographic, Socioeconomic, Clinical information) proper collection, management and use of information within healthcare systems will determine the system's effectiveness in detecting health problems, defining priorities, identifying innovative solutions and allocating resources to improve health outcomes. Application in the field If clinical governance is to truly function effectively as a systematic approach to maintaining and improving the quality of patient care within a health system, it requires advocates. It also requires systems and people to be in place to promote and develop it. The system has found supporters outside of the UK. The not-for-profit UK hospital accreditation group the Trent Accreditation