audit Clinical effectiveness Research and development Openness Risk management Information Management Education and training It is no longer considered acceptable for any clinician to abstain from continuing education after qualification – too much of what is learned during training becomes quickly outdated. In NHS Trusts, the continuing professional development (CPD) of clinicians has been the responsibility of the Trust and it has also been the professional duty of clinicians to remain up-to-date. Clinical audit Clinical audit is the review of clinical performance, the refining of clinical practice as a result and the measurement of performance against agreed standards – a cyclical process of improving the quality of clinical care. In one form or another, audit has been part of good clinical practice for generations. Whilst audit has been a requirement of NHS Trust employees, in primary care clinical audit has only been encouraged, where audit time has had to compete with other priorities. Clinical effectiveness Clinical effectiveness is a measure of the extent to which a particular intervention works. The measure on its own is useful, but decisions are enhanced by considering additional factors, such as whether the intervention is appropriate and whether it represents value for money. In the modern health service, clinical practice needs to be refined in the light of emerging evidence of effectiveness but also has to consider aspects of efficiency and safety from the perspective of the individual patient and carers in the wider community. Research and development A good professional practice is to always seek to change in the light of evidence-led research. The time lag for introducing such change can be substantial, thus reducing the time lag and associated morbidity requires emphasis not only on carrying out research but also on efficiently implementing said research. Techniques such as critical appraisal of the literature, project management and the development of guidelines, protocols and implementation strategies are all tools for promoting the implementation of research practice. Openness Poor performance and poor practice can too often thrive behind closed doors. Processes which are open to public scrutiny, while respecting individual patient and practitioner confidentiality, and which can be justified openly, are an essential part of quality assurance. Open proceedings and discussion about clinical governance issues should be a feature of the framework. Any organisation providing high quality care has to show that it is meeting the needs of the population it serves. Health needs assessment and