How non-clinical managers utilise clinical governance to improve hospital performance: A qualitative study of four South African hospitals
1
School of Public Health, Walter Sisulu University, Mthatha,, South Africa
2
Institute for Clinical Governance and Healthcare Administration, Walter Sisulu University, Mthatha,, South Africa
3
Global Centre for Human Resources for Health Intelligence, Walter Sisulu University, Mthatha,, South Africa
4
Society and Health Research Institute, Walter Sisulu University, Mthatha,, South Africa
5
School of Population Health, University of New South Wales, Sydney, Australia
6
George Institute for Global Health, University of New South Wales, Sydney, Australia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Clinical governance has emerged as a crucial framework for enhancing the quality of healthcare and patient safety worldwide. However, its implementation in resource-limited settings remains poorly understood, particularly regarding the role of non-clinical managers who constitute a significant proportion of hospital leadership. While clinical managers possess medical expertise, non-clinical managers bring essential skills in administration, finance, human resources, and strategic planning. Understanding how non-clinical managers navigate and utilise clinical governance frameworks in these contexts is essential for developing evidence-based strategies that enhance hospital performance, improve patient outcomes, and inform health policy in similar resource-constrained environments globally.
METHODS:
A qualitative approach was utilised to conduct individual, semi-structured, in-depth interviews with non-clinical managers of the four study hospitals. The study employed an inductive analysis approach to interpret the emerging themes.
RESULTS:
The study revealed nine interconnected themes regarding non-clinical managers' utilisation of clinical governance, including variable understanding and implementation of clinical governance frameworks. Centralised decision-making structures that limit managerial autonomy and accountability. Critical human resource shortages and capacity deficits across all levels. Inconsistent clinical service delivery, governance, and protocol implementation. Inadequate infrastructure and resource availability. Dysfunctional patient flow and referral systems. External governance constraints and inter-organisational coordination challenges. Blame culture and low staff morale that undermine collaborative governance. Participants suggested strategic interventions, including collaborations with medical universities, the application of evidence-based protocols, and workforce development programs.
CONCLUSIONS:
The study demonstrates that the utilisation of clinical governance by non-clinical managers to improve hospital performance is significantly limited by a fundamental governance paradox: accountability without corresponding authority. Effective clinical governance implementation requires comprehensive health system reforms that address centralised decision-making, workforce capacity, resource allocation, and infrastructure development, rather than relying solely on hospital-level interventions. The findings provide evidence for policy reforms that prioritise managerial autonomy, decentralised authority, and investment in workforce development.
Clinical governance has emerged as a crucial framework for enhancing the quality of healthcare and patient safety worldwide. However, its implementation in resource-limited settings remains poorly understood, particularly regarding the role of non-clinical managers who constitute a significant proportion of hospital leadership. While clinical managers possess medical expertise, non-clinical managers bring essential skills in administration, finance, human resources, and strategic planning. Understanding how non-clinical managers navigate and utilise clinical governance frameworks in these contexts is essential for developing evidence-based strategies that enhance hospital performance, improve patient outcomes, and inform health policy in similar resource-constrained environments globally.
METHODS:
A qualitative approach was utilised to conduct individual, semi-structured, in-depth interviews with non-clinical managers of the four study hospitals. The study employed an inductive analysis approach to interpret the emerging themes.
RESULTS:
The study revealed nine interconnected themes regarding non-clinical managers' utilisation of clinical governance, including variable understanding and implementation of clinical governance frameworks. Centralised decision-making structures that limit managerial autonomy and accountability. Critical human resource shortages and capacity deficits across all levels. Inconsistent clinical service delivery, governance, and protocol implementation. Inadequate infrastructure and resource availability. Dysfunctional patient flow and referral systems. External governance constraints and inter-organisational coordination challenges. Blame culture and low staff morale that undermine collaborative governance. Participants suggested strategic interventions, including collaborations with medical universities, the application of evidence-based protocols, and workforce development programs.
CONCLUSIONS:
The study demonstrates that the utilisation of clinical governance by non-clinical managers to improve hospital performance is significantly limited by a fundamental governance paradox: accountability without corresponding authority. Effective clinical governance implementation requires comprehensive health system reforms that address centralised decision-making, workforce capacity, resource allocation, and infrastructure development, rather than relying solely on hospital-level interventions. The findings provide evidence for policy reforms that prioritise managerial autonomy, decentralised authority, and investment in workforce development.
| eISSN: | 2654-1459 |
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