To quote the Foreword to this book ‘many of the qualities of clinical governance are difficult to assess’ and ‘attitudes to clinical governance are very positive, but it remains a concept which needs much skill and commitment to implement’. The challenge for the editors was to assemble a volume that engages, informs and is practical and usable. The book is divided into four parts. The first discusses the concepts of quality in the National Health Service (NHS) and clinical governance which was introduced in 1997.

The second part describes the operational structures required to move the enterprise forward and highlights a number of underlying tensions. Why is it so difficult to get clinical quality onto the agenda of so many NHS trust boards? How will the original concept of clinical governance as a tool to ensure continuous improvement of services survive the shift from the Commission for Health Improvement (CHI) to the Healthcare Commission with its emphasis on the inspection and monitoring of key performance indicators, few of which are clinical outcomes? To sustain the engagement of clinicians and clinical teams John Sandford’s prediction that ‘over time, the relationship between good clinical governance, patient outcome and public health may become clearer’ is probably insufficient.

The next part discusses eight ‘key elements’ from the involvement of service users through risk management, appraisal and clinical audit to inter-agency working. Each chapter stands independently, often with some excellent yet profoundly simple advice on ‘making things work’ (for example, risk management and clinical audit). There are many hidden gems, for example Mary Lindsey’s table on good and bad organisational practice in relation to policies and procedures.

The fourth part attempts to translate clinical governance into the clinical context. Many authors emphasise the clinical team as central to clinical governance. After all at its most basic clinical governance must be about those involved with services being able to describe what they do, how they know it works and how they can make improvements. This is far from easy, particularly without well-defined systems for the management of clinical information.

Overall this book is a good comprehensive guide to contemporary management in the NHS and it will be invaluable in teaching and supervising trainees and for recently appointed clinical directors. Although there is some overlap in the content, this allows consideration of different approaches. However, a loose-leaf format might have facilitated updating. Consider how quickly the CHI has come and gone!

The use of this guide will facilitate the cultural shift necessary to allow the consistent and dependable delivery of high quality services, which is at the heart of clinical governance.