Clinical Governance in Musculoskeletal Care—An Online Cross-Sectional Survey of What Allied Health Professionals Participate in, and What They Value

Rationale

Clinical governance (CG) is a systematic approach to improving care quality, ensuring healthcare organisations and professionals are accountable for safe, effective, and continuously advancing practice. Traditionally, CG frameworks follow the ‘seven pillars’ model: risk management, education and training, patient and carer experience, information management, clinical effectiveness, clinical audit, and staff management. However, optimal CG may also require additional elements. Despite its importance, research on CG, and clinicians' views, remains limited, particularly in musculoskeletal (MSK) care where calls for reform are growing.

Aim

To explore the views of NHS MSK Allied Health Professionals (AHPs) on CG, establishing what activities are undertaken and valued. An additional objective was to identify any differences between clinical leads and non-leads.

Methods

This exploratory study used an anonymous online cross-sectional survey built with Qualtrics software. Questions were informed by evidence and MSK think-tank discussions, enhancing content validity. The survey evaluated general opinions as well as perspectives on the seven pillars and 23 additional CG activities, including teamwork, culture, and leadership. It was disseminated via social media (X) and Interactive CSP (iCSP) to maximise the response rate. Predominantly ordinal data were analysed using descriptive statistics, with qualitative comments examined using content analysis.

Results

Data from 52 participants were analysed. 96.15% were physiotherapists, 90.38% worked in the NHS, and 53.85% held clinical leadership roles. Respondents viewed CG positively, with 73.08% strongly agreeing it was essential for care quality. Most participated in and valued both the seven pillars and additional activities. No substantial variance was observed between clinical leads and non-leads.

Conclusion

MSK AHPs in this study strongly supported CG and valued a broader range of activities than the seven pillars model asserts. Findings suggest current approaches may not fully reflect the scope of CG as perceived by clinicians, highlighting the need for more inclusive CG frameworks.