The Royal College of Surgeons in Ireland (RCSI) has today launched 'A Framework for Surgical Clinical Governance', a comprehensive national framework designed to strengthen patient safety, accountability and quality improvement across surgical services in Ireland.

Developed by the Expert Group on Best Practice in Clinical Governance Surgical Leadership Working Group convened by RCSI President Professor Deborah McNamara in June 2024, the framework provides clear, practical guidance for hospitals on embedding effective patient-centered clinical governance in everyday practice.

Aligned with international best practice, the framework is intended for use across public, voluntary and independent healthcare settings. It outlines four key domains - morbidity and mortality meetings, multidisciplinary team engagement, patient safety and clinical audit, and the governance of innovation, research and new technologies – which are central to the safe and effective governance of surgical care.

It outlines clear expectations for how surgical governance should operate in practice and stresses the importance of transparency, documentation and follow-through, ensuring that learning from adverse events and near misses leads to meaningful improvement.

The framework provides a Governance Maturity Model which surgical services can use to assess the extent to which their governance arrangements are embedded, reliable and integrated within the wider hospital system, and in planning progressive improvement over time.

It also addresses the governance of innovation in surgery, recognising the rapid pace of change in areas such as new technologies, devices and digital tools. It sets out principles for the safe and ethical introduction of new practices, including evidence-based evaluation, appropriate training and credentialing, multidisciplinary oversight and ongoing monitoring of outcomes - supporting innovation while maintaining patient safety.

The framework was developed following the largest-ever consultation undertaken by RCSI, with surgeons across specialities and hospitals sharing their experiences of systems that work well and systems that need attention. It also acknowledges the pressures facing the health service, including increasing demand, workforce shortages, and capacity constraints.

Professor Deborah McNamara, President of the Royal College of Surgeons in Ireland, said: “Surgeons are privileged to care for people at some of the most vulnerable moments in their lives. With that privilege comes the profound responsibility to learn from our experiences, as enabled by safe, transparent and learning-oriented surgical governance.

“High-quality surgical care depends on strong clinical governance, clear accountability and a culture of continuous learning. The public have the right to high quality and safe surgical care. This framework is RCSI’s constructive contribution to the national effort to improve patient safety and support our surgical workforce, providing practical guidance for surgeons, clinical leaders and healthcare organisations to support patient safety and improve outcomes. In particular, the use of the Governance Maturity Model will support our hospitals in reflecting on the areas of improvement they need to priortise.”

Mr David Moore, Chair of the Expert Group on Best Practice in Clinical Governance in Surgery and RCSI Council Member, said: “Surgical teams across Ireland are committed to delivering safe, effective care, often under significant pressure. This framework is designed to support that work by providing a clear, consistent structure for governance that is clinically led, evidence-informed and focused on learning and improvement. Our aim is to help surgical services strengthen governance in a way that is practical and sustainable.”

A Framework for Surgical Clinical Governance includes an implementation roadmap and a governance maturity model to support hospitals and surgical services in assessing current practice and planning progressive improvement over time.

The framework is available to view or download here.