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Introduction
The ideology of governance is frequently espoused within healthcare organisations as a strategy to safe guard the standard of clinical care. However, many clinicians grapple with understanding the primary principles of governance, and how the various structures relate and contribute to the functioning of the healthcare organisation. Defining governance is complex, and as a result there has been a proliferation of definitions proffered and varying models implemented. Regardless, there appears to be an aggregate of essential attributes associated with the governance process which include leadership, stewardship, accountability, direction and control (Davies and Walley, 2000). In turn, governance is commonly perceived to be a system through which an organisation is directed, managed and held accountable. The Australian Council on Healthcare Standards (2004) elucidate that governance emphases the need for shared responsibility and accountability of governing bodies, managers and clinicians in the provision of patient care, which endeavours to minimise risks to consumers, whilst striving for continued quality improvement, and the transparent monitoring and reporting of outcomes. Operationally, it establishes the objectives and strategies of an organisation and how these will be achieved in conjunction with risk management and assessment, and how compliance and performance is optimised (Som, 2004).
The functioning of healthcare organisations is complex and dynamic, and as a result varying levels of governance processes are commonly employed in order to address its multiple facets; such as corporate governance, clinical governance, medical governance and research governance, which ideally are interlinked and working collegially to achieve organisational goals. However, discordance between governance processes has emerged in many healthcare organisations due to their varying agendas and functional models. The role of corporate governance centres on operational and financial management, adherence to legislative requirements, and ensuring that the organisation functions efficiently and effectively, whilst evaluating risk and promoting accountability (Australian National Audit Office (ANAO), 2003; Witherall, 2002; Organisation for Economic Cooperation and Development (OECD), 1999). Conversely, clinical governance has a greater emphasis on maintaining and improving the quality of patient care within the healthcare system, with relevant strategies in situ for monitoring and evaluating the prescribed targets for quality (Halligan and Donaldson, 2001). The dichotomy of governance suggests that these two streams are mutually exclusive, and as a result they have had a propensity to occur in...