Architecting patient safety: a narrative review of the evolution of a clinical governance framework at a regional hospital (2022–2025)

Abstract

Structured clinical governance (CG) is the key element that contributes to delivering qualitative patient care, particularly within the public sector hospitals. This narrative review gives the complete picture of the transformation of patient safety framework that occurred at Kulhudhuffushi Regional Hospital (KRH) during the years 2022–2025. The hospital has diligently taken steps to transform itself from a committee-oriented governance model to a more centralized organization with proactive involvement in addressing the findings of inspections, thereby resulting in the establishment of the Quality Improvement Department (QID). This article explores the key role of governance policies and strategies that have served as the foundation for setting up this system. The key implementations include a meticulous documentation framework that sets standards for the entire clinical and administrative process. The process is designed to follow a two-tiered audit process that stabilizes the system, contributing to continual improvement with qualitative outcomes. The system includes monitoring the Key Performance Indicator (KPI) to relentlessly support and streamline key clinical areas in the hospital. The system acts as an integrative approach that incorporates data such as clinical incidents, patient complaints, and mortality review in a learning-based approach to quality and patient safety. The critical lesson learned along the way is that a systematic and architected approach to develop or enhance quality and patient safety governance in a healthcare system, especially in a resource-constrained and regional geography, is essential. The KRH model has potential implications for others seeking to establish robust governance structures to deliver qualitative patient care and safety.