Navigating the nexus: Enhancing engagement in New Zealand’s clinical governance landscape

This study explores the experiences of engagement in clinical governance within New Zealand's rural, primary, and urban health sectors before the July 2022 health sector reform that replaced District Health Boards with a national health system. Clinical governance is internationally recognised as a quality framework ensuring safe and effective patient care. Its success depends on a culture supported by knowledgeable staff and governance directors and the relationship between service delivery and organisational governance. The study adopts a qualitative descriptive analysis using selected grounded theory methods. Data were collected through semi-structured interviews with 11 participants, including clinicians, governance directors, and executive leaders across healthcare sectors. Analysis revealed three themes: trust and receptiveness, power and voice, and clinical-governance dynamics. These themes highlight that clinical governance is a contested space influenced by past relationships and governance dynamics. Trust was found to be vital for fostering relationships, shaped by previous experiences. However, trust often eroded due to power imbalances and dissent in governance interactions. A critical tension emerged between clinical imperatives and governance objectives, creating opposition that hindered collaboration. Institutional practices, such as governance’s reliance on senior management for staff interactions, exacerbated this divide by limiting direct connections and understanding. The study concludes that clinical and governance goals are divergent, sometimes obscuring patient-centred care. Addressing these tensions requires acknowledging differing motivations, re-evaluating the governance-management divide, and ensuring safe spaces for conflict resolution. Additionally, fostering trust through early interventions like appointing navigators during board formation could enhance relational dynamics. Recommendations include integrating engagement strategies into government policies, requiring healthcare governance documents to highlight the importance of engagement, and addressing motivators within governance environments. Governance groups should prioritise conflict management and safe spaces, while navigators could help new boards navigate complexities. These findings are intended to inform strategic planning, engagement guidelines, and training programs within New Zealand’s healthcare system. Sharing this knowledge with agencies such as the Health Quality and Safety Commission, Te Whatu Ora, and professional organisations could influence future governance and clinical leader training.