It has now been some years since the introduction of the concept of clinical governance (CG) in the UK NHS, and many countries and health systems have since had CG firmly on the policy agenda. This is for several reasons. First, are concerns about health care quality improvement and patient safety, driven by various lapses in professional standards and the monitoring and promotion of these. These concerns have also been propelled by obvious gaps in the systems of care—gaps in the way in which professionals work together, and between the different professionals involved in patient care. Second, because of the so-called 'management-clinician divide' which exists in many health systems and hospitals, especially in countries such as the UK and New Zealand where there has been a strong influence of 'managerialism' in recent years. A third reason relates to the obvious knowledge of front-line service delivery that health professionals can bring to the decision-making arena. This means decisions in a CG environment are derived from a knowledge base that encompasses more than just strategic and financial considerations.

CG promises to address these concerns as it entails building a system of management and leadership which features health professionals in the foreground. If CG is 'the system' of professionals and management working together for the same goals, then clinical leadership is an element of that system with professionals stepping up into leadership positions and leading for improvement by example. With CG, all professionals and managers may be expected to play a role. Fewer professionals may have specific 'leadership' roles, but all should still take an active interest in leading improvement of patient services and the system in which they work.

The research-base for CG is gradually building, providing a strong rationale for making it a founding principle for any health system or service provider organisation. Studies have demonstrated links between clinically-led organisations and superior performances on quality of care and financial indicators.Yet despite its importance, CG remains under-researched when compared with other core policy issues facing today's health systems.

There remain questions around how CG is defined and what exactly its scope is, leading some to question what the focus of it should be, how it should be designed and implemented, and health professionals themselves demanding more specific information. It could even be suggested that CG is a 'fuzzy' management concept; that without crucial detail on the structures which should be aimed for, or the roles that should be created in a health system to support CG, it will always be challenging building clinically-governed organisations. Furthermore, each organisation could end up building its own version of CG, possibly repeating mistakes made elsewhere. We, therefore, need more research into what works and why.

Questions also abound around how to measure CG and leadership. Various studies have looked at components of assessment, largely deploying qualitative and case study methods, although some have also sought to quantify developmental progress across different health organisations. Some studies have developed frameworks for assessing different dimensions of CG. There are also various self-assessment tools. The divergence in approaches may be expected in a field of management and organisational research but also points to another important gap. This is the need for improved methods for researching CG, especially the approaches and tools which might be used for this, along with broader agreement on these.