Quality Governance, Ethics and Accountability

Introduction

Healthcare quality is not sustained by isolated clinical expertise or occasional inspection. It depends on governance: the structures, relationships, processes and values through which an organisation directs care, monitors performance, manages risk and remains answerable to patients, professionals, regulators and society. Quality governance therefore connects board-level strategy with bedside practice.

The subject is strategically important because quality failures are rarely caused by a single incompetent individual. They often arise from weak systems: unclear authority, poor information flows, inadequate staffing, normalisation of deviance, conflicts of interest, defective escalation processes or organisational cultures that discourage speaking up. Conversely, high-quality organisations make responsibilities explicit, use reliable evidence, protect patient rights and treat accountability as a mechanism for learning rather than merely punishment.

This chapter examines board oversight, clinical governance, audit, transparency, disclosure, privacy, informed consent and accountability. It also addresses ethical tensions involving safety, confidentiality, autonomy, equity and scarce resources.

Learning Objectives

By the end of this chapter, the reader should be able to:

1. Explain the meaning and scope of healthcare quality governance.
2. Distinguish corporate governance, clinical governance and operational management.
3. Design board-level oversight arrangements for quality and safety.
4. Evaluate clinical audit, transparency and disclosure systems.
5. Apply ethical principles to consent, privacy, confidentiality and resource allocation.
6. Analyse accountability systems and distinguish just accountability from blame.
7. Recommend governance responses to a complex quality and safety case.

1. The Meaning and Architecture of Quality Governance

Governance is the process by which an organisation is directed, controlled and held to account. Quality governance applies this process to the safety, effectiveness, patient-centredness, timeliness, efficiency and equity of care. It includes both formal mechanisms—committees, policies, reporting lines and audits—and informal mechanisms such as professional norms, leadership behaviour and organisational culture.

Three related concepts should be distinguished:

These domains overlap. A board that approves an unsafe staffing model is exercising corporate authority with clinical consequences. A clinical department that ignores a recurring medication error is failing in clinical governance. A manager who does not implement a risk-control procedure is failing operationally. Effective quality governance aligns all three levels.

A useful accountability chain is:

Purpose and values → standards → responsibilities → measurement → review → action → learning

Governance is weak when any link is absent. For example, measurement without responsibility produces reports but not improvement; responsibility without authority produces frustration; standards without patient involvement may produce technically compliant but insensitive care.

1.1 Dimensions of quality governance

A mature system normally contains the following dimensions:

• Strategic direction: quality objectives are part of organisational strategy and budgeting.
• Clinical leadership: qualified clinicians participate in decisions affecting care.
• Risk management: hazards are identified, assessed, controlled and escalated.
• Performance intelligence: data are valid, timely, stratified and interpreted in context.
• Professional accountability: competence, scope of practice and ethical conduct are monitored.
• Patient and public voice: patients influence priorities, design and evaluation.
• Learning and improvement: adverse events lead to system redesign, not only individual sanctions.
• Transparency: relevant information is communicated honestly and accessibly.

2. Board Oversight and the Quality Committee

The governing board has a duty of care, stewardship and oversight. It should not practise medicine or manage every incident. Its role is to ensure that the organisation has the capability, information and culture required to deliver safe, effective and equitable care.

Board oversight should answer five questions:

1. What quality outcomes is the organisation trying to achieve?
2. What risks could prevent those outcomes?
3. How reliable are the data presented to the board?
4. Who is responsible for corrective action?
5. How does the board know that improvement has occurred and been sustained?

A board quality committee may support this work, but delegation does not eliminate board accountability. The committee should have a clear charter, access to independent expertise and authority to require reports from executives and clinical leaders. Its agenda should include patient stories, safety signals, workforce capability, complaints, equity, audit findings, serious incidents and the status of improvement actions—not only financial or activity data.

2.1 The board quality dashboard

A dashboard should balance outcome, process, structure, experience and balancing measures. Examples include hospital-acquired infection rates, medication reconciliation completion, mortality adjusted for case mix, patient-reported experience, staff speak-up climate and unplanned readmission. A single indicator should never be treated as a complete representation of quality.

When comparing performance, leaders should examine definitions, denominators, case mix, missing data, statistical variation and potential gaming. A falling incident-reporting rate may indicate safer care, but it may also indicate fear of reporting. Similarly, shorter length of stay may represent efficiency or premature discharge. Interpretation requires triangulation.

For a rate-based indicator, the general calculation is:

Here, the numerator is the number of events, the denominator is the relevant population or opportunities, and k is a scaling constant such as 1,000 or 100,000. The numerator and denominator must refer to the same period, population and event definition. Rates should not be compared without considering exposure, case mix and uncertainty.

2.2 Board information asymmetry

Boards usually know less about frontline realities than clinicians and patients. This information asymmetry creates a governance risk: management may unintentionally or deliberately filter bad news. Countermeasures include independent quality reporting, direct access to clinical and patient representatives, unannounced visits, executive walk-rounds, confidential staff channels and regular review of unresolved concerns.

A high-reliability board asks not only, “Did the target improve?” but also, “What could make this measure misleading?” and “Which groups are not represented in the data?”

3. Clinical Governance in Practice

Clinical governance is the framework through which healthcare organisations are accountable for continuously improving the quality and safety of care and for creating an environment in which high standards flourish. Its components commonly include:

• evidence-based practice and clinical guidelines;
• professional education, credentialing and scope-of-practice control;
• clinical audit and outcome review;
• incident reporting and risk management;
• morbidity and mortality review;
• patient experience and complaints management;
• research governance and data integrity; and
• continuous quality improvement.

Clinical governance should not be reduced to compliance. A service may satisfy documentation requirements while delivering fragmented or inequitable care. Governance must therefore examine whether standards are meaningful, clinically appropriate and experienced as beneficial by patients.

3.1 Responsibility matrices and escalation

Every major quality objective should have a named accountable executive and an operational owner. A responsibility matrix can distinguish who is responsible for performing an activity, accountable for its result, consulted in decisions and informed of progress. Ambiguous ownership is a common reason that corrective actions remain open.

Escalation thresholds should be defined in advance. For instance, a cluster of similar medication incidents, a sudden rise in mortality or a privacy breach may require immediate executive notification, temporary controls and regulatory communication. Escalation should be based on risk, not solely on public visibility.

4. Ethics as the Foundation of Governance

Ethics concerns what ought to be done, while governance creates the structures through which decisions are made and justified. A technically efficient decision may still be ethically unacceptable if it violates autonomy, discriminates unfairly or conceals material information.

Four widely used principles are:

• Respect for autonomy: competent persons should be able to make voluntary, informed decisions.
• Beneficence: action should promote patient welfare.
• Non-maleficence: avoid preventable harm and reduce foreseeable risk.
• Justice: distribute benefits, burdens, opportunities and risks fairly.

These principles do not automatically produce one answer. A patient’s refusal may conflict with clinicians’ perception of benefit. A privacy restriction may limit public-health surveillance. A costly treatment for one patient may reduce the capacity to treat many others. Ethical governance makes the conflict explicit, identifies affected parties, applies relevant law and policy, and records reasons that can be publicly defended.

4.1 Procedural justice

When decisions involve scarcity or disagreement, procedural justice is especially important. A fair process should be transparent about relevant reasons, based on evidence, open to revision, consistent across comparable cases and accountable to an appropriate review body. This does not guarantee agreement, but it improves legitimacy.

Ethics committees, clinical ethics consultation and multidisciplinary review can support difficult decisions. Their role is advisory unless formal authority is granted by law or policy. They should not replace clinical responsibility or become a mechanism for avoiding difficult executive decisions.

5. Clinical Audit and Quality Improvement

Clinical audit is a systematic process of measuring care against explicit criteria and implementing change when required. Its cycle is:

Select standard → collect data → compare performance → explain gap → implement change → re-audit

Audit differs from research. Research seeks generalisable new knowledge, whereas audit assesses whether existing standards are being achieved in a defined service. In practice, the distinction can be complex; projects involving randomisation, experimental interventions or generalisable findings may require research ethics review.

A useful audit criterion should be specific, evidence-informed, measurable and relevant. For example, “eligible patients receive documented medication reconciliation within 24 hours of admission” is more auditable than “medication management is good.”

The compliance proportion is:

If 84 of 100 eligible records meet a criterion, compliance is 84%. This figure describes the reviewed sample; its interpretation depends on sampling method, data quality and whether the cases represent the service.

Audit alone does not improve care. Improvement requires understanding why performance falls short. A gap may reflect knowledge, workflow design, equipment, staffing, incentives or contradictory policies. Punishing clinicians for a process defect can suppress reporting while leaving the hazard intact.

6. Transparency, Candour and Disclosure

Transparency means making relevant information accessible and understandable to those entitled to receive it. It includes performance reporting, explanation of decisions, disclosure of conflicts of interest and communication about incidents. Transparency is not equivalent to indiscriminate publication of confidential data.

6.1 Open disclosure after harm

Open disclosure is an honest, timely and compassionate communication process after a patient has experienced harm or a significant unexpected outcome. It normally includes:

1. a prompt factual explanation of what is known;
2. an expression of regret or apology where appropriate;
3. an explanation of immediate actions to protect the patient;
4. a commitment to investigate and provide further information; and
5. opportunities for questions, support and follow-up.

The distinction between an apology and an unsupported admission of legal liability is jurisdiction-specific. Organisations should provide staff with legal and communication guidance, but legal advice must not be used as a reason for evasion or misleading statements. Disclosure should avoid speculation, defensive language and premature attribution of blame.

Patients and families should not have to discover serious errors through records, media or informal conversations. Candour is both an ethical obligation and a safety intervention: accurate information enables treatment, preserves trust and may reveal related risks.

6.2 Public reporting

Public reporting can improve accountability and stimulate improvement, but poorly designed measures may create gaming, avoidance of high-risk patients or concealment of incidents. Reports should provide definitions, time periods, limitations and context. Equity-sensitive reporting should examine whether quality differs by language, disability, socioeconomic position, ethnicity, geography, age or other relevant characteristics, while protecting small-group privacy.

7. Privacy, Confidentiality and Data Governance

Privacy concerns a person’s control over personal information and bodily or personal space. Confidentiality is the professional and organisational duty to protect information entrusted during care. Data governance concerns the rules, roles, controls and lifecycle processes governing collection, access, use, sharing, retention and disposal.

A robust data-governance system includes:

• clear purposes and lawful bases for data use;
• data minimisation and proportionality;
• role-based access controls;
• authentication and audit logs;
• encryption and secure transmission where appropriate;
• retention and deletion schedules;
• breach detection, response and notification procedures;
• staff training and sanctions for misuse; and
• patient-facing explanations of data use.

Privacy is not absolute. Disclosure may be justified or required for direct care, serious and imminent risk, public-health protection, legal obligations or approved research. The decision should use the least intrusive disclosure necessary, respect applicable law and be documented.

A governance committee should distinguish identifiable, pseudonymised and anonymised data. Removing names does not necessarily anonymise data if individuals can be re-identified through combinations of dates, locations, diagnoses or rare characteristics. Data sharing agreements should specify purpose, permitted users, security, retention, onward disclosure and responsibility for breaches.

7.1 Artificial intelligence and secondary data use

AI systems introduce additional governance questions: Was the training data lawfully obtained? Does it represent the population? Can performance be audited across subgroups? Who reviews false positives and false negatives? Can clinicians understand the system’s limitations? Who is accountable when an automated recommendation contributes to harm?

AI should support, not obscure, professional accountability. Human oversight must be meaningful: a clinician should have sufficient authority, time and information to challenge an output. Monitoring should continue after deployment because data drift, workflow changes and altered patient populations can degrade performance.

8. Informed Consent and Shared Decision-Making

Informed consent is a process of communication and authorisation, not merely a signed form. Valid consent generally requires capacity, adequate information, voluntariness and a decision that relates to the proposed intervention. Information should cover the nature and purpose of the intervention, material benefits, material risks, reasonable alternatives—including no treatment—and the consequences of refusal.

Capacity is decision-specific and may fluctuate. A person may be unable to make one complex decision but able to make another. Where capacity is absent, substitute decision-making should follow applicable law and the person’s known wishes and best interests. Emergency treatment without prior consent may be justified when delay threatens life or serious health and no authorised decision-maker is available, but the basis should be documented and consent sought for continuing care when feasible.

Consent is vulnerable to power imbalance. Patients may agree because they fear losing care, misunderstand professional authority or face language and literacy barriers. Interpreters, accessible information, teach-back and adequate time improve voluntariness and understanding. Financial incentives and organisational targets should not distort recommendations.

9. Accountability, Just Culture and Fair Response

Accountability means being answerable for decisions, conduct and outcomes within one’s role and authority. It should operate at multiple levels:

• Individual: competence, honesty, professional conduct and compliance with reasonable procedures.
• Team: communication, handovers, peer checking and collective situational awareness.
• Organisational: staffing, equipment, policy, training, reporting systems and leadership.
• System: regulation, financing, supply chains, professional standards and social determinants.

A just culture distinguishes among human error, at-risk behaviour and reckless behaviour. Human error calls for consolation, redesign and learning. At-risk behaviour involves a choice where risk is underestimated or normalised; coaching, incentives and removal of unsafe conditions may be appropriate. Reckless behaviour involves conscious disregard of substantial risk and may warrant disciplinary action. The categories require careful investigation, not automatic labelling.

This approach does not eliminate personal responsibility. Rather, it avoids the false choice between “blame nobody” and “blame somebody.” Leaders should ask both: “What did the person do?” and “What conditions shaped that action?”

9.1 Incident investigation

A proportionate investigation should establish facts, identify contributing conditions, hear the perspectives of patients and staff, and produce actions with owners and deadlines. Root cause analysis is best understood as a structured exploration of contributing factors, not a search for one ultimate cause. Common methods include timelines, process mapping, five-whys questioning, fault trees and barrier analysis.

Actions should prioritise stronger controls. Removing a hazardous step, redesigning equipment or automating a forcing function is generally more reliable than reminders alone. Every action should have a mechanism, responsible owner, completion date and effectiveness measure.

10. Ethical Allocation of Scarce Resources

Healthcare managers routinely allocate scarce operating-room time, medicines, beds, staff attention and capital. Ethical allocation should be based on relevant clinical need, expected benefit, urgency, equity and evidence—not social worth, wealth, celebrity or the ease of treating a patient.

A defensible allocation framework should:

1. define the resource and the decision population;
2. identify clinically relevant criteria;
3. assess evidence and uncertainty;
4. examine equity and potential discrimination;
5. involve appropriate clinical and ethics expertise;
6. communicate the process and reasons; and
7. provide review or appeal mechanisms.

Cost-effectiveness analysis may inform stewardship, but it should not be used mechanically. A common ratio is:

where C₁ and C₀ are the costs of a new and comparator intervention, and E₁ and E₀ are their effects, measured in the same outcome unit. The incremental cost-effectiveness ratio is meaningful only when the alternatives, perspective, time horizon, discounting approach and outcome measure are clearly specified. It is a decision aid, not a complete statement of justice. Distributional effects, catastrophic need, uncertainty and patient preferences may require additional consideration.

11. Illustrative Case: Disclosure, Privacy and System Accountability

Background

A fictional regional hospital introduces an electronic prescribing module. During the first month, several prescriptions are displayed in a confusing format. A patient with renal impairment receives an excessive dose of a medicine and develops serious harm. The pharmacist identifies the error during reconciliation. The patient is stabilised but requires prolonged admission.

Problem

The hospital must treat the patient, disclose the event, protect privacy, investigate the technology and decide whether to suspend the module. The board is concerned about reputational damage. A senior manager suggests describing the event as an isolated prescribing mistake until the investigation is complete.

Analysis

The event involves clinical risk, human factors, software design, implementation governance and communication ethics. The pharmacist’s action prevented further harm, but the error should not be attributed solely to the prescriber without examining display design, training, alert fatigue, workload, renal-function data and testing. Privacy requires that public communication exclude unnecessary identifying details. Transparency requires that the patient and family receive timely, accurate information.

The organisation should assess whether other patients are exposed, introduce an immediate safety control, notify appropriate authorities where required and preserve relevant system logs. The board should receive an independent report rather than relying exclusively on the implementation team.

Approach and solution

The hospital convenes a multidisciplinary review including the patient representative, prescriber, pharmacist, nursing representative, informatics specialist, risk manager and ethics adviser. It provides the patient with an explanation, apology for the harm, treatment plan and contact point for further questions. The module is temporarily restricted for high-risk medicines while a safer interface and verification step are implemented.

The investigation identifies three contributors: the system displayed dose units inconsistently; renal-function results were not visible at the prescribing screen; and implementation training used idealised test cases. Corrective actions include interface redesign, mandatory visibility of renal function, targeted simulation, independent usability testing and a 30-day review of high-risk prescriptions. The board receives measures of action completion and subsequent prescribing errors, while public reporting describes the hazard and corrective measures without identifying the patient.

Outcome

The case demonstrates that candour and privacy can coexist. It also shows that accountability extends beyond the clinician who entered the prescription. The prescriber remains responsible for reasonable checking, but the organisation is accountable for the conditions under which prescribing occurred.

Learning points

• Disclosure should begin with the patient’s welfare, not reputational strategy.
• Technology changes clinical work and therefore requires clinical governance.
• Incident investigation should examine barriers, interfaces and implementation decisions.
• Corrective actions must be measurable and tested for effectiveness.
• Confidentiality limits unnecessary detail; it does not justify concealment.

12. Implementation Framework for Managers

Managers can strengthen governance through a staged approach:

Stage 1: Establish purpose. Define quality objectives in patient-centred terms and align them with strategy and resources.

Stage 2: Map accountability. Identify board, executive, clinical, team and individual responsibilities. Clarify escalation routes.

Stage 3: Build information reliability. Standardise definitions, validate data, report limitations and triangulate quantitative indicators with qualitative evidence.

Stage 4: Create psychological safety. Protect speaking up, respond respectfully to concerns and avoid retaliation for good-faith reporting.

Stage 5: Integrate ethics and rights. Embed consent, privacy, equity, disclosure and conflict-of-interest review in routine processes.

Stage 6: Act and learn. Prioritise high-reliability controls, assign owners, measure effects and re-evaluate unintended consequences.

Stage 7: Communicate. Explain decisions to patients, staff, regulators and the public in language appropriate to each audience.

Challenges and Limitations

Governance systems can become bureaucratic, producing excessive reporting without safer care. Metrics may distort priorities when targets are rewarded more than outcomes. Transparency can be limited by privacy law, litigation concerns or commercial confidentiality, although these constraints should be interpreted narrowly and honestly. Ethics committees may lack diversity or influence. Just culture may be misunderstood as leniency, while disciplinary systems may still overreact to visible individual mistakes.

Resource constraints create genuine conflicts. A small organisation may not be able to maintain extensive internal expertise and may need regional partnerships or external review. Governance structures must therefore be proportionate to risk, not copied mechanically from larger institutions. Finally, no framework can eliminate uncertainty. Good governance makes uncertainty visible, supports reasoned decisions and remains open to correction.

Contemporary Directions and Best Practices

Contemporary quality governance is moving toward integrated safety, equity and digital governance. Patient-reported outcomes, experience-based co-design, real-time safety surveillance and human-factors engineering are increasingly important. Regulators and boards are paying greater attention to algorithmic bias, cybersecurity, climate-related disruption and workforce wellbeing.

Best practice includes:

• keeping patients and communities represented in governance;
• combining outcome, process, experience and equity measures;
• ensuring independent challenge to executive reports;
• using proportional, learning-oriented investigations;
• publishing clear policies for disclosure and data use;
• auditing access to electronic records;
• testing new technologies in realistic clinical conditions;
• linking improvement actions to accountable owners and effectiveness measures; and
• reviewing governance performance itself.

Chapter Summary

Quality governance links organisational purpose, clinical standards, measurement, accountability and learning. Corporate governance sets direction and oversees risk; clinical governance assures professional and clinical quality; operational management implements reliable care. Boards require balanced, trustworthy information and must challenge apparent success as well as visible failure.

Ethical governance protects autonomy, privacy, welfare and justice. Informed consent is a communication process, confidentiality requires proportionate information controls, and open disclosure demands timely, compassionate honesty after harm. Clinical audit measures practice against explicit standards, but improvement requires understanding and changing the systems that shape behaviour.

Accountability should be proportionate and fair. A just culture distinguishes error, at-risk behaviour and recklessness while retaining responsibility at individual, team, organisational and system levels. Scarce resources should be allocated through transparent, evidence-informed and equity-sensitive processes. Digital tools and AI require explicit oversight of data quality, bias, explainability, human control and post-deployment safety. Ultimately, governance is successful when patients experience safer, more effective and more trustworthy care—not merely when an organisation produces compliant reports.

Key Terms

Accountability: The duty to explain and take responsibility for decisions, conduct and outcomes.

Clinical governance: The framework for maintaining and improving clinical quality and safety.

Confidentiality: The duty to protect information entrusted during care.

Consent: Voluntary authorisation based on adequate information and decision-making capacity.

Corporate governance: Direction, control and oversight of an organisation.

Data governance: Rules and responsibilities for managing data throughout its lifecycle.

Disclosure: Communication of relevant information about an event, decision or risk.

Equity: Fairness in access, treatment, outcomes and distribution of resources.

Informed consent: Consent obtained through meaningful communication about benefits, risks and alternatives.

Just culture: An approach that balances learning with proportionate individual accountability.

Open disclosure: Honest communication with patients and families after harm or an unexpected outcome.

Patient safety: Prevention and reduction of avoidable harm associated with healthcare.

Privacy: A person’s interest in controlling access to personal information and personal space.

Procedural justice: Fairness and transparency in decision-making processes.

Quality audit: Systematic comparison of care with explicit standards.

Root cause analysis: Structured investigation of contributing factors in an adverse event.

Transparency: Making relevant information accessible, understandable and open to scrutiny.

Whistleblowing: Reporting serious wrongdoing or risk through protected channels.

Review Questions

Short Answer Questions

1. Distinguish corporate governance from clinical governance.
2. What are the four commonly used principles of healthcare ethics?
3. Why is a clinical audit cycle incomplete without re-audit?
4. State two requirements of valid informed consent.
5. What is meant by a just culture?

Long Answer Questions

1. Explain how a board can exercise effective oversight of quality without interfering in clinical decision-making.
2. Discuss the ethical and managerial requirements of open disclosure after a serious patient-safety incident.
3. Describe how privacy, confidentiality and data governance should operate in an electronic health-record environment.
4. Evaluate the strengths and limitations of clinical audit as a quality-improvement method.
5. Explain how governance structures can support fair allocation of scarce healthcare resources.

Analytical / Application Questions

1. A hospital’s incident-reporting rate falls by 30% while staff survey results show declining psychological safety. Analyse two possible interpretations and recommend a board response.
2. A clinical AI tool performs well overall but produces more false negatives for a minority population. Design a governance and accountability response.
3. After a medication error, a manager proposes disciplining the prescriber immediately. Using just-culture principles, explain the investigation steps and possible responses.

Multiple Choice Questions with Answers

Question 1

Which statement best describes clinical governance?

A. A framework for improving and assuring the quality and safety of clinical care

B. A method for preparing the annual financial statements

C. A system for replacing professional judgement with algorithms

D. A marketing process for improving an organisation’s reputation

Correct Answer: A. A framework for improving and assuring the quality and safety of clinical care

Question 2

What should a board do when an incident-reporting rate falls unexpectedly?

A. Assume that safety has improved

B. Stop collecting incident data

C. Triangulate the result with other evidence, including speak-up and safety-culture data

D. Immediately dismiss the quality manager

Correct Answer: C. Triangulate the result with other evidence, including speak-up and safety-culture data

Question 3

Which element is essential to valid informed consent?

A. A signed form in every circumstance

B. Voluntary decision-making based on relevant information

C. A decision that always agrees with the clinician’s recommendation

D. Consent obtained only from a family member

Correct Answer: B. Voluntary decision-making based on relevant information

Question 4

In clinical audit, what follows comparison of performance with a standard?

A. Automatic disciplinary action

B. Explanation of any gap and implementation of change

C. Deletion of the data

D. Publication of patient-identifiable records

Correct Answer: B. Explanation of any gap and implementation of change

Question 5

Which response is most consistent with a just culture after an ordinary human error?

A. Automatic termination

B. Concealment to protect reputation

C. System learning, support and risk reduction

D. Public identification of the staff member

Correct Answer: C. System learning, support and risk reduction

Question 6

A service records 45 compliant cases out of 60 eligible cases. What is its compliance percentage?

A. 25%

B. 45%

C. 60%

D. 75%

Correct Answer: D. 75%

Question 7

Which practice best supports privacy in electronic health records?

A. Allowing all employees unrestricted access

B. Using role-based access controls and audit logs

C. Sharing complete records for every secondary purpose

D. Deleting all records immediately after discharge

Correct Answer: B. Using role-based access controls and audit logs

Question 8

What is the primary ethical purpose of open disclosure?

A. To avoid all regulatory scrutiny

B. To provide honest, compassionate information and support after harm

C. To assign blame before facts are established

D. To guarantee that litigation cannot occur

Correct Answer: B. To provide honest, compassionate information and support after harm

Question 9

In the incremental cost-effectiveness ratio, the denominator represents:

A. The difference in effects between alternatives

B. The total organisational budget

C. The number of staff involved

D. The total cost of the new intervention only

Correct Answer: A. The difference in effects between alternatives

Question 10

Which is the strongest governance response when an electronic prescribing interface contributes to a medication error?

A. Rely only on a reminder to prescribers

B. Blame the last person who entered the prescription

C. Examine system design, introduce controls and monitor effectiveness

D. Stop all incident reporting

Correct Answer: C. Examine system design, introduce controls and monitor effectiveness