Section D Healthcare Governance
- Nov 18, 2025
- 6 min read
Index
Introduction: Clinical Governance at the Front Line
Chronic Disease Management and Force Readiness
From Incident to Insight: Managing ASERs Effectively
Information Governance: Caldicott, FOI and GDPR in Daily Practice
Speaking Up and Standing By: Whistleblowing and Chaperone Policies
Legal and Ethical Duties in Armed Conflict
Safe Systems in Practice: MDSOs, Committees and Governance Meetings
Clinical Audit: Turning Data into Better Care
Health Promotion for Populations at Risk
Key Skills and Practical Takeaways
Introduction: Clinical Governance at the Front Line
Working as a healthcare professional within the armed forces demands more than clinical competence; it requires a deep understanding of governance, ethics, legal frameworks and systems of accountability that protect both patients and personnel.
These CPD reflections draw on experience within the Royal Navy medical environment and explore how chronic disease management, incident reporting, information governance, whistleblowing, chaperoning, medico-legal frameworks and structured governance processes all interlock to support safe, ethical and effective care.
At Kraken Medical, we recognise that many clinicians operate under similar pressures: balancing operational readiness with high standards of patient-centred care. This article turns those experiences and competencies into practical insights that can be applied across a wide range of clinical settings.
Chronic Disease Management and Force Readiness
Chronic disease management in the armed forces is not simply about symptom control; it has direct implications for operational capability and quality of life.
Coordinating Care and Follow-Up
Supporting personnel with chronic conditions involves:
Coordinating specialist appointments and reviews
Ensuring regular monitoring and appropriate investigations
Facilitating timely follow-up and treatment adjustments
Efficient appointment scheduling and tracking are essential for continuity of care. When chronic disease pathways are well managed, clinicians help maintain both the health of the individual and the overall readiness of the unit.
Robust Documentation
Accurate, up-to-date records form the backbone of chronic disease management. Key elements include:
Diagnosis and problem lists
Current medications and treatment plans
Relevant investigations and monitoring results
Documented changes in clinical status or functional capacity
These records allow any clinician accessing the notes to make safe, informed decisions, particularly in deployed or rotational environments where continuity of personnel can be challenging.
Professional Development
Chronic disease management is an evolving field. Keeping current with guidelines, emerging therapies and service models is essential, especially for conditions that commonly impact military populations (e.g. musculoskeletal disorders, mental health conditions, metabolic disease).
From Incident to Insight: Managing ASERs Effectively
The process for raising and managing an Accident, Sickness and Emergency Report (ASER) is a critical part of clinical governance.
Meticulous Documentation
Effective ASER management starts with clear, factual recording:
Date, time and location of the incident
Individuals involved
Concise, objective description of what occurred
Immediate actions taken
High-quality documentation underpins later review, decision-making and lessons learned.
Timely Escalation and Response
Once an ASER is identified, prompt and appropriate escalation is essential:
Informing relevant medical staff, command and safety personnel
Instigating immediate risk mitigation where needed
Ensuring the affected individual receives appropriate assessment and care
This responsiveness supports both individual safety and organisational learning.
Collaborative Follow-Up
ASERs are not just forms – they are opportunities for systems improvement. Working with other departments to gather further information, analyse causative factors and contribute to action plans is a core governance skill.
Information Governance: Caldicott, FOI and GDPR in Daily Practice
Information governance is a recurring theme throughout modern clinical practice, and in a military context it carries additional sensitivities.
Caldicott Principles in Action
Knowledge of the Caldicott Principles ensures that patient information is:
Justified in its use
Used only when necessary
Limited to the minimum required
Accessed on a strict “need-to-know” basis
Accurate, secure and handled lawfully
Clinically, this means thinking carefully before sharing information, documenting the rationale for information sharing, and using secure communication channels.
Freedom of Information (FOI)
Understanding FOI legislation helps clinicians and managers:
Distinguish between information that can be disclosed at an organisational level and confidential personal data that must be protected
Respond appropriately to authorised requests for information
Support transparency and accountability without compromising confidentiality
General Data Protection Regulation (GDPR)
Knowledge of GDPR translates into everyday practice by:
Ensuring lawful bases for processing patient data
Obtaining and respecting patient consent where appropriate
Informing patients of their rights over their data
Safeguarding data through secure storage, appropriate access controls and clear retention policies
Taken together, Caldicott, FOI and GDPR create a framework in which clinicians can share what is necessary for safe care while honouring legal and ethical obligations.
Speaking Up and Standing By: Whistleblowing and Chaperone Policies
Whistleblowing: Safeguarding Standards
The whistleblowing policy is a practical mechanism to uphold patient safety and professional integrity. Confidence in this policy allows clinicians to:
Raise concerns about unsafe practice, poor care or unethical behaviour
Escalate issues through appropriate channels without fear of reprisal
Contribute to a culture of openness, learning and improvement
A key skill here is recognising when a concern moves from a local issue to something that requires formal escalation, and then documenting and reporting it appropriately.
Chaperone Policy: Protecting Patients and Clinicians
The chaperone policy reinforces dignity, safety and trust, particularly during intimate or potentially sensitive examinations. Good practice includes:
Explaining the role and purpose of a chaperone in plain language
Offering and recording the presence (or decline) of a chaperone
Ensuring the chaperone is appropriately trained and understands their role
Encouraging patients to voice preferences or concerns
Clinicians who understand and apply chaperone policies well create safer, more comfortable environments for both patients and staff.
Legal and Ethical Duties in Armed Conflict
Healthcare professionals in the armed forces must navigate the intersection of medicine, law and ethics.
International Humanitarian Law (IHL) and Law of Armed Conflict (LOAC)
Key responsibilities include:
Understanding protections afforded to civilians, the wounded, the sick and those hors de combat
Recognising prohibited acts such as targeting civilians or using indiscriminate weapons (within the scope of clinical awareness)
Providing care impartially, based on clinical need, regardless of allegiance
Clinicians also have a duty to report violations of IHL/LOAC observed in the course of their role.
The Geneva Conventions
Knowledge of the four Geneva Conventions underpins:
The humane treatment of wounded and sick personnel on land and at sea
Appropriate care and conditions for prisoners of war
Protection of civilians during conflict
In practice, this means treating every human being encountered in a clinical context with dignity, impartiality and adherence to medical ethics, whether they are allies, civilians or enemy combatants.
Safe Systems in Practice: MDSOs, Committees and Governance Meetings
Medical Department Standing Orders (MDSOs)
MDSOs operationalise best practice into clear, repeatable procedures. Effective use involves:
Knowing where to find the relevant MDSO quickly
Implementing it accurately in real-time clinical scenarios
Documenting adherence in the notes
Providing feedback when procedures could be refined
This consistent use of standard operating procedures promotes safety and reduces variation in care.
Unit Health Committee: Front-Line Health Strategy
Participation in a Unit Health Committee allows clinicians to:
Contribute to discussions on unit health needs and priorities
Shape policies, protocols and health promotion initiatives
Advocate for resources, service improvements and support pathways
Bring forward concerns and feedback from personnel
It is an opportunity to influence health at a population level, not just individual patient encounters.
Healthcare Governance Meetings
Healthcare Governance Meetings sit at the heart of quality, safety and accountability. They typically address:
Review and updates of policies and procedures
Audit results, incident trends and patient safety data
Risk management and mitigation strategies
Resource allocation and service development
Ethical issues and patient experience
Engaging with these meetings develops skills in interpreting data, contributing to improvement plans and understanding how local practice links to organisational priorities.
Clinical Audit: Turning Data into Better Care
Clinical audit is a structured way to test whether practice matches agreed standards – and to improve when it doesn’t.
Key stages clinicians contribute to include:
Data Collection – Ensuring information is reliable, complete and representative
Analysis – Comparing current practice against standards and guidelines
Identifying Gaps – Highlighting discrepancies and exploring reasons behind them
Action Planning – Co-designing realistic, evidence-based changes with stakeholders
Implementation – Supporting the roll-out of new or revised processes
Re-audit and Monitoring – Checking whether changes have delivered the intended improvements
Skills gained through audit work—such as critical appraisal, systems thinking and change management—are increasingly core to modern clinical roles.
Health Promotion for Populations at Risk
Beyond responding to illness, clinicians play a vital role in proactive health promotion, particularly for populations at increased risk.
This involves:
Identifying at-risk groups based on occupation, environment, lifestyle or underlying health factors
Designing targeted education sessions (e.g. mental health resilience, cardiovascular risk reduction, sexual health, substance misuse, injury prevention)
Promoting healthy behaviours around nutrition, exercise, sleep and stress management
Encouraging screening and early help-seeking to catch problems before they escalate
Tailoring messages to cultural, social and logistical realities of the target group
Monitoring impact and adjusting approaches based on feedback and outcomes
In a military context, high-quality health promotion contributes directly to resilience, readiness and long-term well-being.
Key Skills and Practical Takeaways
Across these domains, several core competencies stand out:
Meticulous documentation – underpinning safe care, incident management and legal defensibility
Confident communication and escalation – for ASERs, whistleblowing and multi-disciplinary work
Information governance literacy – Caldicott, FOI and GDPR applied in real clinical decisions
Ethical resilience – providing impartial care and upholding legal frameworks in challenging contexts
Systems thinking – engaging with MDSOs, committees, governance meetings and clinical audit
Population health perspective – combining chronic disease management with targeted health promotion
These are not “nice-to-haves” but integral elements of modern healthcare practice—military or civilian.
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