The Commission for Health Improvement is redesigning its clinical governance review process in a bid to get closer to the 'heart' of the hospital patient's experience.

CHI maintains that reviews so far have delivered an accurate picture of the trusts involved, but the redesign is addressing aspects of the process that have been criticised as unfair. The fine-tuning underway since the pilot reviews were completed has been stepped up to make the whole clinical governance review programme more robust and transparent.

The sharp increase in workload faced by CHI this year as a result of rolling out the reviews across the country has forced the improvements, admitted CHI director of nursing Liz Fradd. She said: 'As a consequence of evaluating every step of our acute review process we have changed almost every element following the pilots.We are now embarking on a complete process redesign.

We are looking again [at how we approach reviews] to accommodate the huge number of trusts, we have to look at - 120 reviews this year and 170 next year.'

Staff questionnaires are being redesigned, with input from external experts linked to the Department of Health human resources directorate. The aim is to marry the CHI review with the annual staff surveys 'so that organisations do not have to repeat these questions for us', said Ms Fradd.

A 'big, complex piece of work' is also being undertaken by the College of Health to help CHI capture patients' perceptions of their care.

But Ms Fradd denied that the changes would make the review process softer or fairer on trusts: 'I would hope that the assessments are fair now. And they should be because we have an assessment framework against which we make these judgements. People are only ever upset by the things that are negative - they are happy to accept comments from the same sources when they are positive.'

CHI's desire to allay fears about the review process was signalled last week by the launch of a comprehensive guide to the reviews. CHI development manager Karen Wright said: 'If people feel anxious about a CHI review, then at least if they have this [guide] they will know what to expect'.

The guide contains a 'confidence table' grading the importance or reliability of opinions about the trust. It coincided with two more review reports (see boxes).

www. chi. nhs. uk

'A learning culture'

CHI on King's Healthcare trust:

many examples of notable practice and governance systems; excellent security for staff and very good bereavement facilities for relatives; impressive user- involvement strategy; high morale among staff; organisation culture is one of learning rather than blame; strong leadership throughout whole trust, including clinical leadership; sorting out untoward events and learning lessons from them is too complex; communications between teams could be improved.

'Strong leadership'

CHI on Homerton Hospital trust:

a commitment to improving quality of care; good work to find out what patients think, including patient surveys; quick response to complaints; a strong system for reporting problems and near-misses; strong leadership and good relationship with staff; admissions process for emergency patients could be streamlined; work needed to address causes of the area's high mortality rates.