Government drives to improve quality in the NHS could give managers responsibility for clinical performance without giving them power to change clinical practice, says the Institute of Health Services Management.

The IHSM welcomes the idea of clinical governance to 'reduce inefficient and inequitable variations in healthcare.' But it warns that the initiative is 'incomplete' because it focuses on doctors rather than the whole healthcare team.

'If non-clinical management fails, it is often because of clinical inadequacies and with the continued emphasis on professional self-regulation it is not clear that managers are able to address such inadequacies directly,' the paper says.

Clinical Governance: clinician, heal thyself, from IHSM , 7-10 Chandos Street, London, W1 9DE. 10