Kieran Walshe and colleagues identified that the next priority for clinical governance was to put it to work in clinical practice ('Scope to improve', 26 October).

We believe the aim of clinical governance - to improve the quality of care for patients - can only be delivered by clinical staff within directorates and services. Clinical staff want to contribute to quality improvements for patients but lack resources. We have set up multidisciplinary teams within directorates to take forward ideas for clinical audit.

The Clinical Improvement Programme (CLIP) is facilitated in 29 directorates by three divisionally based small teams of audit and clinical effectiveness staff.

Multidisciplinary CLIP teams identify areas for quality improvement, agreeing several projects to take forward using rapid-cycle audit methodology.

This delivers well-focused baseline audit, followed by change, and then monitors the effect of change on an indicator of quality improvement - all within six months to one year.

Because staff themselves agree what to audit, there is ownership of projects and a will to see them through the audit cycle.

The CLIP teams are now helping the directorate to knit together the other strands of clinical governance: for example, guideline implementation, clinical risk reduction and critical incident reporting This has been achieved while the trust was undergoing major internal reorganisation.

CLIP teams report to the patient service directors and up through the trust's clinical governance committee structures to assure the chief executive that the trust is delivering the clinical governance agenda.

Kieran Walshe's team found little progress in putting in place processes closer to the clinical workface in the West Midlands. Our approach demonstrates improvements in quality of care for our patients.

Alison Bramley Divisional clinical governance manager Royal Infirmary of Edinburgh Lothian University Hospitals trust Edinburgh