CAN/HSO 1003:2021 Clinical Governance Standard – Public Review

The public review of the draft of HSO’s Clinical Governance Standard for Canadian and global audiences will take place from March 22nd to May 23rd, 2021.

Everyone is welcome to take this opportunity to review and comment on the draft standard before it is published. HSO will use the feedback to improve the standard with guidance from the Technical Committee overseeing the work. Once published, the standard will be reviewed in five years’ time. There will continue to be future opportunities to improve it as part of an evergreen review process.

Important note: CAN/HSO 1003:2021 (E) Clinical Governance is NOT part of the Qmentum Accreditation or Distinction Programs at this time. If, in the future, this standard or other components are introduced to assessment programs that you are a part of, you will receive ample notice and direction from your accreditation body.

About the standard

This will be the first edition of CAN/HSO 1003:2021 (E) Clinical Governance and it is applicable to health and social services organizations offering a number of clinical (health and social) services. The standard is being developed to be an HSO Global standard and National Standard of Canada intended for public and private health and social service organizations that provide multiple services across the continuum of care.

The standard is been designed to support health and social service organizations to ensure that everyone in and associated with the organization (leaders, providers, patients/clients, families including caregivers, community members, and partners in the system) work collaboratively in a team-based and interprofessional manner to provide clients with the right care at the right time for the best possible client experience and outcomes.

The standard will guide clinical management and clinical service providers in organizations to work with clients and families to:

  • Design clinical programs and services to meet community needs
  • Provide clients with a people-centred care journey
  • Set up effective ways for collaborating to make shared clinical decisions at organizational and direct care levels. This includes defining who makes the decisions, how those affected by the decisions participate in the decision making, and how those involved are held accountable for the outcomes of the decisions
  • Continuously improve the quality, and optimize the delivery, of safe, reliable, integrated and people-centred care

Clients receiving services at the organizations can expect to experience care that is safe and coordinated across all the services. Clients can expect to fully participate in their own care decisions. They can ask questions and have safe and open conversations with their clinical service providers and other team members. Clients and families can also expect to have opportunities to participate, along with others in the community, in organizational decision making and changes related to improving clinical services and care delivery to better meet community and client needs.

The draft standard is divided into 3 sections:

  1. Designing People-Centred Services to Meet Client and Community Needs
  2. Engaging Stakeholders in Clinical Governance and Shared Decision-Making
  3. Continuously Improving Clinical Quality and Safety

Development process

CAN/HSO 1003:2021 (E) Clinical Governance is being developed using the best available evidence by the HSO Working Group on Clinical Governance with oversight by the HSO Leadership and Governance Technical Committee. Technical Committee members include patients and family members, clinicians and health service administrators, government and health services stakeholders, and researchers. Working Group members provide specific expertise in the realm of clinical governance.

Tell us what you think

We are asking everyone who has an interest in this standard, such as people who have experiences using health services, health and social service providers, leaders in health and social service organizations, and others who have expertise in this subject matter, for their views on the proposed standard.

You can provide feedback in general or on specific criteria.

The public review is open for 60 days. We greatly appreciate your feedback on the new standard. The public review is open until 11:59 PM EST on May 23, 2021. The simplest way to respond is to follow the link at the bottom of this page and provide your feedback in the questionnaire that follows.

Draft Standard  Questionnaire

Draft Standard Questionnaire

What happens next?

The Technical Committee will review and consider each comment received and will incorporate feedback as applicable. We expect to release the final version of the standard by end of 2021.

For more information, questions or concerns regarding the standards, please contact us at