Robin Gauld, Simon Horsburgh, Maureen Alice Flynn, Deirdre Carey, Philip Crowley

Purpose Clinical governance (CG) is an important foundation for a high-performing health care system, with many countries supporting its development. CG policy may be developed and implemented nationally, or devolved to a local level, with implications for the overall approach to implementation and policy uptake. However, it is not known whether one of these two approaches is more effective. The purpose of this paper is to probe this question. Its setting is Ireland and New Zealand, two broadly comparable countries with similar CG policies. Ireland's was nationally led, while New Zealand's was devolved to local districts. This leads to the question of whether these different approaches to implementation make a difference. Design/methodology/approach Data from surveys of health professionals in both countries were used to compare performance with CG development. Findings The study showed that Ireland's approach produced a slightly better performance, raising questions about the merits of devolving responsibility for policy implementation to the local level. Research limitations/implications The Irish and New Zealand surveys both had lower-than-desirable response rates, which is not uncommon for studies of health professionals such as this. The low response rates mean the findings may be subject to selection bias. Originality/value Despite the importance of the question of whether a national or local approach to policy implementation is more effective, few studies specifically focus on this, meaning that this study provides a new contribution to the topic.