Ask a patient how they chose their surgeon, and the answer is almost always the same: a relative’s neighbour, a colleague’s uncle, a name repeated often enough to sound trustworthy. There is no other way to choose, because there is nothing to check against. This is what a failure of clinical governance looks like from the outside: invisible, until you need it.
The solution is not one database or law. Governance requires a culture built on three habits.
First, self-reporting: doctors log their own Continuing Medical Education (CME) credits, publications, and case outcomes for official tracking.
Second, peer review: clinicians assess each other’s technical competence, and peer flagging, intended for improvement, not punishment, addresses issues unnoticed by patients and administrators. For example, Even Hospital has an internal clinical governance portal where every doctor’s credentials and case history are visible to hospital leadership, and doctors can report on each other’s practices, both positive and negative, without penalty.
Third, independent audit: an unbiased body with no financial interest in any hospital or doctor periodically verifies self-reported data against electronic medical records and publishes the results.
None of this needs new technology. India runs a biometric identity system for 1.4 billion people. Building governance for 1.5 million doctors is a much smaller problem. EMRs already generate most of the raw material an auditor needs. The need of the hour is institutional support from the state government or the National Medical Commission. Karnataka, with hospitals already experimenting with internal governance, is a natural place to pilot it before a national rollout.
This does not exist today. It is important to be precise about what clinical governance means and how far India is from it.
Clinical governance is a simple idea with a technical name. It means monitoring the health of a healthcare institution the way a hospital monitors the health of a patient: tracking whether its doctors are practising ethically, competently, and safely, documenting what they do, and course correcting when something goes wrong. It is not one policy. It is a habit of measuring, recording, reviewing, and improving that has to run continuously, not just at the point of licensing.
India has licensing. It lacks the habit.
Every doctor is centrally credentialed by the NMC and, since health is a state subject, by bodies like the Karnataka Medical Council. These councils issue licenses and lay out a professional code of conduct. A doctor can practise for decades without either body knowing their caseload, complication rate, or patients’ experience with them, until someone complains. There is no routine review. No file says who she is as a clinician.
NABH accreditation is India’s closest attempt at institutionalising governance, and it mandates documentation, but practice varies across departments: some log everything, while others do the bare minimum.
This isn’t a training issue but a lack of independent verification. In the U.S., surgeons must log procedures, report rates, complete education, and recertify every decade. The Leapfrog Group grades nearly 3,000 hospitals on safety, using a public, independent methodology and awarding letter grades that are freely available.
Hospital grading, by itself, is biased, so external verification is essential. Without it, governance in India becomes self-reported and unverified, akin to invisibility. Anomalies like a surgeon taking six hours for a procedure that normally takes an hour should be flagged; in a functioning system, peers intervene. In India, such signals often go unnoticed until they cause complications.
Until such governance exists, patients in India will keep choosing surgeons by asking a neighbour and hoping everything goes well.