Development of Clinical and Health Governance: Primary Health Care in the Lisbon and Tagus Valley Region

Abstract The Clinical and Health Councils (Conselhos Clínicos e de Saúde - CCS) became responsible for implementing Clinical and Health Governance (Governação Clínica e de Saúde - GCS) in primary health care (PHC) in Portugal. However, this project suffered political abandonment, although there are cases of continuity due to the dedication of CCS professionals. Considering the lack of evidence on the impact of GCS concerning the horizontal integration of the Functional Units of Health Center Groups (Agrupamentos de Centros de Saúde - ACES), the present study sought to identify micropolitical elements that could enhance this horizontal integration. The modified Delphi technique (Policy Delphi) was used as a methodology involving a group of ten experts with experience in academia, in administrative structures, and in the CCS, who shared their experiences to answer the research questions. The results revealed, on the one hand, a general tendency, on the part of the experts to accept that the CCS fulfilled the competences that were assigned. On the other hand, they identified economic and social limitations in the development of the project, as well as the fragmentation of care and tensions generated by disparities between the Functional Units. This study also made it possible to suggest a set of micropolicies capable of promoting the integration of GCS in PHC.