CPD Shorts: Governance for sonographers

By Cat Lee, trainee consultant radiographer, Royal Devon University Healthcare NHS Foundation Trust - Eastern Services 

As healthcare practitioners, clinical governance should underpin our daily activities, ensuring that they are safe and continually improving(1).

This ensures that our patients receive the best quality care possible. By understanding what governance is and how we can use it as practitioners we can help to improve the services that we provide. This short CPD article, based on the seven pillars of clinical governance,(2,3) will outline some key areas to consider as sonographers, to embed quality improvement into our roles. In each pillar, we provide some reflective prompts to consider in your own practice.

Seven key points:

• Patient and Public involvement
  • We should be involving patients in decision-making about their own care and design of our services. As sonographers we have a unique opportunity to spend a 20-minute appointment with them. This creates the potential for health-related conversations with our patients. The choices we offer could be as simple as what time or which location a patient prefers their appointment. It could be about supporting them in their decision about whether to have an internal scan or not; whether to attend and accept screening appointments or tests; or sign-posting them to smoking cessation or for dietary advice if they want us to.
  • In your own practice:
    • How do you support patients to make decisions about their care? Could you do more? If so, what?
    • Do you feel confident to do so? 
    • What can you do to improve your confidence in having these types of conversations?
    • Does your department consult with its service users when creating new clinics? Could you promote a change of departmental culture and suggest this happens in future? Could you evaluate your service with patient views being collected?
• Clinical Effectiveness
  • We should be basing our clinical decisions in ultrasound on policy which is grounded in evidence and research. In ultrasound the right person should “do the right thing to the right person at the right time in the right place”(3)
  • In your own practice:
    • Are your local policies based on the most up-to-date research and evidence? If not, can you gather the evidence to update your documentation with your managers? Do you understand how NICE create their guidance, and the hierarchy of evidence that they base their recommendations on?(4,5)
    • Is there a question or dilemma in your department that warrants exploration with a formal research project? Do you know what you need to do in your workplace to carry out research ethically?
    • Is your scope of practice up to date? How does your department ensure that practitioners are safe to practise ultrasound, and any extended-role skills that may take place? 
    • Does your department have sonographer preceptorship?(6) Do you have competency forms? If not, is there any of this that you could help implement or change?
• Risk Management
  • As sonographers we are responsible for our patients and our own safety. We should be working in a safe environment, according to our departmental safety protocols and reporting any events or risks. We should feel psychologically safe enough to raise concerns and report mistakes or incidents, in a department with a culture of learning from any errors.
  • In your own practice:
    • Have any extended role skills been risk assessed?
    • Is information and support about work-related musculoskeletal disorders for sonographers available? Have you completed your display screen equipment (DSE) self-assessment?
    • Is there a departmental policy for daily emergency equipment checks? Does your department have a policy for daily ultrasound equipment safety checks? If not, could you implement these?
    • Could you get involved in incident resolutions in your department somehow?
• Staff Management
  • There is a requirement for safe staffing levels in order for departments to operate within legal and regulatory requirements(7,8). Furthermore, those staff employed should be competent to carry out the role they are appointed in to. Ongoing competency assessment should also be carried out throughout careers. Ultrasound departments are notoriously under-established(9) and there are ongoing concerns about sonographer registration and competency(10) and in particular mapping international qualifications to CASE and National Occupational Standards(11,12). Quality ultrasound departments will require effective leadership.
  • In your own practice:
    • Are you aware of SoR and BMUS international recruitment advice for sonographers?(13) Could you use this advice to improve recruitment in your department?
    • Are you aware of the CoR education and career framework?(14) Where does your role sit in the framework?
    • Can you make any plans to develop your own leadership skills?
    • Have you got a job plan? Do you need one? If so, are you aware of the AHP job planning guidance?(15)
    • Do you understand the difference in scope of practice for some areas dependent on whether you are statutorily registered or not?
• Information and IT
  • As sonographers we are used to working with information and technology. 
  • In your own practice:
    • Is there any area of your practice that you could improve or streamline by implementing an IT solution? Patient appointments? Patient feedback? Patient measured outcomes? QA? Research and audit?
    • Are you confident about AI and how that is integrating into your area of practice?(16) Is there anything you could do to improve your knowledge?(17,18)
• Education and Training
  • Sonographers with professional registration will be aware of their obligation to remain up to date in their skills and knowledge in order to provide safe and effective care for patients.(19,20). Those without professional registration should also continue to update their knowledge, skills and competence to protect patients
  • In your own practice:
    • Are you aware of your professional standards surrounding continuing professional development (CPD)?
    • Are there any cost-effective and creative ways that you could improve your clinical knowledge?
    • Could you implement an interesting cases meeting?
    • Have you carried out a gap-analysis to plan your CPD in the year ahead ready to present in your personal development review (PDR)? Have you booked your PDR? If not, make sure you get one. It is a requirement of the Care Quality Commission(21) 
• Audit
  • Finally, to ensure that practitioners and services are monitored for quality and opportunities to improve, audit needs to take place. As a minimum, sonographers should be involved in peer review of image and report quality(5). There are plenty of other opportunities for sonographers to get involved with audit in their departments.
  • In your own practice:
    • Is there an audit schedule in your department?
    • Are all ultrasound practitioners within your organisation audited? If not, is there something you can do to influence or implement this?
    • Is there an audit you could take on and complete? This could be around a local or national standard that you are particularly interested in.
    • Do you know how to register an audit with your local audit department?

Further reading/references

1. NHS England. Governance, patient safety, and quality. Available from: https://www.england.nhs.uk/mat-transformation/matrons-handbook/governance-patient-safety-and-quality/
2. Flint, J. Seven pillars of clinical governance, 2024. Available from: https://www.salford.ac.uk/spd/seven-pillars-clinical-governance#:~:text=Clinical%20governance%20is%20the%20process,excellence%20in%20patient%2Dcentred%20care.
3. NHS North West. Clinical governance, 2021. Available from: https://nwpgmd.nhs.uk/sites/default/files/Clinical%20Governance.pdf
4. National Institute for Health and Care Excellence (NICE). How we develop NICE guidelines, 2024. Available from: https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/how-we-develop-nice-guidelines#:~:text=Our%20recommendations%20are%20put%20together,to%20any%20future%20guideline%20updates.
5. British Medical Ultrasound Society (BMUS). Peer Review Audit Tool – Explanatory Notes, 2014. Available from: https://www.bmus.org/static/uploads/resources/Peer_Review_Audit_Tool_-_Explanatory_Notes_with_logo.pdf   
6. British Medical Ultrasound Society (BMUS). Preceptorship and Capability Development Framework for Sonographers, 2023. Available from: https://www.bmus.org/bmus-publications-1/preceptorship-and-capability-development-framework-for-sonographers/    
7. NHS. Principles of Safe Staffing for Radiography Leaders 2024. Available from: https://www.sor.org/learning-advice/professional-body-guidance-and-publications/documents-and-publications/policy-guidance-document-library/principles-of-safe-staffing-for-radiography-le-(1)   
8. Royal College of Radiologists and College of Radiographers. Quality Standard for Imaging (QSI), 2022. Available from: https://www.collegeofradiographers.ac.uk/about-the-college/qsi
9. Society and College of Radiographers (SoR). Ultrasound Workforce UK Census 2019, 2019. Available from: https://www.sor.org/learning-advice/professional-body-guidance-and-publications/documents-and-publications/policy-guidance-document-library/ultrasound-workforce-uk-census-2019 
10. Professional Standards Authority. Register of Clinical Technologists meets Accredited Registers ‘public interest test’, 2024. Available from: https://www.professionalstandards.org.uk/sites/default/files/attachments/Register%20of%20Clinical%20Technologists%20meets%20Accredited%20Registers%20%E2%80%98public%20interest%20test%E2%80%99.pdf
11. Skills for Health. CI.C.2019 Perform, interpret and report on ultrasound examinations, 2019. Available from: https://tools.skillsforhealth.org.uk/competence-details/html/4302/
12. Consortium for the Accreditation of Sonographic Education. Standards for sonographic education, 2025, v4.0. Available from: https://www.case-uk.org/standards/
13. SoR and BMUS. Recruiting international sonographers and those without a CASE accredited award: Guidance for employers, 2024. Available from: https://www.sor.org/learning-advice/professional-body-guidance-and-publications/documents-and-publications/policy-guidance-document-library/recruitment-of-sonographers-without-a-case-accredi 
14. College of Radiographers. Education and career framework for the radiography workforce, 2022. Available from: https://www.sor.org/learning-advice/professional-body-guidance-and-publications/documents-and-publications/policy-guidance-document-library/education-and-career-framework-for-the-radiogr-(1)
15. NHS England. Allied health professionals job planning: a best practice guide, 2019. Available from: https://www.england.nhs.uk/ahp/allied-health-professionals-job-planning-a-best-practice-guide/ 
16. Royal College of Radiologists. Artificial intelligence (AI). Available from: https://www.rcr.ac.uk/our-services/artificial-intelligence-ai/ 
17. Society and College of Radiographers (SoR). AI for healthcare professionals e-learning session goes live, 2023. Available from: https://www.sor.org/News/X-ray/AI-for-healthcare-professionals-e-learning-session   
18. Society and College of Radiographers (SoR). Artificial intelligence: Guidance for clinical imaging and therapeutic radiography workforce, 2021. Available from: https://www.sor.org/Learning-advice/Professional-body-guidance-and-publications/Documents-and-publications/Policy-Guidance-Document-Library/Artificial-intelligence-Guidance-for-clinical-imag 
19. Health and Care Professions Council. Standards of continuing professional development. Available from: https://www.hcpc-uk.org/standards/standards-of-continuing-professional-development/
20. Register of Clinical Technologists. Continuing professional development (CPD), 2024. Available from: https://therct.org.uk/information-for-registrants/continuing-professional-development-cpd/
21. Care Quality Commission. Regulation 18: Staffing, 2024. Available from: https://www.cqc.org.uk/guidance-providers/regulations/regulation-18-staffing