Clinical governance is seen as a relatively new concept; but a long history of health care quality improvement sits behind it. Over the last 20 years, a number of approaches have been tried and discarded, with some inadequately implemented and others poorly adapted from other industries. Quality programs have evolved slowly, hampered by a conservative and complex health care culture and a lack of focus, data and resources. Despite the advent of clinical governance, driven by a patient safety crisis, many of these issues remain unresolved, and are impacting current clinical governance implementation. Reflecting on the quality journey clearly demonstrates that the potential of clinical governance cannot be realised without the leadership, commitment and support of governing bodies and executives.