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About the Clinical Excellence Commission

The Clinical Excellence Commission (CEC) has a central role in the responsibility for quality and safety in the NSW health system. It was established in 2004 to promote and support improved clinical care, safety and quality across NSW. The CEC is guided by NSW Health values of Collaboration, Openness, Respect and Empowerment.

A key role of the CEC is building capacity for quality and safety improvement in health services. This is driven through training and education initiatives, such as Clinical Practice Improvement and Patient Safety programs.

The CEC is a board-governed statutory health corporation established under the Health Services Act 1997.

Safe Patients Rewarding Workplaces

Clinical Excellence Commission

Mission and Vision


To build confidence in health care in NSW, by making it demonstrably better and safer for patients and a more rewarding workplace.


The CEC will be the publicly respected voice providing the people of NSW with assurance of improvement in the safety and quality of health care.

Key Functions

The key functions of the CEC are to:

  • Provide system-wide clinical governance leadership with local health districts and specialty networks, including support of the implementation and ongoing development of local quality systems
  • Develop policy and strategy related to improvements of clinical quality and safety across the NSW public health system and promote and support improvement in clinical quality and safety in public and private health services
  • Identify, develop and disseminate information about clinical quality and safety in health care on a Statewide basis, including (but not limited to):
    • Working with the Health Education and Training Institute to provide advice and inform the Institute's development, provision and promotion of training and education programs
    • Identify priorities for and promo the conduct of research about clinical quality and safety in health care
  • Review adverse clinical events arising in the NSW public health system and develop responses to those incidents including (but not limited to):
    • Co-ordinating responses to specific incidents with system or statewide implications;
    • Providing advice to the Director-General on urgent request or emergent patient safety issues and staff safety issues in a clinical setting
  • Monitor clinical quality and safety processes and performance of public health organisations and to report to the Director General and Minister
  • Provide the Bureau of Health Information with relevant data about clinical quality and safety in the public health system, to support its public reporting function
  • Consult broadly with public health organisations, health professionals and members of the community in performing its functions
  • Provide advice to the Director-General and Minister for Health on issues arising out of its functions
  • Develop three-year strategic plans and an annual work plan, linking these activities and priorities to the Statewide directions and priorities of NSW Health and work in accordance with these plans and service compact agreed with the Director-General.

The CEC fulfils these functions by:

  • Providing advice to the Minister and Director-General of Health
  • Notifying system-wide safety concerns
  • Conducting quality system assessments
  • Working with public health organisations to facilitate quality improvements
  • Providing a source of expert advice and assistance
  • Developing and promoting a Statewide approach to improving safety and quality
  • Engaging clinicians and the community
  • Identifying and developing training and education strategies and clinical tools
  • Leading the development and system-wide dissemination of evidence-based guidelines
  • Focussing on system issues for improvement across NSW.

CEC Strategic Plan 2012 - 2015

CEC Strategic Plan 2012 - 2015 - PDF ~347Kb

CEC Strategic Plan 2012-2015


The CEC Strategic Plan 2012-15 outlines priority directions from 2012 to 2015, to ensure that the CEC continues to add value to patient safety and clinical quality within an evolving context. It was developed in consultation with staff and board members, and endorsed by the CEC board on 21 June 2012.


With an overarching aim of "Quality in Systems, Excellence in Care", key result areas (KRAs) are:

  • KRA 1: Work with consumers, managers and clinicians to improve healthcare processes and outcomes
  • KRA 2: Work with healthcare services to improve systems of care and the safety of patients
  • KRA 3: Identify, monitor and address risks with timely, meaningful and accurate information
  • KRA 4: Provide informed strategic advice to support quality and safety improvement
  • KRA 5: Ensure that our governance arrangements and partnerships build the effectiveness and credibility of the CEC.


Operational Management

Operational management of the CEC is overseen by a chief executive officer, supported by directors who are responsible for discrete portfolio areas.

Directors and Portfolios


Chief Executive Officer

Prior to his appointment to the CEC, Cliff Hughes had a 25-year career as a cardiothoracic surgeon in Sydney. He has been chair or a member of numerous State and federal committees associated with quality, safety and research in clinical practice for health care services. Prof Hughes has held various positions in the Royal Australasian College of Surgeons, including Senior Examiner in Cardiothoracic Surgery and member of the College Council. He has been a member of four editorial boards and has published widely in books, journals and conference proceedings on cardiothoracic surgery, quality and safety. Prof Hughes has a particular passion for patient-driven care, better incident management, quality improvement programs and development of clinical leaders.

Deputy Chief Executive Officer
Dr Peter Kennedy MBBS, FRACP

Director Patient Safety
Adjunct Prof Tony Burrell MBBS, BA, FANZCA, FCICM

  • Incident review, analysis, reporting
  • Complaints
  • Coroners
  • Health Care Complaints Commission
  • Therapeutic Goods Administration recalls
  • Safety alerts
  • Sepsis
  • Surgical Mortality: Collaborating Hospitals' Audit of Surgical Mortality (CHASM), Special Committee Investigating Deaths Under Anaesthesia (SCIDUA)
  • CRRC

Director Clinical Governance
Dr Paul Curtis MBBS, MHA, FRACMA

  • Accreditation
  • Antimicrobial Stewardship
  • Credentialing
  • Directors of Clinical Governance Forum
  • Healthcare Associated Infections
  • Hand Hygiene

Director Information Management, A/Director Corporate Services
André Jenkins BA (Hons)

  • Chartbook
  • IM&T
  • Internet
  • Intranet
  • Knowledge Management
  • Records Management
  • TRIM

Director Patient-Based Care
Dr Karen Luxford BSc (Hons1), PhD, FAIM

  • Citizens Engagement Advisory Council
  • Partnering with Patients program
  • Consumer Advisor panel
  • Top 5 program
  • Recognise, Engage, Act, Call, Help (REACH)



Service Compact 2013-14

Service Compact - PDF ~532kb


Common Board - CEC and ACI

Chair and members of the boards of the Clinical Excellence Commission and the Agency for Clinical Innovation

Deputy Premier and NSW Minister for Health, Carmel Tebbutt, announced the appointment of a new board for the Agency of Clinical Innovation and the Clinical Excellence Commission on March 15, 2010.

The establishment of the Agency for Clinical Innovation (ACI) is part of the Government's response to the Garling Inquiry into the acute care system in NSW public hospitals.

The ACI will also actively engage clinicians and consumers by establishing appropriate clinical and consumer groups by June 2010. These groups will advise the board by providing experience and expertise in the development of new models and standards of care.

Common board membership will strengthen collaboration and cooperation, particularly in the identification of priorities and work plans. Prof Cliff Hughes, CEO of the Clinical Excellence Commission and Dr Nigel Lyons, CE of the Agency for Clinical Innovation will sit on their respective boards, further reinforcing the links between the two organisations.


A/Prof Brian McCaughan

Associate Professor Brian McCaughan

A/Prof Brian McCaughan is a cardiothoracic surgeon whose major clinical interest is the management of lung cancer. He is a Clinical Associate Professor at the University of Sydney. Prof McCaughan was a member of the Ministerial Advisory Committee on Quality in Health Care. He was appointed to the NSW Health Council and served as the President of the New South Wales Medical Board from October 1999 until December 2004. He is currently chair of the Sustainable Access Health Priority Taskforce and a member of the Health Care Advisory Council for NSW Health. In 2009 he was awarded Member of the Order of Australia for his services to medicine




Ken Barker

Ken Barker Mr Barker has many years experience in NSW public sector and financial management and strategic expertise. As former Chief Financial Officer of NSW Health, he has expertise in the NSW public health system and its position within the Australian health care system. Ken is a graduate of the Australian Institute of Company Directors and a Fellow of the National Institute of Accountants. He was awarded the Public Service medal in 2002 and was chair of the NSW Treasury Managed Fund Advisory Board for 16 years. He is currently the financial/business expert on the National Blood Authority Advisory Board and independent member on its audit committee.



Dr Andrew Cooke

Andrew Cooke Dr Cooke is currently a resident medical officer at St George and Sutherland hospitals. He also has a Master of Laws, and practised as a solicitor with public and private sector experience in NSW and Victoria. He received the Sydney University Medical School Travelling Fellowship in 2008 and a full Commonwealth Scholarship to Cambridge to undertake graduate training in law (medicine) in 2001 and 2002.


Robyn Kruk

Robyn Kruk

Ms Kruk is a current member of the CEC board, initially appointed in February 2009. She is the Secretary of the Commonwealth Environment, Water, Heritage and Arts portfolio. Ms Kruk is a former practising psychologist and has many years of experience in senior roles in the public sector, including Director-General of Health and Director-General of the Department of Premier and Cabinet. She holds a Bachelor of Science, Psychology (Hons), Master of Administration and has completed the Harvard Advanced Management Program.




Prof Carol Pollock

Carol Pollock

Prof Pollock trained as a specialist in renal medicine, was appointed as a kidney specialist and senior lecturer to Royal North Shore Hospital in 1991 and the Professorial Chair of Medicine in 2000. Carol is currently chair of the Area Health Advisory Council and Chair of Research for the Northern Sydney Central Coast Area Health Service. She is the immediate past chair of the Greater Metropolitan Clinical Taskforce, which has transitioned into the ACI. She is a founding director and currently chairperson of Bio Med North, a company supporting the development of intellectual property out of the health sector, and sits on the boards of several philanthropic organisations supporting medical research.

Professor Carol Pollock, who was the inaugural Chair of ACI/CEC boards, has accepted the position of Chair of the Governing Council for the Northern Sydney Local Health Network (LHN) and had agreed to stay on as a member of the Boards.




Tomas Ratoni

Tomas Ratoni

Mr Ratoni is currently a paediatric clinical nurse consultant in the northern sector of NCAHS. He has a background primarily in paediatric critical care and paediatric and neonatal retrieval medicine. More recently he has discovered a taste for general paediatrics. He has a passion for teaching and is an instructor for APLS (Australia).




A/Prof Gabriel Shannon

Gabriel Shannon

Prof Shannon is a current member of the Clinical Excellence Commission board. He has experience in rural health, having practised in Orange and the Central West of NSW since 1980. He is currently a staff specialist physician, the Director of Physician Training at Orange Base Hospital. He is Sub-Dean of Orange Campus of the School of Rural Health, University of Sydney and is the Clinical Leader of the Clinical Governance Unit at Greater Western Area Health Service.




Chief Executives

Prof Clifford Hughes, AO

 Professor Clifford F Hughes, AO

Prof Clifford Hughes is the CEO of the Clinical Excellence Commission in NSW. For 25 years, until January 2005, he was a senior partner in an extremely busy cardiothoracic surgical practice at Sydney's Royal Prince Alfred Hospital. He holds fellowships in the Royal Australasian College of Surgeons, the American College of Surgeons, the American College of Cardiology and the American College of Chest Physicians, as well as the Cardiac Society of Australia and New Zealand. Prof Hughes was awarded the Order of Australia in 1998 for "service to cardiac surgery, international relations and the community".






Clinical Council

The Clinical Council was established to provide expert opinion, direction and advice to the board of the Clinical Excellence Commission (CEC). It comprises medical, nursing and allied health staff and managers, who contribute to the development and delivery of the CEC's programs and advise the board on strategies to achieve comprehensive clinician participation.


  • A/Prof Gabriel Shannon

Deputy Chair

  • Phillip Ebbs


  • A/Prof Sergio Diez Alvarez
  • Brad Ceely
  • Dr Sarah Dalton
  • Dr Michael Dinh
  • Anthony Dombkins
    Prof Michael Fullham
  • Dr Jonathan Gatward
  • Dr Randall Greenberg
  • Prof Alison Kesson
  • Dr Peter Landau
  • Dr Damien Limberger
  • Kerrie O'Leary
  • Clare Quinn
  • John Rihari-Thomas
  • Dr Warwick Stening
  • Prof Jeremy Wilson
  • A/Prof Peter Zelas

Year In Review

More information about the CEC Year In Review is available in the following publications:-

Corporate Governance

Corporate Governance Attestation Statement - Clinical Excellence Commission

Photo Credits

The CEC gratefully acknowledges Queensland Health and iStockphoto for permission to use their photography throughout this website.