With the introduction into the discourse of the UK National Health Service (NHS) of the term Clinical Governance in the 1997 Department of Health White Paper, A New NHS, Modern and Dependable, arguable a new and distinct phase in the relationship between the government of the day and the providers of health care was begun. As a concept Clinical Governance is difficult to define, its very ambiguity aids the ability of different stakeholders to, rhetorically at least, accept it in principle. In its ability to appeal to a strengthening of professional self-regulation on the one hand, whilst simultaneously stressing the need for a greater visibility of accountability and enforcement on the other, the concept can appear to offer a win-win outcome for health professionals, managers, auditors, politicians and patients alike. This paper, uses insights, gleaned from early empirical research within a large NHS Hospital Trust to produce a narrative account of the efforts of a group of medical and technical support staff to introduce a series of Integrated Care Pathways (ICPs), which to many of the actors involved, would stand as a concrete example of clinical governance in action. In striving to make a reality of these conceptual notions, many of the tensions inherent in implementing ICPs and clinical governance came to the fore. As such it makes an ideal precursor and pilot project for highlighting some of the problems facing the introduction of clinical governance into the everyday culture of the NHS.