The notion of role clarity, and its impact on clinical governance, has not been previously considered within academic literature. The purpose of this research article was to add to theoretical knowledge surrounding the clinical governance and the effect that role clarity has on governance operationally. The context of Irish health care and Irish hospital boards is used to explore this phenomenon. A mixed-methods approach was used to appreciate the central phenomenon. The doctoral dissertation this article was drawn from identified that the adoption of similar or consistent structures and processes between Irish acute care hospitals would aid efficiencies, both human and cost, on multiple levels. Ultimately, the article concludes that role clarity is a significant component in the determination of effective health care. Hospital boards and their individual members should be cognizant of the implications of role clarity and its impact on effective and efficient clinical governance.