Islamic Republic of) Objectives: Free access to information as a public right has become a critical issue in healthcare. Some health systems disclose information about hospitals performance to influence patients' choice. The main purpose of this study is to explore barriers to transparency improvement of hospitals performance in Iran. Methods: This qualitative study was conducted during January to August 2017 in Iran through face-toface interviews (18 various interviewees in macro, meso and micro levels of health system with different academic orientation and expertise) and through a comprehensive and purposive document analysis. The data was analyzed using a thematic analysis method. Results: Five main themes were identified, including: lack of regular hospitals' performance data available to the government; lack of transparency culture among health system authorities; concerns about transparency of hospitals' poor performance; absence of rule of law and Lack of adequate maturity in the country's health system governance which weaken democracy. Therefore the decision making system mostly supports special groups rather than public. Conclusions: There are serious barriers against improving transparency of hospitals in Iran. The most important challenge found was "authorities unwillingness to promote transparency". This challenge has become more prominent due to the existence of conflict of interests among authorities and power of the pressure groups to influence the public sector. Therefore, interviewees suggested that the necessary infrastructures be created prior to promoting transparency. Among the most important preliminaries is managing conflict of interest in the health system to have decisions in favor of public interests.

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