Implementing Clinical governance in Iranian hospitals: purpose, process and pitfalls

Abstract

IntroductionClinical governance as an approach to improving the quality and safety of clinical care has been run in all Iranian hospitals since 2009. This study aimed to provide a comprehensive overview of the processes and challenges faced in implementing clinical governance (CG) in acute-care hospitals in Iran.MethodsWe conducted an in-depth, qualitative, multi-case study using semi-structured interviews with a range of key stakeholders and review of relevant documents. This study was conducted in 2011–2012 in six governmental hospitals affiliated with Tehran University of Medical Sciences. The data were analyzed using framework analysis.ResultsThe interviewees, predominantly senior managers and nurses, expressed generally positive attitudes towards the benefits of CG. Four out of the six hospitals had a formal strategic plan to implement and execute CG. The emergent barriers to the implementation of CG included insufficient resources, the absence of clear supporting structures, a lack of supportive cultures, and inadequate support from senior management. The main facilitating factors were the reverse of the barriers noted above in addition to developing good relationships with key stakeholders, raising the awareness of CG among staff, and well-designed incentives.ConclusionsThere is a positive sense towards CG, but its successful implementation in Iran will require raising the awareness of CG among staff and key stakeholders and the successful collaboration of internal staff and external agencies.

The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies

“…Studies were published between 2013 and 2017. Three studies [33, 36, 38] were carried out in the northern part of Iran (Tehran province), while 5 and 2 studies were performed in the centre [30–32, 37, 39] (Isfahan, Kerman and Yazd provinces) and in the west [34, 35] (Qazvin and Tabriz provinces) of Iran, respectively. Eight studies conducted semi-structured interviews, 1 study performed focus groups and the remaining studies performed both semi-structured interviews and focus groups.…”

“…To properly implement a policy, a legislation that facilitates its implementation is needed. Clinical governance was implemented in Iran’s health system with appropriate goals and objectives; however, in many cases, the lack of clear and explicit laws caused executive and administrative problems [31, 33, 37, 38].…”

“…Through such structure, employees, with a strong policy and organisational status, would have been more motivated to pay attention to its better implementation due to the use of potential financial benefits and performance enhancement. The absence of such a structure has hindered the full implementation of clinical governance [31, 33, 35, 36, 38].…”

“…An integrated coordination is a key factor in the concept of primary healthcare and health promotion. Our synthesis showed that all measures of implementing clinical governance were only taken by the MOHME and the remaining stakeholders did not actively participate in clinical governance implementation [30, 33, 36, 38].…”

Barriers for the Using of Information Systems in Hospitals: A Qualitative Study

“…Although, information management and use of information systems are performing in hospital accreditation plans and clinical governance quality improvement plans. Clinical governance is a framework, in which service providers are responsible for continuous quality improvement (19).…”