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

Introduction: Clinical 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. Methods: We 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. Results: The 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. Conclusions: There 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 agencie