Prioritizing barriers to implement clinical governance in teaching hospitals of Iran: A mixed method study

Clinical governance, as a program to improve the quality of health care, was introduced in all hospitals in Iran in 2009. However, implementation assessments revealed that the program was not adopted in many hospitals. This study aimed to determine and prioritize barriers to clinical governance program implementation in hospitals of Shahid Beheshti University of Medical Sciences. This qualitative study was performed in the first part of this exploratory mixed methods study. A purposive sample of 25 individuals who were involved in the implementation of the program was selected. They participated in semi-structured interviews and the data were analyzed using content analysis. In the second part (quantitative), a questionnaire was prepared based on the first phase of the study, and 74 stakeholders completed the questionnaire, which included all extracted obstacles to the establishment of clinical governance. They rated these obstacles with a 5-point Likert scale. A total of 9 themes were discovered in the qualitative part of the study. These themes were prioritized as follow: (1) weak organizational leadership, (2) insufficient human resources, (3) inappropriate organizational culture, (4) inadequate financial resources, (5) insufficient knowledge of personnel and management, (6) inappropriate monitoring and evaluation, (7) lack of coordination (8) deficiencies in policies and procedures, and (9) incomplete registration system and inadequate documentation. The results of this study showed that significant barriers exist in implementation of the clinical governance program in hospitals. These problems have to be addressed in order for the implementation procedure to be successful.