Clinical Governance: The Challenges of Implementation in Iran

Background and Objectives: The Iranian Ministry of Health and Medical Education has introduced clinical gov‌ernance as the accepted model of hospital healthcare improvement. Subsequently, a growing movement for implementing clinical governance in health facilities has emerged. This study aimed to explore the opinions of the relevant experts and executives to provide insight into current challenges, barriers and inadequacies in implemen‌tation of clinical governance in Iranian health settings.   Methods: A qualitative approach was adopted. A purposeful sample of 17 participants was interviewed in the spring of 2012. The study sample was selected from among clinical governance executives of teaching hospitals affiliated with Kerman University of Medical Sciences and the academicians involved in administration of the clini‌cal governance. The Framework method was adopted for data analysis.   Findings: Seven themes explain challenges of implementing clinical governance, including human resources, management, communication, training, culture, resources, and monitoring and regulations. Adequate quality human resources, particularly experts in clinical governance should be dedicated. Leadership commitment to support implementation of clinical governance should be improved. Administrators need to get more familiarized with the concept and requirements of clinical governance. High ranking authorities should avoid rapid turnover of management teams. Adequate communication regarding of clinical governance is needed to be established among different deputies of the Ministry of Health and Medical Education. Hospitals must be encouraged to share their experiences in clinical governance. Training programs should be based on needs assessment, have definite goals, and focus more on practical as‌pects of clinical governance. The felt need for change must be promoted among hospitals’ administrations and staff. Teamwork between staff must be promoted. Expectation for rapid achievements and early frustration in time taking reforms must be ad‌dressed by appropriate training. Appropriate infrastructure and mechanisms for reporting, interpretation, and analysis of quality indicator data should be developed. Adequate financial and physical resources should be appropriated. Efficient monitoring and assessment systems must be implemented. Progress in implementation of clinical gover‌nance should be appropriately supervised and evaluated. Constant feedback on staff performance and outcomes of interventions should be provided. Adequate supportive laws and regulations, legally guaranteeing implementation of clinical governance should be developed.   Conclusions: Considering inter-relation of the identified themes and subthemes, our study recommends that a sys‌tems approach should be adopted for successful implementation of clinical governance. While fundamental solutions to the identified challenges require long-term reforms in the health system, some obstacles such as inadequate lead‌ership support, rapid rotation of managers, lack of financial and physical resources, inefficient monitoring system, and inefficient training programs may be addressed in a relatively short run.