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Health Res Policy Syst. 2019 Jan 9;17(1):3. doi: 10.1186/s12961-018-0399-5.

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

Author information

1
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. masoudbehzadifar@gmail.com.
2
Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy.
3
Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
4
Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
5
Department of Epidemiology, Faculty of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.
6
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
7
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
8
National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
9
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.

Abstract

BACKGROUND:

Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran.

METHODS:

Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data.

RESULTS:

Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation.

CONCLUSION:

The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented.

TRIAL REGISTRATION:

CRD42017079077 . Dated October 10, 2017.

KEYWORDS:

Clinical governance; Iran; challenges; meta-synthesis

PMID:
30626377
PMCID:
PMC6327528
DOI:
10.1186/s12961-018-0399-5
[Indexed for MEDLINE]
Free PMC Article

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