title: Clinical governance implementation in a selected teaching emergency department: a systems approach.
abstract: BACKGROUND
  Clinical governance (CG) is among the different frameworks proposed to improve the quality of healthcare. Iran, like many other countries, has put healthcare quality improvement in its top health policy priorities. In November 2009, implementation of CG became a task for all hospitals across the country. However, it has been a challenge to clarify the notion of CG and the way to implement it in Iran. The purpose of this action research study is to understand how CG can be defined and implemented in a selected teaching emergency department (ED).
  
  
  METHODS
  We will use Soft Systems Methodology for both designing the study and inquiring into its content. As we considered a complex problem situation regarding the quality of care in the selected ED, we initially conceptualized CG as a cyclic set of purposeful activities designed to explore the situation and find relevant changes to improve the quality of care. Then, implementation of CG will conceptually be to carry out that set of purposeful activities. The activities will be about: understanding the situation and finding out relevant issues concerning the quality of care; exploring different stakeholders' views and ideas about the situation and how it can be improved; and defining actions to improve the quality of care through structured debates and development of accommodations among stakeholders. We will flexibly use qualitative methods of data collection and analysis in the course of the study. To ensure the study rigor, we will use different strategies.
  
  
  CONCLUSIONS
  Successful implementation of CG, like other quality improvement frameworks, requires special consideration of underlying complexities. We believe that addressing the complex situation and reflections on involvement in this action research will make it possible to understand the concept of CG and its implementation in the selected setting. By describing the context and executed flexible methods of implementation, the results of this study would contribute to the development of implementation science and be employed by boards and executives governing other clinical settings to facilitate CG implementation.
authors.affiliation: Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Heyrani
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Maleki
authors.forename: Ahmad Barati
authors.initials: AB
authors.lastname: Marnani
authors.forename: Hamid
authors.initials: H
authors.lastname: Ravaghi
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Sedaghat
authors.forename: Mosadegh
authors.initials: M
authors.lastname: Jabbari
authors.forename: Davood
authors.initials: D
authors.lastname: Farsi
authors.forename: Abdoljavad
authors.initials: A
authors.lastname: Khajavi
authors.forename: Zhaleh
authors.initials: Z
authors.lastname: Abdi
mesh_terms: D054976:Clinical Governance / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000379:methods*; D006784:Hospitals, Teaching; D006801:Humans; D007492:Iran; D058996:Quality Improvement / Q000458:organization & administration*; D012107:Research Design; D013597:Systems Analysis; D057170:Translational Research, Biomedical / Q000379:methods*