title: Rocky milieu: challenges of effective integration of clinical risk management into hospitals in Iran.
abstract: Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM) system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses' experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of "rocky milieu" as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1) organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change), (2) limitation of resources (financial, human, and physical and equipment resources), and (3) variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload). Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM.
authors.affiliation: Department of Community Health Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: Jamileh
authors.initials: J
authors.lastname: Farokhzadian
authors.affiliation: Department of Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Nahid.nayeri@gmail.com.
authors.forename: Nahid Dehghan
authors.initials: ND
authors.lastname: Nayeri
authors.affiliation: Department of Nursing Ethics, Medical Ethics and law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Fariba
authors.initials: F
authors.lastname: Borhani
mesh_terms: D006761:Hospitals; D006801:Humans; D007492:Iran; D007857:Leadership; D009726:Nurses; D015279:Organizational Culture; D061214:Patient Safety; D036301:Qualitative Research; D011787:Quality of Health Care; D012308:Risk Management
keywords: Clinical risk; clinical governance; clinical risk management; healthcare risk; patient safety; quality improvement