title: Implementing Clinical governance in Iranian hospitals: purpose, process and pitfalls.
abstract: BACKGROUND
  Clinical governance as an approach to improving the quality and safety of clinical care has been run in all Iranian hospitals since 2009. This study aimed to provide a comprehensive overview of the processes and challenges faced in implementing clinical governance (CG) in acute-care hospitals in Iran.
  
  
  METHODS
  We conducted an in-depth, qualitative, multi-case study using semi-structured interviews with a range of key stakeholders and review of relevant documents. This study was conducted in 2011-2012 in six governmental hospitals affiliated with Tehran University of Medical Sciences. The data were analyzed using framework analysis.
  
  
  RESULTS
  The interviewees, predominantly senior managers and nurses, expressed generally positive attitudes towards the benefits of CG. Four out of the six hospitals had a formal strategic plan to implement and execute CG. The emergent barriers to the implementation of CG included insufficient resources, the absence of clear supporting structures, a lack of supportive cultures, and inadequate support from senior management. The main facilitating factors were the reverse of the barriers noted above in addition to developing good relationships with key stakeholders, raising the awareness of CG among staff, and well-designed incentives.
  
  
  CONCLUSIONS
  There is a positive sense towards CG, but its successful implementation in Iran will require raising the awareness of CG among staff and key stakeholders and the successful collaboration of internal staff and external agencies.
authors.affiliation: Ph.D. of Health Services Management, Assistant Professor. Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran.
authors.forename: Bahram
authors.initials: B
authors.lastname: Mohaghegh
authors.affiliation: Ph.D. of Heath Policy, Assistant Professor, School of health Management and information sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ravaghi
authors.affiliation: Ph.D. of Economics and Social Policy, Professor, University of Birmingham, United Kingdom.
authors.forename: Russell
authors.initials: R
authors.lastname: Mannion
authors.affiliation: Specialist of Social Medicines, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Peigham
authors.initials: P
authors.lastname: Heidarpoor
authors.affiliation: Ph.D. of Health Services Management, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Haniye Sadat
authors.initials: HS
authors.lastname: Sajadi
keywords: Iran; acute-care hospitals; clinical governance; qualitative study