title: Implementing clinical governance in Isfahan hospitals: Barriers and solutions, 2014.
abstract: BACKGROUND
  In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance.
  
  
  OBJECTIVE
  In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions.
  
  
  METHODS
  This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software.
  
  
  RESULTS
  According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors.
  
  
  CONCLUSIONS
  Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.
authors: Department of Health Services Administration, School of Management and Medical Information, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Masoud
authors: M
authors: Ferdosi
authors: Department of Health Services Administration, School of Management and Medical Information, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Farhad Bahman
authors: FB
authors: Ziyari
authors: Quality Improvement Unit, Dr. Ali Shariati Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mehran Nemat
authors: MN
authors: Ollahi
authors: Department of Health Services Administration, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran; School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran.
authors: Amaneh Rahim
authors: AR
authors: Salmani
authors: Department of Health Services Administration, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran; School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran.
authors: Noureddin
authors: N
authors: Niknam
keywords: Clinical governance; Isfahan; clinical governance team; hospital