| 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 |