Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

Document Type: Original Article

Authors

1 Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

2 Department of Hospital Management, Clinical Governance Office, Ministry of Health and Medical Education, Tehran, Iran

3 Department of Community Medicine, Shahid Beheshti Medical University, Tehran, Iran

4 Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background
Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran.
 
Methods
A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS.
 
Results
Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process.
 
Conclusion
Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities.

Keywords

Main Subjects


 

  1. Bengoa R, Kawar R, Key P, Leatherman S, Saturno P. Quality of care. A process for making strategic choices in health systems. Geneva: World Health Organization; 2006.
  2. Davies H, Mannion, R. Clinical governance: striking a balance between checking and trusting. In: Smith P, editor. Reforming Health Care Markets: An economic perspective. Buckingham: Open University Press; 2000. p. 247–67.
  3. Scaly G, Donaldson L. Clinical governance and the drive for quality improvement in the NHS in England. BMJ 1998; 317: 61–5. doi: 10.1136/bmj.317.7150.61
  4. Degeling P, Maxwell S, Iedema R, Hunter D. Making clinical governance work. BMJ 2004; 329: 679–82. doi: 10.1136/bmj.329.7467.679
  5. Jafari GH, Khalifeh Gari S, Danaie Kh. Hospital Accreditation Standards in Iran. Tehran: Ministry of Health and Medical Educationr; 2011. p. 1–3.
  6. Ravaghi H, Heidarpour P, Mohseni M, Mostofian F, Rafiei S, Dastjerdi R. Clinical Governance Report. Tehran: Ministry of Health and Medical Education; 2010.
  7. Mcmahon R. Clinical Governance: evaluation and intuition. J Nurs Manag 1999; 7: 315–6. doi: 10.1046/j.1365-2834.1999.07315.x
  8. Hogan H, Basnett I, McKee M. Consultants’ attitude to clinical governance: Barriers and incentives to engagement. J Public Health 2007; 121: 614–22. doi: 10.1016/j.puhe.2006.12.013
  9. Wilkinson A, Witcher B. Fitness for use: Barriers to full TQM in the UK. Management Decision 1991; 29: 46–51. doi: 10.1108/eum0000000000086
  10. Dawson P, Palmer G. Quality management: the theory and practice of implementing change. Melborne: Longman; 1995.
  11. Wilkinson AJ, Marchington M, Barrie D. Enhancing the contribution of the human resources function to quality movement. Quality Management Journal 1993; 1: 35–46.
  12. Sohal AS, Samson D, Ransay L. Requirements for successful implementation of TQM. Int J Technol Manag 2002; 16: 505–19.
  13. Campbell SM, Sweeney GM. The role of clinical governance as a strategy for quality improvement in primary care. Br J Gen Pract 2002; 52: S12–7.
  14. Fenton-O’Creevy M. Employee involvement and the middle manager: evidence from a survey of organizations. J Organ Behav 2001; 19: 67–84. doi: 10.1002/(sici)1099-1379(199801)19:1%3C67::aid-job827%3E3.0.co;2-y
  15. Masters RJ. Overcoming Barriers To TQM’s Success. Quality Progress 2006; 29: 53–5.