Hospitals’ Readiness to Implement Clinical Governance

Document Type : Original Article


1 Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran

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

3 Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran

4 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran


Quality of health services is one of the most important factors for delivery of these services. Regarding the importance and vital role of quality in the health sector, a concept known as “Clinical Governance” (CG) has been introduced into the health area which aims to enhance quality of health services. Thus, this study aimed to assess private and public hospitals’ readiness to implement CG in Iran.
This descriptive and cross-sectional study was carried out in 2012. Four hundred thirty participants including doctors, nurses, diagnostic departments personnel, and support staff were chosen randomly from four hospitals (equally divided into private and public hospitals). Clinical Governance Climate Questionnaire (CGCQ) was used for data collection. Finally, data were entered into the SPSS 18 and were analyzed using statistical methods.
Among the CG dimensions, “organizational learning” and “planned and integrated quality improvement program” scored the highest and the lowest respectively for both types of hospitals. Hospitals demonstrated the worst condition with regard to the latter dimension. Furthermore, both types of hospitals had positive picture regarding “training and development opportunities”. Private hospitals scored better than public ones in all dimensions but there was only a significant difference in “proactive risk management” dimension between both types of hospitals (P< 0.05).
Hospitals’ readiness for CG implementation was “average or weak”. In order to implement CG successfully, it is essential to have a quality-centered culture, a culture specified by less paperwork, more selfsufficiency, and flexibility in hospitals’ affairs as well as centring on shared vision and goals with an emphasis on continuous improvement and innovation.


Main Subjects

  1. Silimperi DR, Franco LM, van Zanten TV, Macaulay C. A framework for institutionalizing quality assurance. Int J Qual Health Care 2002; 14: 67-73.  doi: 10.1093/intqhc/14.suppl_1.67
  2. Power M. The audit society—Second thoughts. International Journal of Auditing 2000; 4: 111-9. doi: 10.1111/1099-1123.00306
  3. Hood C, James O, Scott C. Regulation of government: has it increased, is it increasing, should it be diminished? Public Adm 2000; 78: 283-304.  doi: 10.1111/1467-9299.00206
  4. O'neill O. A question of trust: The BBC Reith Lectures 2002. Cambridge: Cambridge University Press; 2002.
  5. Mojtaba S. Designing and implementing clinical governance in pilot hospitals. Tehran university of medical sciences; 2006. [In Persian]
  6. Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998; 317: 61-5. doi: 10.1136/bmj.317.7150.61
  7. Donaldson LJ, Gray J. Clinical governance: a quality duty for health organisations. Qual Health Care 1998; 7: S37-44. 
  8. Kassirer JP. The quality of care and the quality of measuring it. N Engl J Med 1993; 329: 1263.  doi: 10.1056/nejm199310213291710
  9. Karassavidou E, Glaveli N, Zafiropoulos K. Assessing hospitals' readiness for clinical governance quality initiatives through organisational climate. J Health Organ Manag 2011; 25: 214-40. 
  10. Bahrami MA, Sabahi AA, Montazeralfaraj R, Shamsi F, Entezarian S. Hospitals’ Readiness for Clinical Governance Implementation in Educational Hospitals of Yazd, Iran. Electronic Physician 2014; 6: 794-800. 
  11. Konteh FH, Mannion R, Davies HT. Clinical governance views on culture and quality improvement. Clinical Governance: An International Journal 2008; 13: 200-7.  doi: 10.1108/14777270810892610
  12. Ekvall G. Climate, structure and innovativeness of organizations: A theoretical framework and an experiment. Stockholm: FArådet, the Swedish Council for Management and Organizational Behaviour; 1983.
  13. Morgan PI, Ogbonna E. Subcultural dynamics in transformation: a multi-perspective study of healthcare professionals. Hum Relat 2008; 61: 39-65.  doi: 10.1177/0018726707085945
  14. Haslock I. Introducing clinical governance in an acute trust. Hosp Med 1999; 60: 744-7. doi: 10.12968/hosp.1999.60.10.1220 
  15. Freeman T. Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire. Health Serv Manag Res 2003; 16: 234-50.  doi: 10.1258/095148403322488937
  16. Nicholls S, Cullen R, O’Neill S, Halligan A. Clinical governance: its origins and its foundations. British Journal of Clinical Governance 2000; 5: 172-8.  doi: 10.1108/14777270010734055
  17. Rose RC, Uli J, Abdul M, Ng KL. Hospital service quality: a managerial challenge. Int J Health Care Qual Assur 2004; 17: 146-59. 
  18. Halligan A. Clinical governance: assuring the sacred duty of trust to patients. Clinical Governance: An International Journal 2006; 11: 5-7.  doi: 10.1108/14777270610646967
  19. Peak M, Burke R, Ryan S, Wratten K, Turnock R, Vellenoweth C. Clinical governance–the turn of continuous improvement? Clinical Governance: An International Journal 2005; 10: 98-105. doi: 10.1108/14777270510594272
  20. Preker AS, Harding A. Innovations in health service delivery: the corporatization of public hospitals.  Washington, DC: World Bank Publications; 2003.
  21. van Zwanenberg T. Clinical governance in primary care: from blind-eye to no-blame culture in one short leap? British Journal of Clinical Governance 2001; 6: 83-6.  doi: 10.1108/14664100110815414
  22. Mehrdad R. Health system in Iran. JMAJ 2009; 52: 69-73. 
  23. National Health Service (NHS). A review of integrated clinical governance in the context of medical revalidation. Britain Revalidation support team; 2011.
  24. Freeman T, Walshe K. Achieving progress through clinical governance? A national study of health care managers’ perceptions in the NHS in England. Qual Saf Health Care 2004; 13: 335-43.  doi: 10.1136/qhc.13.5.335
  25. Som CV. Clinical governance: a fresh look at its definition. Clinical Governance: An International Journal 2004; 9: 87-90.  doi: 10.1108/14777270410536358
  26. Warwick C. The new NHS: modern dependable. British Journal of Midwifery 1998; 6: 265.   doi: 10.12968/bjom.1998.6.4.265
  27. Moran R. “There’s no time to learn”… like the present. Clinical Governance: An International Journal 2003; 8: 46-56.  doi: 10.1108/14777270310460010
  28. Luthans KW, Lebsack SA, Lebsack RR. Positivity in healthcare: relation of optimism to performance. J Health Organ Manag 2008; 22: 178-88. doi: 10.1108/14777260810876330
  29. McSherry R, Pearce P. Clinical governance. Chichester: John Wiley & Sons; 2010.
  30. McSherry R. Factors influencing collaborative working. In: McSherry R, Warr J, editors. Implementing Excellence In Your Health Care Organization: Managing, Leading And Collaborating: managing, leading and collaborating. Maidenhead:Open University Press; 2010. 
  31. McSherry R, Warr J. An introduction to excellence in practice development in health and social care. Maidenhead: McGraw-Hill International; 2008.
  32. McCormack B, Manley K. Evaluating Practice Developments. In: McCormack B, Manley K, Garbett R, editors. Practice Development in Nursing. Oxford: Blackwell Publishing Ltd; 2004.  doi: 10.1002/9780470698884.ch5
  33. Som CV. Exploring the human resource implications of clinical governance. Health Policy 2007; 80: 281-96.  doi: 10.1016/j.healthpol.2006.03.010
  34. Manley K. Transformational culture: A culture of effectiveness. In: McCormack B, Manley K, Garbett R, editors. Practice Development in Nursing. Oxford: Blackwell Publishing Ltd; 2004.  doi: 10.1002/9780470698884.ch4
  35. Specchia ML, La Torre G, Siliquini R, Capizzi S, Valerio L, Nardella P, et al. OPTIGOV-A new methodology for evaluating Clinical Governance implementation by health providers. BMC Health Serv  Res 2010; 10: 174.  doi: 10.1186/1472-6963-10-174
  36. Wilkinson JE, Rushmer RK, Davies HT. Clinical governance and the learning organization. J Nurs Manag 2004; 12: 105-13.  doi: 10.1046/j.1365-2834.2003.00435.x
  37. Storey J, Buchanan D. Healthcare governance and organizational barriers to learning from mistakes. J Health Organ Manag 2008; 22: 642-51.  doi: 10.1108/14777260810916605