Ziari Abbas, Rassouli Maryam, Mirbaha-Hashemi Fariba, Heidarnia Mohammad Ali, Abachizadeh Kambiz
Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2019 Dec 18;33:140. doi: 10.34171/mjiri.33.140. eCollection 2019.
Clinical governance, as a program to improve the quality of health care, was introduced in all hospitals in Iran in 2009. However, implementation assessments revealed that the program was not adopted in many hospitals. This study aimed to determine and prioritize barriers to clinical governance program implementation in hospitals of Shahid Beheshti University of Medical Sciences. This qualitative study was performed in the first part of this exploratory mixed methods study. A purposive sample of 25 individuals who were involved in the implementation of the program was selected. They participated in semi-structured interviews and the data were analyzed using content analysis. In the second part (quantitative), a questionnaire was prepared based on the first phase of the study, and 74 stakeholders completed the questionnaire, which included all extracted obstacles to the establishment of clinical governance. They rated these obstacles with a 5-point Likert scale. A total of 9 themes were discovered in the qualitative part of the study. These themes were prioritized as follow: (1) weak organizational leadership, (2) insufficient human resources, (3) inappropriate organizational culture, (4) inadequate financial resources, (5) insufficient knowledge of personnel and management, (6) inappropriate monitoring and evaluation, (7) lack of coordination (8) deficiencies in policies and procedures, and (9) incomplete registration system and inadequate documentation. The results of this study showed that significant barriers exist in implementation of the clinical governance program in hospitals. These problems have to be addressed in order for the implementation procedure to be successful.
临床治理作为一项提高医疗保健质量的计划，于2009年在伊朗所有医院推行。然而，实施评估显示，许多医院并未采用该计划。本研究旨在确定并排列出沙希德·贝赫什提医科大学附属医院临床治理计划实施过程中的障碍及其优先级。 这项定性研究是在这项探索性混合方法研究的第一部分进行的。我们选取了25名参与该计划实施的人员作为目的抽样样本。他们参与了半结构化访谈，并使用内容分析法对数据进行了分析。在第二部分（定量研究）中，基于研究的第一阶段编制了一份问卷，74名利益相关者完成了问卷，问卷涵盖了临床治理建立过程中所有提炼出的障碍。他们用5点李克特量表对这些障碍进行了评分。 在研究的定性部分共发现了9个主题。这些主题的优先级如下：(1) 组织领导力薄弱，(2) 人力资源不足，(3) 组织文化不恰当，(4) 财政资源不足，(5) 人员和管理层知识欠缺，(6) 监测与评估不当，(7) 缺乏协调，(8) 政策和程序存在缺陷，(9) 登记系统不完整且文件记录不足。 本研究结果表明，医院临床治理计划的实施存在重大障碍。为使实施程序取得成功，必须解决这些问题。
