Journal of Education and Health Promotion

Abstract Clinical governance is a systematic approach to enhancing the quality of primary health care and
ensuring high clinical standards, responsiveness to performance, and continuous improvement
in service quality. The objective of the current study was to investigate the global experiences
of clinical governance in primary health care. In the present systematic review, relevant articles
from different countries were searched in various databases such as MD PubMed from Medline
portal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult until
April 2019. The searched articles were checked through CASP and PRISMA checklists, and their
results were extracted. Of the 17 selected studies, 16 belonged to developed countries, including
England (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were divided
into three general categories: (1) principles of effectiveness and risk management, (2) deployment
requirements such as structural and organizational needs, resource and communication, and
information management, and (3) barriers of clinical governance toward providing primary health
care. it is recommended that a suitable framework or model be developed and designed adapted
to the local culture and taking into account all effective dimensions for a proper establishment and
implementation of clinical governance in primary health care.

Abstract Introduction: 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. Aims: 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. Materials and 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. Conclusion: 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.