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.
IntroductionClinical governance as an approach to improving the quality and safety of clinical care has been run in all Iranian hospitals since 2009. This study aimed to provide a comprehensive overview of the processes and challenges faced in implementing clinical governance (CG) in acute-care hospitals in Iran.MethodsWe conducted an in-depth, qualitative, multi-case study using semi-structured interviews with a range of key stakeholders and review of relevant documents. This study was conducted in 2011–2012 in six governmental hospitals affiliated with Tehran University of Medical Sciences. The data were analyzed using framework analysis.ResultsThe interviewees, predominantly senior managers and nurses, expressed generally positive attitudes towards the benefits of CG. Four out of the six hospitals had a formal strategic plan to implement and execute CG. The emergent barriers to the implementation of CG included insufficient resources, the absence of clear supporting structures, a lack of supportive cultures, and inadequate support from senior management. The main facilitating factors were the reverse of the barriers noted above in addition to developing good relationships with key stakeholders, raising the awareness of CG among staff, and well-designed incentives.ConclusionsThere is a positive sense towards CG, but its successful implementation in Iran will require raising the awareness of CG among staff and key stakeholders and the successful collaboration of internal staff and external agencies.
Context: The operating room is a unique environment in which learning happens through interactions with others and facing complex situations. The results of studies show that non-technical skills play a key role in successful technical performance in critical situations. Therefore, the identification and assessment of them are very valuable. This review study was performed to identify and critique non-technical skill assessment tools for surgical team members. Evidence Acquisition: The Carnwell and Daly critical review method was used for the study design. Articles and documents were searched in databases of PubMed, Google Scholar, Scopus, and ScienceDirect from 1999 to 2019. Results: This literature review yielded 13 assessment tools of non-technical skills in the operating room, including ANTS, AS-NTS, N-ANTS, ANTS-AP for the anesthesia team, OTAS, Oxford NOTEHS, Oxford NOTECHS II, and Revised NOTECHS for the surgical team, SPINTS for scrub nurses, and OSANTS, NOTSS, SDM-RS, and SLI for surgeons. Conclusions: Since the development of the tools depends entirely on the context and task analysis of any member of the surgical team, all countries must customize the available tools and develop similar tools for other members of surgical teams.
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