Hospital governance accountability challenges in Iran: a qualitative study

Area of Science:

• Healthcare Management
• Public Health Policy
• Organizational Studies

Background:

• Effective hospital governance is essential for quality care and patient safety.
• Despite reforms, Iranian hospitals face persistent governance and accountability challenges.
• Understanding these challenges is vital for improving healthcare delivery.

Purpose of the Study:

• To identify and analyze the challenges within hospital governance and accountability structures in Iran.
• To gather insights from hospital administrators and policymakers on existing barriers.
• To inform future reforms aimed at enhancing hospital management.

Main Methods:

• Qualitative study employing semi-structured interviews.
• Purposive sampling of 23 hospital administrators and governance experts in Iran.
• Thematic analysis based on Braun and Clarke's framework for data interpretation.

Main Results:

• Identified governance structure challenges: lack of medical staff councils, presidential governance, physician dominance, centralization, and rigid regulations.
• Identified accountability structure challenges: administrative, financial, and socio-political dimensions, including favoritism, centralized planning, and political pressures.
• These factors significantly impact hospital operations and accountability.

Conclusions:

• Reforms are needed in Iranian hospital governance and accountability frameworks.
• Recommendations include establishing medical staff councils and boards of trustees.
• Decentralization of decision-making and regulatory revision are crucial for improved accountability.