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. 2025 Jul 10;25(1):946.
doi: 10.1186/s12913-025-13100-1.

Hospital governance accountability challenges in Iran: a qualitative study

Mohammad Ali Jalilvand  1 , Ahmad Reza Raeisi  2 , Nasrin Shaarbafchizadeh  3
Affiliations

Hospital governance accountability challenges in Iran: a qualitative study

Mohammad Ali Jalilvand et al. BMC Health Serv Res. .

Abstract

Introduction: Hospital governance is crucial for ensuring the quality of care and patient safety. Despite numerous reforms in hospital governance accountability structures in Iran, some challenges persist. This study identifies the challenges of governance accountability structures in Iranian hospitals from the perspectives of administrators and policymakers.

Methods: This qualitative study used semi-structured interviews with 23 hospital administrators and governance experts in Iran. Participants were selected through purposive sampling. Interviews were conducted face-to-face, online, or by phone, and data were analyzed using thematic analysis based on Braun and Clarke's framework.

Results: The study identified two main themes: governance structure challenges and accountability structure challenges. Governance structure challenges included internal issues such as the lack of a medical staff council, presidential governance, and the dominance of physicians, as well as external matters like centralization and rigid regulations. Accountability challenges encompassed administrative, financial, and socio-political dimensions, with issues such as the preference for personal relationships over accountability, centralized planning, and political pressures affecting hospital operations.

Conclusion: The study highlights the need for reforms in Iranian hospital governance and accountability structures. Recommendations include forming boards of trustees and medical staff, decentralizing decision-making, and revising regulations to improve clinical, financial, and socio-political accountability. These changes could enhance the overall governance and accountability of Iranian hospitals.

Keywords: Accountability; Governance structure; Hospital; Iran.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was part of a Ph.D. thesis supported by the School of Management and Medical Information Sciences, Isfahan University of Medical Sciences. It was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki. The Ethics Committee of Isfahan University of Medical Sciences approved the study (Ethics Code: IR.MUI.NUREMA.REC.1400.223). Ethical standards were followed to ensure respect for the participants’ rights, health, and privacy. In compliance with Articles 9 and 25 of the Declaration of Helsinki, written informed consent was obtained from all participants in Persian. Participants were informed of their right to withdraw from the study at any stage without any negative consequences. Data were kept confidential and were used solely for research purposes. This study also adhered to Article 24 of the Declaration of Helsinki regarding protecting privacy and confidentiality. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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