Batoul Ahmadi - School of Public Health and Institute for Public Health Research, Tehran University of Medical Science, Tehran, Iran.
Mohammad Keshvari - Master Departments of Management and Health Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran.
Abbas Homauni - Master of Healthcare Management, Shahid Sadoughi University of Medical Science, Yazd, Iran
Hojat Gharaei - Healthcare Management, Hamadan University of Medical Science, Health Center of Hamadan, Hamadan, Iran.

Introduction: This study aimed to identify the challenges of risk management in the context of clinical governance in selected hospitals of Tehran University of Medical Sciences. Materials and Methods:This study was implemented in two phases: qualitative step and quantitative step (survey). The first step was conducted using in-depth interviews and the second was carried out through a survey by questionnaire. Data were collected in hospitals through in-depth interviews with hospitals managers and the experts involved in clinical governance who had been introduced by the hospital manager. All professionals affiliated with clinical governance in Baharloo, Firoozgar, Farabi, Shahid Rajai, Ziaeian, Motahari and Sina hospitals were selected. Results: 35 experts involved in clinical governance were interviewed. According to these experts, the main obstacles in hospital risk management were: Lack of an error reporting culture, exaggerated fear of the consequences, and physicians lack of interest in this domain. High workloads in this area have led to a reduction in employees contributions. Conclusion: Establishing clinical governance in health care organizations has had many benefits, such as improving patient care, increased level of patients satisfaction, establishment of a risk management system, improvement in staff and health-care personnel cooperation, and achieving a more successful organizational management. Appropriate changes in the organizational culture are necessities for the successful establishment of risk management. Human and cultural obstacles that hinder the implementation of risk management in hospitals are evident; thus, major actions are necessary to implement risk management properly in a disciplined manner.

Clinical governance, Medical error, risk management