Table 3.

Known barriers to clinical governance in primary health care in the reviewed studies

Known barriers to clinical governance	Title	Country	Author and year
The unprofessionalism of primary care organizations	Clinical governance in primary care: A literature review	England	Tait (2004)[25]
Paucity of human resources, lack of clarity and transparency of laws, misdivision of staff among employees	Implementing clinical governance in English primary care groups/trusts: Reconciling quality improvement and quality assurance	England	Campbell and Sweeney (2002)[27]
Distrust of health care providers, separation of health from other health sectors, lack of transparency in primary care frameworks, doctors’ dominance over health system, staff concerns, lack of external control over primary care organizations, attention to short-term achievements, resource constraints, inadequate leadership, lack of proper learning	The role of clinical governance as a strategy for quality improvement in primary care	England	Campbell and Sweeney (2002)[27]
Lack of staff independence, political pressures	A qualitative study of the cultural changes in primary care organizations required to implement clinical governance	England	Marshall et al. (2002)[13]
Hierarchical structure and diverse educational achievements, service providers’ sense of disability and weakness, lack of multi-knowledge-based learning (educational discipline)	Clinical governance in primary care: Participating in clinical governance	England	Pringle (2000)[28]
Hierarchical structure, absence of professional management and quality assurance	Clinical governance in primary care: Improving quality in the changing world of primary care	England	Rosen (2000)[29]
Paucity of an encouragement system	Clinical governance in primary care: Knowledge and information for clinical governance	England	McColl and Roland (2000)[30]
Bureaucratic control	New Zealand’s independent practitioner associations: A working model of clinical governance in primary care?	New Zealand	Malcolm and Mays (1999)[32]