Perceived barriers to the improvement of the performance transparency of hospitals in Iran: a qualitative study

Introduction
Free access to information as a public right has become a critical issue in healthcare. Some health systems disclose information about hospitals’ performance to influence patients’ choices. However, there is little transparency in Iran. Objectives. As a basic step to improve the transparency of hospitals’ performance in Iran, this study was designed to explore the perceived barriers to transparency.

Material and methods
This qualitative study was conducted through eighteen face-to-face interviews with macro-, meso- and micro-level experts of the health system with different academic orientations. The data was analyzed using a thematic analysis method.

Results
Five main themes were identified, including inadequate regular hospital performance data available to the government; lack of transparency culture among health system authorities; concerns about the transparency of hospitals’ poor performance; absence of rule of law and immaturity of the country’s health system governance, which weakens democracy. Therefore, the decision-making system mostly supports special groups rather than the public.

Conclusions
These barriers have become more prominent due to the existence of the conflict of interests among authorities and the power of pressure groups. Therefore, interviewees suggested that the necessary infrastructures be created prior to promoting transparency. Among the most important prerequisites is managing the conflict of interest in the health system to have decisions favor public interests.