Hospital

Provider-oriented moral hazards associated with the prescriptions paid by insuring Organizations

Baheshte Ebrahimi

Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.
Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.
Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.
Conclusion: The abuse in the health service provision is a high risk for health care managers in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

Socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces

Soraya Nouraei Motlagh

Introduction: Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces.
Methods: Data required for the study were collected from the household expenditure and income survey (HIES). The study population included 5547 households in the western provinces of the country. Logistic regression method was used to determine the most important factors affecting the use of dental services, and the focus index was used to measure inequality between income groups. Data analysis was performed using Stata software version 14.
Results: The highest and lowest percentages of dental services among households were related to Hamedan (7.02%) and Lorestan (3.19%) provinces, respectively. The results of the focus index showed that the benefits and costs of dental services were concentrated among households with higher socio-economic status. In other words, inequality benefits the rich. Being a female head of household and increased size of the household leads to a decrease in the use of these services. The higher education level of the head of the household and the increase in the number of employed and literate household members showed a positive relationship with the utilization of dental services.
Conclusion: Benefiting from dental services was significantly higher among higher socio-economic groups. These inequalities can be avoided by introducing and implementing targeted policies. Low-income households, lower education levels, and the unemployed should be the focus of health policies to address unmet dental care needs.

The effect of transformational management in the organization on quality of work life of the staff of Shohada-ye Tajrish Hospital in Tehran

Mohammad Hossein sadeghian

Background:The most important and difficult process in any organization is to create change in the organization because today organizations have to react to changes in the environment.The purpose of this study was to investigate the effect of transformational management on quality of work life of the staff of Shohada-ye Tajrish Hospital in Tehran.
Materials & Methods:The is a descriptive-analytic and cross-sectional study that was conducted in Shohada-ye Tajrish Hospital in Tehran in 2020. Data collection tools were Transformational Management Questionnaire(Bass and Olivier)and Quality of Work Life Questionnaire(Walton 1973). Based on Cochran's formula, 234 employees of Shohada-ye Tajrish Hospital in Tehran were selected as study population.The reliability and validity of the measuring tools were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis. Pearson correlation test and structural equation test were used to analyze the data.
Results:The research findings indicated that there was a positive and significant correlation between transformational management with safe and healthy work environment, growth opportunity and security, fair and adequate pay, employee legalism,social affiliation,social cohesion and integration, development of human capabilities and the general atmosphere of working life. In addition, 92% of the variance in quality of work life was explained by the research model.
Conclusion:Considering the impact of transformational management on the development of human capabilities, senior managers should formulate and implement appropriate programs to improve the quality of work life and provide conditions for employees to enjoy their organization and work.

Factors affecting open innovation in public hospitals of Guilan province

Karim Kiakojouri

Introduction: In the present era, the implementation of open innovation process is necessary for any organization, and hospitals as the main medical centers are no exception. In fact, hospitals, as health operational units, are always directly exposed to changes in the field of health services. Therefore, the present study has investigated the factors affecting open innovation in public hospitals in Guilan province.
Methods: From the point of view of purpose, this research is an applied study and in terms of data collection, it is in the category of descriptive research, which was conducted cross-sectionally in 1400. The statistical population of the study was 1600 senior managers and staff of public hospitals in Guilan province. For sampling, a non-randomized judgmental sampling method was used to access community members (senior managers and employees with at least a bachelor's degree). 250 questionnaires were used to perform the test. Data collection tools are standard questionnaires. The reliability of the questionnaire was confirmed through Cronbach's alpha, and the validity of the questionnaires was confirmed through the face and content validity, convergent and divergent validity. The structural equation modeling method has been used to test the research hypotheses. The software used in this research is SPSS 26 and Smart PLS3.
Results: The results of the structural equation modeling test showed that among the external factors, cooperation with partners and the user, among the internal organizational factors, organizational structure, exploratory learning, and organizational culture, and finally among the individual internal factors, organizational motivation affects the open innovation of public hospitals in Guilan province. The impact of trust between partners, technology, personality traits, and knowledge on hospital open innovation has been rejected.
Conclusion: In collaboration with other health care services, universities, and users, hospitals should develop appropriate policies to transition from a closed innovation system to open innovation, and support effective measures in this regard.

Management style of educational and medical centers in Qazvin: Perception of frontline staff from the structure and condition

Rana Soheylirad

Introduction: Management is one of the most important factors that can affect the performance of an organization such as hospital. Therefore, identifying the management style used in hospitals can be useful empirical evidence to solve many hospital problems. In this study, the management styles used in the educational-medical centers of Qazvin University of Medical Sciences have been studied and determined.
Methods: In this descriptive-analytical study, a sample of 411 people was selected using random sampling method from a population of 2265 employees working in university hospitals in Qazvin. The required data were collected using a valid Clark management style questionnaire and through employee perception survey. Finally, the obtained information was analyzed in the space of STATA 15 and SPSS 16 software.
Results: Individuals reported the highest frequency (42%) for autocratic style items and the lowest frequency (25%) for delegating style items. Autocratic style had the highest total mean (3.22 of 5) and delegating style had the lowest total mean (2.87 of 5). Apart from autocratic style, there was a significant difference between hospitals in terms of the use of participative and delegating styles (p <0.05).
Conclusion: In all hospitals, the dominant management style was autocratic style. It is suggested that managers be taught about the techniques and functional benefits of participative and delegating styles.

Presenting a conceptual model of the effects of health tourism development on community welfare: A Grounded Theory Approach

Forough Roodgarnejad

Introduction: Health tourism is one of the most lucrative and competitive industries in the world and is a new field of tourism. The purpose of this study is to present a conceptual model of health tourism development on community welfare.
Materials and Methods: This research is qualitatively exploratory. The study population included university professors and health tourism managers. Fifteen people participated in the study through purposive non-probabilistic sampling and through semi-structured and in-depth interviews. Data analysis was performed with MAXQDA10 software and a grounded theory approach based on three stages of open, axial and selective coding. To check the validity, two methods of participatory feedback and receiving the opinions of colleagues, and to ensure the reliability of the interviews, two methods of retesting and two coders were performed.
Results: The data analysis was based on 100 keywords (open source). By identifying the relationship between the codes, 18 common concepts were categorized. The main concepts were categorized according to the axial coding method. Because traces of medical and health facilities, health tourism infrastructure, and relationship development policies were seen in most of the interviewees' quotes, they were selected as the central sub-categories of health tourism and these three items were placed at the center of the model. And other categories were associated with it.
Conclusion: The development of health tourism is a tool for the development of society and increases investment in the political, social, cultural and economic sectors of society, creates employment, increases income and people's satisfaction and vitality, and promotes the development of welfare, the improvement of the quality of life and wellbeing.

The Effect of Internal Marketing Orientation on Nurses’ performance with the Mediating Role of Nurses’ Engagement

Mitra Rezvani

Background: The performance of nurses as the largest human resources element of health care organizations has an important impact on the quality and results of patients' treatment. The main purpose of this research is to investigate the impact of internal marketing orientation on nurses’ performance by considering the mediating role of nurses’ engagement.
Materials & Methods: In this regard, while reviewing the implications of internal marketing orientation, engagement with the job and performance of employees, using path analysis and structural equation modeling, we examined the effect of internal marketing orientation on the performance of nurses by examining the role of mediation in job engagement. The study population included nurses of Sasan and Parsian hospitals in Tehran. Stratified random sampling and a questionnaire were used to collect the data. In order to analyze the data, Kolmogorov-Smirnov tests were used for the normal test and Path Analysis and Structural Equation Modeling for confirmation of hypotheses.
Results: Results showed that internal marketing orientation, through the engagement of nurses, influences their performance. Moreover, it was proved that internal marketing orientation has a direct relationship with engagement, but it does not directly influence nurses’ performance.
Conclusion: The most significant achievement of this research is that the managers and executives of healthcare centers can provide a more suitable environment for nurses caring patients, through improving working conditions. Implementing internal marketing orientation is one of the practices that can enhance nurses’ performance through affecting work attitudes, especially work engagement.

Competence of hospital managers as a necessity for optimal and effective management of the Iranian health system; Letter to the Editor

Ghasem Rajabi vasoukolaei