Hospital

Challenges of public-private partnership model in public hospitals in Yazd

Mohamad Zarezade

Introduction: Despite many challenges, public-private partnership in hospitals is recognized as one of the most attractive investment platforms for the private sector. This study conducted to assess the challenges of private sector partnership with public hospitals using the public-private partnership model in public hospitals in Yazd.
Methods: The present qualitative research conducted in 2021. The viewpoints of 15 faculty members, directors, managers and operational experts on the participation of the private sector, those related to the transfer and contracts and the parties of the private sector are extracted through a semi-structured interview guide and analyzed using content analysis in three stages.
Results: A total of 10 main themes including economic and policymaking problems, insufficient manpower readiness, lack of support authority, weak partnership laws, lack of knowledge and experience of managers in partnership, lack of financial transparency, conflict of interest, poor coordination, lack of cultural readiness and trust-building and lack of plans and supervision in the field of partnership in 28 sub-themes extracted.
Conclusion: There are challenges related to policymaking issues and the resulting instability, incoordination of different units, unpreparedness of manpower and contract details in using different models of public-private partnership in hospitals, in which the use of the same procedures, transparency and the meeting requirements of the private sector are recommended for partnership and the formulation of laws and contracts free from any shortcomings and weaknesses that could lead to the loss of the public sector.

The effect of health sector evolution plan on the prevalence of cesarean and vaginal delivery in public hospitals in Kermanshah province: an interrupted time series analysis (2009-2019)

Satar Rezaei

Background: The aim of this study was to evaluate the effect of health sector evolution plan (HSEP) on the prevalence of cesarean section and vaginal delivery in public hospitals in Kermanshah province.

Methods: In the present study, cesarean section (C-section) and vaginal delivery data were collected and evaluated in 17 public hospitals from 2009 to 2019. The main variables of this study included the prevalence of C-section and the prevalence of vaginal delivery for 121 months, both were obtained by dividing the number of deliveries by C-section and vaginal delivery by the total number. Interrupted time series analysis was used to examine the effect of HSEP on the prevalence of cesarean and vaginal delivery rates.

Results: The prevalence of C-section before and after the HSEP was 42.5% and 43.2%, respectively. Months before the intervention, the rate of C-section was increasing by 0.13%, which was statistically significant. In the first month after the intervention, the prevalence of C-section decreased by 3.6% that was statistically significant. The share of C-section in the months after the implementation of the HSEP showed a monthly increase of 0.12% compared to before the intervention, which was statistically significant.

Conclusions: The results of the study showed that the HSEP has led to a significant reduction in C-section in short term, but in the months after the implementation of the plan, the prevalence of C-section has increased again.

Applications of Dynamic System Simulation in Health Care : A Systematic Review

Shahram Tofighi

Background: The use of simulation models can help elucidate the intuitive behavior of complex health care problems. Today, the complexity of problems goes far beyond our capacity to solve them manually. System simulation is considered as a wise option by approaching structural problems and understanding the complex interactions within the problems and their changes. The purpose of this study is to review the most advanced applications of system dynamics in healthcare.
Materials and methods: This study is a systematic selection of articles that explored the applications of system dynamics in health care in 11 databases between 1999 and 2019. The focus of this research was on articles with the keywords including system dynamics in health care, dynamic health care analysis, continuous health care simulation or dynamic health care simulation.
Results: 79 articles related to system dynamics applications in healthcare were identified in databases. Eighty-five percent of the articles focused on finance, politics, government, regulation, public health, and health care planning. Among the articles, the patient's treatment path, obesity and demand for healthcare workforce were examined.
Conclusion: The tendency to use continuous simulation in healthcare has increased. However, the power of hybrid simulation can take advantage of the inherent strength of the system dynamics overview perspective, and in a hybrid model it can utilize a holistic perspective for managing health care systems. Potential areas with the application of systems dynamics in future research include planning and policy-making in public health decision-making, purchasing quality management, care and risk.

Promoting and Hampering Factors in the management of entrepreneurial human capital in the field of health care

Malikeh Beheshtifar

Introduction: change and innovation for gaining competitive advantage in health system will lead to the continuation of activities in health care. Therefore, managers ' entrepreneurial orientation to promote organizational goals in the turbulent health industry is one of the requirements of human capital managers. Materials and Methods: In this study , semi-structured interviews were conducted to identify promoting and obstacles in the organizational entrepreneurship factor to design entrepreneurial human resource management model and were analyzed by content analysis method . The population of the study consisted of operational and middle managers in the field of health, among which 20 were selected by non-probability and snowball sampling methods .
Results: The results showed that organizations in health care areas are influenced by three factors of managers , employees and environment of the organization and have an impact on the organizational entrepreneurship variable in human capital management. In the case of obstacles and promoting factors, employees and managers had the highest number of codes (meaning unit) respectively.
Conclusion : Human capital managers in the field of health by creating the necessary ground in strengthening the driving factors and overcoming the confounding factors of corporate entrepreneurship in their management strategies and processes promote the performance of the staff and personnel and consequently play a significant role in the health of the entire society .

Financial and human resources distribution Efficiency of public hospitals by provinces in Iran 2018

Zohreh SHaker

Background and Aim: Hospital is organization which its performance improvement is very important. In order to do this, we must evaluate the allocated resources and performance of hospitals. Calculating hospitals efficiency is one of the possible ways to evaluate the performance of them. In this study, the efficiency of allocated financial and human resources of public hospitals by provinces is examined.
Materials and Methods: This study was conducted in 2017-2018. Data were collected from 31 provinces of Iran. Input (including: number of physicians, number of nurses and number of active beds per ten thousand population) and output (number of hospitalizations and number of outpatients per ten thousand people). Data were collected from studies. The efficiency analyzing of the provincial treatment department was performed with DEAP software.
Results: The input population (nurse, doctor, bed) is related to hospitals and health centers in Semnan, Yazd and Mazandaran provinces And the least amount of input was related to Sistan and Baluchestan, Khuzestan, North Khorasan provinces. The highest output (inpatient and outpatient) belongs to East Azarbaijan province and the lowest output belonged to Hamedan province. Efficiency score, variable return to scale and constant return to scale for all hospitals in the country are 0.565, 0.813 and 0.47, respectively.
Conclusion: proper and correct distribution of resources between provinces may increase efficiency of resource distribution.

Designing a competency model for middle-level nurse managers using Fuzzy Delphi Method (FDM)

Mohammad Ali Cheraghi

Background: Identification of competencies is necessary base for a succession plan and efficient human resource management. Studies show that this important issue has been neglected by using the competency model at the middle-level nurse managers.
Since, the methods based on fuzzy logic provide the possibility of mathematical formulation of ambiguous concepts, such as competence. The aim of this study was to design a competency model for middle-level nurse managers using FDM in the second half of 1399.
Materials & Methods: This study was conducted according to health system management studies. The population included all managers of nursing services (matrons) of hospitals affiliated to Tehran University of Medical Sciences. Census sampling used and research samples included 14 nursing service managers (as experts). After reviewing literatures, an initial conceptual model was designed. In the following, two next steps were conducted as a survey form was used to receive the opinions of experts confirming the model leveling. In the second step, the indicators were screened using the FDM.
Results: All participants were female and 9 people had a master degree. The experts' agreement with the model leveling was 90%, which indicated that it was approved. In FDM, the indicators with crisp values higher than 0/7 were confirmed by experts. The design model consisted of 3 dimensions technical, relational, perceptual, 6 components, 14 indicators and 28 sub-indicators.
Conclusion: This study showed that the criteria for selecting middle-level nurse managers include various dimensions of competence including technical, relational and perceptual. Senior managers can use the results of this research to achieve an appropriate planning for succession plan.

Identifying and prioritizing effective factors in the demand for inter-hospital transfer of patients

Seyyed Mohammad Mehdi Baki Hashemi

Background: thousands of people die or suffer from irreversible damage due to lack of timely and adequate services in medical centers. This research seeks to identify and prioritize factors affecting the demand for patient transfer and provide the most effective measures to facilitate this process.
Materials and Methods: This research is combined in terms of method and inductive research in terms of type of research. The population of study is the senior and middle managers of Guilan University of Medical Sciences who were selected as a sample member using purposive sampling method. The factors affecting patient transfer demand were identified using qualitative data obtained from exploratory studies, then these factors were prioritized using fuzzy Delphi method.
Results: In the first part, a set of factors affecting the demand for patient transfer were identified, and in the second part, the importance and priority of these factors were determined. The results of the research showed fourteen main factors, including disproportionate distribution of specialized human resources, ineffective planning, inefficient management, and inefficiency of human resources.
Conclusion: Inefficient organizational processes and organizational structures along with real needs have been identified as reasons for patient transfer demand,which requires special attention of supervisors and management of organizational development and administrative transformation of universities. It seems that the formation of a special monitoring and planning working group to remove obstacles in a centralized manner at the highest organizational level and a special look at the reports of the care monitoring center as the most effective measure can be used to manage the dispatch process, planning, Monitor and remove obstacles.

The Necessity of Training a Health-Oriented Management Perspective for The Managers of Military Clinics (Letter to The Editor)

Serajaddin Gray