Hospital

Professional Challenges of Medical Social Work in the Safe Discharge of Patients A Qualitative Study

Ahmad Kalateh Sadati

Background and Purpose: Discharge planning, as a process for the safe transfer of patients, has always been challenged by the interventions of medical social workers. Identifying these challenges prevents disruptions in effective planning. This research aims to explore the challenges faced by medical social workers in discharge planning.
Materials and Methods: This is a qualitative study conducted in Iran in 2023. Data were collected through semi-structured face-to-face and telephone interviews with 16 social workers working in hospitals and were manually analyzed using thematic analysis.
Results: The findings of this study revealed that hospital social workers encounter structural and professional challenges during discharge planning. As a result, themes such as professional isolation, erosive environment, back-breaking costs, inefficient structures, and professional pressures were identified, with the main theme being unattended discharge.
Conclusion: The results indicate that social workers in hospitals are faced with poor cooperation and participation, a lack of facilities and equipment, and socio-economic barriers at the community level. They encounter professional challenges in adhering to professional principles and values and in maintaining the quality of social work services in discharge planning. Given the importance of post-discharge interventions, organizational, structural, and professional reforms at both the micro and macro levels are recommended.

Estimating the total cost of imaging services of a hospital using the time-driven activity-based costing method (TDABC) in 2018

Sanaz Zargar balaye jame

Background and Purpose: Medical imaging is one of the most expensive sections of a hospital due to the use of superior technology, specialized personnel, and adherence to special protective regulations, all of which have a direct impact on the diagnosis and treatment of diseases. Time-driven activity-based costing (TDABC) provides an overview of hospital activities, enabling the identification and management of costs and resources with greater accuracy and ease. The purpose of this study is to examine the total costs of services and the unused capacity of resources to provide financial management solutions for hospital administrators.
Materials and Methods: This descriptive and retrospective study was conducted on the statistics and accounting data of a general hospital in Tehran in 2018. The study falls under the category of applied research due to the potential use of the results in financial management and resource consumption. The data collection method included the review of documents and financial statements, timing of all activities in the imaging department, and calculations based on the time-driven activity-based costing method, using Excel software, with the elimination of the cost of unused resources.
Results: The study found that the total cost was mostly below the approved tariffs, with the main cost components being 34% manpower, 23% overhead, 22% equipment, and 15% consumables. The findings indicated that only 58% of resource provisioning expenses played a role in determining the total cost of services.
Conclusion: The findings of this research suggest that reducing the unused capacity of resources and organizational reforms can decrease the total cost of services, increase profitability, and optimize resource usage to enhance the quality of hospital services.

Investigating the Socio-Economic Factors Affecting Affordability and Availability of Medications for Patients with Diabetes

Hadi Hayati

Background: The rise in healthcare expenditures, particularly drug costs, has posed a significant challenge to the healthcare system. This issue is particularly critical for chronic diseases such as diabetes, as various factors influence patients' access to these medications and their financial ability to pay for them. Thus, this study aimed to investigate the access and purchasing power for anti-diabetic drugs in pharmacies and hospitals in Khorramabad city in 2022.
Materials and Methods: This descriptive-analytical study included patients and visitors to private pharmacies and hospitals in Khorramabad. The required information was collected through patient prescriptions, pharmacy records, interviews, and checklists based on the World Health Organization protocol. Data analysis was performed using t-test, chi-square, ANOVA, and logistic regression, utilizing SPSS version 21 software.
Results: The findings revealed that among the socio-economic factors affecting the financial ability to pay for diabetes medications, income level is identified as a significant factor, particularly in patients with underlying conditions, where their income is adversely impacted. Additionally, the results indicated that, unlike the free market, in the healthcare and pharmaceutical market, no socio-economic factor from the demand side (i.e., patients) influences pharmacies as drug suppliers in terms of the accessibility index.
Conclusion: Despite the good availability of medications in pharmacies, the financial constraints faced by patients in covering medication costs suggest that government intervention through measures such as enhanced insurance coverage and medication subsidies could support economically disadvantaged groups.

Optimizing the supply chain of kidney allocation to patients waiting for organ transplant

Farzad Firouzijahantigh

Background and purpose: The organ transplant network is among the most complex and challenging systems in the healthcare sector. This study presents a three-objective hierarchical location model for kidney transplants, aiming to simultaneously minimize total time and costs while maximizing geographic equity in the supply and demand network for donated kidneys. Various transportation modes within the network are also analyzed.
Materials and Methods: This applied research was conducted over a one-year period in 2022 (1401 in the Iranian calendar) in the province of Sistan and Baluchistan. The proposed mathematical model was implemented in GAMS software and solved using the Torabi-Hosseini method and epsilon constraint technique.
Results: The model recommended establishing candidate locations for organ collection units and transplant centers without the need for air transport equipment. It suggested that only the candidate location number 2 at Zabol Hospital Transplant Center should be equipped with air transport facilities, while the other proposed locations do not require the establishment or use of air emergency services.
Conclusion: The results indicate that the designed kidney transplant network is practical and feasible. Efficient network management ensures that all organ recipients, even those far from the provincial center and in remote areas, have timely access to the necessary facilities and equipment for transplant operations.

Designing a management competency model in order ‎to optimize management systems in Karaj hospitals

Roholah Hosseini

Background and purpose ‎: Managers, as the most important organizational decision-makers, have a significant and decisive role in the success and development of hospitals. Competency models help hospital managers to apply the knowledge, skills, and experiences needed to fulfill their responsibilities and mission. It helps them to do their jobs more successfully. The purpose of this study is to design a management competency model in order to optimize management systems in Karaj hospitals.
Methods‎: The current research is based on a quantitative approach, and in terms of its purpose, it is an applied research type, and in terms of data collection, it is a survey type. The statistical population of his research was all employees and medical staff in the hospitals of Karaj city. The sample size is 384 people and stratified random sampling method was used.The data was collected using a researcher-made questionnaire whose validity was confirmed by experts. The software used in this research is SPSS22 and AMOS.
Results: ‎According to the findings The impact of the six main dimensions of the management competency model included Knowledge competence (1.02), personal competence (0.98), interactive competences (0.38), executive competences (0.51), value and moral competences (0.42) and in The maximum job qualifications (0.41) were determined.
Conclusion: Based on the findings The impact of knowledge and personal competence on management competence in hospitals is higher than other dimensions. In other words, management competence in the hospital is highly dependent on the knowledge and personal competence of managers. Also, based on the goodness of fit index, the hospital management competency model was modified and evaluated within the standard. It is suggested to provide the basis and preparations for the implementation of the model for appointing competent managers and improving the competence of the hospital management system.

Networking of accountants and the use of strategic management accounting techniques in hospitals: the moderating role of hospital information systems and organizational culture (Study of Kerman hospitals)

Amir Fazel

Background and Purpose: Today, the use of strategic management accounting techniques within organizations is expanding rapidly. However, the implementation of these techniques and the examination of variables affecting them in hospitals remain largely unexplored. The aim of this research is to investigate the impact of accountants' networking on the use of strategic management accounting techniques, considering the moderating roles of hospital information systems and organizational culture.
Methods: This descriptive-correlational study utilized a 43-question questionnaire, whose validity and reliability were confirmed. The statistical population consisted of all employees and accountants in the finance and accounting departments of hospitals in Kerman, totaling 141 individuals. The census method was used to complete the questionnaire, with 139 questionnaires returned. Structural equation modeling and Smart PLS 3 software were used to test the research model.
Results: Statistical indices confirmed the model's appropriate fit (GOF=0.738). Networking of accountants, hospital information systems, and results-oriented culture positively influence the use of strategic management accounting techniques, whereas innovative culture has no effect. Additionally, hospital information systems and results-oriented culture positively moderate the relationship between accountants' networking and the implementation of strategic management accounting techniques, while innovative culture does not have any moderating effect.
Conclusion: This research contributes to the expansion of strategic management accounting techniques in hospitals and highlights the importance of influencing factors. Hospitals should apply these techniques while giving due consideration to the factors that affect them.

Investigating the effect of experiential marketing on intention to revisit healthcare and treatment organizations: A case study of clinics of the social security organization in Qom

leila Nazarimanesh

Background and Purpose: Experiential marketing is a type of marketing strategy that attracts and engages customers by creating real-life experiences, allowing them to form lasting positive memories. Creating an excellent customer experience in the healthcare sector is challenging. Therefore, the aim of this study is to investigate the effect of experiential marketing on the intention to revisit social security clinics in Qom province.
Methods: This quantitative and applied research utilized a survey approach for data collection. The statistical population comprised clients of the social security clinics in Qom province. A total of 522 individuals were invited to participate in the study using stratified random sampling. Data analysis was conducted using covariance-oriented structural equation modeling with the help of Amos V24 software.
Results: The effect of experiential marketing (with dimensions of sensory experience, physical experience, emotional experience, cognitive experience, and relational experience) on the intention to return to the clinic was confirmed, with a path coefficient value of +0.540. Additionally, the structural indicators of the model and the validity of the constructs demonstrated a good fit for the model.
Conclusion: Experiential marketing, along with the enhancement of patient-doctor relationships, is crucial. Patient-centered facilities can increase the likelihood of patients returning to clinics by focusing on experiential marketing, providing amenities, and utilizing technologies to improve service delivery.

An overview of virtual clinics in health systems: An opinion article

Ebrahim Jaafaripooyan

The provision of virtual health care has currently received ample attention from health systems worldwide, due to the recent conditions and events. Many countries are trying to provide their preliminary visits and a relatively wide range of other care virtually, paving the way towards the introduction of virtual clinics. However, in many countries, this concept has not been clearly defined, and the characteristics that are necessary to use the virtual clinics are still unknown. This perspective has sought to explain the concept of virtual clinics and their characteristics with a brief review of related literature.