Hospital

Fraud Detection and Providing Mitigation Solutions in Iran Health Insurance Organization

Mohammad Arab

Background and purpose: Abuse within health insurance systems represents a significant challenge for health systems globally, leading to substantial negative repercussions. This study investigates instances of abuse in the Iranian Health Insurance Organization and proposes strategies to mitigate such abuses within its primary insurance processes.
Methods: This applied study employs a qualitative methodology, with data collected via semi-structured interviews. Experts from the Iranian Health Insurance Organization were interviewed to gather their insights. Data analysis was performed using conventional content analysis, and MAXQDA 20 software was used for coding and categorizing the findings.
Results: Instances of abuse within Iran’s health insurance system were classified into two main categories: "providers" and "service recipients," which were further divided into 18 subcategories. The underlying causes of these abuses were analyzed on two levels: macro-level factors (economic, cultural-social, legal, and technological) and micro-level factors (implementation processes, oversight, and service delivery). Based on these findings, strategies for reducing abuse were proposed in three primary areas: "planning," "execution," and "control." These strategies included revising and amending relevant laws and regulations, enhancing technological infrastructure, and improving information systems in the planning phase; verifying the identities of service recipients and providers during service delivery; and strengthening oversight personnel, alongside continuous inspections, in the control phase.
Conclusion: This study indicates that revising laws and regulations within the insurance sector, upgrading technological infrastructures, providing continuous training for claims assessors, enhancing inter-organizational communication, and strengthening oversight of service providers are essential strategies for preventing abuse in the Iranian Health Insurance Organization.

The Necessity of Standardization of Emergency Operation Centers in Universities of Medical Sciences: A Response to the Challenges of Managing Emergencies and Disasters

MohammadReza Khajeh Aminian

Background and purpose: The Emergency Operations Center (EOC) is a centralized facility designed to coordinate disaster management activities across all phases of the disaster management cycle. EOCs play a vital role in facilitating efficient and effective responses by coordinating information and resources. This study aims to highlight the importance of establishing a standardized framework for EOCs in Iranian universities of medical sciences and to examine its key dimensions.
Methods: This study is a commentary article that compiles information from published literature on the framework of emergency operations centers. It focuses on two prominent global frameworks: the World Health Organization’s Public Health Emergency Operations Center Framework and the U.S. Federal Emergency Management Agency’s Emergency Operations Center Guidelines. The study emphasizes the necessity of creating a standardized framework for emergency operations centers in Iranian universities of medical sciences.
Results: EOCs across different countries vary in terms of their missions, authorities, and resources. Consequently, the frameworks used in these centers are not uniform, and are largely shaped by the governance and regulatory requirements specific to each country.
Conclusion: A standardized framework, tailored to the specific needs and conditions of Iran, is essential for EOCs at universities of medical sciences. Such a framework could enhance the operational capabilities of these centers during incidents and disasters, improving their responsiveness and effectiveness.

Presenting Fearless Organization Model in Iran's Healthcare System

Ahmad Vedadi

Background and purpose: A fearless organization fosters psychological safety, ensuring that every member feels secure to express concerns, ask questions, or share mistakes without fear of humiliation, ridicule, or punishment. This research aims to introduce the Fearless Organization Model in Iran's healthcare sector, with a focus on the Ta’amin Ejtemaie hospitals.
Methods: This research employs a mixed-methods approach. In the qualitative phase, methods such as meta-synthesis, expert Delphi, and Shannon’s entropy were used to identify the components of a fearless organization. The quantitative phase involved structural equation modeling (using surveys distributed among the staff of Ta’amin Ejtemaie hospitals in Tehran) to validate the research model.
Results: The Fearless Organization Model consists of two main dimensions: “Behavioral” and “Structural.” The behavioral dimension includes "managers' behavioral components" and "employees' behavioral components." The structural dimension includes "organizational components," "human resource components," and "environmental components." Key characteristics of a fearless organization include: creating psychological security, openness, transparency, accountability, humble listening, quick employee feedback, learning from mistakes, encouraging knowledge sharing, avoiding silence, and promoting open communication. Effective response systems and coherent organizational structures for extracting ideas and concerns, as well as fostering a supportive culture, are essential.
Conclusion: The findings of this study emphasize the importance of addressing both behavioral and structural dimensions in creating a fearless organization. However, the behavioral dimension plays a more significant role than the structural one. Within the behavioral dimensions, "employee behavior" is the most crucial factor. Managers should focus on cultivating behaviors that promote security and openness within the organization. This research can serve as a foundation for further studies on the drivers and barriers to establishing fearless organizations in different contexts.

Drivers and Barriers of Medical Tourism Development in Public Hospitals from the Perspective of Healthcare Staff: A Case Study of Masih Daneshvari Hospital

Shadi Khalilolahi

Background and purpose: The globalization of medical tourism has intensified competition among destinations, making it crucial to identify key success factors. While research emphasizes the role of host communities in tourism development, non-medical aspects of medical tourism remain underexplored. This study examines healthcare staff perspectives to identify the drivers and barriers affecting medical tourism in public hospitals.
Methods: This qualitative study employed structured interviews with 16 healthcare staff at Masih Daneshvari Hospital, selected through purposive sampling. Interviews were conducted in person during the summer of 2024 until data saturation was reached. Data analysis followed an inductive content analysis approach using MAXQDA software for coding, grouping, and categorization of themes into drivers and barriers.
Results: Key drivers of medical tourism development include skilled human resources, strong medical potential, affordable healthcare and associated costs, and the presence of complementary attractions. Conversely, major barriers include inadequate welfare services for medical tourists, managerial and institutional inefficiencies, hospital infrastructure deficiencies, and political and cultural challenges.
Conclusion: Developing a successful medical tourism sector requires a holistic approach. Identifying, prioritizing, and implementing strategic plans to strengthen facilitators and address obstacles are essential steps toward sustainable growth in this field.

Structural Analysis of Factors Influencing the Resilience of the Hospital Medical Equipment Supply Chain Using Fuzzy MICMAC

mandana sahebzadeh

Background and purpose: The complexity and extreme fluctuations in the healthcare environment, along with the occurrence of unforeseen disasters and risks, have increased the likelihood of disruptions in hospital supply chains. Strengthening supply chain resilience is a key strategy to mitigate these challenges and ensure the continued delivery of efficient and effective hospital services during crises. This study aims to conduct a structural analysis of the factors influencing the resilience of the hospital medical equipment supply chain using the Fuzzy MICMAC approach.
Methods: This mixed-method (qualitative-quantitative) study included faculty members knowledgeable in the field, heads of medical equipment departments in universities and hospitals, senior managers from medical equipment manufacturing and importing companies, and healthcare administrators. Data were collected through checklists and semi-structured interviews. Fuzzy matrix completion and MICMAC analysis were used for data processing, performed using Fuzzy MICMAC software.
Results: Among the identified factors, logistics management was found to have the highest impact on the resilience of the hospital medical equipment supply chain. In contrast, factors such as integration and coordination, cooperative relationships, competition, flexibility, human resource management, and risk/crisis management had the lowest direct impact. Environmental conditions, transparency and protection, information-sharing systems, and human resource management were identified as the least affected factors. Economic factors emerged as a highly influential indirect factor, significantly affecting supply chain resilience.
Conclusion: To enhance the resilience of hospital medical equipment supply chains, logistics management and economic factorsmust be prioritized. Additionally, agility and speed, risk/crisis management, competition, and the development of integrated and cooperative relationships play a moderately indirect role and should be considered in strategic planning.

The Role of the Electronic Service Desk in Enhancing Structural Capital at Tehran University of Medical Sciences During the COVID-19 Pandemic

Mashallah Torabi

Background and purpose: In the current decade, the development of intellectual capital has emerged as a key driver for enhancing both individual and organizational performance. The deployment of electronic service desks can contribute significantly to this development, particularly in strengthening structural capital. This study aimed to examine the impact of implementing an electronic service desk on the structural capital of Tehran University of Medical Sciences during the COVID-19 pandemic.
Methods: This qualitative study employed a multi-case research approach. Data were collected through semi-structured interviews with managers and experts in the domains of service desk operations and university education. Additional data were gathered by reviewing institutional documents and client feedback reports. Identified factors were subsequently validated through focus group discussions. Content analysis was used to analyze the data.
Results: The most prominent impact of the electronic service desk was improved management of client-related statistics and enhanced reporting capabilities to relevant authorities. Other significant effects included easier user access, the ability to refer documents to other departments or organizations, improved resolution of requests during initial user contact, and enhanced interactions with clients.
Conclusion: The electronic service desk played a vital role in sustaining and enhancing the quality of educational services during the pandemic, while aligning with public health protocols. Furthermore, it laid the foundation for managerial innovation within the university’s educational service delivery system.

A Review of Patient Waiting Time and Its Determinants in Emergency Departments in Iran

Abdosaleh Jafari

Background and purpose: The aim of this study was to investigate the waiting time of patients referred to the emergency department and the factors affecting it in the country.
Methods: A search was conducted in the scientific databases PubMed, Science Direct, ProQuest, Scopus, Web of Science, Mag Iran and Civilica with the keywords waiting time, duration, emergency, Iran, etc. The Search period was up to 2024/02/06. After applying the search strategy, 26 studies were included in the study.
Results: The findings of the present review study (rapid review) showed that the average time from patient arrival in the emergency department to the first doctor's visit ranged from about 2 minutes to about 32 minutes, the average time from patient arrival in the emergency department to the first treatment ranged from 3.7 minutes to 262 minutes, the average time from request to the first test result was from 20.17 to 629.2 minutes, the average time from request to the first radiology result was from 5.85 to 1080 minutes, and the average time from request to the first ECG result was from 3.7 to 32.3 minutes. Also, the most important factors affecting the waiting time of patients referred to the emergency department included individual factors related to the patient, reason for referral, factors related to the hospital and emergency department, and factors related to human resources in the emergency department.
Conclusion: This study showed that patients' waiting time in the emergency department depends on various factors. To reduce it, improvements in triage, workforce management, the use of smart technologies, infrastructure enhancement, and patient education are recommended.

A Review of the Trend in Health Expenditure as a Share of Household Budget in Iran: Letter to the Editor

Farhad Ghaffari