Showing 352 results for Type of Study: Original Article
Asra Khalili, Ali Mohammad Mosadegh Rad, Shahram Ghafary, Ebrahim Jaafaripooyan,
Volume 23, Issue 1 (5-2024)
Abstract
Background and purpose: Effective management of human resources is crucial for improving healthcare services, as personnel are an organization's most valuable asset. This study aims to identify challenges in human resource management and propose solutions to enhance service quality in hospital settings.
Methods: This qualitative study employed semi-structured interviews with 53 managers and key decision-makers from Social Security hospitals in Tehran, using purposive and snowball sampling techniques. Thematic analysis was utilized to analyze the data. The validity and reliability of the qualitative findings were ensured through participant and expert review methods.
Results: The study identified numerous human resource challenges, categorized into five main groups and 20 subgroups. Key issues included flawed recruitment and hiring processes, unfavorable working conditions, weak human resource organization, inadequate staff training, and ambiguity in employment laws and regulations. Proposed solutions, classified into five main groups and 29 subgroups, encompassed: enhancing recruitment and hiring processes, fostering a dynamic organizational culture, improving human resource productivity and efficiency, transforming hospitals into learning organizations, providing comprehensive and effective training, and increasing transparency in rules and regulations, particularly in job descriptions.
Conclusion: Regular identification of human resource management challenges and implementation of evidence-based, scientific, and operational solutions can significantly improve human resource management and, consequently, hospital performance in Social Security hospitals.
Jamil Sadeghifar, Nasim Eyvani, Ghasem Rajabi Vasukolai, Naser Farhamand Moghadam, Shahram Ekhtyari,
Volume 23, Issue 1 (5-2024)
Abstract
Background and purpose: Creating sustainable income, enhancing economic perspectives, optimizing and managing costs, and generating revenue in the health system—especially in hospitals, which are primary providers of medical services—are critically important. These have become priority, vital policies. This study was conducted to compare the recorded costs in patient files with the approved global tariffs for surgeries at Imam Khomeini Hospital in Kermanshah.
Methods: This descriptive cross-sectional study was conducted at Imam Khomeini Educational and Therapeutic Hospital in Kermanshah in 2022. The research population included financial records for surgeries under the global tariff, covering the last six months of 2020 and the first six months of 2021. Data were collected from the Hospital Information System (HIS) and analyzed using SPSS-22 software.
Results: Among 357 cases involving 13 types of surgeries reviewed in this study, tonsillectomy, pterygium, and appendectomy surgeries resulted in losses, while other surgeries were profitable. Considering the average actual cost of each surgery, in 14% of the surgeries, the global tariff was lower than the average actual cost, while in 86% of cases, the global tariff proved beneficial to the hospital.
Conclusion: Although most centers that apply the global surgery tariff are financially unprofitable, implementing operational plans based on essential resources and designing corrective actions to reduce global costs—particularly by managing patient length of stay—can improve efficiency and productivity.
Saied Moradi, Mohammadreza Rabiee Mandejin, Mohammad Mohammadi,
Volume 23, Issue 1 (5-2024)
Abstract
Background and purpose: The implementation of key components in the selection of meritorious candidates, ensuring they possess the necessary capabilities for key and sensitive positions, and adhering to the principle of meritocracy in the distribution of power and division of duties and responsibilities among society’s elites, not only contributes to the stability, growth, and development of the country but is also one of the secrets to the success and longevity of leaders. Therefore, this article aims to explain the factors influencing the competence development of public hospital managers, guided by the general policies of the health system.
Methods: The research was developmental in purpose and qualitative in method, utilizing thematic analysis. The statistical population included books, articles, documents, and knowledgeable human resources, comprising government management experts, hospital managers with a master's degree or higher, and at least ten years of experience in hospital management. The study employed a purposive approach with semi-structured interviews, continuing until theoretical saturation was reached (16 interviews)
Results: A total of 18 competence development factors were identified, categorized into 75 components and 671 dimensions. The implementation of the Strauss-Corbin model revealed that causal conditions included leadership, doctors, and staff. Intervening conditions encompassed the economy, research technology, and education. In addition to goals and missions, organizational platform, creativity, services, and structure were considered contextual conditions. Human resource management, public relations, and religion were identified as strategies, while the resulting consequences were classified into expertise, a knowledge-based economy, and internationalization.
Conclusion: According to the research findings, it appears that to advance, upgrade, and excel in hospitals that play a critical role in the health of society, these identified factors can be utilized to enhance the competence of public hospital managers.
Seyed Mohammad Mahdi Heydari Baghdadabad, Alireza Maetoofi, Ali Farhadi Mahalli , Mojtaba Tabari,
Volume 23, Issue 2 (8-2024)
Abstract
Background and purpose: Hospitals play a critical role in promoting public health and well-being in social contexts. This necessitates codified standards aimed at maintaining treatment quality and enhancing social satisfaction. Hospital accreditation policy evaluation is considered a systematic process that can have significant social and functional implications for hospitals. This study aims to present an evaluation model of hospital accreditation policy based on the process of paradigmatic phenomenology.
Methods: Using Husserl's (1970) phenomenological approach, this study developed a paradigmatic evaluation model in five analytical steps. First, through interviews with experts and open coding, propositional themes related to the phenomenon under study were identified. A focus group was then formed to discuss and analyze these propositions. Each proposition was scored using the Q-method checklist, with scores ranging from +6 to -6, to identify paradigmatic clusters.
Results: During the qualitative analysis, 16 interviews resulted in 138 open codes. After eliminating redundancies and overlapping codes, 50 propositional themes were finalized. These themes were organized into conceptual clusters within the framework of paradigmatic phenomenology, following Husserl's methodological steps.
Conclusion: The study's findings underscore the formation of a hospital accreditation policy evaluation model structured around causal, intervening, contextual conditions, strategies, and outcomes. This model has the potential to enhance the effectiveness of healthcare service delivery and improve the overall quality of treatment in society.
Ehsan Ameri,
Volume 23, Issue 2 (8-2024)
Abstract
Background and purpose: As part of Iran’s Health System Transformation Plan (HSTP), the first service package aimed to reduce out-of-pocket expenses for hospitalized patients in hospitals affiliated with the Ministry of Health and Medical Education. This study evaluates the effectiveness of the policy in reducing patient payments at teaching hospitals under Golestan University of Medical Sciences.
Methods: This descriptive-analytical cross-sectional study was conducted between 2021 and 2022. A total of 384 participants—including healthcare workers, medical staff, and physicians—were randomly selected from teaching hospitals affiliated with Golestan University of Medical Sciences. Data were collected using a 35-item researcher-designed questionnaire, validated by experts, with a Cronbach's alpha reliability score of 0.83. Data analysis was performed using SPSS version 22, Kolmogorov-Smirnov tests, and a one-sample t-test.
Results: Indicate a gap of -0.11 between the current situation and the desired outcome of the HSTP’s first axis (reducing patient payments). Analysis using the gap analysis matrix revealed that the primary shortcoming is in regulatory oversight.
Conclusion: While the Health System Transformation Plan has successfully reduced out-of-pocket expenses for hospitalized patients, it has not fully met the program’s intended financial relief targets. Further policy adjustments are required, particularly in expanding universal insurance coverage and ensuring adequate financial resource allocation to improve accessibility and affordability for patients.
Khatere Khanjankhani, Tina Seirafi, Sajjad Bahariniya, Atefeh Ebrahimi, Seyed Masood Mousavi,
Volume 23, Issue 2 (8-2024)
Abstract
Background and purpose: Medication errors, which are more commonly committed by nursing staff compared to other hospital personnel, can lead to severe and sometimes irreparable complications for patients. This study aimed to investigate the factors contributing to medication errors among nurses in selected hospitals affiliated with Shahid Sadoughi University of Medical Sciences, Yazd.
Methods: This descriptive-analytical cross-sectional study was conducted in 2021. A total of 302 nurses were selected from four teaching hospitals affiliated with Yazd University of Medical Sciences. Data were collected using a standardized questionnaire designed to examine medication errors across three domains: managerial, human, and environmental factors. Data analysis was performed using t-tests, ANOVA, and Pearson's correlation coefficient with SPSS version 26 software.
Results: Managerial factors emerged as the most significant contributors to medication errors. The leading causes of errors within the managerial, human, and environmental domains were: nurse shortages relative to patient numbers (mean ± SD: 4.34 ± 2.44), fatigue due to workload (4.17 ± 0.98), and high work density during shifts (6–12 hours), respectively. A statistically significant relationship was observed between environmental factors and gender (p=0.008)
Conclusion: Strategies to mitigate fatigue from workload, such as balancing nurses' shifts and increasing staffing levels, are recommended to enhance nurses' performance and reduce errors. Additionally, developing standardized protocols, implementing continuous monitoring of medication administration, and fostering a culture of teamwork are critical in minimizing medication errors.
Hasan Jafari, Mohammad Kazem Rahimi, Farnoosh Ghomi, Atiye Dehghan Niri ,
Volume 23, Issue 2 (8-2024)
Abstract
Background and purpose: Political intelligence is critical for enhancing managerial performance and organizational productivity, while effective communication skills are essential for successful leadership. This study aims to examine the relationship between political intelligence and communication skills among managers and officials in teaching hospitals in Yazd City.
Methods: This descriptive, cross-sectional, and applied study was conducted on 65 hospital managers, selected via census. Two standardized questionnaires were employed to measure political intelligence and communication skills. Data were analyzed using descriptive statistics and analytical tests in SPSS version 26.
Results: The mean (±SD) score for political intelligence was (107.15±11.96), and for communication skills, it was (59.46±7.46)—both above average. No significant relationship was found between political intelligence scores and any demographic variables. However, a significant association was observed between overall communication skills and the gender variable (p=0.029). Spearman’s correlation analysis revealed a positive correlation between political intelligence and communication skills (r=0.527).
Conclusion: The findings underscore the importance of enhancing both political intelligence and communication skills among hospital managers. In particular, the lower scores in the sub-dimensions of social games (within political intelligence) and feedback skills (within communication skills) indicate a need for targeted improvement programs. These enhancements could contribute to better managerial performance and overall organizational effectiveness.
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Volume 23, Issue 2 (8-2024)
Abstract
Ali Ghaffarian, Azam Cheraghi, Masoud Ferdosi,
Volume 23, Issue 2 (8-2024)
Abstract
Background and purpose: Accreditation is one of the most widely recognized and reliable methods for evaluating the quality of hospital services. However, its implementation is often accompanied by various challenges for hospitals. This study aimed to identify the challenges associated with accreditation in small and single-specialty hospitals from the perspective of those involved in the process.
Methods: This qualitative descriptive study was conducted with the participation of 30 individuals, including hospital staff, national accreditation evaluators, and experts from the Ministry of Health's Monitoring and Accreditation Office. Data were collected through semi-structured interviews and individual sessions. Content analysis was used to process the data, which was analyzed using Max-QDA software (version 20).
Results: The accreditation challenges of small hospitals were categorized into four main themes: "accreditation process," "human resources," "structural issues," and "financial constraints." For single-specialty hospitals, challenges were grouped into three themes: "accreditation process," "human resources," and "uniformity of accreditation standards." Common challenges for both hospital types included low staff motivation, insufficient training in accreditation procedures, and issues related to evaluators.
Conclusion: In addition to general accreditation challenges, small and single-specialty hospitals face unique obstacles due to their specific conditions and inherent differences from other hospitals. To ensure the successful implementation of accreditation programs in Iran, policymakers should thoroughly examine the identified challenges and incorporate these insights into national hospital accreditation planning and implementation strategies.
Elaheh Torabi, Reza Mirzaei, Ahmad Heydari, Jalil Jarrahi Feriz,
Volume 23, Issue 2 (8-2024)
Abstract
Background and purpose: The physical and environmental characteristics of hospital spaces play a crucial role in influencing patient stress levels, particularly before and after surgery. This study aims to examine the impact of architectural elements in hospital environments on reducing stress among surgical patients, contributing to the enhancement of healthcare environments and patient well-being.
Methods: This descriptive-analytical study was conducted in the general surgery department of Razi Hospital. Data were collected through a structured questionnaire administered to patients before and after surgery. The validity of the questionnaire was assessed using Smart PLS 3 software, and reliability was measured using Cronbach's alpha. The collected data were analyzed using structural equation modeling.
Results: Among male patients, sensory elements had the greatest effect on reducing stress before surgery, while form-based elements had the least impact. After surgery, sensory elements remained the most influential, whereas spatial configuration had the least effect. Among female patients, symbolic components (e.g., cultural and religious symbols) had the most significant impact before and after surgery, while form-based elements had the least influence.
Conclusion: The gender of patients and the physical design of hospital spaces significantly influence stress reduction among surgical patients. Designing hospital environments with calming elements such as soothing colors, natural light reflections, relaxing sounds, pleasant scents, and culturally relevant symbols can enhance the overall patient experience and improve recovery outcomes.
Shadi Khalilolahi, Nasrin Kazemi, Saeid Besharati, Atefe Abedini, Mohammad Varharam,
Volume 23, Issue 3 (11-2024)
Abstract
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.
Farokhlegha Mohammadi, Mandana Sahebzadeh, Yahya Hematyar Tabatabaei,
Volume 23, Issue 3 (11-2024)
Abstract
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.
Milad Mehri, Mohammad Efatpanah, Ebrahim Jaafaripooyan, Mohammad Arab,
Volume 23, Issue 3 (11-2024)
Abstract
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.
Fatemeh Sadat Vahabzadeh Moghadam, Ahmad Vedadi, Karam Allah Daneshfard,
Volume 23, Issue 3 (11-2024)
Abstract
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.
Maryam Goodarzi, Mashallah Torabi, Maryam Ahmadi, Hamideh Hamidi, Samira Elmi, Reyhaneh Sadat Karimi, Fatemeh Golmahi, Samira Mortezaie, Parisa Nezari,
Volume 23, Issue 3 (11-2024)
Abstract
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.
Elham Haghshenas, Ali Ghangalikhan Hakemi, Samira Raoofi, Sara Akhavan Rezayat, Soheila Damiri, Saeed Nateghi, Maryam Radinmanesh,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: Given the interdisciplinary nature and multiple stakeholders involved in electronic prescribing systems, their implementation process encounters numerous complexities. This qualitative study aimed to explore and clarify the challenges associated with electronic prescribing and prescription dispensing systems.
Methods: A qualitative content analysis was conducted in 2021 (Iranian calendar: 1400). Data were collected through semi-structured interviews with 25 key informants from the treatment management sector and affiliated hospitals of Tehran University of Medical Sciences. The collected data were analyzed using conventional content analysis methodology facilitated by MAXQDA 10 software.
Results: Approximately 350 initial codes were identified, which were categorized into four main themes with eight sub-themes: policy preparation (establishing a policy secretariat and achieving political consensus), policy formulation (developing policy content and advocacy), policy implementation (planning and executing policies), and policy evaluation (monitoring and evaluating policies).
Conclusion: Ensuring public health remains the ultimate goal of the healthcare system. Electronic transformation, particularly in establishing electronic health records, can significantly improve healthcare service quality. Integrated policymaking among the various institutions involved, enhancing technical and procedural infrastructure, human resource training, and societal cultural readiness are essential factors for the effective implementation of electronic prescription systems and the enhancement of healthcare quality.
Leila Bornaye Agah, Amin Qasem Beglou, Abasat Mirzaei,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: Developing countries strive for solutions to attract medical tourists. Digital marketing is explored here. The aim is to assess digital medical marketing criteria and their relation to health tourist acceptance in selected Tehran hospitals in 2022.
Methods: A descriptive-analytical approach using mixed methods. Qualitatively, through text review, digital medical marketing criteria were identified using fuzzy Delphi, resulting in 5 factors and 61 concepts. Quantitatively, after distributing questionnaires among 30 experts, 25 valid questions were retained. The sample included 125 experts from health tourism units and hospital staff. Kendall's correlation and Chi-square tests were run via SPSS 18.
Results: Identified criteria encompassed multilingual websites, content, digital systems, human resources, and health tourist attraction. Kendall's correlation indicated significant relations with human resource performance (r=0.413), website content (r=0.247), and digital systems (r=0.235) significantly influencing tourist attraction (p<0.01). Chi-square tests revealed significant differences in multilingual websites, website content, digital systems, and human resource performance impacting health tourist attraction (p<0.01).
Conclusion: Iran's medical tourism benefits from enhancing service quality, website content, human resource performance, and digital systems, leading to increased health tourist attraction.
Abbas Jahangiri,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: Pharmaceutical pollutants in hospital wastewater pose significant environmental and public health risks. This study aimed to identify and prioritize effective strategies for removing these contaminants from the wastewater of selected hospitals in Markazi Province, Iran.
Methods: This descriptive-analytical study employed a multi-criteria decision-making (MCDM) approach. Initially, a comprehensive review of scientific literature, expert interviews, and consultation with professionals in environmental health and wastewater treatment was conducted. Relevant strategies and prioritization criteria were identified using MAXQDA 2022. Subsequently, the Analytic Hierarchy Process (AHP) method was applied using Expert Choice version 11 software to assign weights to criteria and rank the identified strategies.
Results: Five key treatment strategies were identified: (1) integrated biological, physical, and chemical treatment methods (hybrid systems), (2) advanced oxidation processes (AOPs), (3) aerobic and anaerobic biological reactors, (4) membrane filtration, and (5) activated carbon adsorption. The prioritization was based on five criteria: (1) pollutant removal efficiency (0.357), (2) environmental compatibility (0.241), (3) implementation and operational costs (0.198), (4) technology durability and sustainability (0.123), and (5) implementation complexity and feasibility (0.081). The final priority scores of the strategies were 0.312, 0.256, 0.211, 0.134, and 0.087, respectively.
Conclusion: The findings indicate that hybrid treatment systems combining biological, chemical, and physical processes offer the most effective strategy for eliminating pharmaceutical pollutants in hospital wastewater. These insights can guide healthcare policymakers and hospital administrators in selecting optimal wastewater treatment methods, contributing to environmental protection and water quality improvement.
Golnoosh Babaei, Hossein Dargahi, Hojjat Rahmani,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: The migration of healthcare workers from developing countries to more developed nations is a long-standing and ongoing trend. The loss of personnel due to migration can negatively impact healthcare systems. Therefore, this study aimed to identify the causes of the tendency to migrate and strategies to reduce it among paramedics at Tehran University of Medical Sciences.
Methods: The present study is an applied research conducted using a mixed-methods approach in three phases: literature review, Delphi method, and expert panel. It was carried out at Tehran University of Medical Sciences in 2024. Based on the literature review, a questionnaire on the causes of and solutions for reducing paramedical staff migration was developed. After confirming its validity and reliability, the questionnaire was distributed among students. The most important strategies for reducing migration were identified through the expert panel. Quantitative data were analyzed using SPSS version 22, while qualitative content analysis was used for the literature review and expert panel data.
Results: The main causes of paramedics’ migration included contextual factors, work-related factors, health system-related factors, individual-related factors, and factors related to the destination countries. According to the findings, increasing salaries and benefits, improving welfare facilities, and enhancing economic conditions were the most important strategies for reducing migration from the perspective of students and experts.
Conclusion: Although some actions, such as raising awareness about the hardships of migration, may influence individuals’ decisions, more fundamental measures—such as improving economic conditions, reforming the healthcare system structure, creating equal job opportunities, and enhancing the social status of paramedics—are essential to control and reduce the migration trend.
Amirhossein Abdolalipour, Masoumeh Mikailiy, Khadijeh Alizadeh,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: This study proposes an integrated model to explore the mediating role of financial performance in the relationship between quality indicators, learning and growth, and the overall performance of hospital facility management services.
Methods: The statistical population included hospital managers across West Azerbaijan Province, Iran. Based on Cochran’s formula, 147 participants were selected using a simple random sampling method. Data were analyzed using Structural Equation Modeling (SEM) via SmartPLS software. Standardized factor loadings were used to assess model fit, and the Z-test was applied to evaluate the statistical significance of the relationships. Predictive power was assessed using the adjusted R² and Stone-Geisser Q² criteria.
Results: The indirect effects of quality indicators (t = 2.41), learning and growth indicators (t = 2.20), and internal process indicators (t = 2.39) on hospital service performance—mediated by financial performance—were all statistically significant (t > 1.96). Standardized path coefficients of 0.201, 0.344, 0.359, and 0.805 further confirmed the model's empirical robustness and goodness of fit.
Conclusion :The findings suggest that improvements in internal processes, service quality, and organizational learning and growth significantly enhance financial performance, which in turn improves the effectiveness of hospital facility management services. These enhancements contribute to increased patient satisfaction, strengthened hospital reputation, reduced operational costs, and ultimately improved revenue and financial efficiency.
