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Volume 6, Issue 4 (11-2012)
Background and Aim: Learning may be the only sustainable competitive advantage for all organizations. A learning organization is an organisation where people continually expand their capacity to create results they truly desire new and expansive patterns of thinking are nurtured collective aspirations are set free people are continually learning from what others have learned. The aim of this research is to study whether a learning organization and its subsystems are established in Shahrekord University of Medical Sciences (SKUMS).
Materials and Methods: This descriptive-survey study was conducted in 2012. Marquardt's standard questionnaire was used to measure learning organization based on Likert's scale with a Cronbach's Alpha coefficient of 0.946. The research sample consisted of 177 staff members (bachelor's degree holders and bove) in seven vice-chancellorships of SKUMS, selected through simple random sampling.
Results: The findings of the study are twofold. (1) According to the results of one-sample t-test with a 95% confidence interval, the mean scores in learning organization and sub-systems of learning dynamics, people empowerment, knowledge management and technology application subsysems were higher than the assumed mean of 3 however, the figure turned out to be equal to the assumed mean for the organization transformation subsystem, and (2) Based on Freidman Test, there was a significant difference between the means of at least 2 learning organization subsystems.
Conclusion: According to the research findings, more attention should be paid to the subsystems of learning organization establishment and balanced development of these subsystems.
Volume 6, Issue 6 (3-2013)
Background and Aim: Financial reforms in the healthcare system go back to 1384. This study aims to analyze and summarize the most important strengths of implementing the first phase of the reform in units affiliated with the Ministry of Health and Medical Education from the experts' point of view at middle and operational levels.
Materials and Methods: In this qualitative research study, 15 coaches of the new financial health management reform along with 8 financial managers of Medical Universities were selected purposefully to participate in expert panels to be interviewed. Data were saturated following the interviews. The data analysis process was conducted applying Kruger method with one of the researchers having no conflicts of interest with the topic.
Results: Human resources enabling, effective trainings, integrated information system, dynamic culture, structural appropriateness, efficiency and effectiveness, and perfect facilities were the seven themes extracted from the content analysis of the interviews each theme was further divided into some sub-themes.
Conclusion: Recognition of the strengths of the first phase of health system's financial management reform may help bring about the possibility of more correct and exact planning to direct these changes and maintain the achievements as well as designing a long-term horizon and determining an ideal vision for the next phases of the reform.
Volume 7, Issue 4 (11-2013)
Background and Aim: Stewardship and delivery of health services are considered as the most important areas in the healthcare system of the Islamic Republic of Iran in 1404. This study was conducted to investigate the main challenges in medical education stewardship because of its importance in the management and leadership of education from the viewpoint of education process providers.
Materials and Methods: This qualitative research was conducted using thematic and framework analyses to obtain the collective view of faculty members of Medical Sciences Universities in Iran. The data were collected applying deep semi-structured interviews. To increase the acceptability of the study, four criteria of Lincoln and Gupta were used. Codes, categories and themes were extracted by expert researchers of qualitative studies who had no conflict of interests with the topic.
Results: Of the 24 faculty members interviewed, 7 were females and 17 were males. They comprised 5 full professors, 8 associate professors, 9 assistant professors and 2 lecturers. The findings of the interviews were categorized in three main lines of stewardship in health system in the form of main and sub themes so that there were 2, 2 and 5 main themes in each line, respectively.
Conclusion : Since many of the challenges extracted from the present interviews are considered as essential interventions for achieving the stewardship functions of health system -- and, as a result, medical education -- , it is important to pay more attention to these challenges and at the same time conduct more complete studies to get more practicable solutions to these problems.
Volume 11, Issue 3 (9-2017)
Materials and Methods: This study was a cross-sectional, descriptive-analytic which was carried out during the years 2014-2015. Four hundred and nineteen experts among all experts in the area of health by snowball and cluster sampling participated in the study. Collecting data was performed through the questionnaire of Health System Perfomance Assessment. The questionnaire’s validity was confirmed using content validity method and its reliability was confirmed using Cronbach's alpha coefficient. Data was analyzed by means of Pearson correlation coefficient test and Regression using SPSS 22 software.
Results: The results of Pearson correlation coefficient test showed that the two component functions on equitable access to health services, the functions of protection against financial risks and actions on targets were equal to 0/827, 0/655 and 0/870. Respectively the results of the test showed 87% of the variance explained the aims of the functional components. Thus, we conclude that the functions of the financial risk for changes in standard deviation units and functions on equitable access to health services was as much as 0/655, and 0/827 predictable.
Conclusion: Since the aspects of performances influence the realization of health system goals, investigating the effects of performances on the health system goals can help policymakers and managers to improve the performance through identifying weaknesses and strengths, review of interventions and healthcare reform, and the management of the health system.
Volume 11, Issue 4 (12-2017)
Materials and Methods: In this cross-sectional study, a valid questionnaire designed by World Health Organization (WHO) was used. From among the households of two selected areas of Mashhad, 561 families that had the background of referring to teaching hospitals were selected via multi-stage sampling. Based on WHO pattern, descriptive and inferential statistics were used for data analysis.
Results: About 50 percent of the respondents expressed the level of responsiveness as good and very good. Information confidentiality domain and the quality of amenities got the highest and lowest ranks from the respondents’ viewpoint, respectively. The highest and lowest importance belonged to the domains of quality care facilities and family and social support, respectively.
Conclusion: Considering the relatively low responsiveness of different domains and also the existing gap between families’ priorities and performance of teaching hospitals, it seems necessary that policymakers pay more attention to patients’ priorities such as the quality of care facilities and the creation of appropriate educational content related to medical students. Also, periodic evaluation of responsiveness can be useful in promoting the responsiveness of teaching hospitals.
Volume 15, Issue 2 (5-2021)
Materials and Methods: The present descriptive-analytical cross-sectional study was conducted in 2017. The sample consisted of 75 senior managers. The research tool was a researcher-made questionnaire whose face validity was confirmed using the opinions of 7 specialists and experts in the field of medical law, health care and medical services management; besides, regarding its reliability, Cronbach's alpha and test-retest reliability coefficients were 0.89 and 0.79, respectively. With SPSS software, data analysis was performed using descriptive statistics including absolute and relative frequency and inferential statistics including Pearson and Ka-square correlation tests.
Results: The level of knowledge of the studied managers was below average in most legal areas and legal standards related to the health system. There was a significant inverse relationship between the level of knowledge of organizational, financial and transactional areas, and administrative and employment of managers with passing relevant training courses (P=0.01 and P=0.04).
Conclusion: TUMS senior managers' level of knowledge in the three areas of organizational, financial, and rules and regulations is at medium and lower than medium levels. To raise the awareness of managers, necessary arrangements such as holding training courses with new methods such as simulation, screenwriting, case study and experimentation and using new technologies such as hybrid knowledge management and technology integration are suggested. Also, creating managers' strategic competency system at the levels of general and specific skills, along with continuous training and monitoring the accountability and feedback provided in management processes, will ensure future reforms.
Volume 15, Issue 3 (8-2021)
Materials and Methods: The present study is applied-developmental in terms of purpose. After reviewing the theoretical foundations and previous research, the governance strategies of the health system were identified. Then, using Fuzzy Delphi Method (FDM) and surveying 13 academic and executive experts who were purposefully selected, the research model was designed. Finally, in order to validate the model, 169 managers and specialists of health system departments in Tehran were interviewed with a questionnaire, and the data were analyzed using structural equation modeling (SEM) and SmartPLS software. At this stage, the sampling method was available and the sample size was calculated by Cochran's method.
Results: According to the research findings, in order to promote health governance, 10 main strategies and 58 sub-strategies should be considered. Identified strategies include strategic orientation, optimal financial resource management, stakeholder partnership development, knowledge resource development, administrative health promotion, technical knowledge development, value and ethical orientation, executive and operational platform development, Service delivery capacity management and Balanced and integrated stewardship. Also, the coefficient of determination for the outcome variable is 0.549 and the intensity of the effect of intervening/ facilitating and contextual factors on governance strategies is equal to 0.610 and 0.533, respectively.
Conclusion: The results showed that the governance of the health system is a multifaceted and complex phenomenon and in order to improve it, a set of strategies must be implemented. In addition, it is suggested that according to the issues and threats facing the health system, a roadmap and a long-term plan should be developed in order to move towards the governance model proposed in the present study.
Volume 16, Issue 4 (10-2022)
Materials and Methods: In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups.
Results: The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P<0.05).
Conclusion: The results showed that despite people’s trust in the expertise and knowledge of physicians and other providers, public trust in health system was relatively moderate, indicating deficiencies in the health system’s performance. Focusing on physician-patient communication and improving communication skills, establishing electronic records and sharing patient information between health service providers, and respecting patient rights can build greater trust in the health system.
Volume 17, Issue 3 (8-2023)
Materials and Methods: This research was carried out using the scoping review method. All published articles and documents about the reasons for induced demand in the health system until June 21, 2023 were searched in nine databases and Google Scholar search engine. Finally, 38 articles were selected and reviewed. The data were analyzed by thematic analysis method and using MAXQDA10 software.
Results: Thirty-eight studies about the reasons of induced demand in the health system were published between 1974 and 2021. The number of researches in this area has been growing since 2011. Overall, 32 reasons for induced demand in the health system were identified and grouped into three categories: macro (health system), meso (health care organization) and micro (provider and receiver of health services). The most frequent reasons for healthcare induced demand in the literature include inappropriate policies, insufficient monitoring, inappropriate payment system, large number of physicians, lack of attention to clinical guidelines, financial motivation of healthcare providers, patient insurance coverage, unreasonable patients’ expectations, inappropriate price of health services, the complexity of the health service and patients’ inadequate medical knowledge.
Conclusion: Induced demand has negative effects on the health system and will lead to an increase in health costs, waste of health resources, a decrease in the efficiency of the health system, and finally, a decrease in people’s access to essential health services. Several factors at different levels of the health system lead to induced demand for health services. Therefore, interventions should be systematically applied at three levels of the health system, healthcare organizations, and providers and recipients of health services to prevent and reduce healthcare induced demand.
Volume 17, Issue 5 (12-2023)
Background and Aim: Futures studies are constantly evolving and help organizations and individuals for better identification of future events, opportunities, and threats. In the field of health, futures studies are also applied for better prediction of health issues in future, control of unpleasant condition and preparing for pleasant future in health system. The purpose of this study is to conduct a scoping review of the futures studies accomplished in the field of health in Iran,
Materials and Methods: This study is a scoping review, conducted based on the Arksey and O’Malley framework with 6 steps including research question identification, related study identification, study selection / screening, data segmentation, summarizing and reporting results and providing guidance and recommendations n. National and international databases and search engines including PubMed, Web Of Science (WOS), Scopus, ProQuest, SID, Magiran, IranDoc and Google Scholar were searched using related keywords. After removing duplicate articles, the remaining articles were screened according to inclusion and exclusion criteria. The results of the selected articles were finally categorized, summarized and reported based on the mentioned steps.
Results: Among of 6691 articles identified, 30 articles reached the final synthesis stage. The articles were classified into forecasting, foresighting, and mixed categories, with the scenario writing method being the most widely used and applied in 20 studies. Also, studies were classified in scope of nature based on quantitative or qualitative and time horizon. Types of futures studies methods in Iran, in the fields of public health, medicine, science and technology, financing, prescription, health tourism, diet, human resources, aging, Covid-19 epidemic, health policy, hospital and macro level of health system were used.
Conclusion: The use of futures studies methods in a targeted manner and on the issues of Iran’s health system can play an effective role in knowing the future for more informed decision-making and planning in order to build a desirable future. The results of this review showed that scattered studies have been conducted with futures studies methods in the field of health, among which the scenario writing method has received more attention.
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