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A Keshtkaran, F Mohabati, S.p Hedayati, A Roshanfard,
Volume 7, Issue 4 (27 2010)
Abstract
Background and Aim: The most important principles in an organization are continuous development and survival. Nowadays, creativity and innovation are vital for survival in a competitive world. The thinking style of a manager in an organization is an important factor in his/her creativity. The purpose of this study was to investigate the relationship between thinking style and organizational innovation in 84 senior and junior managers of Shiraz educational hospitals in 2008.
Materials and Methods: In this descriptive-analytical study 84 top and mid-level managers of Shiraz teaching hospitals were selected by the census method. Data were collected using two standard questionnaires, one for thinking style and one for innovation, the content validity and reliability of which had been confirmed. A preliminary test showed the Cronbach's alpha for the thinking style and organizational questionnaires to be 0.83 and 0.72, respectively. Data analysis was performed using Spearman correlation test.
Results: The Spearman correlation analysis showed a statistically significant, although weak, relationship between thinking style of senior and junior managers of Shiraz teaching hospitals and their organizational innovation. A pragmatic thinking style had the strongest association with organizational innovation.
Conclusion: The thinking style of a teaching hospital manager plays a vital role in his/her creativity. No thinking style is particularly preferred any thinking style may give desirable results as regards creativity of a manger, depending on the circumstances and conditions.
Sh Tofighi, M.r Maleki, M Shahabi, M Delpasand, A Nafis,
Volume 8, Issue 3 (23 2010)
Abstract
Background and Aim: Inequality in the distribution of hospital recourses is a great obstacle in planning and provision of health care. This inequality in mainly observed in the government hospitals in a country. The objective of the present study was to determine the distribution of specialized physicians and active beds in the Iranian government hospitals between 2001 and 2006
Materials and Methods: The method used in the study was retrospective, descriptive- analytical. The data were analyzed (Lorenz Curve and Gini index estimation), using the Excel Software.
Results: Based on the Gini coefficient, the distribution of specialized physicians during the 5-year period (2001-2006) was 0.0876, 0.0874, 0.0909, 0.0329, 0.0951, and 0.0520, respectively. The corresponding figures for active beds were 0.024, 0.0171, 0.0208, 0.0251, 0.0212, and 0.084.
Conclusion: The findings of the study indicate that, in spite of differences in the proportions of specialized physicians and active beds among the provinces with regard to their populations, the distributions in the government hospitals have been equitable. The results of this study can provide useful insights for the country's Health Ministry policy-makers.
Ar Heidari, Ar Mirahmadizadeh, A Keshtkaran, M Javanbakht, K Etemad, M Lotfi,
Volume 9, Issue 1 (14 2011)
Abstract
Background and Aim: AIDS is a lethal disease, for which there is no treatment or any vaccine to prevent it. The injection-drug use and unprotected sexual behavior are two factors important in HIV transmission. This study was conducted to determine changes in high-risk sexual and injection-drug use behaviors associated with HIV among drug users referring to Methadone Maintenance Treatment centers in Shiraz, Iran.
Materials and Methods: This before-after interventional study with no control group included drug-users (n=694) referring to all the 7 MMT centers in Shiraz, Iran in 2009. The data were collected by interviewing patients and using a questionnaire. The software used for data analysis was SPSS 15, the statistical test being the Wilcoxon test.
Results: The average age of the clients was 36.5 ± 9.5 years. Most of them were males (% 92.1) and single (% 43.1). 37.3 % of them being injection-drug users. The proportion of the injection-drug users having had at least one shared injection one week before referring to an MMT center was 23.3%, which decreased to 9.2% after one week. Analysis of the data also showed that 25.2% of the addicts had had at least one unprotected sexual contact during the previous month the proportion decreased to 21.0% one month after referring to an MMT center. The reductions in the mean numbers of both shared injections and unprotected sexual contacts were statistically significant (p <0.001).
Conclusion: Considering the effectiveness of the MMT centers in reducing risky behaviors of injection-drug users, it is essential to expand these centers at both the national and regional levels quantitatively and qualitatively and encourage drug-users to refer to them and seek help. This will help greatly in the prevention of HIV.
Aziz Kassani, Mahmoud Reza Gohari, Mir Taher Mousavi, Mohsen Asadilari,
Volume 10, Issue 2 (24 2012)
Abstract
Background and Aim: Social capital composed of networks, norms and values, which facilitates cooperation within and between groups to achieve mutual benefits and common goals. Social capital increases the benefits of investing in physical and human capital. In a society that favors more social capital, collaboration is easier. This study investigates the validity and reliability of a social capital tool, which had been administered through a large population-based survey using factor analysis.
Materials and Methods: Data were obtained from Urban Health Equity Assessment and Response Tool (Urban HEART-1) survey in Tehran. Factor analysis is a method of discovering structural position of variables to reduce them into a limited number of components which are more fundamental. The reliability of the questionnaire and main components of the tool were investigated through factor analysis.
Results: According to factor analysis, three main components of social capital including, individual trust, cohesion/ social support and social trust/associative relations, were recognized. These three components explained 66.14% of total variance of the social capital tool. Also, overall Cronbach's alpha coefficient was 0.88 which indicates high reliability of the questionnaire.
Conclusion: Social capital tool, which was administered in Urban HEART project, covers the main components of social capital framework with high reliability and validity, which is suitable to be used in other population-based surveys.
Akram Bani Asadi, Soudabeh Vatankhah, Agha Fatemeh Hosseini,
Volume 11, Issue 1 (8-2013)
Abstract
Background and Aim: Quality measurement and management has changed to be one of the most important topics in health care today. This study aims to analyze service quality through Importance-performance Analysis tool in selected hospitals.
Materials and Methods : This is an Analytical-descriptive study. Research community was all admitted patients to four hospitals during a specific period, the sample of the study consists of 284 inpatient person selected by stratified random sampling method. The main instrument was a questionnaire consists of two parts "importance" and "performance" with the same items in 8 dimensions. Assigning the scores for each of those service items in a two-dimensional diagram with four cell, each gives special guideline for hospitals. SPSS 17.0 for windows was employed for the scale measurement.
Results: The results of the study indicate that the most important dimensions in patients attribute with 3.55 mean were for "accountability" and the best performance in patients point of view was for "responsiveness" and "reliability". The key dissatisfier with least importance and performance score was for "service organization" with the mean of 3.11.
In analyzing service quality, reliability, empathy, assurance and accountability dimensions were located in Cell I, service process was located in Cell II, service organization was located in Cell III and finally tangibles and responsiveness dimensions were located in Cell IV.
Conclusion: Application of IPA to these data showed that developing service process management system in order to improve process of service delivering is important directions for hospitals to work on.
Amir Ashkan Nasiripour, Mohammad Reza Maleki, Pouran Raeisi, Marzieh Javadi,
Volume 11, Issue 2 (11-2013)
Abstract
Background and Aim : It is impossible to deny the threats and risks endangering the process of health care when offering the services. Confirming this fact does not mean ignorance the risk, or allowance to medical and nursing mistakes to happen however, it can mean approaching the problem to come up with practical solutions and minimize the risks in the process of providing health care services. The present study was conducted periodically as an applied multi-stage research.
Materials and Methods : To do a model of clinical risk management, different authentic texts on risk management in health sector were reviewed focusing on the models available. All such models were tabulated, analyzed and compared together which resulted 62 primary variables. The variables were, then, validated being used in a questionnaire responded by 20 nurses and doctors which, this time, produced a confirmed questionnaire of 40 variables. After that, 215 subjects chosen through a random and a stratified sampling were asked to respond to that questionnaire, making an exploratory factor analysis as well.
Results : This study was done, using principal components analysis as with a rotation of Varimax loadings showed a variety of factors (19 factors) available in the models of clinical risk management were loaded as "organizing and policy-making" factor. This factor illuminated a sum of 25.3% of variances in the model of clinical risk management. The results also showed the loading factor of variables as among 0.5 and 0.7 which indicated a fine correlation among them and the participants' view.
Conclusion: It was concluded that "the best care of the patient is accepted as a common perspective in organization" and "the effect of the treatment team's clinical performance on their financial payments" are the most and the least important variables respectively with 0.739 and 0.548 as factor load.
Mahmoud Reza Gohari, Parisa Mokhtari Hesari, Zeynab Moghaddami Fard, Reza Khoda Bakhshi,
Volume 12, Issue 1 (5-2014)
Abstract
Background and Aim : identifying the risk factors for metastasis is major concern for treatment processes of cancer patients. Metastasis makes patients frail and increase hazard of death. It also decreases physical and psychological quality of life of patients. Aim of this study is determining of prognostic factors for metastasis of breast cancer using conditional regression model.
Materials and Methods: in this survival study, hospital records of 246 women with breast cancer who underwent surgery and treatment at hospital Fayyazbakhsh were used. Patients were followed until 2012 May and their final situations recorded. Metastasis free survival estimated with Kaplan-myier method. To determine the prognostic factors, a conditional regression model called PWP fitted. All statistical analysis was conducted with R software, version 2.10.
Results: 202 patients (82.1%) were alive until follow up and 44 patients (17.9%) died.54patients experience metastasis. 11 patients (4.7%) had two metastases. Most of metastases were shown in bone, liver, lung and brain. Median metastasis free survival (MFS) estimated 64 month. One, two and three year MFS were 88%, 80.1% and 76.6%, respectively. Lymph node involvement and HER2 were shown as prognostic factors for metastasis. Age, Esterogen Receptor, Prosterogen Receptor, Grade and tumor size were not significant ( P> 0.05).
Conclusion: number of lymph nodes involvement as a prognostic factor involve more nodes and increase risk of metastasis and death. Thus prognosis and treatment of cancer in early stages increase survival of patients.
Mohammad Reza Tavakoli, Saeed Karimi, Marzieh Javadi, Alireza Jabbari,
Volume 14, Issue 1 (6-2016)
Abstract
Background and Aim: In 1995 the new plan (system) of hospital administration plan/scheme (fee for service) was communicated. According to this plan a proportion (percentage) of the hospital income would be allocated to the hospital staff as a fee for service; the remaining would, after deducting other expenditures, be allocated for the autonomy of the hospital. Based on the plan/scheme, the Supervisory Board will consist of two main committees, namely, the High Supervisory Board and the Supervisory Board for the Centers (hospitals). The main objective of this study was to evaluate the performance of the Supervisory Board in the new system of hospital administration plan in selected teaching hospitals of Esfahan, Iran in 2014.
Materials and Methods: This was a qualitative research. Eleven individuals were selected by targeted sampling and interviewed using semi-structured interviews. The thematic analysis method was used to analyze the data.
Result: Based on the thematic analysis results, the main source of weakness in the underlying and structural factors (developing programs and the implementation phase) was the Hospital Administration Supervisory Board in the new system.
Conclusion: It can be concluded that the most notable findings in this study are weaknesses in the underlying and structural factors (developing the program) and weak underlying and structural factors (implementation of the program). The findings will help health policy-makers to develop suitable strategies and a plan of action to minimize weaknesses of the new fee for service scheme/plan.
Maryam Yaghoubi, Marzieh Javadi, Saeid Karimi, Vahid Pirasteh,
Volume 16, Issue 2 (9-2018)
Abstract
Background and Aim: Iran's Health Sector Evolution Plan (HSEP) is one of the most important national health reform plans. HSEP has attracted many criticisms. An important criticism is about its service costs. This article reports the results of a project conducted to compare the costs of normal and caesarian section delivery before and after implementation of the HSEP.
Materials and Methods: This was an applied research project using hospital accounting records as data. A total of 120 delivery files (60 normal delivery and 60 caesarian section) were selected randomly from the accounting software of a large hospital in Isfahan before and after May, 2014.The data in each subject’s file ─ paid shares of the hospital, patient and insurance ─ but not hoteling, inpatient and other costs was extracted. The health service providers’ incomes based on the annual tariffs of the services and changes in payments for each service for gynecologist and anesthesiologists were calculated. Data were analyzed using the excel software.
Results: The costs of normal delivery and caesarian section after implementation of the National HSEP had increased by 193% and 226%, respectively. In addition, of the treating physicians (gynecologists and anesthesiologists) had also increased by 257% for the normal and by 130% for caesarian section. Changes in the sums of money involved in service delivery indicates shifting of parts of the costs from the patients to the health subsidy and insurance systems.
Conclusion: The health System Evolution has not lead to real reductions in the out-of-pocket money paid by the patients. Higher cost of services will imply the need for better cost management. Increased costs of services will be to the benefit of neither patients nor the health system. This would mean that in designing and implementation of the Health Sector Evolution Plan economic aspects should be taken into consideration more carefully.
Asgar Aghaei Hashjin, Mehdi Sahraei,
Volume 18, Issue 2 (9-2020)
Abstract
Mohammad Hossein Mehrolhasani, Noura Rafiee, Sara Ghasemi,
Volume 18, Issue 3 (11-2020)
Abstract
Background and Aim: The “Package for mental and social health promotion and drug abuse prevention” was developed in response to the importance of, and concerns relate to, the mental and social health in the population. Since any policy and plan needs to be assessed to find its weaknesses, strengths and challenges to ensure its successful implementation, this study aimed to find and explain the executive leadership challenges of this service package from the service provider's perspective.
Materials and Methods: This study was a qualitative research, the data being collected through interviews and reviewing the relevant documents. The research population included experts from Kerman University of Medical Sciences, Kerman, Iran, those in charge of the package implementation, urban community health center officials and health care providers. The interviewees were selected using a targeted sampling method.
Results: Based on the interviews, the findings were categorized into four main themes: low public cooperation, difficulty in communication, missing links in design and implementation of packages, and methods of payment to service providers. In addition, the findings based on reviewing the documents were grouped as objectives, plans, activities, target groups, and interventions related to this service package.
Conclusion: Based on the findings of this study, it can be concluded that the implementation challenges of the mental health care package fall into three categories, namely, policy-making, facilities, and personal challenges. Proper changes and reforms at the public policy-making level, creating individual awareness and providing proper facilities for the implementation of the package can help overcome these challenges.
Ali Mohammad Mosadeghrad, Rahim Khodayari, Mehdi Abbasi, Fereshte Karimi,
Volume 19, Issue 2 (9-2021)
Abstract
Background and Aim: The health financing system is the process of collecting, pooling and managing financial resources to purchase health services. Sustainable financing of the Iranian health system is crucial for achieving universal health coverage. The purpose of this study was to identify strategies for sustainable financing of the Iranian health system.
Materials and Methods: This study was conducted using the scoping review in 2020. The following databases and search engines were searched systematically between 21.03.2002 and 21.09.2020 to find studies related to sustainable financing strategies for the Iranian health system: PubMed, Web of Science, Scopus and Embase, Magiran, Iranmedex and SID databases, and two search engines; i.e., "Google" and "Google scholar”. Finally, 47 studies were selected and analyzed using the MAXQDA software and the framework analysis method.
Results: A total of 40 strategies were identified for strengthening the sustainability of Iran's health financing system, which were grouped into three categories: collecting funds, pooling funds and purchasing health services. The most frequently cited strategies for sustainable financing of the Iranian health system were the following: increasing the health share of gross domestics product, expanding tax revenues, pre-payment methods of health financing, strengthening public-private partnership, increasing the efficiency of the health system, reducing health system costs, consolidating insurance funds, eliminating insurance overlaps, value-based health service tariffs, optimizing health services support packages, and fixed payment methods based on the performance of the health service providers.
Conclusion: The Iran's health financing system must be strengthened in such a way as to make it possible to collect, pool and manage sufficient financial resources to be used to purchase health services for the people to ultimately ensure universal health coverage leading to the promotion of the public’s health.
ُsamane Miresmaeelii, Ali Mohammad Mosadegh Rad, Ebrahim Jaafaripooyan,
Volume 22, Issue 2 (9-2024)
Abstract
Background and Aim: Accreditation as an external assessment model is considered a key program for evaluating health care organizations. The new health service accreditation system in Iran seems to lack the necessary standards for evaluating outpatient services and general clinics. The objective of this study was to design, based on the experiences of other countries, a model for accreditation of general clinics in Iran
Materials and Methods: This research was a qualitative review study conducted in two phases First, the methods and standards of accreditation of general clinics of selected countries were identified through a comparative review. In the second phase, the conceptual framework of the accreditation of these clinics was developed by an expert panel.
Results: The proposed framework for the accreditation of clinics starts with registering the application in the system and updating the information. After the clinic's self-evaluation and external evaluation, amendments will be made.
The key areas proposed for the accreditation of clinics included management and leadership, information management, process management, human resource management, salaries, and operational results. The country's clinics can be ranked in five levels, namely, excellent, good, average, poor, and substandard.
Conclusion: Considering the processes and areas determined in this study and the lack of a systematic approach, the proposed accreditation model could provide a scientific and practical method for the internal and external evaluating bodies to provide a relevant and valid evaluation of the general outpatient clinics in Iran.
