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5. An empirical investigation of organizational readiness towards hospital autonomy

Author

Alaei Kalajahi, Riaz, Ghorbani, Mohammad, Arab, Mohammad, Jaafaripooyan, Ebrahim, Yaseri, Mehdi, Alaei Kalajahi, Riaz, Ghorbani, Mohammad, Arab, Mohammad, Jaafaripooyan, Ebrahim, and Yaseri, Mehdi

Abstract

Background: We aimed to investigate Tehran’s University of Medical Sciences (TUMS) affiliated hospitals organizational readiness toward implementing the ‘Autonomous Hospitals’ program as a change initiative from a managerial perspective in 2020. Methods: A census covering all eligible managers working in TUMS affiliated hospitals, Tehran, Iran (350 individuals) was carried out. Overall, 281 questionnaires were returned (a 30% non-responsiveness rate). A standard construct was adopted for data collection which was validated through a process of translation-back translation, face validity, and content validity (CVI=0.86, CVR=0.76). The reliability was acquired using Cronbach’s alpha coefficient (0.87 and over 0.7). Both descriptive and inferential statistics were employed to draw conclusions.SPSS 26 was used for data analysis. Result: Total organizational readiness for change (TORC) in hospitals was 60.75%±10.11 showing a state of medium to upper-medium readiness status. Also, the 'Clear mandate and centralized leadership' theme scored the lowest mean (53.02%±15.78) for ORC. 'Hospital accreditation level' (r=-0.14, P≤0.05), ‘bed occupancy rate’ (r=-0.19, P ≤0.05), and 'leadership status' (r=0.26, P≤0.001), also showed significant association with TORC. In addition, 'standardized bed occuPancy rate' (P≤0.05, B=-2.41), a 'male' leader (P ≤0.05, B=3.42), and 'academic affiliation' (P≤0. 1, B=-9.52), were good Predictors of TORC based on ‘Backward Multiple Linear Regression’ analysis. Conclusion: Full support from hospital and headquarters executives, delegation of sufficient decision-making authority to hospital managers, and implementation of comprehensive performance evaluation criteria were prerequisites for robust hospital autonomy in TUMS-affiliated hospitals.

Published
2024

6. Burden of nosocomial infections in intensive care units: Cost of antibiotics, the extra length of stay and mortality rate.

Author

Zolfaghari, Masoome, Seifi, Arash, Jaafaripooyan, Ebrahim, Jahangard-Rafsanjani, Zahra, Afhami, Shirin, Mohammadi, Mostafa, Meybodi, Mohammad Masoud Emami, Salehi, Mohammadreza, and Mohammadnejad, Esmaeil

Subjects
NOSOCOMIAL infections, CATHETER-related infections, INTENSIVE care units, CATHETER-associated urinary tract infections, URINARY tract infections, MEDICAL care costs, ESCHERICHIA coli, URINARY catheterization, IMPLANTABLE catheters
Abstract

Background: Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients' condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs. Methods: The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients' information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded. Results: During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central lineassociated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin. Conclusion: This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Contextual approach to the performance analysis of Iran's national accreditation programme for healthcare organisations

Author

Jaafaripooyan, Ebrahim, Agrizzi, Dila, and Brailsford, Sally

Subjects
658, HJ Public Finance
Abstract

The importance of focusing on performance measurement systems (PMSs) in the public sector has increased following the introduction of new public management (NPM) initiatives, which placed a greater emphasis on organisational accountability and performance measurement. PMSs have always been a key player in ensuring accountability and improvement in the practices of public sector (e.g. healthcare) organisations. Critical features of the health sector have particularly warranted the application of various internal or external PMSs in this area as well as the regular assessment of their own performance. This is crucial in terms of both maintaining their alignment with the initially determined objectives and improving their merits and capabilities to continuously detect the deficiencies and malpractices in healthcare organisations (HCOs). Iran’s national accreditation programme for healthcare organizations (NAPH) has served as the sole element of macro control and regulation in the country’s health sector at national level. It has been set up to reflect, operationalise and guarantee the intentions of the government for promoting quality and safety in the local HCOs, mainly hospitals, across the country. Despite the NAPH’s importance and vital position in the country’s health system and its long-time implementation, the contextual effects of this evaluator mechanism on the individual hospitals have not been empirically researched in current organizational context; i.e. there is a lack of empirical evidence in the literature on how this macro PMS impacts in practice on the hospitals at local level. Accordingly, this study aims to render a contextual evaluation of the performance of this evaluatory system. A middle-range thinking (MRT) research approach has informed the study. Drawing on this approach, Broadbent and Laughlin’s theoretical framework was adopted to both guide the empirical work and help with the analysis and interpretation of the empirical data. The findings of the study showed that it was mainly the financial benefits rather than the quality improvement merits of the current hospital accreditation and evaluation programme that were apparently the main rationale behind the conformity of the hospitals. Both dysfunctional and beneficial consequences were associated with the NAPH by the hospitals’ members. In addition, the hospitals showed different reactions including rejection and gaming as well as absorption to achieve the beneficial gains of the programme. However, they also adopted some requirements of the NAPH exclusively in view of its perceived merits and some other contextual factors. Changes in the hospitals as a result of the programme occurred mostly in the early years following its introduction or modification. This study further provides both theoretical and practical research implications for policy and practice for the improvement of this evaluation mechanism

Published
2011

19. Nurses' Perspectives on Inpatient Care Responsiveness at the Gazan Public Hospitals

Author

Shaqura, Iyad Ibrahim, Jaafaripooyan, Ebrahim, Hosseini, Mostafa, Shagora, Abed El Raheem Shaban, and Sari, Ali Akbari

Subjects
Palestine, Inpatients, Cross-Sectional Studies, Hospitals, Public, Surveys and Questionnaires, Inpatient care, Nurses, Humans, Original Article, Responsiveness, Gaza, Hospitals
Abstract

Background Responsiveness is one of the intrinsic goals of health systems. This study aimed at assessing the responsiveness of inpatient care in accordance to nurses' perspectives, particularly in internal medicine ‘medical’ and surgical departments, at the Gazan public general hospitals in 2020. Methods This cross-sectional descriptive study was conducted at 5 public general hospitals in Gaza. Data were collected from 277 nurses using an interview-based questionnaire composed mainly of 36 items to measure responsiveness on a 4-point Likert scale. Descriptive statistics, independent t-test and analysis of variance (ANOVA) using SPSS 22.0. Results The overall responsiveness was about 77.5%. Access to social support was the highest-performing domain but it was the less important. Dignity was the second-highest in performance but the most important domain. Choice of provider and quality of basic amenities were almost the lowest in both performance and importance. Hospital, marital status, educational level, position at work, income, department, and the experience in the current ward have led to significant differences in the level of responsiveness. Conclusion Supply-side should be considered to delineate the status quo of responsiveness accurately. There is a room for further improvement in the interpersonal domains of responsiveness without extravagant expenditures. Policymakers need to emphasize on better allocation of budget for client-orientation domains of responsiveness as well. Hospital characteristics had a pivotal role in creating significant differences among respondents. Likewise, socioeconomic status and cultural diversity of nurses led to significant variations in their responses, hence, this calls for robust and well-designed researches, including non-public hospitals, to determine the most influential factors.

Published
2021

20. A Mixed Methods Multicenter Study on the Capabilities, Barriers, and Opportunities for Diabetes Screening and Management in the Public Health System of Southern Ethiopia

Author

Habebo,Teshome Tesfaye, Jaafaripooyan,Ebrahim, Mosadeghrad,Ali Mohammad, Foroushani,Abbas Rahimi, Gebriel,Shita Yohannes, Babore,Getachew Ossabo, Habebo,Teshome Tesfaye, Jaafaripooyan,Ebrahim, Mosadeghrad,Ali Mohammad, Foroushani,Abbas Rahimi, Gebriel,Shita Yohannes, and Babore,Getachew Ossabo

Abstract

Teshome Tesfaye Habebo,1,2 Ebrahim Jaafaripooyan,2 Ali Mohammad Mosadeghrad,2 Abbas Rahimi Foroushani,3 Shita Yohannes Gebriel,4 Getachew Ossabo Babore5 1Disease Prevention and Control Directorate, Kembata Tembaro Zone Health Department, Durame, SNNPRS, Ethiopia; 2Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran; 3Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran; 4Ponte San Pietro, Bergamo, Lombardy, Italy; 5Department of Nursing, College of Health Sciences and Medicine, Wachemo University, Hossana, EthiopiaCorrespondence: Teshome Tesfaye Habebo, Tel +251 913789262, Email teshometesfaye22@gmail.comBackground: More than half of diabetics’ in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia.Methods: We applied a mixed methods study. To assess the healthcare systems’ capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly.Results: Our study findings indicated that there were good opportunities and encouraging capabilities like government commitment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system’s structural problems, skilled professionals’ inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and

Published
2022

28. Challenges of Reproductive Health Management in the Camps of Internally Displaced Persons: A Systematic Review

Author

Mosadeghrad Ali Mohammad, Jaafaripooyan Ebrahim, and Shahmoradi Mostafa

Subjects
Contingency plan, business.industry, Internally displaced person, Political science, Scopus, General Medicine, Cochrane Library, Public relations, business, Inclusion (education), Mental health, Checklist, Reproductive health
Abstract

BACKGROUND Internally Displaced Persons (IDPs) in the camps face many reproductive health challenges. They should meet their needs timely to save their lives. This paper outlines a systematic review to discuss the challenges of reproductive health management in the camps of internally displaced persons.METHODS: For this research, electronic databases including PubMed, Science Direct, Scopus, Pro Quest, Google Scholar and Cochrane Library till January 1, 2020 were searched. A threestage screening process was used for the selection of literature due to PRISMA checklist. Finally, a thematic synthesis approach was applied to analyze the data.RESULTS: In total, 133 articles were identified; 11 articles met the inclusion criteria for entering the process of final analysis. The findings were demonstrated in six main categories of availability and accessibility of reproductive health services, sexual and gender-based issues, human rights, social and cultural issues, coordination and collaboration, and mental health issues. The remarkable result of this study highlighted that the main challenges are lack of access to health services, violence against women and lack of household education.CONCLUSION: Results of this systematic review present valuable advice for policy makers and managers to prepare and respond effectively and timely to reproductive health challenges of internally displaces persons. Disaster preparedness plans and contingency plans for maintaining and developing reproductive health in IDPs camps are recommended.

Published
2021
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29. Policies and Practices Catalyzing the Use of Generic Medicines: A Systematic Search and Review

Author

Shahmoradi, Mostafa, Mosadeghrad Ali, Mohammad, and Jaafaripooyan, Ebrahim

Subjects
Gilbert Syndrome, Motivation, Pediatrics, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Cost saving, Review, General Medicine, Jaundice, Policy, Male patient, Policies and practices, Generic medicines, Systematic review, Drugs, Generic, Humans, Medicine, Brandgeneric, Health Expenditures, medicine.symptom, business, Liver function tests, Clinical evaluation, Unconjugated hyperbilirubinemia
Abstract

BACKGROUND: The use of generic medicines instead of branded, is one of the main policies to decrease the expenditures and provide access to affordable and essential medicines in low and middle-income countries. The present study aims to systematically create a comprehensive synthesis of demand-side policies, encouraging the use of generic medicines.METHODS: The study systematically searched and reviewed the articles in Medline, Scopus, Web of Science, and Embase from 1.1.2000 to 12.5.2019. A total of 6435 records were identified during this period of time (Medline (n=315), Scopus (n=4323), Web of Science (n=71) and Embase (n=1726)). All stages are conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyzed (PRISMA).RESULTS: The encouraging policies and practices were classified into four categories from 44 articles analyzed, including; Prescribing, Dispensing, Patients/consumers, and healthcare organizations. Subthemes were also explored in relation to each category as; education, financial incentives, generic substitution, advertising approaches, and enforcement.CONCLUSION: Various policies should be taken into consideration to encourage successful generic medication prescribing, dispensing, and consumption in both supply and demand-side. Economic, political, socio-cultural, technological, legal, and structural factors could as such accelerate the policies’ effect. Studying the experience of successful countries can be helpful for policymakers.

Published
2021
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32. The Magnitude, Types, and Roles of Social Support in Diabetes Management among Diabetics’ in Southern Ethiopia: a Multilevel, Multicenter Cross-Sectional Study

Author

Jaafaripooyan,Ebrahim, Habebo,Teshome Tesfaye, Mosadeghrad,Ali, Rahimi Foroushani,Abbas, Anshebo,Dawit G/Michael, Jaafaripooyan,Ebrahim, Habebo,Teshome Tesfaye, Mosadeghrad,Ali, Rahimi Foroushani,Abbas, and Anshebo,Dawit G/Michael

Abstract

Ebrahim Jaafaripooyan,1 Teshome Tesfaye Habebo,1,2 Ali Mohammad Mosadeghrad,1 Abbas Rahimi Foroushani,3 Dawit G/Michael Anshebo4 1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran (the Islamic Republic); 2Disease Prevention and Control Directorate, Kembata Tembaro Zone Health Department, Durame, SNNPRS, Ethiopia; 3Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran (the Islamic Republic); 4Public Health Emergency Management Directorate (PHEM), Kembata Tembaro Zone Health Department, Durame, SNNPRS, EthiopiaCorrespondence: Teshome Tesfaye Habebo Email teshometesfaye22@gmail.comIntroduction: Lifelong medical management is the main intervention to reduce diabetes-related morbidities and premature deaths; yet, social support can be a vital intervention to improve diabetics’ health. Therefore, this study aimed to determine the magnitude, types, and role of social support in diabetes management in southern Ethiopia.Methods: A multi-stage systematic sampling was applied to recruit 634 adult diabetics from the three-tiered healthcare system in the region. We proportionally distributed the sample size between randomly selected ten health-care facilities across the hierarchy. Pretested questionnaires and checklist; Epi-Info, and SPSS software used for data collection; entry, and analyses, respectively, and the statistical significance was determined at a P-value ≤ 0.05.Results: A total of 240 females and 356 males completed the study, and the overall magnitude of the social support was 50.20% [95% CI: 46.19%, 54.21%], and it was categorized into non-material and material with 44.13% [95% CI: 40.14%, 48.12%] and 34.23% [95% CI: 30.42%, 38.04%] magnitudes, respectively, and social support was left to the patients’ families and friends whereas formal institutions and the public sectors were rarely offering when the p

Published
2021

38. Practicing patients’ rights in Iran: a review of evidence.

Author

Sharifi, Tahere, Gooshki, Ehsan Shamsi, Mosadeghrad, Ali Mohammad, and Jaafaripooyan, Ebrahim

Subjects
PATIENTS' rights, RIGHT of privacy, FREEDOM of association, PATIENT compliance
Abstract

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and MetaAnalysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers. [ABSTRACT FROM AUTHOR]

Published
2021

39. Real-Life Incentives Driving Public-Private Partnership in Diagnostic Services.

Author

Baniasadi, Akram, Sari, Ali Akbari, Foroushani, Abbas Rahimi, Sirizi, Mehdi Jafari, and Jaafaripooyan, Ebrahim

Subjects
PUBLIC-private sector cooperation, DIAGNOSTIC services, PUBLIC sector, PRIVATE sector, SEMI-structured interviews, PARTNERSHIP agreements
Abstract

BACKGROUND: Diagnostic services are highly critical in the success of treatment processes, overly costly nonetheless. Accordingly, hospitals generally seek the private partnership in the provision of such services. This study intends to explore the incentives owned by both public and private sector in their joint provision of diagnostic services under the public-private partnership agreement. METHOD: A qualitative, exploratory study was employed in Tehran hospitals from October 2017 to March 2018. Around 25 face-to-face, semi-structured interviews were conducted with the purposively recruited hospital managers, heads of diagnostic services and managers of private companies. Interviews were transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12". RESULTS: Three main categories and nine sub-categories represented the incentives of public sector, and four main categories and seven sub-categories signified those of private sector. The incentives of public sector included the status-quo remediation, upstream requirements, and personal reasons. As such, the individual, social and economic incentives and legal constraints were driving the behavior of the private sector. CONCLUSIONS: Financial problem and gain were the most noted incentives by the partners. Attention to the either side's incentives and aims is likely to ensure the durability and effectiveness of such partnerships in the health sector. [ABSTRACT FROM AUTHOR]

Published
2020
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40. Effect of dual practice on service delivery time by surgeons in the Islamic Republic of Iran: multi-level analysis of a national survey, 2016

Author

Bayat, Mahboubeh, primary, Shokri, Azad, additional, Khalilnezhad, Roghayeh, additional, Mirbahaeddin, Elmira, additional, Khodadost, Mahmoud, additional, Fattahi, Hamed, additional, Zalani, Gholamhossein Salehi, additional, Harirchi, Iraj, additional, Yaser, Mehdi, additional, Jaafaripooyan, Ebrahim, additional, and Akbari-Sari, Ali, additional

Published
2018
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48. Recent Iranian Health System Reform: An Operational Perspective to Improve Health Services Quality.

Author

Mahdavi, Mahdi, Parsaeian, Mahboubeh, Jaafaripooyan, Ebrahim, and Ghaffari, Shahram

Subjects
HEALTH care reform, MEDICAL quality control, HEALTH services administration
Abstract

The operational management of healthcare services is expected to directly touch patient experiences. Iranian Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the operational management of healthcare delivery within a reform agenda by setting benchmarks for 'number of visit per hour' and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has faced with mixed reactions and various doubts have been cast on its successful implementation. This manuscript aims to shed some light on the operational challenges of the initiative and the requirements of its successful implementation. [ABSTRACT FROM AUTHOR]

Published
2018
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49. Key performance indicators (KPIs) for healthcare accreditation system

Author

Agrizzi, Dila, Jaafaripooyan, Ebrahim, and Akbarihaghighi, Faizollah

Subjects
health services administration, education, geographic locations, health care economics and organizations
Abstract

Purpose – this paper aims to propose valuable performance indicators for evaluation of an accreditation programme, as an effective external assessment scheme in healthcare.Design/methodology/approach – the paper is based on an exploratory research which has used semi-structured interviews to collect data from a number of healthcare accreditation experts. The respondents were selected from different universities and accreditation-associated institutions in developed and developing countriesincluding Iran. They were chosen through “snowball sampling technique”.Findings – thematic content analysis of the data provided the following key performance indicators (KPIs) which are hoped to be influential in evaluating the performance of healthcare accreditation programmes. For example; the effect of accreditation in a society, cost of accreditation for all participants (e.g. hospitals,accrediting bodies), tangible improvement in the outcomes of patients care or satisfaction after accreditation, satisfaction of different stakeholders with theaccreditation results, and a focus on features and requirements of local health care economy by accreditation programme.Originality/value – this study is deemed to be unique and novel at ascertaining a number of invaluable dimensions for evaluating the performance of accreditation programmes in public sector, specifically health care. It has sought to contribute to the knowledge in the area of performance measurement and improvement in the public sector.

Published
2010

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