Search

Managerial stability is believed to play a crucial role in the success of health care organisations and health managers. High managerial turnover seems to be a common phenomenon of the Iranian health system. This study thus aimed to investigate the reasons for managerial turnover in Iranian hospitals.Following a qualitative approach, 53 semi-structured interviews were conducted with different managerial levels in the hospitals, the high officials of medical universities, and health policymakers. Interviewees were selected using the purposive sampling techniques. Interviews were continued up to the data saturation. Data analysis was conducted thematically using MAXQDA 10.Four groups of reasons were identified leading into the managerial turnover in hospitals, ranging from the micro to macro level factors, that is, those related to the managers, hospitals, medical universities, and the country. Insufficient support from the officials, managerial poor performance, conflict with other managers and colleagues, changes of senior managers, and presidential and parliamentary elections representing the key reasons underlying the turnover of hospital managers in Iran.Given the variety of reasons emerged behind the managerial turnover, the efforts to improve the awareness and engage the all actors ranging from health policymakers to organisational decision-makers could be a valuable step to regulate and optimise the managerial turnover and stability in health care organisations in order to enhance the productivity and accountability in healthcare industry, particularly in the hospitals.

Purpose This study aims to predict the behavior of donors to give to the health sector compared with other sectors in Shiraz city, South Iran, using the revised theory of planned behavior (TPB). Design/methodology/approach This was a descriptive-analytic cross-sectional study. A standard questionnaire, which comprising 32 items, was used to survey 277 donors affiliated with various charitable associations in the city of Shiraz, South of Iran, in 2018. Participants were selected using stratified sampling and simple random sampling techniques. The authors used a revised TPB, a general model to predict and explain behavior across various types of behaviors and predict behavior based on an individual’s attitudes and beliefs. This model was used to examine the influence of eight social-psychological variables (attitude, perceived behavioral control [PBC], subjective norm, descriptive norm, moral norm, past behavior, intention behavior, self-reported) on an individual’s intention to donate to health sector charity. Data was analyzed using SPSS software version 22.0. Findings The score of all constructs of TPB in the health sector was significantly higher than in the non-health sector (P < 0.001), except for the PBC. This indicates that it does not influence the donors’ behavioral intention in selecting of charitable activity domains (e.g. health and non-health). The constructs of the moral norm, descriptive norm and past behavior in the health sector donors; and the constructs of attitude, moral norms and the variables of the annual income, and work experience in the non-health sector donors were identified as significant predictors of donors’ intention behavior. Moreover, attitude, moral norm, descriptive norm, past behavior, male gender and the annual income were the significant predictors of donors’ intention to give to health charity initiatives. Originality/value One of the most important mechanisms to compensate for the shortage of resources of the health system is the use of donors’ participation capacity. However, different donors act differently in selecting charitable activity domains, including the health sector and non-health sector (e.g. school-building donors’ association, house-building donors’ association, city-building donors’ association, library-building donors’ association, etc.). To attract donors’ participation in the health sector, some interventions to change the behavioral intention of donors towards the health sector through constructs of TPB should be taken.

Introduction 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 patients needed it. Though sex, educational level, and health-care hierarchy were not significantly associated with the social support, residence, some occupations, presence of diabetic family members, acute medical conditions, blood glucose level, compliance to medical follow-ups, treatment adherence, and taking anti-diabetic drugs a day before the current visit to health-care facility were all statistically significantly associated with social support. Conclusion One of every two adult diabetic patients in southern Ethiopia was receiving any social support, and social support for diabetic people reduces medical follow-ups absenteeism, improves treatment adherence, glycemic level controlling, and helps lifestyle modifications. Therefore, to keep diabetic people healthy and achieve diabetes management goals, the Ethiopian healthcare system, institutions, and concerned stakeholders should strengthen the social support for diabetic patients.

Patient experience is assumed pivotal for improving health services operations. The patient experience of healthcare services in Iran has been mostly assessed through the satisfaction and quality of single services or activities at individual providers, clinical departments, or health facilities. However, given the rise of chronic and multi-morbid conditions, health services for these conditions consist of several activities and interactions through a journey that patients take in the health system. To fill in this gap, we propose focusing on the assessment of patient experience on the patient journey through the health system. We advocate that there is much potential for improving the patient experience by rethinking the operations management of health services to embrace the patient experience of the healthcare journey. Rethinking health operations management may include an exhaustive list of interventions. Concisely, at the strategic level, policy-makers while understanding the need for shifting towards the patient experience, make sure that operational level management is experience oriented. This would be pursued through a strategic approach to patient experience, reconsidering qualifications for operational management, and benchmarking to identify and share best practices. Lessons learnt from previous quality improvement programmes are also considered as a capacity to establish the experience orientation.

Public reporting of hospitals' performance data is a growing trend. This transparency may improve patient choices, competition, and service quality. This study aims to provide recommendations to improve hospitals' transparency in Iran. A qualitative study designed with 18 semi-structured interviews. Recommendations were categorized into five main themes, including passing a comprehensive law on transparency to create political commitment, educating people and healthcare providers to create the culture, developing a simple and efficient structure to foster transparency, and monitoring and evaluating transparency. The most important issue is political commitment. If it exists, the rest of the obstacles can be solved.

Objective(s): Hospital accreditation is “an external evaluation of a hospital’s structures, processes, outputs and outcomes by an independent professional accreditation body using pre-established optimum standards”. Accreditation is a strategy for ensuring the quality, safety, effectiveness and efficiency of hospital services. The efficacy of an accreditation program depends on the validity of the accreditation governance, methods, standards, and the surveyors. Iranchr('39')s hospital accreditation system faces some challenges. Benchmarking leading international accreditation bodies’ methods benefit the Iranian hospital accreditation system. Hence, this study aimed to compare the Iranian hospital accreditation methods with the world leading international hospital accreditation bodies’ methods. Methods: A comparative research was used in this study in 2019. The Iranian hospital accreditation methods was compared with those of the Joint commission international, the Accreditation Canada international and the Australian Council on Healthcare Standards International. Framework analysis was used for the qualitative data analysis in this study. Results: While the Iranian hospital accreditation program is governmental and compulsory, the three leading international accreditation programs are private, not for profit, and voluntary. While Iran’s hospital accreditation method includes the self-assessment and the on-site survey, the other countries use self-assessment, on-site survey, un-noticed survey, periodic review, examining key performance indicators and measuring patient satisfaction. The international accreditation award levels include “Fully accredited”, Provisionally accredited” and “Not accredited” and the accreditation certification is valid for 3-4 years. The Iran’s accreditation certificate is valid for 2 years and consisted of 7 levels from “Excellent” to “Not accredited”. Conclusion: Complementary evaluation methods should be used to strengthen the validity and reliability of Iran’s hospital accreditation program. Furthermore, the time period of the accreditation certificate validity should be increased and the awards levels should be decreased.

Purpose This study aims to explore the challenges of providing primary health care (PHC) to Afghan immigrants in Tehran as an important global human right issue. Design/methodology/approach In this exploratory study, a total of 25 purposively selected PHC providers, including physicians, psychologists and midwives, were approached for face-to-face, semi-structured interviews, lasting 30 min on average. Thematic analysis was used to analyze the data. Findings The most common challenges of providing PHC to Afghan immigrants were categorized at individual, organizational and societal levels. Communication barriers and socioeconomic features emerged at the individual level. The organizational challenges included mainly the lack of insurance coverage for all immigrants and the lack of a screening system upon the immigrants’ arrival from the borders. At the societal level, the negative attitudes toward Afghan immigrants were causing a problematic challenge. Research limitations/implications The main limitation was the possibility that only health-care professionals with particular positive or negative perspectives about immigrants enter into the study, because of the voluntary nature of participation. Practical implications Findings can help policymakers adopt evidence-informed strategies for facilitating PHC provision and improving the access to health care in immigrants as a global human right concern. Social implications This study alerts about undesirable consequences of certain attitudes and behaviors of the society toward immigrant health. Originality/value To the best of the authors’ knowledge, this is one of the first studies conducted in PHC centers in Tehran Province that explores the challenges of providing PHC to Afghan immigrants.

Deciding on pharmaceutical subsidy is regarded as a challenging issue for healthcare policymakers in Iran in most times. Public preferences, rarely attended in Iran, could be invaluable for including a particular drug in the list of subsidized medications.The current study aims to elicit the public preferences to develop an evidence-based decision-making framework for entering a drug into the list of subsidies in Iran.Discrete Choice Experiment (DCE) was employed to elicit the public preferences. Around 34 attributes were identified based on the systematic review and interview with 51 experts. By holding an expert panel, 7 attributes were finalized, namely: the survival after treatment, quality of life after treatment (QoL), alternative treatment, age group of the target population, cost burden for the government, disease severity, and drug manufacturer country. Next, 1224 households were selected for the survey in the city of Tehran, using random cluster sampling. Data were analyzed using conditional logit model.The survival after treatment (β = 1.245; SE = 0.053) and disease severity (β =- 0.143; SE = 0.043) had the highest and lowest priority, respectively, in the preferences for allocating subsidy to a drug. In developed region, unlike the other two regions, the level of domestic drug production (β =- 0.302; SE = 0.073) was inversely associated with preferences toward allocating subsidy to a drug. In contrast to other districts, those living in district number one (β = 2.053; SE = 0.138) gave the highest value to promoting the QoL after treatment.It is suggested that policymakers pay more attention to attributes such as effectiveness and alternative treatment when developing an evidence-based framework for entering a drug into the list of subsidies. This study highlighted the public belief in the government's subsidy for medicines, provided that, this results in an increased survival and QoL.

Responsiveness is the ability of health system to satisfy non-clinical people's expectations. This review aimed at assessing responsiveness of hospitals' services in the low- and middle-income countries, and identifying the influencing factors. This systematic review followed the PRISMA guidelines. PubMed, Scopus, Web of Science and ProQuest were searched. Studies of all designs aiming to assess responsiveness of hospitals' services in the period from 2005 up to the end of 2018 were included. Quality was appraised based on McMaster University tool. Results were presented as a narrative review. Fifteen studies originated from five low-middle- income countries have been included. Results have been proposed under five subtopics; level and distribution of responsiveness and its domains at hospitals, rank of domains according to the participants, and factors affecting responsiveness and its related domains. Most studies have focused on responsiveness level, but not the distribution. Socioeconomic status, organisational, systemic, and contextual factors have led to varied responsiveness, consequently, policymakers would benefit from these valuable results while planning for improving health system in order to accomplish its intrinsic goals. Further research is required in the low- and middle-income countries other than the five included in this review. Using the World Health Organization questionnaires for measuring responsiveness is recommended, and the contextual variations should be considered.

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.

BackgroundDeciding on pharmaceutical subsidy is regarded as a challenging issue for healthcare policymakers in Iran in most times. Public preferences, rarely attended in Iran, could be invaluable for including a particular drug in the list of subsidized medications.ObjectivesThe current study aims to elicit the public preferences to develop an evidence-based decision-making framework for entering a drug into the list of subsidies in Iran.MethodsDiscrete Choice Experiment (DCE) was employed to elicit the public preferences. Around 34 attributes were identified based on the systematic review and interview with 51 experts. By holding an expert panel, 7 attributes were finalized, namely: the survival after treatment, quality of life after treatment (QoL), alternative treatment, age group of the target population, cost burden for the government, disease severity, and drug manufacturer country. Next, 1224 households were selected for the survey in the city of Tehran, using random cluster sampling. Data were analyzed using conditional logit model.ResultsThe survival after treatment (β = 1.245; SE = 0.053) and cost burden for the government (β = − 0.140; SE = 0.050) had the highest and lowest priority, respectively, in the preferences for allocating subsidy to a drug. In developed region, unlike the other two regions, the level of domestic drug production (β =− 0.302; SE = 0.073) was inversely associated with preferences toward allocating subsidy to a drug. In contrast to other districts, those living in district number one (β = 2.053; SE = 0.138) gave the highest value to promoting the QoL after treatment.ConclusionsIt is suggested that policymakers pay more attention to attributes such as effectiveness and alternative treatment when developing an evidence-based framework for entering a drug into the list of subsidies. This study highlighted the public belief in the government’s subsidy for medicines, provided that, this results in an increased survival and QoL.

Background: Economic evaluation is used for the optimal allocation of resources in the health sector. While a large number of economic evaluation studies have been conducted, there is less critical review of these studies. We critically examined the economic evaluation studies of preventive health interventions. Methods: The study was carried out using critical review method. Seven databases (i.e., PubMed, Cochrane Database of Systematic Reviews, Web of Science, Science Direct, Scopus, Springer Link, and Elsevier) were searched to find articles on economic evaluation of health interventions published from 1985 to 2018. In addition, the references of retrieved studies were hand screened for articles that were not indexed in these databases. Finally, 206 articles, including 33 cost- benefit analysis, 146 cost- effectiveness analysis, and 27 cost- utility analysis were included in this study. These studies were critically evaluated using a checklist of 11 criteria. Results: Only 20% of the studies met all the methodological criteria of health economic evaluation. The cost perspective, costs type, cost data source, and cost measurement were not explained and discussed in 17%, 20%, 5%, and 33% of studies respectively. Outcome data sources and outcome valuation method were only mentioned in 53% and 69% of studies. The sensitivity analysis and results’ generalizability were not reported in 16% and 46% of studies. Conclusion: The quality of economic evaluation studies is low, and it can be misleading if resource allocation decisions are made using this evidence. Authors should use valid protocols to conduct and report economic evaluation studies, and journals’ editors should use valid checklists to evaluate these articles.

Background: COVID-19, a rapidly spreading virus, has severely challenged all countries worldwide with no certain prevention and treatment so far. Various clinical and public health interventions have been in action since its first report in December 2019. Sharing the lessons learnt and strengths and weaknesses might cast some light on the future similar crisis management.Methods: This was a qualitative exploratory research including 22 semi-structured, face-to-face, virtual interviews with key informants and decision makers in the management of current epidemic. Data was analyzed using thematic analysis. Results: The lessons learnt from and the weaknesses and challenges of COVID crisis management were categorized under the main areas of management and planning, workforce and education and research, decision making and communication. Conclusions: The current unprecedented crisis has affected various aspects of human life. Policy makers and managers, especially in health care, worldwide are struggling to abate the consequences of this nasty virus, though facing tough challenges. Here some hands-on and real-time experiences from the fight of a developing and highly affected country against this virus is provided which might be of a high value. Whatever approach adopted, it is key to be multifaceted and support all rightly mentioned aspects of health as physical, mental and social.

BackgroundThis study aimed at measuring the responsiveness level of inpatient services according to patients’ perspectives, and identifying the factors affecting its performance at the Gazan public general hospitals, particularly in internal medicine and surgical departments, in 2020.MethodsIt was a cross-sectional descriptive study, conducted in 5 public general hospitals in Gaza. Data were collected between October 2019 and June 2020 in a survey included 675 inpatients using an interviewed questionnaire. Data were analyzed using software SPSS 22.0 and by applying descriptive statistics, independent t-test and analysis of variance (ANOVA), and post hoc Scheffé test. ResultsThe overall responsiveness was “above moderate”, 80.15% and 80.9%, for both internal medicine and surgical departments, respectively. Access to social support, confidentiality and dignity were the highest-performing domains, while, choice of provider and quality of basic amenities were the lowest. Dignity and confidentiality were the most important domains based on patients’ viewpoints. Hospital type, medical department, and hospital stay in addition to the educational level, marital status, employment status, income, and insurance status were the most influential factors on the level of responsiveness and its domains. ConclusionThe assessment of the responsiveness of inpatient services at public hospitals is useful in integrating the health system goals. Inpatient care responsiveness was satisfactory in the Gazan public hospitals, however, there is a room for further improvements. Reform strategies should be directed toward the domains of weak performance and the important ones as well. Attention should be given to the supply-side such as hospital characteristics as they significantly affect the level of responsiveness and its domains. Further research is required to carry out mixed-method studies, moreover, the non-public hospitals need to be covered.

Introduction: Unequal distribution of resources has always been a concern for health systems in addressing access issues in relation to health services.It might have a devastating effect on health outcomes and in a way incur the direct and indirect costs. The purpose of this study thus is to investigate the trend of pharmacists’ distribution in Iran.Methods: In this retrospective longitudinal study, data were collected for a four-time period; 2007, 2012, 2016 and 2019,from the Statistical Center of Iran and Islamic Republic of Iran Medical Council. The sought indicator was the number of pharmacists per 10,000 population. Gini coefficient and Lorenz curve were used to measure and analyze the inequality using STATA software and ArcGIS software was used to map the pharmacists’ distribution.Results: The results showed that the number of pharmacists in 2007 was 12986 and increased by 69% (21919) in 2019, however the inequality in the distribution of pharmacists has not yet disappeared. Gini coefficient values for 2007, 2012, 2016 and 2019 were 0.26, 0.23, 0.21 and 0.19, respectively. The Gini coefficient decreased by 27% during the study period and from 2007 to 2019, pharmacy per capita increased in all provinces of Iran.Conclusion: The trend of pharmacist distribution in Iran indicates an overall decrease in the inequality level. However, the inter-provincial distribution of pharmacists is significantly unequal, demanding full attention of national and provincial authorities. The results might also inject plenty of insights into the evidence-based policy making at the ministerial level.

Background: Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran. Objective: The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations. Methods: In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005-2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed. Results: Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p

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.

This paper examines the operation of an accreditation programme for hospitals in Iran. It explores the process of accreditation as a regulatory control system and analyses hospitals’ responses to this type of control. We draw on the notion of steering and argue that the accreditation system is transactional in nature. Our findings show that hospitals conform to the scheme, although they also resist some of its requirements. On a wider policy level, we suggest that accreditations offer the accreditor the opportunity to impact on how activities are undertaken, but hospitals require incentives in order to make the necessary organisational changes.

Introduction In recent years, platelet rich plasma (PRP) has been receiving increasing attention for the treatment of soft tissue injuries. These numerous applications have raised a great deal of questions and debate about the effectiveness of this method. This study aimed to determine the efficacy of PRP in improving sports injuries and subsequently throw some light on these controversies. Methods A systematic review of the literature and meta-analysis of results were undertaken. All related databases, such as PubMed, Cochrane Database of Systematic Reviews, DARE, and EMBASE, were searched on the use of PRP on athletes and in sports medicine. The search was conducted from June 2013 to February 2014. Results Our search retrieved 905 studies, of which 13 randomized control trials (RCT) met our inclusion criteria for systematic review and meta-analysis. All articles were appraised by Critical Appraisal Skills Program (CASP) checklist for RCT studies. The analysis of the results of pain scores and physical activity/functions did not show any superiority for PRP as opposed to the other options. Conclusions The meta-analysis showed no more effectiveness for PRP application in sports-related injuries in terms of physical function improvement and pain relief. Therefore, the extensive use of PRP for such injuries should be limited. Well-designed RCTs are needed to support the findings.

Agenda-setting is the process by which problems and alternative solutions gain or lose public and elite attention. This study aimed to demonstrate new population policy agenda-setting in Iran using the multiple streams model developed by John Kingdon. The study was conducted using a qualitative approach in the years of 2014–2015 and consisted of 15 semi-structured interviews with Iranian key informants. The sampling was purposeful and continued using snowball method until the data saturation is reached. In addition, 25 policy documents were reviewed and analyzed. The data analysis was conducted using the framework analysis by MAXQDA software. The problem stream was highlighted with the release of 2006 census and reaching total fertility rate to below the replacement level in Iran. Political stream formed by supporting the high-ranking officials of the country, academics and researchers, the mass media, clergy and particularly leadership. Policy stream continued with policies such as the future plan of children [Barname-e-Atiyeh], funding removal for population control and also abolished the previous limiting rules, formulation of the new law on the maternity leave. Finally, with the overall population policies notification by the supreme leader of the revolution, the window of opportunity was opened and the issue of population growth was set as agenda. In conclusion, application of the multiple streams model and identification of its various aspects in the new approach of the population policy in Iran would assist policy-makers and officials in this area of policy to recognize the problem better and thereby make more evident and rich policies. Further studies to understand better the interactions between these streams and development of this model in the country population policy recommended.

One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services.The aim of this article is to examine the impact of DP on service delivery time by surgeons.We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age.The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (β = 0.427). Female specialists (β = -0.049) and full-time specialists (β = -0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P0.001) and as the population increases, FTE increases (P0.05).Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.أثر الممارسة المزدوجة على زمن تقديم الجراحين في » جمهورية إيران الإسلامية « للخدمات: تحليل متعدد المستويات لدراسة مسح وطنية، 2016.محبوبة بيات، آزاد شكري، رقية خليل نزاد، الميرامير بهاء الدين، محمود خدادوست، حامد فتاحي، غلامحسين صالحي زلاني، ايرج حريرجي، مهدي ياسري، إبراهيم جعفري بويان، علي أكبري ساري.إن ظاهرة الممارسة المزدوجة من أنماط العمل التي تؤثر على تقديم الأطباء الاختصاصيين للخدمات، والمقصود بالممارسة المزدوجة أن يعمل الطبيب في القطاعين العام والخاص في وقت واحد. يمكن للممارسة المزدوجة في القوى العاملة الصحية في مجال الجراحة أن تؤثر على الوصول إلى الجراحين تأثيرًا ضارًّا يتعذّر ضبطه، وعلى كفاءة وفاعلية وجودة الخدمات الجراحية.تهدف هذه المقالة إلى التعرف على تأثير الممارسة المزدوجة على زمن تقديم الجراحين لخدماتهم.استخدمنا نموذجًا مُسْبَق الإعداد لجمع البيانات عن الاختصاصيين في الجراحة في جميع المستشفيات الإيرانية وعددها 925 مستشفىً. استخدمنا رموز الهوية الطبية الوطنية ورموز الهوية لمجلس الأطباء والاسم الأول واسم الأسرة واسم الأب في التوافق بين البيانات. استخدمنا التحوُّف الخطي المتعدد المستويات لتقييم الارتباط بين الممارسة المزدوجة وبين متغيرات الدراسة مثل نوع التوظيف، ودرجة عضو هيئة التدريس، والخبرة، ونوع الجنس، والسن.أمضى 4642 طبيبًا اختصاصيًّا بالجراحة، يمثلون 31.08 % من مجموع عدد الجراحين، 1.09 ساعة في هذه الدراسة (الانحراف المعياري 0.33) من معادلات ساعات التفرغ في تقديم خدمات الرعاية الصحية. واتضح أن الأطباء الاختصاصيين ذوي الممارسة المزدوجة يكون لديهم زمن تقديم الخدمات طويلً. (0.427 = β). وتمضي الاختصاصيات (β = –0.049) كما يمضي الاختصاصيون المتفرغون (0.082– = β) وقتاً أقصر في تقديم خدمات الرعاية الصحية. أما التخصصات الدائمة (فتكون معادلات ساعات التفرغ فيها أعلى (P0.001) ومع ازدياد أعداد السكان تزداد معادلات ساعات التفرغ (P0.05).رغم أن للممارسة المزدوجة تأثيرًا مباشرًا على ساعات عمل الأطباء الجراحين، إلا أنه يبدو أن النصيب الأكبر في الاختلاف في أوقات العمل قد استفادت منه الخدمات في القطاع الخاص، مما أدى إلى تدني فرص الوصول إلى الخدمات الجراحية في القطاع العام. ولذلك فإن من الضروري وضع مقاربة منهجية لتنظيم الممارسة المزدوجة.Répercussions de la double pratique sur les délais de prestation de services par les chirurgiens en République islamique d’Iran : analyse pluri-niveau d’une enquête nationale, 2016.L’un des modes de travail qui affecte la disponibilité des médecins spécialistes est le phénomène de la double pratique, c’est-à-dire le cumul de plusieurs activités professionnelles dans les secteurs public et privé. L’absence de contrôle de la double pratique parmi les professionnels de santé en chirurgie peut avoir des répercussions néfastes sur l’accès aux chirurgiens ainsi que sur l’efficacité, la rentabilité et la qualité des prestations chirurgicales.L’objectif du présent article est d’étudier l’impact de la double pratique sur le temps consacré à la prestation de service par les chirurgiens.À l’aide d’un formulaire préstructuré, nous avons recueilli des données concernant les chirurgiens spécialisés dans l’ensemble des 925 hôpitaux que compte la République islamique d’Iran. Les données ont été comparées en utilisant les numéros d’identification nationaux des médecins, leurs numéros d’inscription à l’ordre des médecins, leurs prénoms, noms et patronymes. La régression linéaire à plusieurs niveaux a été appliquée afin d’évaluer le lien entre la double pratique et les variables étudiées, à savoir le type de recrutement, l’exercice de fonctions d’enseignement, l’expérience, le sexe et l’âge.Les 4642 chirurgiens spécialisés inclus dans cette étude, représentant 31,08 % du nombre total des chirurgiens identifiés, consacraient en moyenne 1,09 heure (écart-type : 0,33) en équivalent temps plein (ETP) à la prestation de services de soins de santé. Les spécialistes s’adonnant à la double pratique faisaient preuve de temps de prestation plus longs (β = 0,427). Les femmes spécialistes (β = –0,049) et les spécialistes travaillant à temps plein (β = –0,082) montraient des temps de prestation plus courts. Les spécialistes permanents avaient un nombre d’ETP plus élevé (p0,001), ce dernier croissant avec l’augmentation de la population (p0,05).Bien que la double pratique ait des répercussions directes sur les horaires de travail des chirurgiens, il semble qu’une plus grande partie de la différence dans le temps de travail soit consacrée à la prestation de services dans le secteur privé, ce qui affecte l’accès aux services chirurgicaux dans le secteur public. Il est donc nécessaire d’élaborer une approche systémique afin de réglementer la double pratique.

Background: Cancer is the third cause of death in Iran. Oncologists play a key role in declining the mortality rate of cancer. Objectives: This study aims to accurately estimate oncologists’ active supply by using 3 sources of capture-recapture (CRC) in Iran. Methods: This was a cross-sectional study in 2015 targeting all oncologists in Iran registered in 3 independent sources, a hospitals national survey (213), database of Iran ministry of health and medical education (180), and the database of continuing medical education (173) were used to identify number of oncologists that were active. Duplicate records between the 3 sources were identified and removed using the Microsoft Office Access software. Medical council codes, names, surnames, as well as national ID codes were used for data linkage between the 3 sources. Results: After removing the duplicate records, a total of 314 oncologists were identified. Based on the selected model, it was estimated that the total number of oncologists were 533 in 2015. They included 325 adult hematologist-oncologists, followed by 88 pediatric oncologists, 47 surgical oncologists, 20 gynecologic oncologists, and 18 urologic oncologists. The estimated ratios for oncologist to population and oncologist to patients suffering from cancer were 0.67 and 1.34 per 100,000, respectively. Completeness of data for all 3 data sources after removing duplicates was 59.13%. Conclusions: This study highlighted the shortage of oncologists in Iran and showed that the quality of Iran specialists’ registration databases needs improvement.

Background: Effective leadership is a vital component of health care systems and has an extensive range of functions in improving organizational effectiveness and efficiency. This study aimed at exploring leadership challenges encountered by leaders in Iranian hospitals. Methods: This qualitative study was conducted on a purposeful sample of 27 members of hospital management team in Tehran using face-to-face semi-structured interviews and in-depth interviews. Thematic analysis was used to analyze and report the data. Results: In this study, 5 main themes emerged upon the challenges of leadership in health care organizations as follow: organizational structure (complexity, centralization, and bureaucracy); human resources (the number and distribution of human resources, staff empowerment, and education, motivational mechanisms, and staff diversity); work nature (sensitivity, stress and tension, customer diversity, and team- oriented); leaders (knowledge and skills, appointment, superiors and colleagues, and time); and context (regulations and programs, cultural issues, social issues, and economic issues). Conclusion: The results of this study shed some light on the leadership challenges in a culturally specific developing country. The results also proved the importance of using educated leaders who are capable of understanding, analyzing, and dealing with such complex challenges.

Introduction: Over the last few decades, total fertility rate (TFR) has followed a downward trend in Iran. The consequences of this trend from the perspectives of some are negative. Considering the macro-population policies in recent years, this study aimed to examine the effect of some macro socio-economic variables, including divorce, marriage, urbanization, and unemployment rate on TFR in Iran from 2002 to 2012. Methods: This time series research was conducted in 2015 using the databases of the National Organization for Civil Registration (NOCR) and the Statistical Center of Iran. The study population was the related data of provinces in the selected variables. The main methods used in the research were the common unit root test, Pedroni Cointegration test, redundant fixed effects tests, correlated random effects-Hausman test, and panel least squares of fixed effects. In order to determine the suitable model for estimating panel data, likelihood ratio and Huasman tests were done using Eviews software, and the fixed effects regression model was chosen as the dominant model. Results: The results indicated that the divorce rate had a negative and significant effect on TFR (p < 0.05). A positive and significant relationship between marriage rate and TFR variables also was observed (p < 0.05). Urbanization rate (p = 0.24) and unemployment rate (p = 0.36) had no significant relationship with TFR. According to F statistic, significance of the overall model also was confirmed (p < 0.001). Conclusion: Due to the lower effect of the studied factors on the reduction of TFR, it seems that variables other than the ones studied, as well as cultural factors and values, might be fundamental factors for this change in the country

Background: Literature abounds with various techniques for efficiency measurement of health care organizations (HCOs), which should be used cautiously and appropriately. The present study aimed at discovering the rules regulating the interplay among the number of inputs, outputs, and decision- making units (DMUs) and identifying all methods used for the measurement of Iranian HCOs and critically appraising all DEA studies on Iranian HCOs in their application of such rules. Methods: The present study employed a systematic search of all studies related to efficiency measurement of Iranian HCOs. A search was conducted in different databases such as PubMed and Scopus between 2001 and 2015 to identify the studies related to the measurement in health care. The retrieved studies passed through a multi-stage (title, abstract, body) filtering process. Data extraction table for each study was completed and included method, number of inputs and outputs, DMUs, and their efficiency score. Results: Various methods were found for efficiency measurement. Overall, 122 studies were retrieved, of which 73 had exclusively employed DEA technique for measuring the efficiency of HCOs in Iran, and 23 with hybrid models (including DEA). Only 6 studies had explicitly used the rules of thumb. Conclusion: The number of inputs, outputs, and DMUs should be cautiously selected in DEA like techniques, as their proportionality can directly affect the discriminatory power of the technique. The given literature seemed to be, to a large extent, unsuccessful in attending to such proportionality. This study collected a list of key rules (of thumb) on the interplay of inputs, outputs, and DMUs, which could be considered by most researchers keen to apply DEA technique.

Background: Performance measurement is essential to the management of health care organizations to which efficiency is per se a vital indicator. Present study accordingly aims to measure the efficiency of hospitals employing two distinct methods. Methods: Data Envelopment Analysis and Pabon Lasso Model were jointly applied to calculate the efficiency of all general hospitals located in Iranian Eastern Azerbijan Province. Data was collected using hospitals’ monthly performance forms and analyzed and displayed by MS Visio and DEAP software. Results: In accord with Pabon Lasso model, 44.5% of the hospitals were entirely efficient, whilst DEA revealed 61% to be efficient. As such, 39% of the hospitals, by the Pabon Lasso, were wholly inefficient; based on DEA though; the relevant figure was only 22.2%. Finally, 16.5% of hospitals as calculated by Pabon Lasso and 16.7% by DEA were relatively efficient. DEA appeared to show more hospitals as efficient as opposed to the Pabon Lasso model. Conclusion: Simultaneous use of two models rendered complementary and corroborative results as both evidently reveal efficient hospitals. However, their results should be compared with prudence. Whilst the Pabon Lasso inefficient zone is fully clear, DEA does not provide such a crystal clear limit for inefficiency.

Background Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. Methods A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. Results Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs’ over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. Conclusion Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs.

Objective. The purpose of this paper is to identify and suggest a number of performance measures to facilitate the evaluation of accreditation programs in healthcare. Methods. The paper is based on an exploratory research which has used qualitative methods, including snowball sampling technique, email interview and thematic content analysis. Participants. Respondents (experts and professionals) were selected from a diverse spectrum ranging from healthcare organizations, universities and accreditation-associated institutions. Results. The analysis of the data provided key measures to be considered in the evaluation of accreditation programs’ impact at macro and micro levels as well as their nature and operations. The measures can be used to, for example, assess the degree of stakeholders’ reliance on accreditation results, measure the cost of accreditation for participating organizations and serve as a formal mechanism for accredited organizations to appeal accreditation decisions. Conclusions. This paper has brought together a number of generic, yet influential and workable, measures which could be utilized for assessing the overall performance of an accreditation program in healthcare. The application of these measures depends on the features of given accreditation program and the context in which the program operates. Therefore, the next step/steps in the assessment of an accreditation program might be choosing the measures suiting that program.

Hospitals have been at the core of health care in most countries during past decades, in view of the importance and criticality of their services and absorbing the highest quota of health care financial resources. Specific problems associated with these organizations in developing countries, such as Iran, have further added to the attention they have received over the course of those years. Efficiency measurement of hospitals based on simple ratios has long been utilized to remedy these problems in Iran. However, application of data envelopment analysis as an advanced method for measuring efficiency of health care organizations is mostly unexplored in this country. The current study has applied this method to investigate technical efficiency of a group of provincial hospitals in Iran. The findings showed that just under 60% of all hospitals at the province were technically efficient, and the remainder faced excess number of inputs (specifically in their non-clinical human resources) that should be attended to by the managers. Implications for practice and research on the efficiency of hospitals in the country and similar settings are provided.