Health policy analysis for stewardship of rehabilitation services.

BACKGROUND AND AIM: There have been a growing interest in investigating the effect of stewardship on other functions of rehabilitation service delivery. Effective stewardship of rehabilitation services can ensure that these services are of high quality, accessible, affordable, and sustainable, and can help achieve the goals of universal health coverage. The purpose of this study was to identify and analyze the policies adopted in the field of rehabilitation services in Iran and in the international arena, and finally to identify policy gaps, areas for improvement, and areas that have been overlooked. METHOD: This research is a policy analysis, carried out through document analysis and Dalglish et al.'s READ approach. Data were analyzed and interpreted using qualitative methodology and directed content analysis. For this purpose, Veillard et al.'s health system stewardship framework was used to analyze the stewardship of rehabilitation services. The dimensions of the stewardship framework, were: Defining the vision for health and strategies and policies to achieve better health; influencing all sectors and advocating for better health; ensuring good governance in line with prevailing values; ensuring the alignment of system design with health system goals; improving existing legal and regulatory instruments; and compiling, disseminating, and applying information. Scott's four criteria were used to assess the authenticity, credibility, representativeness, and meaning of the documents. Those that did not meet even one of the Scott's criteria were excluded from content analysis. FINDINGS: A total of 16 documents were identified, all of which met Scott's criteria and none were excluded from the study. A total of six themes and 56 subthemes were extracted. The contents of all the documents were extracted under six themes of Veillard et al.'s health system stewardship framework. Overall, the results show that national documents place greater emphasis on the development of preventive healthcare and health promotion. Documents often focus on engaging NGOs and the families of people with disabilities and on intersectoral collaboration for knowledge production and the development of intersectoral knowledge networks. In terms of health system governance in line with prevailing values, documents are mainly focused on health system stewardship by the Ministry of Health and on evidence-based decision-making with the participation of target groups. Also, documents place more emphasis on upgrading the national infrastructure and increasing access to rehabilitation services. CONCLUSION: In some areas of rehabilitation services, there is a gap between national documents, which reflects differences in priorities, approaches, resources, and instruments available to strengthen rehabilitation services at the national and international levels.

Roles and competencies of medical faculty members: A competency framework.

PURPOSE: Medical education requires competent faculty members with the ability to create change in medical education. The focus on teacher competency are emerged as the results of medical education movements toward learner competency. The purpose of this study was to identify medical faculties competencies in their main roles and to provide a competency framework. METHOD: The integrative review approach was utilized for identifying competencies and expert opinions was conducted to assigned competencies to roles and academic ranks. The search strategies were conducted in online databases including PubMed, Scopus, WOS and Eric to detect studies published from May 2003 to May 2023. RESULTS: The identified competencies were classified to four themes including (1) essential personal competencies, (2) technical/functional competencies, (3) enabling competencies, and (4) meta-competencies. CONCLUSION: According to the results, a competency framework was proposed which is a valuable tool for various important decisions related to faculty, such as promotions and tenurship.

Investigating the implementation challenges of the research doctoral program and providing related solutions: a qualitative study.

BACKGROUND: Doctoral programs have consistently garnered the attention of policymakers in medical education systems due to their significant impact on the socio-economic advancement of countries. Therefore, various doctoral programs have been implemented with diverse goals. In Iran, a research doctorate program, known as PhD by Research, was introduced primarily to engage in applied research related to healthcare needs. Nevertheless, the achievement of the program's goals has been questioned. This study aimed to identify the implementation challenges of the Research Doctorate Program and its solutions in Iran. METHOD: This descriptive qualitative study followed the Standards for Reporting Qualitative Research: A Synthesis of Recommendations and was conducted in two steps. Firstly, the challenges of the Iranian Ph.D. by research program were identified through the perspectives of the program's students and graduates. In the second step, relevant solutions to these challenges were determined by focus groups of key informant experts. The transcripts were analyzed using qualitative content analysis. RESULTS: Five students and six graduates were interviewed in the first step and seven experts participated in the second one. The challenges and related solutions are explored in four main themes, including: (1) admission criteria, (2) program goals and expected outcomes, (3) curricula, and (4) financial and human resources. The study showed that various dimensions of the doctoral program are not aligned with each other and how to adapt the program in these dimensions. CONCLUSION: The study revealed the importance of a systematic approach in defining various dimensions of doctoral programs according to program goals and provided specific solutions for defining a research doctorate program in the context of a low- and middle-income country.

Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis.

INTRODUCTION: The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. METHOD: For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. RESULTS: After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. DISCUSSION: This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system's resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

Hospitals during economic crisis: a systematic review based on resilience system capacities framework.

BACKGROUND: Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals' policy solutions during the economic crisis using the resilience system capacities framework. METHOD: This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system's six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). FINDINGS: After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers' competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. CONCLUSION: The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Factors Affecting COVID-19 Transmission and Modelling of Close Contact Tracing Strategies.

BACKGROUND: Close contact tracing is an essential measure that countries are applying to combat the epidemic of COVID-19. The purpose of contact tracing is to rapidly identify potentially infected individuals and prevent further spread of the disease. In this study, based on the factors affecting the COVID-19 transmission, a scoring protocol is provided for close contact tracing. METHODS: First, the factors affecting the COVID-19 transmission in close contacts were identified by a rapid review of the literature. Data were gathered by searching the Embase, PubMed, Google Scholar, and Scopus databases. Then, by formulating and scoring the identified factors with two sessions of the expert panel, close contact transmission risk score determined, and a protocol for contacts tracing was designed. RESULTS: Close contact transmission risk depends on the contact environment characteristics, the infectivity (virus shedding) of the sentinel case, and contact characteristics. Based on these factors, the close contact transmission risk score and contact tracing protocol were prepared. CONCLUSION: The close contact transmission risk scores will provide the ability to contact classifications and developing specific tracing strategies for them. Given that there are not any specific treatments for COVID-19 and lack of universal vaccination, applying nonpharmaceutical measures such as contact tracing along with physical distancing is very crucial. Therefore, we recommended this model to the evaluation of exposure risk and contact tracing.

Identification of the most appropriate variables for measuring the efficiency of Iranian public hospitals: Using Delphi technique.

CONTEXT: Selecting variables is a fundamental step in evaluating comparative efficiency because the results of measuring efficiency depend on the used variables. AIMS: The aim of this study is to provide a comprehensive set of input and output variables for measuring efficiency with an emphasis on application in general hospitals in Iran. MATERIALS AND METHODS: This study comprised a literature review followed by a Delphi survey process. After extracting the variables from the literature review in order to reach consensus on them and identify the native variables, the researchers used the Delphi technique in three rounds. Thirty Iranian hospital managers, in Alborz, Saveh, Qazvin, Qom, and Hamadan universities, participated in this study. For analysis, the interquartile range (IQR) and median were used. IQR was used to assess the agreement of Delphi panel members. RESULTS: After literature review, nine indicators were identified as input variables and 11 indicators were identified as output variables. After the proposed changes by Delphi members, 24 input variables and 24 output variables were identified to measure hospital efficacy. Finally, ten variables were selected as inputs and ten variables were selected as outputs to measure the performance of public hospitals in Iran by using the consensus of the members in the Delphi panel. CONCLUSIONS: This study proposes a framework for selecting the most appropriate variables for measuring the hospital efficiency with an emphasis on nonparametric methods. Choosing variables to measure hospital efficiency requires infrastructure such as an intelligent information system.

A holistic view on implementing hospital autonomy reforms in developing countries: a systematic review.

The excessive use of resources, inefficiency and poor service quality in public hospitals has led developing countries to create reforms in public hospital governance, including autonomization. Hospital autonomy refers to the delegation of administrative rights to the hospital management team. The purpose of the present research is to review different aspects of hospital autonomy reforms in developing countries, such as incentives, preparations, obstacles and facilitators to change prior to implementation, impacts on achieving Universal Health Coverage (UHC) goals, challenges, outcomes and implications for implementation. A systematic review of the evidence from developing countries was performed. The results showed that these countries have undertaken autonomy reforms in order to improve the efficiency, quality and accountability of their hospitals. Also, studies emphasized the role of the World Bank in facilitation and guidance, and identified bureaucratic culture and political instability as barriers to change for the implementation of hospital autonomy reform. Preparations were limited to two key areas, i.e. ensuring access to healthcare services and ensuring the implementation of these reforms. The main challenges were lack of infrastructure, poor planning and policymaking, poor programme control, limited decision rights, inappropriate incentives and weaknesses in the accountability system. The results indicated that these reforms had no discernible effect on quality, efficiency and other management indicators, while leading to an increase in hospital costs and out-of-pocket payments. Also, implementing these reforms affected the progress toward achieving UHC. Overall, the results showed that there are two factors in failed implementation of these hospital reforms in developing countries: (1) lack of a systematic and holistic view, and (2) incomplete or poor implementation of different aspects of these reforms.