Developing a model of public health system strengthening during pandemic of new emerging respiratory diseases for Iran: A protocol study.

The objective of this article is to propose a protocol for developing a model for strengthening the public health system in Iran. Currently, there is no clearly articulated model for strengthening public health systems during the pandemic of new emerging respiratory diseases in Iran. The protocol described here aims to: (1) identify components for strengthening public health systems, during the pandemic of new emerging respiratory diseases worldwide, (2) identify components for strengthening Iran's public health system, and (3) design a model for strengthening the public health system in Iran during the pandemic of new emerging respiratory diseases. The protocol proposes three phases. In the first phase, a realistic review will be conducted to identify components for strengthening public health systems worldwide based on six building block framework. In the second phase, a qualitative study will be used to identify components for strengthening public health systems in Iran during the pandemic of new emerging respiratory diseases. In the third phase, an initial model will be designed, and the Delphi technique will be used to finalize the model. Due to fragility and the significant strain that public health systems experienced during the pandemic, it is imperative to introduce a model that strengthens public health systems through some initiatives and strategies and explains the mechanisms by which they operate. A realist review and qualitative study will provide the evidence needed to support the effective implementation of public health interventions, taking into consideration the diverse contexts of these interventions in Iran.

Hospital performance evaluation indicators: a scoping review.

BACKGROUND: Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. METHODS: We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. RESULTS: We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. CONCLUSION: The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.

Hospital governance accountability structure: a scoping review.

INTRODUCTION: Hospitals, as complex organizations with clinical, financial, and social functions, face different barriers to providing high-quality and safe services at reasonable costs. Various initiatives have been carried out in hospital governance to improve quality, safety, and accountability. This research aims to identify the structures and dimensions that make hospital governance accountable. METHODS: The research used Arksey and O'Malley's scoping review framework to examine the research literature on hospital governance structure and accountability. The literature review included PubMed, Web of Science, Embase, Scopus ProQuest, Google search engine, and Google Scholar databases from 2010 to 2023. Data were analyzed using the content analysis method. RESULTS: Excluding unrelated and duplicate sources, 40 articles and reports were included in the study. The studies were reviewed and analyzed based on organizational type, type of source, year of publication, objectives, and key findings. Accountable governance features were extracted from the selected articles and reports. The four main themes include inclusive governance, commitment to accountability, planning for accountability, and autonomous governance. Thirteen subthemes were extracted from the study literature. CONCLUSION: Various initiatives have been implemented regarding the reform of the governance structure of public hospitals in different countries. Many of these reforms aim to improve financial and clinical accountability. The study results could be used to identify the structures and dimensions that make hospital governance accountable.

Post-discharge follow-up system in psychiatric patients: A case study of Farabi Hospital in Isfahan.

BACKGROUND: Mental illness is one of the most common problems in human societies and the continuation of care and post-discharge follow-up. This study was conducted to define a post-discharge follow-up framework for Farabi Hospital in Isfahan. MATERIAL AND METHODS: This was a multistage study, including, interviews literature review, and focus group discussions. Participants included 18 purposefully selected nurses, physicians, and managers, directly involved in the discharge process of Farabi Hospital in Isfahan. The interviews were semi-structured. Data were organized using MAXQDA10 software. The initial framework was set through the extraction of semantic main and secondary codes. The framework was finalized through three several focus group discussion sessions. RESULTS: Results included of 17 sub-categories and seven main categories as "education," organizational arrangement," "team-building," "patient and family participation and trust," "engaging some supportive institutions of community," "process management" and "information management." CONCLUSIONS: To implement a post-discharge follow-up system for psychiatric patients in Farabi Hospital of Isfahan must be concentrated to patient and family education, team building, organizational arrangements, participation, and trust of patients and family, while engaging community health centers and notice to information and management and process management.

The organizational health components for small-sized health-care organizations: A systematic review.

BACKGROUND: Organizational health (OH) is an organizational aspect in which staff is encouraged to be clearly involved and participate in decision-making, problem solving, and collaborating to improve organizational climate and culture. Multilevel staff involvement facilitates strengthened relationships, open communication, trust, and organizational commitment. The purpose of this study was to find components of OH for small-sized health-care organizations. METHODS: A systematic review across three key databases by using an extensive list of keywords components and interventions was conducted. This survey included studies that explored various OH elements, components and interventions. RESULTS: It comprises 34 full-text studies from 221 received studies. Afterward, the OH elements were classified into three main categories (OH elements, organizational health literacy, and organizational health interventions). Then, according to the reviewed data, 23 dimensions were defined similarly for all groups of studies and relevant explanations related to them were reported. CONCLUSION: The OH encompasses multiple dimensions. Empirical research is required for designing a questionnaire according to the final extracted components and measuring its validation in small-sized health organizations.

Designing the competency-based training model of Iranian medical tourism.

BACKGROUND: Despite the great comparative advantage of Iran in terms of infrastructure, technology, and human resources as well as the significance of medical tourism in the tourist industry, in practice, the quality of human resources has received less attention. Consequently, this study was conducted to design a model of competency-based training for Iranian medical tourism. MATERIALS AND METHODS: This study was an exploratory mix, and the Delphi method and semi-structured interviews were used for the qualitative part of this study. In the second part, the analytical method was utilized for the quantitative part of this study. RESULTS: The results indicated the main components of medical tourism to be public interactions and private interactions and seven subcomponents. Medical Tourism's Competency includes three main components and seven subcomponents. CONCLUSION: Although some training separated and scattered is present in Iran's medical tourism. However, Iran requires a comprehensive training model of which its design was explained in this paper.

Public-private partnership in Iranian hospitals: Challenges and opportunities.

BACKGROUND: Nowadays, various strategies are applied by governments to control costs and finance hospitals and the health sector. Public-private partnership (PPP) option is one of these strategies. Considering the growing importance of hospitals in different communities and their problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This study aimed to identify the challenges and opportunities of PPP in the country's hospitals and then offered an appropriate solution to overcome these challenges. MATERIALS AND METHODS: This is a qualitative study and content analysis approach is undertaken. The participants were selected through purposive sampling and data were collected using a semi-structured interview with experts in the public and private health sector until the saturation point achieved. Data analysis was performed through the thematic analysis of expert's statements using MAXQDA. 10 software in this sector. RESULTS: According to the study results, 3 main themes (challenges, opportunities, and solutions), 10 sub-themes, and 32 codes were identified in relation to the public and private partnership. 4 sub-themes on challenges of PPP, 3 sub-themes on partnership opportunities and 3 sub-themes on challenges solutions were identified. CONCLUSION: The results of this study revealed that given the discussed challenges the most important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated outsourcing backed with adequate supervision could solve many current hospitals' problems.

Health-care reform implementation challenges at suburban areas in Isfahan province: A qualitative study.

BACKGROUND: Health system reform plan in public health sector in Iran in the first phase focused on improving primary health care in suburban areas in and around big cities. The present study was conducted to assess the implementation process challenges of the reform plan in comprehensive health service centers at suburban areas of Isfahan in 2019. MATERIALS AND METHODS: This qualitative study with conventional content analysis approach was conducted in 2019. Participants were purposefully selected and interviewed at provincial levels from Isfahan University of Medical Sciences health department and health-care providers of comprehensive health services centers. The saturation point was reached after 21 face-to-face semi-structured interviews. Thematic analysis was employed to analyze transcribed documents assisted by MAXQDA version 10. RESULTS: The results revealed four main themes; the human resource management, the executive management, the electronic infrastructure, and the resource management. The major challenges in the implementation planning process included: the referral system, monitoring and supervision, electronic services infrastructure in the design and development of the EHR called the SIB system, lack of instructions guide, salaries and benefits, inconsistent financial and human resources and inappropriate allocation of theses resources. CONCLUSION: Despite the achievements in the development of the Iran health system reform plan, there were many challenges in the implementation planning process. It is recommended that theses challenges be reviewed and amended by health system managers and policymakers.

Resource generation challenges for burn care in Iran.

BACKGROUND: Given the importance of investment in human and physical resources and knowledge in burn injuries for improving health service performance, this study endeavoured to identify resource production challenges in the burn care of Iran. METHODS: In this descriptive qualitative study, semi-structured interviews were conducted with 21 key informants. The purposive sampling method was applied to select interviewees, and data collection through interviews was continued to achieve data saturation. Using the framework of Adams et al. for health resource production, the directed content analysis approach was undertaken to analyse the qualitative data. RESULTS: Three main themes and seven sub-themes were identified, and the main themes (sub-themes) were human (the lack of motivation, job stressors and the lack of clinical staff), physical (capital resources and consumables) and intellectual (burn care education and staff training) resources. CONCLUSION: In general, investment in different areas would help provide better burn services, including educating and empowering employees, motivating through identifying and defining their needs, and considering points for job stressors as work hardship, burnout and workplace harassment. Other areas of investment are increasing the recruitment of burn section personnel, providing burn specialized equipment and updating them, providing standard physical space, and supplying consumables such as medicines and dressings.

Main Factors Affecting the Readiness and Responsiveness of Healthcare Systems during Epidemic Crises: A Scoping Review on Cases of SARS, MERS, and COVID-19.

Background: Given the significance of the preparedness and responsiveness of healthcare systems in relation to epidemics, this study aimed to determine their influencing factors during epidemic crises with a view to utilizing the findings in the battle against the coronavirus disease 2019 (COVID-19) outbreak. Methods: This scoping study was conducted in 2020 via the Arksey and O'Malley approach. A systematic search was conducted on five online databases from January 2000 to June 15, 2020. Initially, 1926 English articles were retrieved based on their abstracts. After the screening process, 60 articles were considered for the final analysis. Data were charted by applying Microsoft Office Excel 2013 and were synthesized via thematic analysis. Results: Five main factors have affected the responsiveness and preparedness of countries during the epidemics of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19: community-related interventions, managerial interventions, socioeconomic factors, the readiness of hospitals and health centers, and environmental factors. These themes are associated with 38 related sub-themes. The thematic framework shows that interactions between these five determinantes can affect the preparedness and responsiveness of healthcare systems during pandemics/epidemics. Conclusion: According to the results, healthcare systems need to pay attention to their internal capacities, managerial interventions, and health centers to overcome the current pandemic. They should also consider such external factors as socioeconomic and environmental determinants that can affect their potential preparedness against pandemic/epidemic crises. Community-related interventions such as improvement of the community health literacy, teamwork, and social responsibility can enhance the readiness of healthcare systems against the COVID-19 outbreak.

'Poverty's scar: A qualitative inquiry of financing shortcomings in specialized burn hospitals.

BACKGROUND: Victims of burn have particular characteristics such as high vulnerability, expensive treatment, and cost of burn services. Thus, the financing of burn services is crucially important. The purpose of the present work is to recognize the financing challenges in Iranian specialized burn hospitals (SBHs). METHODS: In the present qualitative descriptive research, purposive sampling was used for selecting key informants with maximum variation at local, provincial, and national levels. Semi-structured interviews were used for data collection. Interviews were continued as long as the saturation point was achieved at the 21 st interview. We employed conventional content analysis using an inductive data-driven coding process and theme development for the analysis of the transcribed documents by MAXQDA Analytics Pro 2018 (VERBI GmbH Release 18.2.0 Berlin). RESULTS: We extracted 3 themes and 12 sub-themes, including resource mobilization (the poor burnt victims, unique feature of the single- SBH, high direct and indirect costs, and poor intra-sectoral advocacy), insurance coverage for burn care (incomplete breadth of population coverage, inadequate depth of benefits package and coverage of costs, and reimbursements of burn care) and mechanism of financial resource allocation (unsuitable payment system, less sustainable budgeting, inappropriate tariffing for burning services, top-down budgeting approach, and politicized budget process). CONCLUSIONS: We suggest that health policy-makers in Iran could modify the SBHs financing system by improving resource mobilization, scaling up insurance coverage for burns, and optimizing the allocation of financial resources. Besides, we propose several points for policy entry to address SBHs financial difficulties. These points are serious attention to vulnerable and the poor burn patients, provision of burn care in multi-specialized hospitals, strengthening intra-collaboration, revision of tariffs, and payments for burn services, and preservation and realization of burn budgeting.

Outsourcing in Health Facilities: Challenges in Medical University of Isfahan in Focus.

INTRODUCTION: Outsourcing is one of the major strategies for keeping competitive gain in today's highly varying markets, especially in health systems. This study endeavored to identify operational challenges of outsourcing health facilities affiliated to Isfahan University of Medical Sciences in the academic year 2019. METHODS: This qualitative study was conducted with content analysis approach. To conduct the interview, key informants were from the managers of health facilities and decision makers of health deputy and managers from private sector were selected through purposive sampling. The saturation point was reached at 12 semi-structured interviewees; this way, data were collected through interviews with experts. A thematic analysis was employed to analyze the transcriptions by MAX QDA10. RESULTS: According to the results of thematic analysis, seven major themes identified as operational challenges of outsourcing health services in health facilities with 40 sub-themes. CONCLUSIONS: Outsourcing health services in health facilities needs to be done more scientifically and logically. Decision makers must predict the challenges and apply solutions before outsourcing, supervise, and evaluate the impacts of outsourcing after at least 1 year.

Rationing access to total hip and total knee replacement in the Islamic Republic of Iran to reduce unnecessary costs: policy brief.

Rationing health services is an inseparable part of the health system of any country in order to achieve universal health coverage. Elective surgery for total hip and total knee replacement places a high financial burden on health systems. Such surgery should be done in a way to ensure that the people who most need it receive the service. Models for rationing total hip and knee replacement surgery were reviewed to suggest the best policy for rationing such surgery in the Islamic Republic of Iran. We propose a system with three main tools: clinical guidelines, gate keepers and waiting lists, with shared decision-making as an auxiliary tool. Patients should be scored at the primary health care level based on clinical and radiographic examination, alternative treatments (conservative treatments) and risk factors, with a set threshold for referral. Patients whose scores are above the threshold should be referred to secondary health care. These patients should be assessed again by specialists based on age, bone condition, surgery risk and other alternative treatments. Patients whose scores are above the threshold should be put on the waiting list for surgery.

Does Intradisciplinary Conflict Influence to Outcomes of Emergency Medicine Residency Program? A Mixed Methods Study.

OBJECTIVE: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors. METHODS: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach. RESULTS: The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits. CONCLUSION: This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

Iranian Households' Payments on Food and Health Out-of-Pocket Expenditures: Evidence of Inequality.

BACKGROUND: Inequality in households' payments on food and health expenditures presents the accessibility and utilization patterns between them. This study investigated the Iranian rural and urban households' inequality in payments on food and Out-of-Pocket health expenditures from 1998 to 2012. METHODS: This descriptive study was conducted through the analysis of Iranian Statistics Centre data on Iranian households' income and expenditures. The Gini Coefficients, Concentration and Kakwani indices have been calculated for Iranian rural and urban households' Out-of-Pocket health and food expenditures. RESULTS: The means of Iranian rural and urban total consumption expenditures inequality were 0.48 and 0.48, respectively. The means of concentration index of food expenditures for rural and urban regions were 0.35 and 0.34, respectively. The means of Out-of-Pocket payments for health services for rural and urban regions were 0.51 and 0.5, respectively. Finally the means of Kakwani index of Out-of-Pocket health payments in rural and urban households were -0.005 and -0.018, respectively. CONCLUSION: There are relative high levels of inequality in Iranian households' payments on food and Out-of-Pocket health expenditures.

Electronic Health in Perspective of Healthcare Managers: A Qualitative Study in South of Iran.

BACKGROUND: The important role of electronic health as well as importance of health care systems awareness and readiness may lead to develop the essential infrastructures for electronic health especially in developing countries. This study aims to investigate goals, gains, applications, challenges and other important issues related to success performance of electronic health. METHOD: This research proposed a grounded theory in a qualitative design and a purposive sampling was used to select participants which consisted of 28 hospital managers and staff field managers working in deputy of health and curative affairs of Medical Science Universities in south of Iran. Semi structured interviews were conducted using a topic guide and intended themes derived from the results using Max QDA software during five steps. RESULTS: Nine themes through interviewees" viewpoints were made up as followed: Electronic health definition, necessity and importance of electronic health, electronic health advantages, relationship between electronic health and internet, physicians" opposition to electronic health, prerequisites for electronic health, solutions for applying electronic health plan, factors affecting electronic health acceptance in society and electronic health system challenges. CONCLUSION: It seems that there are good circumstances in the south medical universities about settlement and implementations of electronic health and their managers are aware of its advantages, importance and necessities. The present findings implicate that these organizations should consider the user friendly and probable resistances of the present clients, in this regard it is suggested that the used technology must be accepted by users, having standard base, inexpensive and simple enough while less vulnerable in response to changes.