Strategies to strengthen a climate-resilient health system: a scoping review.

BACKGROUND: Climate change is a major global threat to human health and puts tremendous pressure on health systems. Therefore, a resilient health system is crucial to enhance, maintain, and restore the population's health. This study aimed to identify interventions and actions to strengthen a climate-resilient health system to deal with the adverse health effects of climate change. METHOD: This study was a scoping review. Five databases and Google Scholar search engine were searched using relevant keywords. Initially, 4945 documents were identified, and 105 were included in the review. Content thematic analysis method was applied using MAXQDA 10 software. RESULTS: Overall, 87 actions were identified for building a climate-resilient health system and were classified into six themes (i.e., governance and leadership; financing; health workforce; essential medical products and technologies; health information systems; and service delivery). The most commonly reported actions were formulating a national health and climate change adaptation plan, developing plans for essential services (electricity, heating, cooling, ventilation, and water supply), assessing the vulnerabilities and capacities of the health system, and enhancing surveillance systems targeting climate-sensitive diseases and their risk sources. CONCLUSIONS: A holistic and systemic approach is needed to build a climate-resilient health system owing to its complex adaptive nature. Strong governance and leadership, raising public awareness, strategic resource allocation, climate change mitigation, emergency preparedness, robust health services delivery, and supporting research, are essential to building a climate-resilient health system.

Resiliency of the Iranian healthcare facilities against the Covid-19 pandemic: challenges and solutions.

BACKGROUND: Health care facilities are responsible for preventing and controlling diseases and must be resilient enough to deal with crises. The Iranian health care facilities have faced challenges in managing COVID-19 pandemic. The purpose of this study was to identify the challenges faced by the Iranian health care facilities during the Covid-19 epidemic and to provide solutions. METHODS: This qualitative study was conducted with a phenomenological approach and using semi-structured interviews with 59 healthcare policy makers, managers, and employees, and medical university faculty members. The participants were selected through purposive and snowball sampling. Thematic analysis was used to analyze the data. RESULTS: Overall, 43 challenges to the resilience of health care facilities during the Covid-19 pandemic were identified and grouped into 8 themes (i.e., leadership and management, planning, organizational culture, organizational learning, employee management, customer management, resource management, and process management. The most important resilience challenges were: fragmented management system; poor leadership; incompatible health network structure; lack of a national holistic plan; poor case detection; insufficient resources; inefficient information system; negative attitude of managers and employee; organizational inertia; failure to build on lessons learned from crises; low workforce preparedness; lack of community-based management; and improper monitoring and evaluation. Managers should use community-based, evidence-based, and integrated management to build health system resilience against COVID-19, have sufficient knowledge and experience to organize operations, use appropriate and effective coordination models, develop a creative and participatory culture, reengineer processes, and provide necessary resources. CONCLUSION: The Iranian health care facilities face challenges that prevent them from becoming resilient, responsive, and efficient in managing COVID-19. Policy makers and managers should increase the resilience of health care facilities to shocks and crises by using the suggested measures.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran.

Background: It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. Aims: To identify the role of midwives in the provision of reproductive health services and recommend improvements. Methods: A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. Results: The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. Conclusion: There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Factors affecting nurses' retention in Iranian hospitals.

AIM: This research was conducted to study the factors affecting nurses' retention in Iranian hospitals. BACKGROUND: Health care systems should pay attention to their human resources' retention to deliver health care services and maintain their organizational values. This issue becomes more significant when we consider the human and financial limitations in place. METHOD: Data were analysed using conventional qualitative content analysis based on the model developed by Elo and Kyngäs. Forty-two managers and nurses were selected by purposive sampling. Data were obtained through 45 semi-structured interviews until data saturation was reached. RESULTS: The data analysis resulted in four main categories and 17 subcategories. The main categories included dignity and respect, ethics and spirituality, empathy, and flourishing. The main theme extracted was 'maternal management'. CONCLUSION: The present study proposes 'maternal management' as a strategy to increase the retention of nurses.

Taxonomy of effective strategies to reduce unnecessary caesareans: a systematic review.

BACKGROUND: The increasing trend in unnecessary caesarean sections has caused maternal and neonatal health concerns worldwide. Various medical and non-medical interventions have been designed and implemented to reduce caesarian section overuse. However, their efficacy is questionable. AIMS: This study aimed to identify and classify effective interventions to reduce unnecessary caesarian sections. METHODS: We searched EMBASE, MEDLINE, Web of Knowledge and Scopus databases for articles, using appropriate search strategies, up to 2 June 2020. Overall, 7951 identified articles were screened and assessed using a valid quality assessment checklist. Finally, 109 eligible studies were included in this review. Thematic content analysis was used to identify and classify the effective interventions. RESULTS: Overall, 188 effective caesarian section reduction measures were identified. They were categorized into 45 actions, 16 intervention groups and 6 WHO building blocks, including "governance and leadership", "financing", "health workforce", "medical products and technologies", "information" and "service delivery". Using qualified and competent staff, intra-partum services, and oversight were the most commonly applied interventions to reduce unnecessary caesarian sections. CONCLUSIONS: A taxonomy of effective strategies to reduce unnecessary caesarian sections was developed in this study. A holistic approach is crucial to addressing the new epidemic of unnecessary caesarian section. Multiple interventions based on the underlying causes of caesarian section overuse should be designed and implemented at local and global levels.

Why TQM does not work in Iranian healthcare organisations.

PURPOSE: Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran. DESIGN/METHODOLOGY/APPROACH: This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation. FINDINGS: TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers' about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers' and employees' commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively. PRACTICAL IMPLICATIONS: Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence. ORIGINALITY/VALUE: Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.