Evaluation of social accountability in hospital managers.

BACKGROUND: Today, hospitals need managers who, in addition to having the necessary skills for management and leadership, are accountable to stakeholders, especially the community. Accordingly, the purpose of this study was to evaluate the social accountability of managers of public and private hospitals in Tehran. MATERIALS AND METHODS: The present study is descriptive-analytical and cross-sectional and was performed on 155 managers of selected public and private hospitals in Tehran. The research tools included a demographic characteristic questionnaire and a researcher-made social accountability questionnaire for managers. Data analysis was performed using descriptive and inferential statistics in SPSS 22 software. RESULTS: The situation of social accountability in the managers of public hospitals was at a weak level and in the managers of private hospitals in Tehran was at a good level. In comparing the status of social accountability and its dimensions in the managers of public hospitals with the managers of private hospitals, the status of social accountability in the dimensions of human resource management, quality improvement, executive management, and overall social accountability were significantly different from each other (P ≤ 0.05). However, in terms of governance, the status of social accountability of public hospital managers was not significantly different from private hospitals (P ≥ 0.05). Overall, the results of social accountability in private hospitals were better than in public hospitals. CONCLUSION: The social response status of managers in private hospitals was better than public ones. Lack of attention of managers to social accountability affects the quality of other educational, health, and medical services. This fact raises the need for managers to pay more attention to the issue of social accountability.

The challenge of outsourcing of hospital services in Iran: A qualitative study.

INTRODUCTION: Outsourcing, as one of the important managerial strategies to improve performance, has become one of the main areas of research in hospital management studies. The aim of this study was to identify the challenges of outsourcing hospital services in Iran. METHODS: This research was conducted in a qualitative manner with the aim of determining the challenges of outsourcing hospital services in Iran. The research community consisted of managers and experts in the field of outsourcing. 21 managers and staff experts of the Ministry of Health, universities, and hospitals affiliated to Iran University of Medical Sciences, Tehran, and Shahid Beheshti, were selected as the target for the interview. Finally, the data were analyzed using content analysis method. RESULTS: Outsourcing challenges were extracted and reported in the form of 6 theme topics and 40 subthemes. The main issues included legal and political challenges, finance, human resources, organizational, managerial, and private sector. CONCLUSION: Outsourcing hospital services in all six areas faced serious challenges. To this end, partnership between the private and government sectors through outsourcing requires the continuous development of effective political, organizational, and managerial capacity in order to guide and manage this process properly and efficiently to ensure that the goals and policies in the field of health. It is clearly understood and not forgotten or neglected.

Assessment of clinical and paraclinical departments of military hospitals based on the Pabon Lasso Model.

INTRODUCTION: Today, it is important to use different indices to measure the performance of hospitals. This study aimed to investigate and evaluate the performance indicators of military hospitals and measurement of performance by using the Pabon Lasso model. METHODS: This was an applied and descriptive-analytical study that was conducted among five military hospitals affiliated to the Army of the Islamic Republic of Iran by using data from 2017 to 2018. Raw data related to performance indicators such as bed occupancy ratio (BOR), average length of stay (ALoS), and bed turnover rate (BTR) were collected by referring to the hospital medical record unit. After comparing performance indicators with the standards of the Ministry of Health, the Pabon Lasso model was used to measure hospitals' performance. RESULTS: In general, the average BOR and bed turnover interval rate are higher than that of the national standard in all hospitals and are in favorable status. However, the average length of stay in all hospitals was in unfavorable status. Furthermore, one and two hospitals were located in zone 3 in Pabon Lasso graph in the years 2017 and 2018, respectively. Overall, there was no change in the performance of the hospitals in the study time periods. CONCLUSION: In general, except for the average length of stay indicator, hospitals had a favorable performance level. Therefore, planning to improve performance indicators should be at the top of the programs.

Staff perspectives on the relationship between knowledge management and social capital with organizational health in selected educational hospitals in Tehran.

INTRODUCTION: Knowledge management enhances efficiency, empowers employees, and enhances organizational health. Social capital provides a good basis for more productive human resources, and training hospitals also play a key role in the health-care system. The purpose of this study was to determine the relationship between knowledge management and social capital with organizational health in selected educational hospitals of Tehran in 2018. METHODS: This analytical cross-sectional study was performed on 310 medical staff of hospitals using proportional sampling method. The data gathering tools consisted of three standard questionnaires of knowledge management, social capital, and organizational health. Data were analyzed using descriptive and inferential statistics using SPSS version 22 software. RESULTS: Most participants in this study were male (8/66%) and in the age group 31-36 years. The mean of knowledge management and organizational health were 3.43 and 3.49, respectively. There is a significant direct relationship between knowledge management components and organizational health. Moreover, there is a significant but weak direct relationship between knowledge management and social capital with organizational health dimensions (P ≤ 0.05). CONCLUSION: Considering the relationship between knowledge management and social capital with organizational health, enhancing the level of organizational health can help to improve the dimensions of knowledge management and social capital. It is suggested that hospital managers, using knowledge management and social capital components, enhance organizational health so that the hospital is more prepared to adapt to the complexities and changes in the market providing services.

The Factors Associated With Direct Medical Costs in Patients With Gastric Cancer: Quantile Regression Approach Compared With Gamma Regression.

OBJECTIVES: Evaluating the costs of illness can provide evidence to improve performance at all levels of health organizations. This study aimed to identify the relationship between the costs of diagnosing and treating patients with gastric cancer and their explanatory variables, using quantile and gamma regressions and comparing the results of the two models. METHODS: This was a cross-sectional and descriptive-analytic study carried out in 2016. In total, 449 patients with gastric cancer were selected at a hospital affiliated with Mashhad University of Medical Sciences. Direct costs and other variables were collected from medical documents. Data were analyzed using the STATA 12 software, using quantile and gamma regression analysis, and the results were compared. RESULTS: The highest average cost per patient was related to hospitalization costs in both metastatic (20 911 034 Iranian Rials) and nonmetastatic patients (20 738 062 Iranian Rials). The lowest average cost was related to biopsy services in nonmetastatic patients. The results of the study also showed that quantile regression is an appropriate substitute for gamma regression and, in some cases, can provide more information for the analysis of disease costs. Based on the results of the quantile regression, being a male and having a shorter stay had a positive effect on cost and the age of the patient had a significantly negative effect. CONCLUSIONS: Examining the cost of a common illness, such as gastric cancer, is an important economic tool for policy makers and decision makers. It provides evidence-based decision making about resource allocation that they can use for future planning and cost control.

Cost analysis based on performance indicators during Healthcare Reform Plan in selected educational hospitals.

INTRODUCTION: Hospitals are the main axis of health-care reforms or national health plans; therefore, accurate recognition of hospital costs based on operational indexes to these plans is necessary. The impact of implementing national health plans on the performance of health systems is ambiguous and misleading; therefore, the aim of this study was to assess the impact of Healthcare Reform Plan (HRP) on the micro level (e.g., educational or university hospitals). METHODS: This study was a descriptive retrospective study that research variables are checked in 1 year before and mean of 3 years after implementation of HRP by self-administrated checklist in selected public-educational hospitals covered by the medical universities in Tehran. The final analysis of the data was performed using cost-performance ratio and independent t-test for comparing the variables' changes before and after HRP. RESULTS: Unlike adjusted hospitalization costs, most operational indexes were not significant. The per capita cost adjusted of hospitalization in first and mean of 3 years after HRP increased 49.49% and 16.31%, respectively (P < 0.001), the adjusted cost per day was increased by 24.48% and 21.46% (P < 0.001), and adjusted cost per bed was increased 47.06% and 20.07% compared to before HRP (P < 0.001). CONCLUSION: Given the lack of alignment in adjusted cost changes in exchange for functional indicators, certainly, it cannot be argued that HRP had a favorable or undesirable effect on the hospitals.

Investigating the effects of human health resource changes on the basic health indicators in Iran: An econometric study.

INTRODUCTION: In the development perspective of each country, it is important to pay attention to the health sector and improve health indicators; therefore, planning in training and distribution of human resources in the health sector is an important factor to achieve the health system goals. The aim of this study was to investigate the effect of changes in health sector human resources on infant mortality rate (IMR), maternal mortality rate (MMR), and under-five mortality rate (U5MR) in Iran. METHODS: This was an econometric study (data panel) that conducted retrospectively and used data from the period 2006 to 2017 among Iranian provinces. Three regression models were used to determine the effect of health sector human resources (physicians, nurses, and paramedical staff) on the IMR, MMR, and U5MR. The random-effects model was selected over the fixed-effects model to assess the effect of health sector human resources on health outcomes. RESULTS: Results showed that the number of physicians in different models has a stronger impact on these mortality rates than those of nurses and paramedics, so that a 1% increase in the number of physicians leads to 2.1%, 3.8%, and 2.2% decrease in IMR, MMR, and U5MR, respectively. Furthermore, per capita income has a bigger impact on these mortality rates than human health resources. CONCLUSION: Increasing the number of human resources in the health sector, especially the number of physicians, by investing in these resources by providing educational facilities, plays an important role in improving the mothers' and infants' health indicators.

Determining the relationship between health literacy level and quality of life among the elderly living in nursing homes.

BACKGROUND: The literacy level of the elderly is predictive of health behaviors, average hospitalization in health centers, and the type of verbal interaction with health service providers; as the level of literacy changes, the quality of life may also change. This study aimed to determine the relationship between health literacy level and quality of life among the elderly living in nursing homes in 2018-2019. MATERIALS AND METHODS: This study was of a descriptive-analytic, correlation type that was performed on 175 elderly of selected nursing homes in Tehran. The research tools included the Abbreviated Mental Test; Control, Autonomy, Pleasure and Self-realization questionnaire-19; and Health Literacy of Iranian Adults Questionnaire (HELIA). Data were analyzed using descriptive and inferential statistics by SPSS 22 software. RESULTS: The total score of health literacy and the quality of life of the elderly was 51.01 and 47.75, respectively. The literacy of most of the studied samples was "inadequate" and "not much adequate" (0-66). The relationship between health literacy and quality of life in the elderly was significant, and there was a direct and statistically significant relationship between them (P = 0.003). That is, by an increase in literacy rates, the scores of quality of life of elderly people were also increased. The correlation was equal to r = -0.28. Health literacy has the ability (31.98%) to predict the quality of life. CONCLUSION: The results showed a lack of enough education literacy, the average quality of life, and the existence of a significant relationship between health literacy and quality of life in the elderly. The wide range of inadequate literacy in the elderly reveals the importance of paying more attention to the issue of literacy in health planning and health promotion at the national and local levels.

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.

Developing and validating a checklist for accreditation in leadership and management of hospitals in Iran.

INTRODUCTION: In the Iranian Accreditation System, leadership and management standards have been almost ignored and not paid enough and necessary attention to the structural components and the infrastructures standards in management and leadership sections. Governing body, medical staff, chief executive officer (CEO), and nursing management standards are inadequate and lack accountability. These standards could lead to reform and finally provide the context for accomplishment of an appropriate accreditation program. MATERIALS AND METHODS: This is a descriptive, comparative, and qualitative study. It was done in two phases. The first phase included literature review of the standards of the selected countries followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing management standards to develop the primary framework for Iranian hospitals. In phase two, the primary framework was validated true three rounds of Delphi technique. RESULTS: Surveying the accreditation system standards in selected countries included the USA, Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify as governing body, medical staff, CEOs, and nursing management standards. The result of this study provides a framework for improvement of the Iranian national accreditation program. CONCLUSION: In regarded to the importance of the leadership and management standards in reform and change and promotion of the health services quality, efficiency, and effectiveness, the results of this study showed that the present standards of the Iranian accreditation assessment system and guidelines lack the necessary infrastructures for implementing a successful national accreditation program.

Implementing clinical governance in Isfahan hospitals: Barriers and solutions, 2014.

INTRODUCTION: In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance. AIMS: In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions. MATERIALS AND METHODS: This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software. RESULTS: According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors. CONCLUSION: Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.