Health System Policy Makers Research Articles

An update on ICES’ Applied Health Research Question (AHRQ) program: Informing public health policy and practice using linked, population-based administrative health data in a collaborative model.

ObjectiveTo provide an update on the key characteristics, refinements to project flow, and future opportunities for a program providing customized research evidence to health system policymakers and providers. ApproachWith a goal to inform health system decision making, the program answers research questions posed by health system requestors that can be answered with linked, population-based administrative data. Now in its 10th year of operation, the program has been refined over time to improve efficiency, usefulness of research products, and requestor satisfaction. Satisfaction surveys and individual-level engagements with requestors are used to collect feedback on the needs of an increasingly diverse group of requests. ResultsWith 508 requests, 82 Data Sharing Agreements, and 257 unique requestors since its inception, the program informs governmental decision making, evaluates intervention effectiveness, and aids grassroots organizations’ planning for services. Notable updates to the program include, inserting multiple opportunities for connection between the program and requestors through the project life cycle to understand goals and needs; assigning staff scientists to shepherd projects and promote efficiency; training coordinators to review privacy impact assessments; and (soon) accepting a broader range of projects to include data beyond the health sector e.g. education. ConclusionThis program continues to improve and is an exemplar of sustainable approaches to supporting health system requestors with evidence from administrative data in program evaluation, planning and policy change. ImplicationsBeing responsive to requestor needs has allowed the program to attract an increasingly diverse range of requesters who can obtain impactful and timely research evidence.

Polypill versus medication monotherapy in the prevention of cardiovascular diseases in Iran: An economic evaluation study.

Cardiovascular diseases (CVDs) are one of the major diseases in developing and developed countries and have high prevalence and mortality rates. Pharmacological interventions, especially the use of combination medications, can have preventive effects in patients with CVDs. Recently, in the PolyIran trial, a combination of atorvastatin, hydrochlorothiazide, aspirin, and valsartan or enalapril (Polypill) was shown to be effective in providing survival benefits as a primary prevention strategy. In the present study, we examine the cost-effectiveness of the use of polypill compared to its individual components (named as medication monotherapy) in the prevention of CVDs in Iran. This was an economic evaluation study conducted to compare the cost-utility of polypill with that of medication monotherapy for 10,000 hypothetical cohorts of people over 35 years of age using the Markov model and with a lifetime horizon. The study perspective was patient perspective and direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio were estimated. To deal with uncertaintysensitivity analyses were used. The results showed that polypill, with the lowest costs (871 USD) and highest QALYs (14.55), had the most cost-utility than medication monotherapy. Also, the results showed that the highest sensitivities were related to the utilities of angina and stroke states. At the 21,768 USD threshold, polypill had a 92% probability of being cost-effective versus other medications. Considering that polypill had the most cost-utility, it is suggested that health system policymakers pay special attention to polypill in designing clinical guidelines. Also, through covering this medication by health insurance organizations, it is possible to complete the country's medicine pharmacopeia in preventing CVDs.

What is the best set of indices/indicators for evaluating “health promotion governance” in health systems? A proposed methodology for health promotion decision-making

ABSTRACT We aimed to identify the indices/indicators needed for assessing health promotion governance in health systems. Data were obtained from a literature review, a modified Delphi process, and an Analytic Hierarchy Process (AHP). The study was conducted from May 2021 to January 2022 using a multi-method design comprised of four sequential stages: (1) a comprehensive literature review for identifying the health promotion indices/indicators originating from the Ottawa Charter’s action areas; (2) a 3-round Delphi survey to identify, by consensus, which of those indices/indicators would be relevant to the health promotion governance in the health system;(3) Analytic Hierarchy Process technique (AHP) to prioritize the selected indices/indicators; (4) presenting the results of AHP to a group of the health promotion specialists of the selected experts to selecting other indices/indicators if necessary. Health literacy was considered the most important index to assess health promotion governance from experts’ perspectives. The per capita public health expenditure was supposed to be the second most important indicator. The indices ranked third and fourth in priority were the health equality and urban health indexes, respectively. The health promotion specialists selected three other indices: the number of policies changed due to advocacy, social capital, and positive health. Based on the results, a series of essential indices/indicators have been proposed depending on the study’s purpose, which can help health system policymakers and managers to assess the health promotion governance in the health system.

Exploring the Challenges in Covering Dental Services through Complementary Insurance in Iran: A Qualitative Study.

Financial protection is crucial for attaining universal health coverage. The inclusion of costly dental services in insurance plans poses a significant challenge for all parties involved in the insurance sector. This study aimed to investigate the challenges of covering dental services by complementary insurance in Iran during 2020-2021. This qualitative research was conducted in Iran during 2020-2021. A triangulation of methods and data sources were employed to achieve a comprehensive perspective. In-depth semistructured interviews were conducted on an individual basis, and all national documents, rules, regulations, and instructions pertaining to complementary dental insurance were thoroughly reviewed. Purposeful sampling was used to select participants from all stakeholder groups engaged in dental insurance coverage, including (1) health system policymakers, (2) insurers, (3) policyholders, (4) care providers (dentists), and (5) insured people. Six open-ended questions were formulated to explore various facets of dental insurance, including (1) development, (2) management, (3) population coverage, (4) premium calculation, (5) services coverage, and (6) payment and reimbursement mechanisms. With the consent of the participants, all interviews were recorded and transcribed verbatim. The gathered data were evaluated using a framework analysis approach in the MAXQDA20 software. Finally, the primary themes, each encompassing multiple subthemes, were identified and presented. A total of 26 interviews were conducted with five groups of interviewees, and nine national documents were evaluated. Six themes were extracted, which included 18 codes from the interviews and seven codes from the documents. The extracted themes were as follows: (1) Insurance commitments and service coverage, (2) reimbursement system, (3) information system, (4) economic issues, (5) population coverage, and (6) regulation and supervision. The high cost of dental services was the most frequent challenge, followed by the insurance commitments and service coverage. The delivery of dental services through complementary insurance in Iran primarily faces economic and service coverage challenges. The resolution hinges on the collaboration between basic and complementary insurance sectors, the development of a unified information system for insured individuals, and the implementation of a risk-adjusted premium plan.

Association between physical activity and sleep quality among healthcare students.

To assess the relationship between physical activity (PA) and sleep quality (SQ) in Mohammed Bin Rashid University (MBRU) students in Dubai, United Arab Emirates. Taking into account this being one of the first studies exploring this aspect among healthcare students in the Gulf Cooperation Council (GCC) countries. This is an analytical cross-sectional study that involved disseminating online surveys via email to students of all 5 colleges in MBRU between March-June 2023. The survey encompassed queries on demographics, the Saltin-Grimby Physical Activity Level Scale (SGPALS), the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and the Pittsburgh Sleep Quality Index (PSQI). The survey was completed by 105 students. Most students were from the medical college (98/105; 93.3%) and were females (84/105; 80.0%). Females engaged the most in low PA (44.0%) while males engaged the most in high PA (42.9%) according to the IPAQ-SF. There was a significant association between SGPALS and gender (p = 0.007, X2 = 12.0). The global PSQI score showed that 70.5% of the students had bad-quality sleep. Sleep efficiency and leisurely PA are significantly negatively correlated (p = 0.026, ρ = -0.217) while sitting minutes and sleep duration are significantly positively correlated (p = 0.030, r = 0.212). Significant negative correlations between sleep efficiency and leisurely PA demonstrate that while exercise has been implicated in the improvement of SQ, excessive exercise can behave as an additional stressor and induce negative changes in the SQ of healthcare students. Meanwhile, significant positive correlations between sleep duration and sitting indicate that adequate rest should not be undervalued in its effects on sleep. Furthermore, the findings of this study highlight public health implications that warrant attention by educators and policymakers in academic health systems.

Hospital Performance Evaluation Checklist in Context of COVID-19 Pandemic: Design and Validation.

Around the world, pandemics have been considered among the main hazards in the last 2 decades. Hospitals are 1 of the most important organizations responding to pandemics. The aim of this study was to design and develop a valid checklist for evaluating the hospitals' performance in response to COVID-19 pandemic, for the first time. This study is a mixed method research design that began in February, 2020 and was conducted in 3 phases: Designing a conceptual model, designing a primary checklist structure, and checklist psychometric evaluation. Known-groups method has been used to evaluate construct validity. Two groups of hospitals were compared: group A (COVID-19 Hospitals) and group B (the other hospitals). The checklist's main structure was designed with 6 main domains, 23 sub-domains, and 152 items. The content validity ratio and index were 0.94 and 0.79 respectively. Eleven items were added, 106 items were removed, and 40 items were edited. Independent t-test showed a significant difference between the scores of the 2 groups of hospitals (P < 0.0001). Pearson correlation coefficient test also showed a high correlation between our checklist and the other. The internal consistency of the checklist was 0.98 according to Cronbach's alpha test. Evaluating the hospitals' performance and identifying their strengths and weaknesses, can help health system policymakers and hospital managers, and leads to improved performance in response to COVID-19.

Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019

BackgroundTuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relationship with the human development index (HDI).MethodsThe present study is an ecological study aiming at investigating the incidence and mortality of tuberculosis in Iran during the years 2010 to 2019. The related data were extracted from the Global Burden of Disease (GBD) website. The spatial pattern attributed to tuberculosis in the provinces of Iran was analyzed using ArcGIS software. In this study, the two-variable correlation method was used to analyze the data extracted to study the correlation between Tuberculosis and HDI.ResultBased on the results recorded in GBD, the incidence of tuberculosis in 2010, that is, 14.61 (12.72, 16.74), declined compared to 2019, namely 12.29 (10.71, 14.09). The age-standardized mortality rate which was 1.63 (1.52, 1.73) in 2010, has decreased compared to 2019: 1.17 (1.07, 1.32). The incidence and mortality rates of tuberculosis in Iran in all age groups have decreased in 2019 compared to 2010. The highest incidence and mortality among tuberculosis patients were recorded in Sistan and Baluchistan and Golestan provinces. The results indicated that there was a negative and significant correlation between the mortality rate of tuberculosis and the human development index in 2010 (r = -0.509, P-value = 0.003) and 2019 (r = -0.36, P-value = 0.001); however, this correlation between incidence and human development index was not significant (p > 0.05).ConclusionSince mortality is mostly observed in areas with low HDI, health system policymakers must pay more attention to these areas in order to improve care and perform screenings to diagnose and treat patients thus reducing the mortality rate of tuberculosis and preventing an increase in its incidence in Iran.

Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study

BackgroundMedical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine.MethodsThis qualitative study involved conducting semi-structured interviews with 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved.ResultsBased on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system.ConclusionDM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM.

How can we improve the experience of mothers whose baby is hospitalized in the NICU?

Aim and objectivesThe aim of this study was to apply a service design to improve the experience of mothers whose baby was hospitalized in the NICU. DesignA Double Diamond design process model. MethodsThe Double Diamond model as a frame for this project consists of four steps (Discover, Define, Develop, and Deliver), each of which provides a problem and a solution. In each phase, we used and chose freely different methods and tools, depending on the nature of our project. ResultsOur results demonstrated that problems and challenges reported by mothers, nurses, and doctors were related to the lack of adequate equipment, unsuitable or shortage of facilities for mothers and personnel, workload, shifts, personnel, inadequate information and training of mothers by doctors and nurses, lack of psychological and financial support and consulting services for mothers, uncertainty about the treatment process and cost, lack of private space for breastfeeding, and the absence of father's involvement in their infant's treatment and care process. ConclusionTo better understand the unique experiences of parents, especially mothers, when their neonates are admitted to the NICU, healthcare professionals, particularly nurses, should interact more with mothers and view this experience from the mothers’ perspective. We provide solutions for this experience through a four-step process called the Double Diamond design process model. ImplicationsBetterment of care practices is the responsibility of health system policymakers, hospital managers, and nurse managers by designing and implementing training programs for nurses and parents and employing all of the relations, supports, conditions, and facilities for the neonate and family.

Global depression in breast cancer patients: Systematic review and meta-analysis.

Breast cancer is known as one of the most common diseases among women, the psychological consequences of which are common in women and affect various aspects of their lives, so this study aims to investigate the prevalence of depression among women with breast cancer globally. The present meta-analysis was performed by searching for keywords related to breast cancer and depression in 4 main databases: PubMed, Embase, Web of Sciences and Scopus in the period of January 2000 to November 2021 and the results of the study using R and CMA software were analyzed. A total of 71 studies were selected in English and the results of the analysis showed that the prevalence of depression in women with breast cancer is 30.2%, with Pakistan having the highest (83%) prevalence of depression and Taiwan having the lowest (8.3%). And in the WHO regions, EMRO region had the highest (49.7%) rate and SEARO region had the lowest (23%) prevalence of depression. Also, with increasing age, the prevalence of depression among women with breast cancer increases. Community and family support for women with breast cancer, holding psychology and psychotherapy courses, lifestyle modifications and training in this area can be effective in preventing the reduction of the prevalence of depression, and given the pivotal role of women in family affairs, this This can be in line with the work of health system policymakers.

Knowledge, Attitudes, and Practice of Infertile Couples About Assisted Reproductive Technology, 2020: A Cross-Sectional Study

Background: The World Health Organization (WHO) has referred to infertility as a worldwide reproductive health problem that threatens the mental health of infertile couples and can lead to disorders such as stress, depression, isolation, and guilt.&#x0D; Objectives: This study aimed to determine infertile couples’ knowledge, attitudes, and behavior regarding assisted reproductive technology in 2020.&#x0D; Methods: This cross-sectional descriptive study was performed on 331 infertile persons referred to Al-Zahra Infertility Center in Shahrekord, Iran, in 2020. Sampling was done by convenience sampling method. Data were collected by a self-administered questionnaire consisting of four parts. The first consisted of 17 demographic questions, the second consisted of 20 questions, the third consisted of 23 questions, and the fourth consisted of 9 questions. The data were analyzed by SPSS software. A P-value of less than 0.05 was considered significant.&#x0D; Results: In this study, 331 infertile persons referred to the infertility clinic of AL-Zahra were studied. The mean awareness of infertile couples was 14.26 (moderate knowledge level), and their mean attitude was 57.01 (negative attitude). Comparison of study participants’ knowledge with gender, address, ethnicity, language, education, the duration of infertility, causes of infertility, female factor, age, and years since marriage was significant (P &lt; 0.05). Comparison of attitudes of study participants with gender, address, education, job, and the duration of infertility and causes of Infertility was significant (P &lt; 0.05). The relationship between the knowledge of study participants and the duration of infertility, cause of infertility, knowledge of (IUI, IVF, ICSI, ZIFT, replaced uterus, donated ovum, sperm donation, and the donating embryo) and attitude towards (IUI IVF replaced uterus donated ovum) was significant (P &lt; 0.05). The relationship between the attitude of study participants and the duration of infertility, knowledge of (IUI, replaced uterus and donated ovum), and attitude of (IUI IVF replaced uterus donated ovum) was significant (P &lt; 0.05).&#x0D; Conclusions: The results of this study indicated that the higher the level of awareness was, the more negative the attitude toward assisted reproductive technology became. In addition, in people who used more pharmacological methods to treat infertility, the rate of using the new assisted reproductive method was less than the pharmacological methods. Therefore, it is recommended that health system policymakers and guardians improve childbearing status in the country by establishing counseling classes and heightening people’s awareness of new methods of assisted reproduction to address misconceptions about these methods.

Cross-Country Study of Institutionalizing Social Participation in Health Policymaking: A Realist Analysis

Strong evidence suggests that interventions based on community participation have a positive effect on a range of health outcomes in different settings. Community participation contributes significantly to the promotion of health at the local level, especially among the more disadvantaged groups of the society. The main goal of social participation mechanisms is to fill the gap between the views of the policymakers and the experiences and needs of the communities. An important point is that institutionalization of social participation in the development of health policies and its continuity over time are essential requirements. The question here is how participation should be institutionalized in the systems that have started this process. We conducted a realistic evaluation of a multicase study of public participation in health system policymaking. Countries including France, Chile, Iran, Thailand, and Tunisia were selected. The study objective was to determine interventions and mechanisms used by these countries for community participation in health policymaking and institutionalizing it. The data were extracted via a literature review for each country using a realistic approach analysis also known as context, intervention, mechanism, and outcome (CIMO) configurations. Thailand and France, which have applied a set of interventions such as supportive legislations, evidence production structures for informed decision making and interactions, accountability and transparency, and providing a context for development of civil society organizations, have succeeded in institutionalizing community participation in health policymaking. Iran, Tunisia, and Chile have been successful in this regard, but they are still far from institutionalizing community participation. Success in the institutionalization of participatory health governance requires a political will and commitment at the highest level in order to minimize the conflicts between economic and political interests of different stakeholders and to implement a set of interventions to maximize social participation in health policymaking.

Nurses’ Perceptions of Expected Organizational and Professional Support in the COVID-19 Pandemic: A Qualitative Study

Background: Nurses, as health advocates and front-line fighters in the coronavirus disease 2019 (COVID-19) pandemic, experience severe professional stress and psychological crises. Objectives: The present study was conducted to explain the nurses’ perception of expected organizational and professional support during the COVID-19 pandemic. Methods: In this qualitative study, data collection was performed through semi-structured, individual, and in-depth interviews. A total of 20 nurses participated in the study through purposive sampling. The data were collected within June-October 2021. The collected data were analyzed based on Granheim and Lundman’s method. Results: The findings of the study were presented in the form of 4 main themes and 10 subthemes, including lack of physical support (i.e., lack of tools and equipment and problems concerning using personal protective equipment to care for COVID-19 patients), lack of psychological support (i.e., paying attention to nurses’ job stress and mutual understanding of managers and nurses), lack of welfare support (i.e., high workload, financial support, providing facilities for nurses for employment, and providing facilities to support staff in childcare), and weakness in efficient crisis management (i.e., insufficient attention of managers to the principles of crisis management and the lack of a standard infectious disease hospital for COVID-19 patients). Conclusions: Health system policymakers should provide comprehensive physical, psychological, and welfare support for nurses, effective professional and organizational context, and efficient crisis management to improve the quality of care.

Investigating the Coefficient of Performance of Hospitals in Meeting the Needs of Nurses

Background: Two of the most important problems of the nursing profession are the job uncertainty experienced by those working in the field and the profession’s status in society. The nurses’ needs have not been adequately addressed by policymakers of the health care system in Iran. Objectives: The present study, conducted in selected hospitals in Iran from March to August, aimed to evaluate the performance of hospitals in meeting the needs of nurses. Methods: The statistical population included 683 nurses from the selected hospitals. Data were collected using a researcher-made questionnaire containing four items with 40 criteria. Results: Hospitals meeting the needs of nurses were classified according to the importance coefficient and in order of importance as follows: job promotion (0.63), spiritual factors (0.62), material factors, (0.57), and job status (0.52). Conclusions: It was recommended that the corrective measures regarding job promotion, spiritual factors, material factors, and job status of the nurses should be designed and implemented by health system policymakers and hospitals’ managers.

Financing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunities

IntroductionNeglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective.MethodsWe carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach.FindingsWe found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients).ConclusionOur findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.

Nurses' recovery experiences during the COVID-19 pandemic in Isfahan, Iran: A qualitative study.

The aim of this study is to explore and describe the recovery experiences of nurses working in COVID-19 wards. The global outbreak of coronavirus in 2020 has extracted job stress for nurses. Job stress has impacts on physical and mental health and performance, so recovery is essential to restore the lost energy resources. Semi-structured interviews were conducted with 12 nurses in Isfahan city of Iran. The research results were extracted as 5 main themes, 14 subthemes and 54 items. The main themes are detachment from work, relaxation, non-work activities, affiliation and meaning. The combination of these themes led to the clear statement that using recovery experiences is a major step toward relieving the nurses' COVID-19-related stress and their physical and mental resuscitation. The use of recovery experiences, including detachment from work, relaxation, non-work activities, affiliation and meaning by nurses, helps them cope with job stressors and regain their resources. It is the responsibility of health system policy makers, hospital managers and nurse managers to design and implement training programmes for nurses to use recovery experiences as stress management techniques in their profession.

Facilitators, barriers and strategies for health-system guidance implementation: a critical interpretive synthesis protocol

BackgroundAs systematically developed statements regarding possible courses of action, health system guidance (HSG) can assist with making decisions about addressing problems or achieving goals in health systems. However, there are conceptual and methodological challenges in HSG implementation due to the complexity of health-system policy-making, the diversity of available evidence and vast differences in contexts. To address these gaps, we aim to develop a theoretical framework for supporting HSG implementation as part of a broader effort to promote evidence-informed policy-making in health systems.MethodsTo develop a theoretical framework about facilitators, barriers and strategies for HSG implementation, we will apply a critical interpretive synthesis (CIS) approach to synthesize the findings from a range of relevant literature. We will search 11 electronic databases and seven organizational websites to identify relevant published and grey literature. We will check the references of included studies and contact experts to identify additional eligible papers. Finally, we will conduct purposively sampling of the literature to fill any identified conceptual gaps. We will use relevance and five quality criteria to assess included papers. A standardized form will be developed for extracting information. We will use an interpretive analytic approach to synthesize the findings, including a constant comparative method throughout the analysis. Two independent reviewers will conduct the literature screening and relevance assessment, and disagreements will be resolved through discussion. The principal investigator will conduct data extraction and synthesis, and a second reviewer will check the sample of extracted data for consistency and accuracy.DiscussionA new theoretical framework about facilitators, barriers and strategies for HSG implementation will be developed using a CIS approach. The HSG implementation framework could be widely used for supporting the implementation of HSG covering varied topics and in different contexts (including low-, middle- and high-income countries). In later work, we will develop a tool for supporting HSG implementation based on the theoretical framework.Registration PROSPERO CRD42020214072. Date of Registration: 14 December 2020.

Consensus on how to optimise patient/family engagement in hospital planning and improvement: a Delphi survey

ObjectivePatient and family engagement (PE) in health service planning and improvement is widely advocated, yet little prior research offered guidance on how to optimise PE, particularly in hospitals. This study...

Reasons for informal payments from the perspective of health care providers and recipients: a qualitative study in Iran

BackgroundInformal payments are one of the major obstacles to health system reform in many developing countries, and its elimination is on the agenda of health system policymakers in many countries, including Iran. This study was conducted to identify the causes of informal payments in the Iranian health system.MethodsThis was a qualitative and exploratory study. The study environment included the Ministry of Health, physicians' offices, medical universities, and hospitals and health centers. The study population included health care providers (physicians and hospital staff, managers, supervisors, and nurses) and health care recipients (patients or patients who had a history of dealing with informal payments). Data were collected using open-ended questions and semi-structured interviews. Snowball sampling method was used to select managers, chief executive officers (CEOs) and nurses. Convenience sampling was used to select physicians due to their lack of participation and cooperation. Content analysis method was used to analyze the data.ResultsReasons for informal payments were divided into 4 themes including: Economic factors (improper tariff valuation of services; failure to increase tariffs proportionate to inflation; lack of comprehensive participation of stakeholders in determining tariffs; tariff inconsistency in the public, private and charity sectors; etc.); socio-cultural factors (decreased social capital of the medical community among the people; improving the quality of life; incorrect comparison of providers' income levels with the income of doctors in other countries; existence of a culture of gratitude and appreciation; health as a priority for society; pride of service recipients; pride of service providers; etc.); service delivery challenges (high professional skills of the doctor; use of modern medical equipment; the monopoly of some doctors, etc.) and legal-political factors (inadequate monitoring by upstream organizations; lack of strict rules; difficulty of proving informal payments; presence of stakeholders in management and policy making processes).ConclusionsKnowing the causes of informal payments can help reduce or eliminate it. The results of this study identified the causes of informal payments in the Iranian health system. Accurate knowledge of the needs and motivations of both health care providers and recipients can be effective in accurately identifying and eliminating this phenomenon.

Determinant factors of hospital service quality and patient satisfaction: Hospital logistics management approach

This study aims to examine the effect of private hospital logistics factors on treatment satisfaction and specialist patient satisfaction. This study has five construction dimensions of hospital logistics, namely physical accessibility, waiting time, consultation time, hospital hotel services, and administrative procedures. Quantitative explanatory studies with 297 sample size were carried out to achieve the research objectives by examining the relationship between the independent and dependent variables through online data collection questionnaires, tabulations and hypothesis analysis with SEM PLS analysis tools. This study shows significant results for all hypotheses which imply the importance of optimizing hospital logistics performance, especially in terms of the five constructs in improving service quality and patient satisfaction. Optimizing hospital logistics elements in private hospital specialist patient care is a challenge that is not easy because it requires strategic planning and proper resource management. The role of various parties, especially hospital managers and Indonesian health system policy makers, in paying attention to the operational flow of hospital logistics, especially private hospitals, in order to strengthen the private hospital service system in providing health services while running the hospital business.