Iranian Public Hospitals Research Articles

Prioritizing the Challenges of Compensation Methods for Doctors and Nurses in Iranian Public Hospitals

Prioritizing the Challenges of Compensation Methods for Doctors and Nurses in Iranian Public Hospitals

Investigating the Mediating Role of Unlearning in the Relationship between Organizational Culture and Knowledge Management in Public Hospitals of Iran

Investigating the Mediating Role of Unlearning in the Relationship between Organizational Culture and Knowledge Management in Public Hospitals of Iran

How public hospitals manage epidemic crises? Lessons from Iranian public hospitals

BACKGROUND: The public hospital preparedness is essential for epidemic disaster like COVID-19 pandemic. This study was conducted to present a hospital management preparedness model of Iran's public hospitals for the epidemic. MATERIALS AND METHODS: The method of this study was an exploratory sequential mix method study (qualitative–quantitative). In this study, qualitative and quantitative methods were used in four stages. (1) Interviews with hospital managers to identify hospital management experiences during the COVID-19 epidemic and categorize the results in themes and subthemes, (2) assessing the performance of public hospitals in managing the coronavirus epidemic in a quantitative method, (3) present the initial hospital management model for a public hospital in epidemic conditions using an expert panel, and (4) validation of the model using the Delphi method. RESULTS: Experiences of hospital managers and specialists were categorized into eight themes: information gathering and environmental analysis, general and operational planning, provision of equipment and physical and financial resources, training and empowerment of human resources, a compilation of instructions and job descriptions, review and ensuring maximum readiness, monitoring and follow-up of service provision and existing problems, evaluation and feedback of performance problems and level of preparation and 51 sub-themes. The quantitative study indicated that all the investigated indicators had a significant decrease in the first month and an increase in the epidemic's continuation. The results were categorized in nine themes and 59 sub-themes, and finally, the model was validated in one round by the Delphi method. CONCLUSION: In Iran, managers have valuable experiences in COVID-19 epidemy management, but these experiences are scattered and not organized. In this study, by a qualitative–quantitative, a model was presented that contains essential points obtained from the experience of hospital managers and experts in actual disaster conditions and is appropriate and fits hospital structure and infrastructure of the health system in Iran.

A Protection Motivation Theory-Based Empowerment Intervention for Promoting Health Behaviors in Women With Human Papillomavirus: An Experimental Study.

This experimental study on 70 women with human papillomavirus, referred to the specialized obstetrics and gynecology clinics of public hospitals in Iran in 2021, revealed that implementing the protection motivation theory-based empowerment intervention could promote their health behaviors.

Healthcare reform and productivity of Hospital: a DEA-based analysis from South West of Iran

BackgroundDifferent healthcare reforms could affect the productivity of hospitals. The aim of this study was to track hospital productivity before and after the recent Iranian healthcare reform in Khuzestan province, South West of Iran.MethodsHospital productivity was evaluated through data envelopment analysis (DEA) and Malmquist productivity index (MPI) from 2011 to 2015 for 17 Iranian public hospitals before and after the health sector transformation plan. We assumed an output-oriented model with variable returns to scale (VRS) to estimate the productivity and efficiency of each hospital. The DEAP V.2.1 software was used for data analysis.ResultsAfter the transformation plan, the averages of technical efficiency, managerial efficiency and scale efficiency in the studied hospitals had negative changes, but technology efficiency had positive changes.44.4% of general hospitals, 25% of multi-specialized hospitals, and 100% of specialized hospitals had positive productivity changes after implementing the health sector evolution plan. The Malmquist productivity index (MPI) had low positive changes from 2013 to 2016 (MPI = 0.13 out of 1) but the mean productivity score had no change after the health sector evolution plan.ConclusionsThe total productivity before and after the health sector evolution plan had no change in Khuzestan province. This and the increase in the utilization of impatient services seemed to be a sign of good performance. But apart from technology efficiency, other efficiency indices had negative changes. It is suggested that in health reforms in Iran, more attention should be paid to the allocation of resources in the hospital.

Factors associated with patients’ mobility rates within the provinces of Iran

BackgroundThe absence of a referral system and patients’ freedom to choose among service providers in Iran have led to increased patient mobility, which continues to concern health policymakers in the country. This study aimed to determine factors associated with patient mobility rates within the provinces of Iran.MethodsThis cross-sectional study was conducted in Iran. Data on the place of residence of patients admitted to Iranian public hospitals were collected during August 2017 to determine the status of patient mobility within each province. The sample size were 537,786 patients were hospitalized in public hospitals in Iran during August 2017. The patient mobility ratio was calculated for each of Iran’s provinces by producing a patient mobility matrix. Then, a model of factors affecting patient mobility was identified by regression analysis. All the analyses were performed using STATA14 software.ResultsIn the study period, 585,681 patients were admitted to public hospitals in Iran, of which 69,692 patients were referred to the hospital from another city and 51,789 of them were admitted to public hospitals in the capital of the province. The highest levels of intra-provincial patient mobility were attributed to southern and eastern provinces, and the lowest levels were observed in the north and west of Iran. Implementation of negative binomial regression indicated that, among the examined parameters, the distribution of specialist physicians and the human development index had the highest impact on intra-provincial patient mobility.ConclusionThe distribution of specialists throughout different country areas plays a determining role in patient mobility. In many cases, redistributing hospital beds is impossible, but adopting different human resource policies could prevent unnecessary patient mobility through equitable redistribution of specialists among different cities.

Key factors affecting succession planning in the leadership of public hospital in Iran: A qualitative study

ABSTRACT Objective We aimed to identify the key factors affecting succession planning in the leadership of Iranian public hospitals. Method The present study used an exploratory, qualitative design. Fifteen key informants and managers working in public hospitals and the Vice-Chancellor for Development of Iran University Medical Sciences were recruited through purposive sampling. Semi-structured, in-depth interviews were conducted with participants from May to June 2020. Data analysis was applied parallel with data collection through a content analysis approach using MAXQDA 11. Results Based on the interviews and extracted data, the findings were identified in five main themes: (1) Strategic goals and needs assessment in line with the organization's goals, (2) Strategic communication and organizational structure, (3) Talent identification and empowerment, (4) Development and excellence of qualified individuals, and (5) Monitoring of succession planning programs. Conclusion It is suggested that public hospitals apply comprehensive support and commitment in implementing succession planning programs. This way, there will be improvements in organizational decisions and policies, and capable and qualified individuals will be used in critical positions. Furthermore, this would also lead to increased work quality, increased personnel motivation, reduced resource wastage, and improved employee career path.

Identification and Prioritization of Critical Factors Affecting the Performance of Iranian Public Hospitals Using the Best-Worst Method: A Prospective Study.

In the ever-changing healthcare environment, policymakers and managers need a comprehensive evaluation system to accurately identify and prioritize factors affecting hospital performance. The present study aimed to identify and rank critical factors affecting hospital performance using the best-worst method (BWM). A cross-sectional study was conducted during 2016-2019 to identify and prioritize factors affecting the performance of Iranian public hospitals using the BWM. Initially, the content validity ratio (CVR) was used to screen the identified factors. Then, using a linear programming formula, a pairwise comparison between the best/worst criterion with all other identified criteria was performed. The most important internal factor was efficiency, and its associated indicators were mainly related to financial factors. Among all external factors, the most prominent were economic, legal, and political factors, which were negatively affected by budgeting policies and the payment system. A megatrend was also identified in the form of a national health insurance system as well as a shift from employer-based to government-subsidized insurance coverage. External factors (economic and political) had a greater impact on the performance of public hospitals than internal factors (efficiency and effectiveness). A preprint of this study was published at https://www.researchsquare.com/article/rs-453223/v1 with doi: 10.21203/rs.3.rs-453223/v1.

Iranian midwives’ lived experiences of providing continuous midwife-led intrapartum care: a qualitative study

Background & ObjectiveContinuity of midwifery-led care during labour and birth is considered optimal. To ensure its sustainability in practice where limited evidence is available, the aim of the present study was to explore midwives’ lived experiences of delivering continuous midwife-led intrapartum care.MethodsThis study took a qualitative approach in meeting its aim. Participants were midwives working in the labour wards of private and public hospitals in Iran. The data were purposefully collected in 2019 through in-depth, semi-structured, and face-to-face interviews with midwives (n = 10) aged between 26 and 55 years. A thematic analysis based on descriptive phenomenology was undertaken to make sense of the data collected.Results“Wanting to lead continuous woman-centered care but being unable to” was identified as an overarching theme. Three other themes “emphasis on the non-interventional care”, “midwifery-specific focus” and “barriers and challenges of midwifery care” were also identified. Ultimately, midwives described knowing how to and wanting to lead continuous ‘woman’-centered care but being unable to. Perceived barriers included lack of familiarity with and knowledge in relation to childbirth, the insignificant role of midwives in decision making, obstetrician utilitarianism, high workloads along with work-related stress argument-driven communication between midwives and obstetricians and an absence of a ‘triangle of trust’ in care.ConclusionFuture research strategies could usefully include obstetricians and focus on the upscaling of midwifery in Iran using continuity of care models, highlight the value of midwives, identify why uptake of antenatal education in Iran is poor and develop user friendly, evidence based, midwife-led programs. Initiatives aiming to promote mutual professional respect, trust and collegiality and increased remuneration for midwifery work would be also welcomed in pursuit of reducing maternal and infant mortality in Iran.

A novel inverse DEA-R model with application in hospital efficiency

The inverse Data Envelopment Analysis (DEA) method is primarily used to analyze the changing relationship between the inputs and outputs of production units while preserving efficiency levels. This paper aims to perform an efficiency and post-efficiency analysis of 130 public hospitals in Iran. However, we faced with some hospital data that are only available in form of ratios. This motivates us to develop a novel and proper inverse DEA methodology capable of dealing with such cases. We develop the theoretical foundation of the inverse DEA-R model as a post-efficiency analysis approach. Both input-oriented and output-oriented inverse models are developed. In the end, we apply the proposed models for efficiency assessment and moreover inverse analysis of 130 public hospitals in Iran.

The impacts of economic sanctions on the performance of hospitals in Iran: implications for human rights

PurposeStudies show that economic sanctions have had major negative impacts on health systems during the past years. The aim of this study is to identify the impacts of US sanctions on the performance of public hospitals in Iran.Design/methodology/approachA qualitative research study was conducted between October 2019 and September 2020 in Kermanshah Province, Iran. Semi-structured, face-to-face interviews, lasting between 25 and 90 min, were carried out with 20 participants in seven public hospitals affiliated to the authors’ institution in Kermanshah Province. Inductive thematic analysis was used to identify themes in the data.FindingsFive main themes emerged from the analysis: resource management challenges; financial restrictions; interruptions in planning; reductions in the quality of service delivery; and changes in organizational relationships.Originality/valueThe results of the present study demonstrate that US economic sanctions have considerably reduced access to necessary medical equipment and medicines for public hospitals in Iran. Policymakers should monitor the distribution of equipment and pharmaceutical products within public hospitals in Iran and take actions to ameliorate shortages during times of economic sanctions.

Rate and Causes of Claim Denials in Iranian Hospitals: A Systematic Review and Meta-analysis

Context: One of the most important income sources of hospitals is the payment of insurance organizations, part of which is not paid as deductions in Iran. Studies have reported different values for insurance deductions, proposing various reasons. Objectives: The present study aimed to provide the published evidence of these deductions and their causes over the past 13 years. Data Sources: This systematic review and meta-analysis was conducted in 2021. Data were collected via searching in databases such as Google Scholar, Scopus, PubMed, Web of Science, SID, Magiran, and Irandoc until August 2021 using keywords such as “deduction”, “medical deduction”, “hospital”, “medical center”, and “Iran”. Data Extraction: To calculate the pooled values of hospital deductions, a random-effects meta-analysis was performed in the Stata software version 15 at 95% confidence interval. In addition, the possible heterogeneity of the studies was evaluated using the I2 statistic, and a forest plot was also used to report the results. Publication bias was assessed using a funnel plot. Results: In total, 16 articles were included in the meta-analysis. The pooled percentage of deductions (PPCD) based on random effects was 5% (95% CI: 2.88 - 7.124), and the hypothesis was rejected (PPCD = 0; Z = 31.26; P = 0.000). Based on the random-effects method, the pooled prevalence of deductions was 45.21% (95% CI: 17.601 - 72.824). Moreover, the pooled prevalence of deductions (PPVD) was considered statistically significant (PPVD = 0; Z = 251.16; P = 0.000). The variation in ES attributable to heterogeneity (I2) was estimated at 99.6%, and documentation problems were considered the most common cause of deductions (17.96%). Conclusions: According to the results, the prevalence of deductions in Iranian public hospitals is significant, and the share of deductions from the bill claimed by the hospital is manageable, albeit small.

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking

BackgroundPatient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses’ point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes.MethodsA cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis.ResultsThe results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in “Staffing” to 53.8% in “Teamwork across Hospital Units”. Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p < 0.05).ConclusionsThis is one of few studies that examine nurses’ perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

Designing a Management Model for Outsourcing Non-Clinical Services in Iranian Public Hospitals

Designing a Management Model for Outsourcing Non-Clinical Services in Iranian Public Hospitals

Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran

Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system.Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals.Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital).Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals.Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency.

Barriers and Facilitators of Implementing WHO Safe Surgery Checklist: A Cross-sectional Study in Public Hospitals of Iran

Background: The implementation of WHO safe surgery checklist (SSC) was proposed by the Ministry of Health and Medical Education in the operation rooms of Iranian hospitals in 2011, but was canceled after several years due to some challenges in implementation. Objectives: This study aimed to investigate the barriers and facilitators of the effective implementation of the SSC. Methods: This cross-sectional study was performed in public hospitals of Tabriz city in 2019. The study population consisted of operation room working staff, and the purposive sampling was used. The research tool was a researcher-made questionnaire designed through literature review and included three parts of demographic variables, barriers, and facilitating factors. Data were analyzed with SPSS-22. Results: The mean of barriers to implementation of the SSC was 3.03 out of 5. The most important barrier to implementing the checklist was the weakness in team working (3.18), while checklist barriers were the least important (2.98). The mean score of facilitating factors was 3.46. Among the facilitators, the highest score was for team working facilitators with a score of 3.47 and the lowest score was for the facilitators associated with the checklist with a score of 3.37. Conclusions: This is one of the first studies that explored the barriers and facilitators of SSC implementation in Iranian hospitals. We identified weak team working as the most important barrier to implementing the checklist. These results help policymakers and hospital managers to implement the checklist more effectively.

Effect of COVID-19 on the Number of CT-scans and MRI Services of Public Hospitals in Iran: An Interrupted Time Series Analysis.

In February 2020, the Ministry of Health and Medical Education in Iran announced the first case of COVID-19. The aim of this study was to investigate the impact of COVID-19 on the number of CT-Scans and MRI services in public hospitals in western Iran. We collected CT-scans and MRI services data from 18 public hospitals via Vice-Chancellor Office, Lorestan University of Medical Sciences from January 2017 to February 2021. Interrupted time series analysis (ITSA) was conducted to assess the impact of COVID-19 on CT-Scans and MRI services. More specifically, ITSA was conducted using ordinary least squares regression with the number of CT-Scans and MRI services per 1,000 registered persons per month as dependent variable. At the beginning of the observation period, the monthly rate of CT-Scans was constant (p for trend = 0.267) at 291.9 (from 95%CI 240.5 to 343.4) per 1,000 registered patients. The first case of COVID-19 coincided with an abrupt increase by 211.8 (from 95%CI 102.9 to 320.7) per 1,000 patients. Thereafter, the trend of CT-Scans did not change (p=0.576) compared to the pre-pandemic period. The rate of MRI services was 363.5 per 1,000 per registered patients per month (P = <0.0001) with a slightly decreasing trend (coefficient=-5; 95%CI, -6.9 to -3.1). The findings of this study showed that crises such as COVID-19 can affect the service delivery process. Health policymakers and decision makers should work to prevent potential reductions in health care during events such as COVID-19.

Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective.

Background:To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran.Methods:A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period.Results:The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services.Conclusion:The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.

The relationship between abusive supervision, psychological ownership, and quality of nursing care: The mediating role of job satisfaction.

This study tested a hypothetical model to evaluate the relationship between job satisfaction, abusive supervision, and psychological ownership with the quality of nursing care. In this cross-sectional study, a sample of 300 nurses from two public hospitals in Iran was selected. Exploratory factor analysis was used to assess the measurement model and the proposed structural model. There was a significant negative relationship between abusive supervision with nurses' job satisfaction and quality of nursing care. A positive relationship between psychological ownership with nurses' job satisfaction and quality of nursing care was observed. Given the importance of nurses' job satisfaction, nursing managers can enhance the quality of nursing care by providing a favorable work environment for nurses.

Analysis of the Structure of Public Hospitals Administration in Iran: A Qualitative Study

Background: Public hospitals account for approximately 80% of the health system resources while producing only 20% of the public sector's output. Objectives: This study aimed to analyze the current administration structure (strengths, weaknesses, solutions, and proposed models) of Iranian public hospitals. Methods: This study is qualitative research with a phenomenological approach. The required data were collected using semi-structured interviews with 58 national experts in the field of hospital management who were selected based on the purposive sampling method. Data were analyzed using the conventional content analysis method. Results: Nine main themes and 34 sub-themes were identified in the weaknesses. The strengths contained four main themes and 16 sub-themes. The proposed solutions had five main themes and 22 sub-themes, and the proposed models from the experts' points of view were composed of four main themes and six sub-themes. The important weaknesses were low commitment and motivation, poor financial management and budgeting, and centralized decision-making and management. The strengths included strong infrastructure, extensive service delivery, government support, and positive social functions. The most important proposed solutions were complying with the requirements of structural reform, development of related assessment indicators, public-private partnership, payment system reform, delegation, manpower management, hospital organizational structure, and reform of the tariff system. Finally, the model of the Board of Trustees, while maintaining government ownership but observing the legal requirements of this structure, was the main suggestion of experts on reforming the structure of the administration of public hospitals in Iran. Conclusions: According to the expert’s opinions, the current structure of Iranian public hospitals has many problems. Managers and policymakers can make the necessary corrections based on the solutions and models proposed in this study.