System Reform Plan Research Articles

Exploration challenges of the implementers of Iran's transformational innovation plan in medical education.

BACKGROUND:The Health System Reform Plan, especially in medical education, has undoubtedly caused changes in the university. The continuation of this project requires recognizing the challenges confronted by those in charge of its implementation. This study aimed to explore the challenges of the implementers of the Transformation and Innovation Plan in Medical Education in the universities of Macroregion 5.MATERIALS AND METHODS:The qualitative research was conducted using the content analysis method. Semi-structured interviews with health and medical education managers were used to collect information. Participants were 11 educational leaders of universities who were selected by purposeful sampling. Data collection continued until data saturation was reached. Data analysis was performed continuously and simultaneously with data collection. The Graneheim and Lundman methods were used to analyze the data.RESULTS:From 11 interviews, one theme, five categories, and 12 subclasses were obtained. Five categories include lack of proper groundwork, weak leadership, structural problems, inability to fund, and inadequate monitoring.CONCLUSION:Innovation and transformation in medical education are one of the critical missions and admirable actions of the Ministry of Health in the field of education, but a review of this plan can, in addition to identifying shortcomings and problems, pave the way for success, and progress in future programs.

Prioritization of Hospital Information System’s Executive Barriers to Patient Payment Reduction and Visitation Quality Improvement Packages of Health System Reform Plan from the Perspectives of Users and Experts in Hospitals of Yazd

Background: Healthcare facilities are dependent on hospital information systems due to the high volume and variation of information in different fields. These systems are a prerequisite for effective and high-quality healthcare provision in hospitals.
 Objectives: The present study intended to prioritize the executive barriers to these systems in patient payment reduction and visitation quality improvement packages of the health system reform plan (HSRP) from the perspectives of users and experts in selected university hospitals of Yazd, Iran, in 2019.
 Methods: The population of this descriptive-analytical study included 110 participants, including experts of information technology (IT) unit, hospital managers, and personnel of the administrative and medical units dealing with the hospital information system. The data collection tool was a researcher-made questionnaire based on similar studies, the validity of which was evaluated by a committee of experts. Also, the reliability of the questionnaire was investigated and confirmed before the study using the Cronbach’s alpha method and a sample of 30 participants. Data analysis was performed using SPSS software version 21.
 Results: Among the six barrier dimensions, the highest mean score belonged to the professional factors (3.46 ± 1.03), followed by human barriers (3.44 ± 0.83). Among professional barriers, the lack of motivation of the personnel in IT learning and get training on the IT-related skills had the highest mean score of 3.67.
 Conclusions: According to the results, outsourcing such services and special budget allocation for hardware and software update and support, holding conferences, and provision of practical training in this field are suitable strategies for better implementation of such systems.

Study of the Effect of Health System Reform Plan Administration on the Satisfaction Level among Medical Doctors and Nurses in Tabriz State Hospitals, East Azerbaijan, Iran

Having three orientations, the Health System Reform Plan (HSRP) has been administered to financially support and protect people, provide fair health services and promote the quality of health services. To be unsatisfied about health and medical services brings undesirable outcomes. The present investigation aimed to study the effect of Health System Reform Plan (HSRP) on the satisfaction level among medical doctors and nurses of Tabriz state hospitals, East Azerbaijan province, Iran in a period from 21th February; 2015 to 22th June; 2015. Statistical population included those patients who referred to Tabriz state hospitals. We used stratified sampling method. To collect data we used questionnaire being presented to the samples after assessing its validity and reliability. We also utilized descriptive and inferential statistics in a way that we used descriptive method to classify, summarize and interpret of obtained data. Then after demonstrating the abnormality of data by Kolmogorov-Smirnov test we used linear and multiple regressions to test research hypothesis and effect from the perspective of inferential method. Obtained results confirmed the research hypothesis and explained that the administration of HSRP affected medical doctors’ level of satisfaction. Also, according to the results of multiple regression tests, doctors and nurses’ satisfaction level was placed at the top of most affected issues from HSRP.

Antibiotic Prescribing in Outpatient Before and After Implementation of the Urban Family Physician and Referral System

Background The Family Physician and Referral System was piloted in Mazandaran and Fars provinces, Iran in 2012. The goal of this program was to improve the provision of health services including medication prescription. Objective This study aimed to determine the trends in antibiotic prescribing in outpatient before and after implementation of the Family Physician and Referral System in Babol, Iran from 2010 to 2018. Methods In this retrospective study, all prescriptions of urban family physicians in Babol, which were registered in the database of the Health Services Insurance Organization of Mazandaran province, were included. The trends of average number of items per prescription, percentage of antibiotics per prescription, frequency of antibiotic groups, and cost of antibiotics were calculated using SQL Server and IBM SPSS version 22. Results The average number of items per prescription was found to be 3.4±1.82, and 2.8±1.60, and percentage of antibiotics per prescription was 49% and 32% in 2010 and 2018, respectively. The most prescribed antibiotic groups were penicillin (54.8%) and cephalosporin (39.9%). Amoxicillin 500mg capsules (13.1%), metronidazole 250 mg (10.2%), and ciprofloxacin 500 mg (8.2%) were the most prescribed antibiotics. Also, the mean cost of prescriptions containing antibiotics compared to the total prescriptions had decreased from 22% in 2010 to 5.5% in 2018. Conclusion The pattern of medication prescription especially antibiotics, improved after the implementation of the Family Physician and Referral System. Due to the positive impact of the Family Physician and Referral System on medication prescription by physicians, we recommend the implementation of this program in low and middle-income countries. Keywords: Antibiotic, medication prescribing, Health system reform plan, Family physician, Trend

Designing a Comprehensive Evaluation Model for Health Reform Plan in Iran

Background: The present study aimed to design a comprehensive model to evaluate the health system reform plan so the indicators of this model can lead to the health reform plan's effectiveness. Hence, this plan's effective factors, including policymakers and managers, suppliers, and clients, were identified and explained. Methods:According to the practical purpose and nature of the research, the combined/mixed research method was used, in 2018-2019. For the qualitative phase, the Delphi technique was used in exploratory interviews, and quantitative methods were used to collect data through a questionnaire. In the quantitative phase, 400 employees of 10 hospitals were selected by stratified random sampling; and in the second section, 300 clients were randomly selected in two hospitals with the highest and lowest evaluation scores in the previous phase. Content analysis method and Delphi technique were used for classification and analysis of qualitative data, and SPSS Ver.22, AMOS Ver.24 and Expert Choicev24 were used for data description and dimensions and indices' weight extraction. Dimensions under consideration include the financial, social responsibility, growth and learning, citizens and client, and internal process fields. Results: The components with the highest and lowest weight and impact on the effectiveness of the plan were identified in the following dimensions: financial field, Social responsibility field, growth and learning field, citizens and client field, internal process field, including weights 0.266, 0.244, 0.202, 0.164, 0.124, respectively. Conclusion: Given the results, the components, indicators, dimensions, and levels of the model designed, the comprehensive evaluation of the Health System Reform Plan in Iran (CEHSRP-IR) with the normal mean was confirmed by the statistical population, and this model can be used in all organizations implementing this plan.

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

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

The Efficiency of Hospitals before and after the Implementation of Health System Reform Plan: a case study of Iran

The Efficiency of Hospitals before and after the Implementation of Health System Reform Plan: a case study of Iran

The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Gilavand A, Mehralizadeh Y. The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members. Family Medicine & Primary Care Review. 2021;23(4):417-421. doi:10.5114/fmpcr.2021.110354. APA Gilavand, A., & Mehralizadeh, Y. (2021). The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members. Family Medicine & Primary Care Review, 23(4), 417-421. https://doi.org/10.5114/fmpcr.2021.110354 Chicago Gilavand, Abdolreza, and Yadollah Mehralizadeh. 2021. "The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members". Family Medicine & Primary Care Review 23 (4): 417-421. doi:10.5114/fmpcr.2021.110354. Harvard Gilavand, A., and Mehralizadeh, Y. (2021). The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members. Family Medicine & Primary Care Review, 23(4), pp.417-421. https://doi.org/10.5114/fmpcr.2021.110354 MLA Gilavand, Abdolreza et al. "The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members." Family Medicine & Primary Care Review, vol. 23, no. 4, 2021, pp. 417-421. doi:10.5114/fmpcr.2021.110354. Vancouver Gilavand A, Mehralizadeh Y. The impact of the Iran Health System Reform Plan on the psychological empowerment of clinical faculty members. Family Medicine & Primary Care Review. 2021;23(4):417-421. doi:10.5114/fmpcr.2021.110354.

Changes in the Rate of Some Rare Neonatal Outcomes After the Implementation of the Health System Reform Plan in Iran: A 70-Month Case Study of an Educational Hospital Research

Background: The health system reform plan (HSRP) was launched in Iran on 15 May 2014, with three approaches to protect people from the financial system, create equity in access to health services, and improve the quality of services. Objectives: The present study aimed at investigating the changes in the rate of some rare neonatal outcomes after the implementation of HSRP in Iran. Methods: The present cross-sectional study was conducted in Izadi Hospital in Qom Province, in which 52,817 vaginal delivery and cesarean sections were evaluated for the incidence of complications from 15 June 2011 to 15 April 2017. The complications included hypoxic-ischemic encephalopathy, low Apgar score, cephalohematoma, clavicle fracture, the Erb palsy, and intracerebral hemorrhage. Complications were compared per 10,000 births before and after the implementation of the plan. Data were analyzed with SPSS software using t- and chi-squared tests. Results: There was a significant increase after the implementation of HSRP compared to before that in the rate of complications per 10,000 vaginal deliveries for stage 2 hypoxic-ischemic encephalopathy (P = 0.001), birth with a low Apgar score (P < 0.001), cephalohematoma (P < 0.001), and clavicle fracture (P = 0.002). In the case of cesarean section, there was a significant increase in the 2 (P = 0.001) and 3 (P = 0.034) stages of hypoxic-ischemic encephalopathy and birth with a low Apgar score (P < 0.001). Conclusions: It can be concluded that HSRP could somewhat achieve its goals on the promotion of vaginal delivery. However, the implementation of the plan was associated with an increase in some minor neonatal complications.

Factors Affecting the Satisfaction of Healthcare Workers with the Healthcare System Reform Plan in Healthcare Networks in Bushehr Province in 2018: A Qualitative Study

Factors Affecting the Satisfaction of Healthcare Workers with the Healthcare System Reform Plan in Healthcare Networks in Bushehr Province in 2018: A Qualitative Study

Implementation of the Health System Reform Plan in Hospital Emergencies of Iran: A Qualitative Study.

Health and efforts to maintain and promote it have always been an essential priority in various countries. This study aims to evaluate the implementation of the health system reform plan in emergency departments in Iran. This qualitative study evaluated five dimensions (finance, social responsibility, growth and learning, service recipients, and internal processes) through examining 70 indicators in 400 healthcare service providers and 300 healthcare recipients after the implementation of reform plan in ten emergency departments affiliated to Shahid Beheshti University of Medical Sciences using the balanced scorecard based on comprehensive evaluation model for the health system reform plan in Iran (CEHSRP-IR), from 2018 to 2019. From the perspective of 51% of service providers and 55% of service recipients, the health system reform plan has achieved its goals in hospital emergencies. Significant gap between the ideal effectiveness and the current situation in health services in hospital emergencies was observed, especially in the educational and financial dimension. According to the findings of this study, adaptation of activities and programs to the model proposed for emergency departments in Health Reform Plan is essential for improving its effectiveness.

Identifying the Obstacles to the Implementation of the Health System Reform Plan and their Ranking by AHP Method

Background and Objectives: Health System Reform Plan was implemented with the aim of modifying the health system structure with the overall aim of responding to the needs of society, improving and promoting the health system and a fundamental step in solving community health problems in the country. The purpose of this study was identifying and ranking the barriers to implementation of health system transformation plan by AHP method. Material and Methods: This study was an applied descriptive-survey study conducted Public Hospitals in Ahwaz. Statistical population was hospital managers, 12 of whom were selected by purposeful sampling. Open and closed questionnaires used for data collection. The t-test used to weight the indices, the AHP technique was used to rank the indices by paired comparisons based on the 9 ° hourly spectrum and also SPSS and the statistical software, Expert Choice, were used. Results: Findings showed that 4 factors (financial, infrastructure, planning and human) with 22 d subfactors were identified as barriers to implementation of Health System Reform Plan that financial barrier with weighted average (0.381), infrastructure weighted average (0.332), Planning with Weighted Average (0.162) and Human with Weighted Average (0.120) gained first to fourth rank, respectively. Conclusion: The results of the study showed that for the successful implementation of the Health System Reform Plan, it is necessary concetrate on the financing of the project, providing the necessary infrastructure, correct monitoring of the implementation, motivation and participation of human resources.

Patients’ Satisfaction of Health Care System Reform Plan in Educational-Medical Centers of Rasht City in North of Iran, 2018

Introduction: One of the goals of the health system is to ensure that people are healthy. Reaching this goal is only possible through the provision of the proper services. The satisfaction of patients with the quality of health care services is used as a questionare to investigate the effectiveness of hospital services concerning consumption management and patient care quality. It assists managers and the decision-making network to identify the strengths and weaknesses of the system. Objective: This study aimed to investigate the satisfaction of hospitalized patients in educational and medical centers of Rasht City, Iran with the “Health Care System Reform Plan” in 2019. Materials and Methods: The present study is an analytical cross-sectional study. A total of 395 patients hospitalized in educational and medical centers of Rasht City were selected based on the stratified random sampling method and according to the inclusion criteria. The study data were collected by a questionnaire examining patients' satisfaction with the “Health Care System Reform Plan” developed by the Treatment Deputy of Guilan University of Medical Sciences. The questionnaire has 37 questions in 5 areas of patient’s satisfaction with hoteling, hospital bills reduction program, resident physician program, notification program, the program for the promotion of normal childbirth. Data analysis performed using descriptive statistics indicators and Mann-Whitney U, Kruskal Wallis, and logistic regression model. Results: The results showed the mean±SD of samples' age was 43.51±18 years. The majority (23.8%) of the samples were less than 30 years old. Moreover, there was a significant difference between satisfaction score of the Plan (P = 0.009) in terms of gender, hospital bills (P = 0.001), resident physicians (P = 0.009), and notification program (P = 0.032). Also, men had a higher overall score than women. The findings of this study showed that the mean ± SD satisfaction was equal to 82.8 9.1 with a minimum score of 39.71. In the logistics model, only two variables of the hospital (P = 0.017) and job (P = 0.001) were considered as the most important factors related to the overall satisfaction with the “Health Care System Reform Plan.” Conclusion: Based on the results of the study, patients' satisfaction with the implementation of the “Health Care System Reform Plan” was at the acceptable level and various factors have contributed to this level of satisfaction.

Evaluation of Clinical Faculty Members' Satisfaction with Implementation of Health System Reform Plan in Iran: A study at the Ahvaz Jundishapur University of Medical Sciences

Background: One of the most important factors in assessing the success of a health system reform plan is the periodic review of the satisfaction of health care providers. Hence, this study was conducted to evaluate the clinical faculty members’ satisfaction with the implementation of the health system reform plan in Iran. Methods: This research is a descriptive and cross-sectional study. The research population of this study included all clinical faculty members employed in the university, 90 of whom were randomly included in this study. A 13-item researcher-made questionnaire was used to assess their satisfaction. Results: The mean score of general satisfaction was 2.17 ± 0.56. The highest dissatisfaction was related to the way of payment of salaries and benefits (93.4%) and the highest satisfaction was related to work hours and work shifts after implementation of the health system reform plan (16.7%) compared to before. In addition, variables of age (P = 0.019) and type of employment (P = 0.027) of clinical faculty members had a significant effect on their satisfaction with the implementation of the health system reform plan. However, the effect of other variables was not significant (P <0.05). Conclusion: Based on the results of this study, the satisfaction of clinical faculty members with the implementation of the health system reform plan was at an undesirable level. It is necessary to pay more attention to the dimensions in which people had the highest dissatisfaction in future planning aimed at periodically monitoring this plan and resolving potential problems.

Factors Affecting on Establishment of Health System Reform Plan in Ardabil Province

Factors Affecting on Establishment of Health System Reform Plan in Ardabil Province

A critical analysis of Iran health system reform plan.

INTRODUCTION:Iran's Health System Reform Plan (HSRP) were initiated in public and hospitals affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to provide a critical analyse of the HSRP and its outcomes.METHODS:The study was carried out as a review critical analyse in 2019. The pertinent articles were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords “health sector,” “reform plan,” “health system reform,” “health services,” “health care system,” and “Iran.” Published articles in scientific national and international journals in Persian and English language, of which the full-texts were available, were entered into the study. Finally, from a total of 75 articles obtained, 45 studies were carefully reviewed.RESULTS:Several factors, which impact in the success of Iran's HSRP such as social-economic and political outlooks, lack of official information and a comprehensive management system, in addition to failure to extend continuous performance control, economic sanctions against Iran. Other factors are limitations on financial transactions between Iran and the rest of the world due to the sanctions, relying merely on a few instructions, and negligence of the required infrastructures. In terms of advantages of the plan, relative decrease in patient's share in medical expenses, improvement of emergency wards, and relative decrease in the rate of C-section operations are notable.CONCLUSION:Better implementation of Iran's HSRP entails the provision of resources and facilities such as stable and adequate resources, proper management of available resources, payment mechanisms reform, attracting, and facilitating private sector's participation.

Challenges of Health System Reform Plan in Bushehr: A Qualitative Study

Challenges of Health System Reform Plan in Bushehr: A Qualitative Study

Designing a Comprehensive Evaluation Model for Health System Reform Plan in Iran: An Approach to Extended Balanced Scorecard

Background: Health and striving to maintain and promote it has always been an important priority in governments, communities, and public policies. To implement health objectives through the Fifth Five-Year National Development Plan of Iran, the health system reform plan with three approaches to the financial protection of the public, creating equity in access to health services, and improving the quality of services has been on the government's agenda since 05.05.2014. Investigations revealed that the lack of a comprehensive and scientific model for evaluating this national program is evident. This study aimed to design a comprehensive model of health reform plan evaluation in Iran. What distinguishes this study from previous studies is the simultaneous attention to the challenges of performance evaluation, social responsibility, and examining them in a comprehensive and coherent model. M aterials and Methods: The present study considered as descriptive-survey research in terms of strategy. The research method was a combination that conducted from 2018 to 2019. The sample size of the qualitative part of the research consisted of 17 academic and executive health experts selected by purposive non-random sampling. In the quantitative part of the study, 400 health service providers selected by stratified random sampling. In this study, content analysis and Delphi technique, and Expert choice v24, SPSS V22 and AMOSV14 software were used to collect, classify, deduce and exploit data, and questionnaires. R es ults: The findings of this study resulted in the design of a 900-scorecard model of the comprehensive evaluation of the health system reform plan in Iran based on 5 dimensions (finance, social responsibility, growth and learning, clients and internal processes), 17 components and 70 indicators. C onclusion: The findings of the quantitative section of the study showed that the indicators, dimensions and levels of the comprehensive evaluation model for health system reform plan in Iran (CEHSRP-IR) qualified for evaluation of the effectiveness of this national program at different organizational levels and executing units of health system reform plan in Iran.

Identification of Public Policy Implementation Barriers (Health System Reform Plan)

Identification of Public Policy Implementation Barriers (Health System Reform Plan)

Inequality Assessment of Hospital Resources Distribution in West Azarbaijan Province Using Economic Indicators, Before-After Health System Reform plan

Background: Equity in access to health care services is one of the main goals of health systems, so that inequality in the geographical distribution of health resources will make it difficult for individuals to access the health care facilities. This study aimed to determine the distribution status of hospital resources and inequality coefficient in the West Azarbaijan province before and after implementation of the health system reform plan. Methods: This cross-sectional and descriptive-analytic study aimed to investigate inequality in the distribution of health resources in cities of West Azarbaijan province before and after health system reform plan using concentration ratio and Hall Tiedman indices. The required data for estimating these indices were the number of specialist physicians and hospital beds, which were extracted from the data base of treatment deputy in Urmia University of Medical Sciences. Data analysis was conducted by Excel software. Results: The results indicated a high spatial concentration in distribution of the health resources in the province, so that fixed beds and specialist physicians were more concentrated in the capital city of province; Urmia. Moreover, inequality in distribution of the resources in cities of the province was highly related to population. Comparisons of the results before and after the health system reform plan showed that the distribution of fixed beds and specialist physicians had decreasing and increasing trends, respectively. Conclusion: The results showed that inequality in distribution of the hospital beds was intensified after implementation of the health reform plan. Furthermore, distribution of specialist physicians after the reform plan, despite its improvement, was not according to the population distribution. Therefore, inappropriate distribution of the above-mentioned resources should be readjusted by adopting redistributive policies.