فهرست مطالب

Evidence Based Health Policy, Management and Economics - Volume:3 Issue:3, 2019
  • Volume:3 Issue:3, 2019
  • تاریخ انتشار: 1398/06/10
  • تعداد عناوین: 8
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  • Mohammad Khammarnia, Fatemeh Setoodehzadeh, Mostafa Peyvand*, Amir Hossein Setayesh, Kosar Rezaei, Ayube Kordtamini, Mohammad Vahedi, Mohammad Najmjahan Dide, Alireza Khorram Pages 154-161
    Background

    The integrated health system (IHS) entitled “SIB” was launched in 2016 aimed to electronic health record (EHR) in the field of health. Given that, in addition to deploying the system, its acceptance criteria by users has a significant effect on its effectiveness and benefits: therefore, the present study was carried out aimed to determine the acceptance rate of IHS technology in health centers.

    Methods

    This study as a cross-sectional survey and applied research was conducted in Zahedan University of Medical Sciences (ZAUMS) in 2017. The population in the present study consisted of all users of SIB system affiliated ZAUMS. Of these, 285 users were selected (physician, health care provider, Behvarz) in five counties affiliated with ZAUMS using multistage cluster sampling. In this study, standard technology acceptance questionnaire was used for data collection. The data were analyzed by SPSS22 software and analyzed using descriptive statistics, one-way Anova, T test and other related tests.

    Results

    About 77.9 % of users used the system for several times a day. The SIB system acceptance rate by 49.5 % of users was moderate and 38.9 % of the users had excellent acceptance of this system. There was a significant relationship between the acceptance rate of SIB system among the users with age, gender, city, level of education, type of employment, place of work and organizational position (P < 0.05).

    Conclusion

    The results of this study show that, most users have accepted and confirmed the SIB system. Modification of the system with regional approach with the opinion and participation of specialists in comprehensive health service centers is suggested. .

    Keywords: Technology Acceptance, Integrated Health System, Users, Zahedan University of Medical Sciences
  • Manal Etemadi*, Hasan Abolghasem Gorji Pages 162-171
    Background

    Nearly all of the rationing mechanisms have negative impacts on the poor. If the fair service access is not set as the top priority in the rationing choices, the poor will experience service limitation and scarcity. This study aims at investigating the effects of rationing policies on the poor covered by Iran Health Insurance System.

    Methods

    This article is based on a qualitative study conducted in 2017. In total, 32 experts of health system financing participated in the study. A purposeful sampling method was applied till reaching knowledge saturation. Data were collected using semi-structured interviews. Afterwards, data was analyzed by framework analysis based on Bennet and Gilson pro-poor health financing system framework using MAXQDA10 software.

    Results

    The main challenge of rationing through the insurance system in Iran is the rationing only for the poor. As a result of rationing decisions, the poor are mostly the first group affected by service limitation only because they exempted from paying the premium. The current implicit or explicit health services rationing policies in each dimension has jeopardized the access of the poor to the services.

    Conclusion

    Every resource allocation and negotiation of service purchaser on the budgets should be aligned with the focus on vulnerable groups and their needs. The access of deprived groups should not be reduced for limited budgets or income prioritization. Every decision about the constraints on the usage of the services should be accompanied by the analysis of potential effects on the poor and preventive policies should be implemented so that the burden of service rationing could not be imposed on the poor

    Keywords: Rationing, Equity, Health insurance
  • Vahid Saberzadeh, Javad Abdollahinia, Pedram Nourizadehtehrani, Hadi Asheghi, Khatereh Khanjankhani* Pages 172-181
    Background

    Undoubtedly, one of the most important objectives of any organization is to provide high quality and desirable goods and services that depend on the performance of human force of the organization. The performance of physicians and nurses is a very important factor in establishing and enhancing the effectiveness of services. Since nurses are the most fundamental medical staff of the hospital, the present study was performed with the aim of investigating the factors affecting the job performance of nurses working in selected teaching hospitals in Tehran in 2018.

    Methods

    The target group of this study included nurses working in inpatient wards of hospitals, of whom 354 individuals were selected by simple random sampling method. The intraorganizational environment questionnaire (Weisbord), five personality traits (NEO personality inventory), and Paterson’s job performance questionnaire were the three data collection tools. The study was conducted in 2018 and the data were analyzed by SPSS20 software using descriptive statistics and artificial neural networks.

    Results

    In the personality traits questionnaire, neuroticism (40.22 ± 6.66) dimension had the highest and responsibility (23.94 ± 4.91) dimension had the lowest mean scores. Also in the inter-organizational environment questionnaire, communication (14.66 ± 4.52) dimension and rewards (21.33 ± 6.54) dimension had the best and worst status, respectively. Comparison of significance coefficients in neural networks showed that dimensions of agreeability (100 %) and marital status (8 %) had the highest and lowest importance in nurses’ job performance.

    Conclusion

    The results reveal that the dimensions of personality traits and job agreeability dimension have the most effect on the employees’ job performance. Hence, it is possible to improve staff performance by hiring people consistent with their work.

    Keywords: Job Performance, Personality, Teaching Hospital, Nurses
  • Batoul Ahmadi, Hosein Rafiemanesh, Reza Shamlou, Yones Kor, Mozhgan Letafat Nezhad, Mojtaba Mehtarpour* Pages 182-190
    Background

    Nurses' self-care assessment and elimination of obstacles with appropriate interventions will have a great impact on their own health as well as the recipients of health services. This study was designed to evaluate self-care status among nurses in selected hospitals in Tehran, Iran.

    Methods

    This cross-sectional study was carried out on 310 nurses working in Tehran University of Medical Sciences hospitals. Data were collected by a questionnaire with 70 questions that was conducted to evaluate the health level in five dimensions. Data were analyzed by using the statistical tests of MANOVA and Pearson’s correlation.

    Results

    The average scores of nurses' self-care in men and women were 244.1 and 245.3, respectively. The highest average score was for the supportive relationships dimension. There was a significant relationship between gender and self-care dimensions (P-value = 0.077). The average scores of self-care for nurses working in the emergency department, general department, surgical department, intensive care unit, and other sectors were 238.5, 247, 240.6, 245.6 and 251.1, respectively. There was a positive relation between supportive relationships dimension, age, and years of employment. In addition, there was a negative relation between the number of children and supportive relationships dimension (P-value < 0.05).

    Conclusion

    This study showed that self-care among nurses in the hospitals of Tehran University of Medical Sciences was moderately high, in a good and acceptable situation. However, there were poor scores in some areas and further study of the nurses’ self-care and its promoting strategies is still required.

    Keywords: Self-care, Nurses, Hospital, Iran
  • Mahdi Mokhtaripayam, Hossein Bouzarjomehri*, Dariush Chivaee, Elyas Hadian Shiva Pages 191-201
    Background

    Equality in resource distribution is one of the important aspects of effectiveness in achieving the goals of health system. Spending more resources in the health sector will not decline the inequality in the distribution of resources. Generating evidence and adopting evidence-based policies are very essential to reduce inequality in the distribution of health resources in the country. The present study investigates the equality trend in the distribution of health sector resources in Iran using Gini coefficient.

    Methods

    This is a descriptive-analytical study performed to investigate the equality trend in the distribution of health workers (Behvarz in Persian), general practitioner, pharmacist, pharmacy and fixed beds over 2006, 2011 and 2016 timelines. Data were extracted from the reports of the Iranian Statistics Center database and according to the population and housing censuses. Moreover, the data from the Plan and Budget Organization of the Islamic Republic of Iran (PBO) reports are used. Finally, data analysis was carried out through using Stata 14 software.

    Results

    The Gini coefficient for general practitioner distribution has had a constant trend. The Gini coefficient for pharmacists and pharmacies has decreased, i.e. the distribution of these resources is improving. In addition, the Gini coefficient for fixed beds and Behvarz has increased, referring to a relative decrease in equality in the distribution of these resources. There is equality in the geographical distribution of Behvarz in 2006 and 2011; but in 2016, there is a relatively unequal distribution. Concerning beds, pharmacies and general practitioners, it can be claimed that geographical distribution is generally equal. Despite the found trends, with respect to the Gini coefficient, the geographical distribution of pharmacists is estimated quite unequal.

    Conclusion

    Although the ratio of each variable to population is different in different provinces, it can be claimed that there is a relative equality in the distribution of general practitioners, Behvarz, pharmacies and fixed beds. In addition, health policy makers and decision makers have to consider the extent to which the target community needs each of these resources, in addition to crude distributional equality.

    Keywords: Distributional equality, Gini coefficient, Health resources, Lorenz curve
  • Mahmood Keyvanara, Nasrin Shaarbafchizadeh, Mohammad Alimoradnori* Pages 202-211
    Background

    Burnout has negative effects on the performance of employees, especially on the operating room personnel, who are in contact with acute patients. The aim of this study was investigating effective factors on occupational burnout among the operating room staff at the teaching hospitals affiliated with Medical University of Isfahan, Iran.

    Methods

    This study was a qualitative content analysis. The study had 20 participants selected from hospital managers, clinical supervisors, operating room supervisors, and hospital matrons in teaching hospitals (al-Zahra, Khorshid, Amin, Kashani, Feyz) of Isfahan in 2016.Participants were selected using the purposeful sampling method until information saturation was reached. Data were collected using a deep semi-structured interview, after thatall interviews were recorded and then transcribed and reviewed. Later, the data were analyzed by MAXQDA/12.

    Results

    In this study, three main themes were achieved internal factors of organization, external factors of organization, as well as individual and personal factors of organization. Totally, these main themes had 51 subthemes. In the process of analyzing the main themes, we found that internal factors of organization had 37 subthemes, external factors of organization had 11 subthemes, and individual and personal factors of organization had three subthemes.

    Conclusion

    Various factors related to job burnout were mentioned by decision makers. It is possible to resolve these factors by proper decisions of managers and heads of hospitals. Managers of hospitals should advance service quality, reduce costs, and decrease losses of burnout due to internal factors of organization, external factors of organization, as well as individual and personal factors of organization.

    Keywords: Staff, medical university, Burnout, Operating room, Qualitative approach
  • Omid Barati, Ahmad Sadeghi, Mohammad Amin Bahrami* Pages 212-221
    Background

    This study aimed to investigate the effects of using a management contract mechanism on hospital’s performance indicators.

    Methods

    A longitudinal comparative study was done in 4 educational hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. The related data to 17 performance indicators (including 4 financial, 6 facility utilization, 2 customers, 3 human resources, and 2 quality indicators) of the studied hospitals were collected for two years before management contract implementation and two years after its implementation using hospital information system (HIS). The collected data were ordered and analyzed using EXCELL and SPSS18 software.

    Results

    The results showed the positive effects of contract management implementation on some financial, facility, customer, human resources and quality indicators. Hospital income, patients’ satisfaction, staff satisfaction and the number of inpatients and outpatients of studied hospitals improved significantly after contracting.

    Conclusion

    Although, the present study showed the benefits of contracting process in delivering hospital services, its success largely depends on the clear monitoring of contract and the continuous development of the managerial capacity of contractors.

    Keywords: Hospital, Contracting, Management contract, Outsourcing, Performance assessment
  • Mohammad Ali Moghbeli, Ali Reza Kalantari, Somayeh Noori Hekmat, Mahshid Salemian Pour, Ehsan Lorafshar, Mohammad Saleh Koushki, Reza Dehnavieh* Pages 222-230
    Background

    Health Technology Incubators (HTI) play an important role in paving the way depicted in Iran’s comprehensive health plan in order to achieve the aimed position in 2025. In light of the emerging nature of these centers in Iran, identification of HTI problems and challenges, as well as appropriate planning to resolve those problems can have a significant effect and improve Iran’s health system functionality.

    Methods

    This qualitative study was conducted in Iran in 2016. Data were collected through interviews with 24 experts (Interviewees included managers, deputies, and employees from the country's incubators) in the field. Purposeful sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis. In all the mentioned steps the Atlas-Ti software has been employed.

    Results

    Challenges of Health Technology Incubators in Iran were categorized into eight concepts- Cultural,   Rules and Principles, Funding, Concentrated Administrative System, Human Resources, Stewardship and Monitoring, Physical space and Equipment, and Communicational. Then 22 challenges were identified with in these concepts.

    Conclusion

    This study suggests that considering the challenges influencing technology incubators in the health sector, a sustainable program for these centers can be designed.

    Keywords: : Incubators, Health care, Innovations, Technology parks, Health technology