نشریه راهبردهای مدیریت در نظام سلامت
سال چهارم شماره 3 (پیاپی 13، پاییز 1398)

Many previous empirical studies indicated appropriate implementation of the fiscal decentralization and transfer of resources and expenses from the central government to local governments was an important factor to improve health outcomes in developing countries. Accordingly, the major purpose of this study was to evaluate the impact of fiscal decentralization indicators on the mortality rate (as an indicators of health measurement) in Iranian provinces.

This study uses the statistical data of variables affecting the mortality rate in provinces of Iran to study the spatial effects of fiscal decentralization indicators on the mortality rate during 2006-2015. To this end, the spatial econometric approach was used. Furthermore, the statistical analyses were performed using the Matlab software.

Findings of the model's estimation indicate that indicators of the fiscal decentralization and mortality rate had a negative and significant relationship. In this regard, 1 % increase in fiscal decentralization indicators of income and expenditure decreased  the mortality rate by 0.19 % and 0.10 % in provinces of Iran, respectively. Other results showed that the spatial proximity effect between provinces of Iran had a positive and significant effect on the mortality rate.

By providing the necessary conditions for expansion of fiscal decentralization, the health level can be promoted in provinces of Iran.

The optimal management of hospitals as the most important centers for providing health services has always been the focus of decision makers and policymakers. The present study aimed to evaluate the technical efficiency of hospitals affiliated to Ardebil University of Medical Sciences using Artificial Neural Network (ANN) method.

The present descriptive, applied, and cross-sectional study was conducted in 2017. The study population consisted of 8 educational and therapeutic centers affiliated to Ardabil University of Medical Sciences and Health Services. Census sampling method was applied to select the participants and researcher-made checklists were used to collect the data. The artificial neural network method was also used to investigate the study objectives. The applied network was a multi-layer prospectron with a Levenberg Marquardt optimization function, a sigmoid tangent transfer function in the middle layer, and a linear function in the output layer. For processing and preparing data, Excel spreadsheet was used and Matlab software were used for analyzing and designing the network.

The results showed that the average technical efficiency of the studied hospitals was 0.75. Ardabil Bou Ali, Khalkhal Imam Khomeini, and Meshkinshahr Valiasr hospitals had the highest technical efficiency (1.00). With regard to the hospital bed occupancy rate, Germi Velayat hospital had the lowest efficiency rate (0.75). Furthermore, Parsabad Imam Khomeini hospital had the lowest efficiency in the number of discharged healthy patients (0.69) in 2017. Finally, the improvement space of each variable was calculated to achieve the total technical efficiency.

According to the results, one of the factors that decreases  the technical efficiency of the educational centers is the low rate of hospital beds' utilization and occupancy rate. In other words, lack of full-capacity operation by the hospital centers and the low rates of active hospital bed imposed costs and consequently reduced the hospitals' performance.

Universities of Medical Sciences are required to take steps to implement dimensions of the learning organization due to their wide-range of activities and their role in maintaining and improving the community health. This study was conducted to determine the compliance of Isfahan University of Medical Sciences with the components of learning organization. 

This descriptive-analytic study was conducted among all senior and middle managers of Isfahan University of Medical Sciences at the Central headquarters, colleges, and hospitals. For data collection, the standard Neife Learning Organization Questionnaire (2001) was applied .Validity of the questionnaire was evaluated in terms of content validity based on the experts' opinion and the questionnaire's reliability was confirmed by calculating the Cronbach's alpha coefficient of 0.89. Data were analyzed using descriptive and analytical statistics such as Pearson correlation coefficient, t-test, and Spearman correlation coefficient through SPSS 20.

The compliance rate of Isfahan University of Medical Sciences with components of the learning organization was 72.60 from the viewpoint of the senior and middle managers of this university in total. The highest mean score was attributed to the individual skills (77.60) and the lowest mean scores were related to the components of mental models (67.03), team learning (70.70), and shared vision (72.20), respectively. Independent t-tests showed that the total mean score of adoption with the learning organization and scores of the shared vision, team learning, and systematic thinking components were significantly higher in male than female managers (p < 0.05).

The Isfahan University of Medical Sciences' compliance with characteristics of the learning organization is at a desirable level. Managers and authorities can achieve the highest level of learning organization by improving all components of the learning organization, especially the mental model, team learning, and shared vision.

The optimal use of research findings is crucial. One of the activities that improves application of research-derived knowledge is the knowledge translation. This study aimed to investigate the status of knowledge translation in Shiraz University of Medical Sciences.

This cross-sectional and descriptive-analytical study was conducted in 2018. The sample size included 143 faculty members of Shiraz University of Medical Sciences selected using the stratified sampling and simple random sampling methods. The required data were collected using a standard knowledge translation questionnaire consisting of 50 items in 4 dimensions. The validity and reliability of the questionnaires were confirmed in the previous studies. The collected data were analyzed using SPSS 21 by descriptive and analytical statistics.

The results showed that overall status of the knowledge translation was weak (2.46 ± 0.67). In this regard, producing useful evidence for decision making (2.77 ± 0.77) and promoting application of evidence (2.33 ± 0.88) had the highest and lowest mean scores, respectively. Furthermore, the overall mean of knowledge translation was significantly different with gender, type of center, and scientific rank (P < 0.05).

Given the undesirable and weak status of knowledge translation, creating a culture of knowledge translation, training about knowledge transfer and utilization of research findings, creating incentive mechanisms, developing transparent processes and guidelines, and strengthening the interaction between knowledge producers and research users are essential.

The internet and social media are considered as new tools to seek health information. Health misinformation is defined as a health-related claim of fact that is false due to the lack of scientific reliable evidence. These kinds of information are produced both intentionally or non-intentionally and can impose negative impact on the population health. This study was aimed to explore the strategies to deal with the health misinformation from the professionals' viewpoints. 

This qualitative study was conducted applying content analysis approach in 2018-2019. In this regard, 8 semi-structured interviews were conducted with health professionals of Shahid Sadoughi University of Medical Sciences. Snowball sampling method was used to identify the eligible interviewees. Data was analyzed using the content analysis by Max QDA 10 software.

Analysis of interviews resulted in a main theme (strategies to deal with the negative consequences of online health misinformation) and 14 sub-themes of training health workers at all levels, creating responsible organizations for public education about the online web, improving the public education efforts, improving the general culture of society on the informed use of online technology,  informing society about the impossibility of trusting all online information, disseminating the educational advertising, placing filters to prevent from the dissemination of inaccurate information, establishing the information verifying and validation mechanisms, improving the book reading culture, raising peoples’ awareness of and sensitivity to misinformation, having accurate accountability by specialists, learning how to think, improving the culture of critical thinking, making correct decisions based on the extensive information/taking into account several items in the case of decision making.

According to the final analysis of the experts' viewpoint, the most important ways to deal with inaccurate information in the cyberspace were to increase the public awareness, reduce the reliability of all published data, and verify them repeatedly. These strategies can prevent from many traumatic consequences.

Promotion and institutionalization of the entrepreneurial culture in the health system is one of the most important components of entrepreneurship development and economic success of countries. Thus, the present study was conducted with the aim of identifying the factors affecting the development of entrepreneurship in the health area, Isfahan University of Medical Sciences in 2017.

This applied qualitative study was conducted in 2017. First, 10 health experts in Isfahan University of Medical Sciences were selected using semi-structured interviews based on the purposeful sampling method. The Delphi method was used to prioritize the factors. To analyze the qualitative data, the framework analysis method of Max QDA 10 software was used. Furthermore, descriptive statistics were used by SPSS 22 for analyzing the Delphi phase data.

In the initial phase, 3 themes (contextualizing, operational, consolidation and institutionalization) and 15 classes were extracted. Then, in the Delphi phase, 12 factors were determined as the effective factors on the entrepreneurship development in the health area. The most important factors in the development of entrepreneurship included empowerment of work forces, customers and stakeholders, as well as attracting internal and external capitals for initiating business with a mean of 4.73.

In strategies of entrepreneurship development in the health area, policymakers are recommended to base their measures and decisions on differentiating the identified factors. In other words, this differentiation improves the entrepreneurship opportunities and outcomes based on the environmental conditions and current resources.

In this review, we investigated various aspects of Policy Delphi technique to make decision-makers more aware of this pertinent method so that they can use it in their policy decisions in their organizations.

 This study was conducted using a review method and by searching the related literature in databases such as PubMed, Scopus and Google Scholar. In addition, texts in related books or reports were also used. The most important keywords were Policy Delphi, decision making tools, health policy making, decision making, and health.

Unlike the traditional Delphi, which seeks consensus on ideas and is a decision-making tool, Policy Delphi is a useful tool for analyzing the policy issues and is more about identifying the opposing views on a policy issue. Policy Delphi seeks to address the policy-related issues and does not seek to reach consensus. In various texts, 6 steps were introduced to this approach: formulating the issues, exposing the options, determining initial positions on the issues, exploring and obtaining the reasons for disagreements, evaluating the underlying reasons, and reevaluating the options. The most important rating scales included desirability, feasibility, importance, and confidence.

Application of Policy Delphi in examining policy changes and policy issues is of high importance and can emerge many unintended and negative consequences for a policy. So, it is recommended to use this tool in the health sector due to its wide setting and complexity and since it has different stakeholders with different views and opinions.

Public-private partnerships (PPP) have been used recently in many countries for reforming the structural health sector. The purpose of this study was to investigate the impact of PPP models in hospitals on raising the awareness of health policy makers, managers, and authorities to make sound decisions and planning.

 This review was conducted in 2019 by searching the databases of Scopus, ProQuest, PubMed, and Google Scholar. The following keywords were used for the search: public private partnership, PPP, public hospital, public private partnership in hospital, and partnership model. Furthermore, Persian equivalents of these key words were searched in databases of Scientific Information Database and Irandoc from 1990 to 2017. A total of 954 articles were studied in a step-by-step manner.

Finally, 21 articles related to the study objectives entered the research. Based on the results collected from reviewing the selected papers, PPP in hospitals were categorized into 9 different categories of Service Purchase, Outsourcing, Management Contract, (Design, Build, Finance, Operate), (Build, Own, Operate), (Build, Own, Operate, Transfer), (Buy, Own, Lease back), Alzira model and Privatization. So, PPP influenced the performance of hospitals.

Overall, PPP can be a good solution for the hospital sector that can improve the hospital performance in the case of providing the necessary contexts. However, these models are not generalizable to all parts of the health system and may face numerous challenges in implementation.