نشریه راهبردهای مدیریت در نظام سلامت
سال هشتم شماره 3 (پیاپی 29، پاییز 1402)

The desire to survive is inherent in any organization; in the private sector, profit, and in the public sector, people's satisfaction is the guarantee of survival. Taking into account the ever-increasing changes and developments, achieving this goal, requires the adoption of a suitable strategy such as the evolution of an organization that, along with patient-centeredness and service quality, encourages government employees to gain the satisfaction of citizens. The main goal of this research is to design organizational evolution in hospitals affiliated with Bushehr University of Medical Sciences.

. This research was carried out qualitatively using grounded theory. To collect data, semi-structured interviews were used and data analysis was done using Strauss and Corbin method and the paradigm model. Purposive sampling was carried out based on which14 interviews conducted with professors of the scientific board of universities and experts working in government hospitals.

The results of the data obtained from the interviews during the process of open, central ,and selective coding led to the creation of grounded theory in the field of organizational evolution in hospitals affiliated with Bushehr University of Medical Sciences. The model designed in this research included 43 sub-categories in the form of 6 main categories of causal, contextual, interventional, central phenomenon, consequences, and strategies.

This research can be a complete road map for hospital managers to move towards an evolutionary organization by providing causal, contextual, and intervening conditions, strategies, and consequences of the central phenomenon of organizational evolutionism. Furthermore, this research will help to better understand this phenomenon.

The evidence of Iran's economy shows that many economic variables, including household health expenditures, can be affected by exchange rate shocks. According to previous studies, the increase in the exchange rate from two channels of the general increase in prices, as well as the increase in the price of medicines and imported medical supplies, increases health expenditures. This study investigated the asymmetric effects of the unofficial exchange rate on the health expenditures of urban households in Iran.

The present applied study investigated the short-run and long-run effects of positive and negative shocks of the unofficial exchange rate, gross domestic product (GDP), and CO2 emissions on the health expenditures of urban households during 1971-2019 using time series data. The data were collected from the database of the Statistics Center and the Central Bank. To investigate the reliability of data, generalized Phillips-Prone and Dickey-Fuller tests and to check the stability of the coefficients, cumulative sum and cumulative sum squares were used. Also, to check the short-run dynamics and adjustment towards the long-run, the error correction model was estimated. The regression model was estimated using the Nonlinear Autoregressive Distributed Lag approach by Eviews (12.0) software. After estimation, diagnostic tests including Wald test, normality, heterogeneity of variance and autocorrelation were performed.

The results showed that the increase in exchange rate has a positive and significant effect on household health expenditures, its reduction has no significant effect Therefore, the effect of exchange rate shocks was asymmetric. Accordingly, 1% increase in the unofficial exchange rate led to a 0.237 % increase in household health expenditures in the short-run and  0.55 % increase in the long-run. In addition, 1% increase in GDP led to 0.49 % increase in household health expenditures in the short-run and 1.57% increase in the long-run. Finally, 1 % increase in CO2 emissions led to a 1.49 % increase in household health expenditures in the long-run.

Based on the results, after the increasing exchange rate shocks and possible future declines, due to the persistence of the shocks effects for up to three years, it is suggested not to stop supportive policies for providing health expenditures, especially for low-income groups.

After the policies are formulated and approved, they are communicated to the managers for implementation. Several factors lead to the failure of health system policies. In this research, these factors have been identified and ranked.

This was an applied research, and in terms of strategy, it was a survey. The research community consisted of 21 experts in the field of health in the Ministry of Health and universities of medical sciences, who were selected through random and targeted sampling. The tools of data collection were interviews and questionnaires, and to analyze data, Failure Modes and Effects Analysis (FMEA) and Analytical Hierarchy Process (AHP) were used.

In this research, 4 dimensions of failure factors regarding the implementation of the health system policy were identified, including governance, management, environmental and financial resources, and 23 components of the mentioned dimensions were identified. Moreover, the most important identified failure factors through AHP and FMEA were prioritized and evaluated.

Knowledge of failure factors can help to improve the capacity of the implementation of health system policies.

Health financing is very important and means providing money, budget or necessary resources for it. Considering the vital role of the government in financing health, in this research, the drivers of financing were identified by the government and possible futures were investigated.

The present qualitative study was developed in 4 phases. Judgmental and snowball sampling methods were applied in all stages. In the first stage, based on theoretical saturation, 15 people and in other stages, 12 experts participated. In the first phase, financing drivers were identified through interviews and thematic analysis. In the second phase, using the researcher-made questionnaire and Micmac 6.1.2 software, the main drivers were extracted. In the third phase, the uncertainty of each of the key drivers was determined by an interactive management approach, and finally, in the fourth phase, compatible scenarios were determined using a researcher-made questionnaire and its analysis with the Scenariowizard 4.3.1 software.

In this research, 14 factors influencing the government funding of the healthcare sector were identified. Moreover, 5 compatible scenarios for financing were obtained. In the "wealthy government" scenario, the financing conditions were favorable by the government, but in the scenarios of "calm inefficient", "inefficient without a plan", "inefficient unstable" and "bankrupt government", the government had many problems and the health sector should focus on other financing methods.

Due to the lack of favorability of most scenarios, it is necessary for healthcare managers to reduce dependence on the government budget and promote financing from other methods. Methods such as financing through the provision of services, charitable donations and insurances, and the stock market should be given serious consideration.

Medical tourism industry as a service industry needs to take measures including branding to attract and retain tourists. This study was conducted with the aim of improving branding in medical centers active in medical tourism, through the test of the brand citizenship behavior development model of employees, which was calculated from a qualitative research based on the Foundation Data Model.

The current field-survey research was conducted on a sample of 384 employees in contact with patients, 10 hospitals with admission departments for international patients in Tehran city, selected using convenience sampling method. The data were collected using a researcher-made questionnaire. The reliability of the questionnaire was evaluated with Cronbach’s alpha index and composite reliability, and its validity was evaluated using content validity and construct validity. Data analysis was done by structural equation modeling using SPSS 22 and Smart Pls 3 software.

All research hypotheses were confirmed, including the effect of causal categories in the three dimensions of organization, employee, and tourist on brand citizenship behavior, the effect of intervening and foundational categories on comprehensive marketing and branding planning except for organizational justice and social responsibility of the organization, the impact of brand citizenship behavior on the comprehensive planning of marketing and branding and finally the effect of brand citizenship behavior by mediation of comprehensive planning of marketing and branding on the consequences related to tourists, organizations, employees and extra-organizations. The evaluation of the structural part of the model and the relationship between the internal and external construct also indicated the optimal fit of the model.

Attracting the support of employees in the direction of extra-role behaviors that strengthen brand identity and benefit from its positive organizational and extra-organizational results, requires the attention of managers and relevant officials to various organizational, managerial, individual, etc. factors. Moreover, creating a strong brand in medical centers requires comprehensive planning to increase the participation of employees of these centers.

The success of any organization depends on the expertise and competence of human resources, especially its managers. Competence is defined as the knowledge and skills necessary to perform a job. The current study aimed to rank the competencies of managers based on the competence model of Dolewis and Higgs (2005), which was carried out using multi-criteria decision-making techniques (combined method of Dimtel and network analysis) in public hospitals of Yazd province.

This inductive approach research was carried out quantitatively during 2021 to 2022 in public hospitals of Yazd province. In this study, multi-criteria decision-making techniques were used including the combined method of Dimtel and network analysis. The statistical population was a group of human resources experts and senior managers of public hospitals in Yazd province. Sampling was done first by judgment and then by snowball method and through the introduction of experts and based on the possibility of access to them, and 15 experts were selected as a sample. After extracting the data from the experts' questionnaires, Dimtel method was used to evaluate the relationships between the indicators.

In the current study, according to the experts’ opinions, the competence model of Doleviz and Higgs (2005) was considered, which included three managerial, personal, and intellectual dimensions. The dimension of managerial competence included components of success, empowerment, development, engaging and effective communication, resource management. The dimension of intellectual competence included components of judgment and critical analysis, perspective and foresight of strategic views. The dimension of personal competence included components of self-awareness and emotional resilience, intuitive understanding, interpersonal sensitivity, influence, motivation, and conscience. Based on the results of the super matrix of network analysis, the weights of competence in order of priority included managerial, intellectual, and personal competence. In managerial competence, the component of resource management, in personal competence, the influence component, and in intellectual competence, the components of foresight and perspective were more important.

In order to be more successful in achieving future goals and perspective, hospital managers should strive to strengthen their competencies, since improving the competence of managers helps them in effective use of resources, better response to clients, and achieving goals, in accordance with the accreditation standards of public hospitals in Yazd province

Leadership competencies in medicine are the key factors in improving the performance of physicians and the health system. The aim of the present study was to design and validate the leadership competencies scale in medicine.

This research was conducted with a qualitative-quantitative approach. The research sample consisted of 12 physician managers in the qualitative stage and 15 people in the content validity evaluation stage using purposive sampling method. In the preliminary implementation stage of the questionnaire, 35 people were selected by convenience sampling and the main implementation stage of the questionnaire 306 students, faculty members, and medical graduate managers were selected using relative stratified random method. Qualitative data were collected by semi-structured interview and quantitative data by questionnaire. To analyze the qualitative data, the Esterberg analysis method was used, and to evaluate the construct validity, confirmatory factor analysis with Smart-PLS3 software was used. To evaluate the validity of quantitative data, content validity index, content validity ratio, Cronbach's
alpha coefficient, convergent validity, and structural equation model fit indices were used. The criteria of credibility, transferability, dependability, and conformability were used using triangulation to evaluate the validity of the qualitative research data.

Competencies and parameters of the questionnaire were extracted into 17 competences and 123 concepts through the coding of interview texts and converted into a questionnaire in 101 items. The content validity of 100 items was valid. The results of factor analysis showed that the factor load of 99 items was valid and 17 components explained the structure of leadership competencies. Based on the fit indices of the model, the measurement scale of leadership competencies in medicine was valid in 17 components and 99 items. These components include perception and impression management, professional ethics, conflict management, problem solving, discipline, informal organization, public communication skills, interpersonal relationship skills, listening, cultural management, professional culture, innovation and creativity, motivation, emotional intelligence, change management, feeling management, participative management.

Attention to the curriculum of leadership competencies in medical education and the application of this scale can improve the quality of leadership in the health system.

The treatment of oral and dental diseases is expensive all over the world and these diseases are considered the fourth most expensive diseases. The aim of the present study is analysis of exposure of households to catastrophic expenditures of oral and dental health care in Ahvaz city.

The present cross-sectional descriptive-analytical study was conducted on 715 households living in Ahvaz city in 2022using multistage sampling. Collecting the data was done through a questionnaire, and logistic model and Stata 17  software were used to analyze the data and estimate the elasticity of influencing factors.

According to the results of the study, the ratio of oral and dental health expenditures to household payment capacity was 59.03 %, and 52.16 % of households faced catastrophic expenditures. Also, supplementary insurances with Odd Ratio (OR) = 1.39, living in the southern region with OR = 1.08, and being in the 2nd income quintile with OR = 1.1 had a strengthening role in facing catastrophic expenditures.

According to the results of this study, in order to reduce the negative effects of oral and dental health expenditures, it seems necessary to modify the financing policies of these services and move towards equity in financing through increasing insurance coverage.