نشریه مدیریت سلامت
پیاپی 93 (پاییز 1402)

Digitalization has become a crucial factor driving innovation in companies, research centers, and governmental organizations. This study aimed to identify the drivers of digital innovation, map the relationships between them, and analyze the effective routes of these drivers within governmental hospitals in Rafsanjan.

This research is pragmatic in its purpose and employs a descriptive survey for data collection, conducted in 1402. The study's population comprised experts from governmental hospitals in Rafsanjan, with a sample of 12 experts selected through the snowball method. The data's validity was confirmed using the content validity ratio index. Data analysis was performed using the fuzzy cognitive mapping method, supported by Fcmapper, Pajek, and Excel software.

The study identified 12 key factors driving digital innovation in governmental hospitals. Fuzzy cognitive map analysis revealed that senior management support, with a coefficient of 1.57, exerted the most influence. Meanwhile, the organization's digital capacity, with a coefficient of 3.24, was found to have the greatest influence. Additionally, the organization's digital capacity, with a coefficient of 3.89, exhibited the highest centrality. This research contributes by identifying key digital innovation factors, establishing causal relationships among these factors, and determining the primary factors influencing others through various digital innovation scenarios within governmental hospitals.

Based on scenario analysis findings encompassing 12 drivers and understanding the causal relationships among them, it is recommended that hospital authorities prioritize the "needs of citizens" driver to foster digital innovation.

The healthcare sector is a primary driver of a country's growth. In light of recent healthcare crises, adequate financing has gained special importance. This research aims to explore potential futures of service-based financing in the healthcare supply chain.

This study, applied in nature and employing a mixed-methods approach, was conducted in Iran over four stages from 2021 to 2023. The first stage involved 15 participants, followed by 12 in the subsequent stages. Participants included healthcare supply chain managers and university professors specializing in healthcare management and research. In the first stage, semi-structured interviews, interview guidelines, and thematic analysis were utilized to identify the drivers of the service-based financing chain. The second stage involved a researcher-made questionnaire and the Micmac software to extract the main drivers. In the third stage, an interactive management approach determined the uncertainty of each main driver. Finally, the fourth stage used a researcher-made questionnaire and the ScenarioWizard software to identify consistent scenarios.

The study identified 20 drivers, with 13 deemed as main drivers, leading to 15 consistent scenarios. The results reveal a contradiction: while the improvement and differentiation of services (coupled with inflation) may increase the cost of services, leading to reduced accessibility for some, failure to improve healthcare services could result in capital flight and inadequate treatment for new diseases.

To resolve this contradiction, two approaches for the healthcare sector can be envisioned: a) customer segmentation based on financial capacity and required services, and b) alternative financing methods. Approach "a" potentially increases social inequality by providing different services based on financial ability. Approach "b", relying on inconsistent income sources like charity, leaves the government's role in financing ambiguous. Consequently, approach "a", supplemented with governmental support for vulnerable groups, appears more viable.

Climate change is a long-term climate variations caused by human activities that alters the composition of the global atmosphere. Climate change is one of the biggest threats to health. Iran's health system should respond to climate change-related health threats. The purpose of this study was to identify the challenges and solutions to build a climate resilient health system for Iran.

This qualitative study was conducted using interpretive phenomenology method and semi-structured interviews with 32 policy makers, managers, experts and researchers from the Ministry of Health, Ministry of agriculture, Ministry of roads and city planning, Environmental protection organization, National meteorological organization, Atomic energy organization, Universities, Associations, and Research institutes. Participants were selected through purposeful and snowball sampling methods. Framework analysis method was used to analyze the data.

Eighty four challenges to the resilience of Iran's health system against climate change were identified, which were grouped into two categories of factors inside the health system, (i.e., governance and leadership; financing; health workforce; facilities, equipment and medicines; health information system; and health services delivery) and factors outside the health system (i.e., political, economic, social, technological, environmental and legal factors). Overall, 91 solutions were identified to solve these challenges and to strengthen Iran's climate resilient health system.

Iran's health system is facing several barriers to be climate resilient. Actions at the macro, meso and micro levels, inside and outside the health system should be carried out to increase the adaptability and resilience of the Iranian health care facilities.

Intersectoral collaboration (ISC) in health program implementation refers to coordinated efforts between the health system and other departments to enhance effective and efficient results. Different missions and goals of organizations make it challenging for their management to establish effective communication. This review was conducted to identify facilitators and barriers for intersectoral collaboration in health program implementation.

This scoping review was conducted using the Arksey & O'Malley framework. The search was conducted in PubMed, Scopus, Web of Science databases, and Google and Google Scholar search engines with related keywords without time limitation until April 2023. The data analysis was conducted using the framework analysis method.

After the screening, 27 studies concerning the barriers and facilitator of ISC were chosen. Facilitators and barriers were classified into two categories: those within the healthcare system, including governance and leadership, financing, human resources, facilities and equipment, information systems, and health service delivery, and those outside of it, encompassing political, economic, social, technological, environmental, and legal factors.

Anticipating potential obstacles in interdepartmental cooperation can mitigate many challenges during program implementation. Strengthening ISC is anticipated to facilitate the implementation of health programs and the attainment of goals.

In recent years, the adoption of electronic referral systems has accelerated worldwide, driven by advances in information technology and communication infrastructure. This study aims to conduct a comprehensive review of the diverse dimensions of electronic referral systems across different countries.

This review was conducted using the Arksey and O'Malley framework. We gathered information without time limitations by searching for relevant keywords in databases such as PubMed, Scopus, Web of Science, SID, MagIran, and Google Scholar search engine. Manual searches were also performed in selected journals. Endnote X8 software was used for data management. Analysis was conducted through manual thematic analysis.

From a total of 4,372 articles and reports, finally, 20 articles were included in this review. The findings were organized into eight primary domains encompassing 51 subcategories. These domains included economic aspects, service quality improvement, enhancement of referral quantity, improved access, increased satisfaction among healthcare providers and recipients, barriers and challenges, the referral process, and facilitators.

The implementation of electronic referral systems has led to positive outcomes, including improved economic efficiency, enhanced quantity and quality of referrals, higher satisfaction levels among healthcare providers and recipients, improved access to care, and streamlined referral processes. Middle-low incomes countries have the opportunity to design and implement electronic referral systems tailored to their specific conditions and capabilities.

Enhancing the efficiency of medical equipment utilization can result not only in reduced treatment costs but also in shorter waiting times and increased patient satisfaction. This study aimed to estimate the utilization coefficient of diagnostic imaging equipment and provide solutions for its improvement.

The present cross-sectional study was conducted using mixed methods approach in two quantitative and qualitative stages. In the first stage, the utilization of three main imaging-diagnostic equipment of a specialized hospital (encompassing three ultrasound machines, two MRI devices, and one CT angiography machine) was investigated from March 2018 to March 2019. The study employed two indices, the calendar utilization coefficient, and the service provision utilization coefficient to gauge the efficiency of equipment utilization. In the second stage, the main causes of reduced equipment utilization and improvement solutions were determined through focused group discussions with the participation of 15 experts using the content analysis method.

Among the assessed equipment, the lowest utilization coefficient was related to the CT angiography at 25% and the intervention ultrasound machine at 33%, respectively. The utilization coefficient for the ultrasound machine in the outpatient and the inpatient departments was 41% and 81%, respectively, and for the MRI machine in the outpatient and the inpatient departments was 84% and 46%, respectively. Common factors contributing to reduced utilization of diagnostic imaging equipment within the hospital comprised insufficient human resources, delays in patient transfers from inpatient departments, inadequate workspace in diagnostic imaging units, and suboptimal preventive maintenance systems.

Maximizing the capacity of diagnostic imaging equipment in the hospital necessitates augmenting and motivating human resources, streamlining workflow and patient transfer across departments, restructuring the workspace within diagnostic imaging units, and making strategic investments in equipment maintenance systems.

Nowadays, accidents are one of the significant public health problems in the world, especially in Iran. The purpose of this study was to perform an exploratory factor analysis of the questionnaire on socio-economic factors affecting the accidents of injured drivers in West Azerbaijan province, Iran.

In this cross-sectional, descriptive-analytical study, 310 drivers who had a traffic accident and were hospitalized in 2020 were recruited. This research consisted of six stages (identification of variables, determining the explanatory indicators, controlling the data fitness, determination of the method and number of factors to be extracted, selection of the method for factor generation, interpretation and naming of factors) and provides recommendations to achieve desired results. The data were analyzed using SPSS v.25 software.

According to the KMO and Bartlett tests, respectively, the correlation and the adequacy of the sample size showed that the indicators could be a factor. By using the method of maximum likelihood analysis and factor rotation method, two factors with eigenvalues greater than one were extracted, and the Scree plot confirmed those two factors. These two factors explained a total of 64.24 of the variance of all variables. Varimax factor rotation was also used to identify items. These factors were direct and indirect factors that affected the occurrence of accidents. In addition, Cronbach's alpha coefficient (α = 0.84) showed the reliability of the above results.

The results showed the validity of the constructs of this questionnaire, and this tool be used in research related to traffic, job promotion, income increase, car safety, education, and public health.

Introduction</span>:</span> Financial analysis provides important information to hospital managers and causes resources to be allocated more accurately. The aim of this study was to identify the structure of financial resources of selected hospitals of Isfahan University of Medical Sciences, Isfahan, Iran, during 2011–2021</span>.</span>
Methods</span>:</span> This descriptive study was conducted based on data from the selected hospitals affiliated with the Isfahan University of Medical Sciences. The data were obtained from budget and financial departments of Isfahan University of Medical Sciences and hospital information system, and then were processed in Microsoft Excel 2016.</span>
Results</span>:</span> The total revenue, hospital revenue from national budget and hospital special revenue have always been on an upward trend in current prices. In constant prices, the total revenue of hospitals increased by 20% in 2021 compared to 2011, and the trend of hospital special revenue has also been decreasing in most of these years. On average, operational revenue had the largest share and non-operational revenue as well as donation and charity had the least share of hospital financial resources. The average share of hospital special revenue (56.41%) was higher than the average share of hospital revenue from public budget (43.59%).</span>
Conclusion</span>:</span> Clarifying the structure of the hospital revenue can provide policy makers with a more comprehensive analysis of the current situation. The results of this study indicated the downward trend of the real hospital special revenue in these years, which indicates the fact that the revenue generating capacity of public hospitals is decreasing. The significant decrease in operating revenues of hospitals and the lack of compensation by the government in the form of hospital revenue from ministerial budget have faced a serious challenge to the self-governance of these hospitals. Therefore, health policy makers should pay serious and urgent attention to the revision or modification of the self-management plan in public hospitals.</span></span></span></div>