Mechanisms of Intersectoral Collaboration in the Health System: A Scoping Review

Background

The implementation of health interventions requires the collaboration of various sectors outside health due to the multidimensional nature of healthcare. Building effective partnerships demands the use of intersectoral mechanisms that facilitate the leadership and implementation of these programs. In this review, the mechanisms of intersectoral collaboration (ISC) and their results were identified.

Methods

This scoping review was conducted in 2020. Using relevant keywords, all documents related to ISC in the health system were identified by searching four databases (PubMed, Scopus, Science Direct, and Web of Science), Google, and Google scholar search engines. In the initial search, 2911 documents were extracted. Based on the selection criteria 52 documents were selected for content analysis.

Results

Five areas of ISC were identified, including funding (collection, pooling, and distribution of funds), governance and leadership (political commitment, rules and regulations, control and evaluation, and stakeholder engagement), structural mechanisms (interorganizational, government-based, and program-based structures), process tools (information tools, support tools, and resource and service sharing), and models and frameworks (general, national, and program-specific models).

Conclusion

An intersectoral framework or model be developed that considers the financial, structural, and leadership aspects as well as the necessary process tools required for each program. Moreover, it should be considered communication and human resources empowerment in each intervention.

Trend analysis of noncommunicable diseases and their risk factors in Afghanistan

Background

Afghanistan is suffering from 40-year chronic conflicts, displacement, and demolition of its infrastructure. Afghanistan mortality survey 2010 shows nearly 46% of all deaths in the country were attributed to noncommunicable diseases (NCDs). In this study, we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years.

Methods

We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation, Global Burden of Diseases 2019. The information on NCD mortality, NCD deaths attributed to its risk factors, NCD percent of total years lived with disability (YLDs) attribution to each risk factor extracted from this database from 2008 to 2019. We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030.

Results

Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019 (50% for both sexes) and this will reach nearly 54% by 2030. Currently, half of NCDs deaths are premature in Afghanistan. The mortality rate and prevalence of risk factors are higher among women. More than 70% of YLDs will be due to NCDs in Afghanistan till 2030. Five risk factors including high systolic blood pressure (28.3%), high body mass index (23.4%), high blood glucose (20.6%), high low-density lipoprotein cholesterol (16.3%), and smoking (12.3%) will have the highest contribution to NCDs death in 2030, respectively.

Conclusions

In general, our study indicates that without any specific intervention to address NCDs in Afghanistan, not only the Sustainable Development Goal target for NCDs will not be met, but an increase in almost all risk factors prevalence, as well as NCD mortality, will be seen in Afghanistan.

Strategies to strengthen a climate-resilient health system: a scoping review

BACKGROUND

Climate change is a major global threat to human health and puts tremendous pressure on health systems. Therefore, a resilient health system is crucial to enhance, maintain, and restore the population's health. This study aimed to identify interventions and actions to strengthen a climate-resilient health system to deal with the adverse health effects of climate change.

METHOD

This study was a scoping review. Five databases and Google Scholar search engine were searched using relevant keywords. Initially, 4945 documents were identified, and 105 were included in the review. Content thematic analysis method was applied using MAXQDA 10 software.

RESULTS

Overall, 87 actions were identified for building a climate-resilient health system and were classified into six themes (i.e., governance and leadership; financing; health workforce; essential medical products and technologies; health information systems; and service delivery). The most commonly reported actions were formulating a national health and climate change adaptation plan, developing plans for essential services (electricity, heating, cooling, ventilation, and water supply), assessing the vulnerabilities and capacities of the health system, and enhancing surveillance systems targeting climate-sensitive diseases and their risk sources.

CONCLUSIONS

A holistic and systemic approach is needed to build a climate-resilient health system owing to its complex adaptive nature. Strong governance and leadership, raising public awareness, strategic resource allocation, climate change mitigation, emergency preparedness, robust health services delivery, and supporting research, are essential to building a climate-resilient health system.

The impact of government subsidy programs on equity in health financing

BACKGROUND

Iran government implemented the targeted subsidy plan in December 2010 to reduce energy consumption and inequality. In addition, the Health Transformation Plan was implemented by the Ministry of Health to reduce out-of-pocket payments. This study aimed to examine the impact of these two government subsidy programs on equity in health financing.

METHOD

In this study, data on 528,046 households were collected using household surveys during 14 years (2007-2020). The Fairness in Financial Contribution index and Catastrophic Health Expenditures index were calculated. Also, a Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of the two mentioned policies and other socioeconomic characteristics of households on their exposure to Catastrophic Health Expenditures.

RESULTS

The FFC index was 0.829 and 0.795 respectively in 2007 and 2020. The trend analysis did not show significant changes in the FFC index between 2007 and 2020. TSP and HTP implementations do not reduce households' exposure to CHE significantly. Crowded households with more elder people, belonging to low-income deciles, without houses, and living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. Highly educated and employed households were exposed to less CHE.

CONCLUSION

The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target households (households with more elderly people, lower incomes, without private houses, crowded, rural, and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.

Measuring Equity of Geographical Distribution of Specialist Physicians in Iran's Health System

Background

Equitable distribution of health care sector resources is one of the most important goals of health systems in all countries. The purpose of this study is to measure equity of geographical distribution of active specialist physicians in Iran's health system.

Methods

The present study was a descriptive-cross-sectional. The statistical population included: all active specialist physicians working in the public, private, social insurance organization, military, charity, and the other health service providers in Iran in 2019. Studied demographic data were collected from Iran's national statistic center. Also, information of specialist physicians was obtained from several databases. Finally, duplicated records were removed, and the number of specialist physicians extracted. Data analysis was performed using Stata V.16 and ArcGIS 10.4 software.

Results

The results showed that the number of specialist physicians per 100,000 population who worked in Iran's health system was 46.81. The provinces of Tehran had the highest and Sistan and Baluchestan had the lowest number of specialist physicians. Also, 52.63% of active specialist physicians provide health services in four provinces, whereas these provinces are 37.13% of the country's population. Total Gini coefficient of the distribution of active physicians in Iran in 2019 was 0.23.

Conclusions

Distribution of specialist physician was different but somewhat equitable in the provinces. However, in some provinces, the ratio of specialist physicians to the population was still low. Therefore, when the number of specialist physicians increased, their distribution should be considered concurrently.

Resiliency of the Iranian healthcare facilities against the Covid-19 pandemic: challenges and solutions

BACKGROUND

Health care facilities are responsible for preventing and controlling diseases and must be resilient enough to deal with crises. The Iranian health care facilities have faced challenges in managing COVID-19 pandemic. The purpose of this study was to identify the challenges faced by the Iranian health care facilities during the Covid-19 epidemic and to provide solutions.

METHODS

This qualitative study was conducted with a phenomenological approach and using semi-structured interviews with 59 healthcare policy makers, managers, and employees, and medical university faculty members. The participants were selected through purposive and snowball sampling. Thematic analysis was used to analyze the data.

RESULTS

Overall, 43 challenges to the resilience of health care facilities during the Covid-19 pandemic were identified and grouped into 8 themes (i.e., leadership and management, planning, organizational culture, organizational learning, employee management, customer management, resource management, and process management. The most important resilience challenges were: fragmented management system; poor leadership; incompatible health network structure; lack of a national holistic plan; poor case detection; insufficient resources; inefficient information system; negative attitude of managers and employee; organizational inertia; failure to build on lessons learned from crises; low workforce preparedness; lack of community-based management; and improper monitoring and evaluation. Managers should use community-based, evidence-based, and integrated management to build health system resilience against COVID-19, have sufficient knowledge and experience to organize operations, use appropriate and effective coordination models, develop a creative and participatory culture, reengineer processes, and provide necessary resources.

CONCLUSION

The Iranian health care facilities face challenges that prevent them from becoming resilient, responsive, and efficient in managing COVID-19. Policy makers and managers should increase the resilience of health care facilities to shocks and crises by using the suggested measures.

Strategies to tackle non-communicable diseases in Afghanistan: A scoping review

Non-communicable diseases (NCDs) and their risk factors are the leading cause of death worldwide and contribute to 74.3% of deaths globally in 2019. The burden of NCDs is escalating in Afghanistan. Currently, every seconds, people in Afghanistan are dying of NCDs. Addressing this challenge in Afghanistan needs effective and practical interventions. This study aimed to identify the strategies developed and implemented in countries with low non-communicable premature death. To conduct a scoping review, we followed the six-step Arksey and O'Malley protocol and searched for eligible articles on eight international databases and the gray literature. The study followed the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. The inclusion criteria were English documents and evidence produced up to 30 November 2021 for the control of NCDs. We excluded incomplete texts, duplicates, and dissertations due to lack of access. We used EndNote X9 and MaxQDA software for data management and analysis. We conducted content analysis for this study. A total of 122 documents developed between 1984 and 2021 met the inclusion criteria. We identified 35 strategies from which the most used strategies were related to unhealthy diets and smoking cessation programs. Canada (26.4%), Korea (19.8%), and the United Kingdom (19%) have the most publications on the control and prevention of NCDs among the countries included in the study. Most strategies were implemented over 2 years (41%). This study recommends specific interventions to control and prevent NCDs for the main risk factors of tobacco use, unhealthy diet, physical inactivity, and the main non-communicable diseases such as heart diseases, cancers, diabetes, and chronic obstructive pulmonary diseases. Afghanistan Ministry of Public Health, the WHO country office, and other involved stakeholders can use the findings of this review to design and implement strategies for controlling and preventing NCDs in Afghanistan. International organizations such as the World Health Organization, United Nations Agencies, the World Bank, and other involving communities should invest in strengthening good health governance in Afghanistan. The Afghan Government should focus on promoting and funding health literacy among the public and self-care to control and prevent NCDs.

Health System Governance Evaluation: A Scoping Review

Background: Governance is one of the critical functions of the health system. Good governance of the health system leads to better performance and outcomes. Evaluation is the first step to improving health system governance. Therefore, this research aimed to identify evaluation tools for health system governance. Methods: In the current scoping review, we searched all documents related to health system governance evaluation indexed in Medline, EMBASE, ProQuest, Scopus, Cochrane Library, Science Direct databases, and Google Scholar search engines to 2022, extracted, and assessed. Finally, documents were selected and analyzed by thematic analysis. Results: Thirty tools were found to evaluate health system governance. Among the proposed tools, 11 specific tools have been designed just for health system governance evaluation, while others have governance as a component of health system evaluation. Health system governance’s significant components are health policy-making, strategic planning, organizing, stewardship, and control. Indicators such as accountability, participation, transparency, equity, efficiency, accountability, corruption control, effectiveness, ethic, the rule of law, and sustainability could be used to evaluate the health system governance.  Conclusion: Different tools have been used to evaluate governance worldwide, and each governance evaluation tool has different components suitable for governance evaluation. However, these tools cannot fully evaluate governance and have shortcomings. A comprehensive evaluation of governance and sharing lessons denrael will affect the health system's capacity and ability to provide quality, safe and effective health services. It will lead to the stability of the health system.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran

Background: It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. Aims: To identify the role of midwives in the provision of reproductive health services and recommend improvements. Methods: A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. Results: The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. Conclusion: There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Comprehensive Disaster Risk Management Standards for Hospitals

Background: Hospitals play an important role in protecting the health and survival of people during disasters. Despite the development of risk management programs worldwide in recent years, hospital preparedness in disasters is low and one reason for that is the lack of hospital standards for disaster preparedness. This study aims to develop hospital accreditation standards for hospital disaster risk management based on national and international experiences. Materials and Methods: We used a mixed-method explanatory sequential approach. At first, a comparative study was conducted and the disaster risk management (DRM) hospital standards were extracted from 10 selected countries, namely the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, and Denmark. Standards were analyzed according to the DRM life cycle and the most comprehensive framework was chosen. For national experiences, purposeful semi-structured interviews were conducted with 22 experts in disastrous events in the country and continued until the saturation stage. In addition, Graneheim and Landman’s contractual content analysis method was used for data analysis. After combining international standards and national experiences, the proposed standards were introduced and the content validity index and content validity ratio were done by 25 experts. Results: Differences were observed in the quality and quantity of the selected countries’ DRM standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. A total of 27 standards from the International Standards Review and 31 standards from interviews were added (a total of 58 standards). The content validity results of the standards were within acceptable limits. After editing and determining the measurement criteria, the final standards were introduced. Conclusion: This study introduces comprehensive DRM standards based on international and national documents and experiences that can be useful for policymakers and accreditation organizations in both developed and developing countries for hospital evaluation. This is also useful for hospitals as a roadmap for promoting preparedness in disasters.

Donors' Participation in Iran's Health System: Challenges and Solutions

BACKGROUND

Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions.

METHODS

This qualitative study was performed using semi-structured interviews with 38 donors and 26 policy-makers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research.

RESULTS

Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers' support, weak legal support and poor monitoring were the most important challenges for donors' participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors' participation in healthcare. A conceptual model was developed to strengthen donors' participation in the health system.

CONCLUSION

Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policy-makers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors' needs are necessary for successful philanthropy initiatives in the health sector.

A Mixed Methods Multicenter Study on the Capabilities, Barriers, and Opportunities for Diabetes Screening and Management in the Public Health System of Southern Ethiopia

Background

More than half of diabetics' in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia.

Methods

We applied a mixed methods study. To assess the healthcare systems' capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly.

Results

Our study findings indicated that there were good opportunities and encouraging capabilities like government commitment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system's structural problems, skilled professionals' inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and evaluation mechanisms have been hampering the service delivery at the system level. While service unaffordability, low awareness level, and lifestyle modification problems were the main challenges at the patient level. Furthermore, outdated paper-based medical record documentation, frequent essential drug stock-outing, essential laboratory service interruptions, and none-use of some available services like HbA1c have been contributing to the barriers.

Conclusion

Despite favorable capabilities available, diabetes management in southern Ethiopia has been struggling with solvable structural defects, poor service delivery and inaccessibility, and patients' poor lifestyle modification. Therefore, public health system restructuring, optimum financing, computerization of medical records documentation, and health system and patient capacity building are strongly recommended interventions to tackle the problem at the grass-root level.

Economic Evaluation of Health Interventions: A Critical Review

Background:

Economic evaluation is used for the optimal allocation of resources in the health sector. While a large number of economic evaluation studies have been conducted, there is less critical review of these studies. We critically examined the economic evaluation studies of preventive health interventions.

Methods:

The study was carried out using critical review method. Seven databases (i.e., PubMed, Cochrane Database of Systematic Reviews, Web of Science, Science Direct, Scopus, Springer Link, and Elsevier) were searched to find articles on economic evaluation of health interventions published from 1985 to 2018. In addition, the references of retrieved studies were hand screened for articles that were not indexed in these databases. Finally, 206 articles, including 33 cost- benefit analysis, 146 cost- effectiveness analysis, and 27 cost-utility analysis were included in this study. These studies were critically evaluated using a checklist of 11 criteria.

Results:

Only 20% of the studies met all the methodological criteria of health economic evaluation. The cost perspective, costs type, cost data source, and cost measurement were not explained and discussed in 17%, 20%, 5%, and 33% of studies respectively. Outcome data sources and outcome valuation method were only mentioned in 53% and 69% of studies. The sensitivity analysis and results’ generalizability were not reported in 16% and 46% of studies.

Conclusion:

The quality of economic evaluation studies is low, and it can be misleading if resource allocation decisions are made using this evidence. Authors should use valid protocols to conduct and report economic evaluation studies, and journals’ editors should use valid checklists to evaluate these articles.

Reasons for turnover of hospital managers in Iran: A qualitative study

BACKGROUND

Managerial stability is believed to play a crucial role in the success of health care organisations and health managers. High managerial turnover seems to be a common phenomenon of the Iranian health system. This study thus aimed to investigate the reasons for managerial turnover in Iranian hospitals.

METHODS

Following a qualitative approach, 53 semi-structured interviews were conducted with different managerial levels in the hospitals, the high officials of medical universities, and health policymakers. Interviewees were selected using the purposive sampling techniques. Interviews were continued up to the data saturation. Data analysis was conducted thematically using MAXQDA 10.

RESULTS

Four groups of reasons were identified leading into the managerial turnover in hospitals, ranging from the micro to macro level factors, that is, those related to the managers, hospitals, medical universities, and the country. Insufficient support from the officials, managerial poor performance, conflict with other managers and colleagues, changes of senior managers, and presidential and parliamentary elections representing the key reasons underlying the turnover of hospital managers in Iran.

CONCLUSION

Given the variety of reasons emerged behind the managerial turnover, the efforts to improve the awareness and engage the all actors ranging from health policymakers to organisational decision-makers could be a valuable step to regulate and optimise the managerial turnover and stability in health care organisations in order to enhance the productivity and accountability in healthcare industry, particularly in the hospitals.

Factors affecting nurses' retention in Iranian hospitals

AIM

This research was conducted to study the factors affecting nurses' retention in Iranian hospitals.

BACKGROUND

Health care systems should pay attention to their human resources' retention to deliver health care services and maintain their organizational values. This issue becomes more significant when we consider the human and financial limitations in place.

METHOD

Data were analyzed using conventional qualitative content analysis based on the model developed by Elo & Kyngäs. Forty-two managers and nurses were selected by purposive sampling. Data were obtained through 45 semi-structured interviews until data saturation was reached.

RESULTS

The data analysis resulted in four main categories and seventeen subcategories. The main categories included dignity and respect, ethics and spirituality, empathy, and flourishing. The main theme extracted was "maternal management".

CONCLUSION

The present study proposes "maternal management" as a strategy to increase the retention of nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Maternal management is a combination of management knowledge and empathy when dealing with the staff's problems. By creating an amiable and empathetic environment, maternal management motivates and encourages the staff. In the face of financial and human resources shortage, what helps retain the staff is a friendly atmosphere and mutual understanding between them and the nursing manager.

Policy options for strengthening evidence-informed health policy-making in Iran: overall SASHA project findings

Background

The institutionalization of evidence-informed health policy-making (EIHP) is complex and complicated. It is complex because it has many players and is complicated because its institutionalization will require many changes that will be challenging to make. Like many other issues, strengthening EIHP needs a road map, which should consider challenges and address them through effective, harmonized and contextualized strategies. This study aims to develop a road map for enhancing EIHP in Iran based on steps of planning.

Methods

This study consisted of three phases: (1) identifying barriers to EIHP, (2) recognizing interventions and (3) measuring the use of evidence in Iran's health policy-making. A set of activities was established for conducting these, including foresight, systematic review and policy dialogue, to identify the current and potential barriers for the first phase. For the second phase, an evidence synthesis was performed through a scoping review, by searching the websites of benchmark institutions which had good examples of EIHP practices in order to extract and identify interventions, and through eight policy dialogues and two broad opinion polls to contextualize the list of interventions. Simultaneously, two qualitative-quantitative studies were conducted to design and use a tool for assessing EIHP in the third phase.

Results

We identified 97 barriers to EIHP and categorized them into three groups, including 35 barriers on the “generation of evidence” (push side), 41 on the “use of evidence” (pull side) and 21 on the “interaction between these two” (exchange side). The list of 41 interventions identified through evidence synthesis and eight policy dialogues was reduced to 32 interventions after two expert opinion polling rounds. These interventions were classified into four main strategies for strengthening (1) the education and training system (6 interventions), (2) the incentives programmes (7 interventions), (3) the structure of policy support organizations (4 interventions) and (4) the enabling processes to support EIHP (15 interventions).

Conclusion

The policy options developed in the study provide a comprehensive framework to chart a path for strengthening the country’s EIHP considering both global practices and the context of Iran. It is recommended that operational plans be prepared for road map interventions, and the necessary resources provided for their implementation. The implementation of the road map will require attention to the principles of good governance, with a focus on transparency and accountability.

Practicing patients’ rights in Iran: a review of evidence

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.

Health Systems of Iran and Portugal: A Comparative Study

Background: A health system consists of people, institutions, and resources that provide health services to meet the health needs of the target population. Health systems in developed and developing countries have different characteristics from which some lessons can be learned. The aim of this study is to compare the two health systems of Portugal and Iran. Methods: The study was conducted in 2021 using a comparative study approach. The WHO's six building blocks framework was used for the comparison (i.e., governance and leadership, health financing, health workforce, health information system, medication, and service delivery). A six-step protocol was used to review the literature. International databases such as Medline / Pub Med and Scopus were searched. Policy briefs, reports, and dissertations were also reviewed. Results: In both countries, the Ministry of Health is centrally responsible for health system governance. Healthcare financing is 80% government-funded in Portugal and 55% in Iran. In both countries, Health systems are mixed (NHS, NHI, and out-of-pocket model) and the unbalanced regional distribution is a major problem for human resources. In Iran, generic drugs are used, while Portugal combines generic and branded systems. In both countries, there are some challenges in integrating health information systems for health centers and hospitals. Conclusion: In both countries, some autonomy should be delegated to the regions. In Iran, public sector investment in the health system in Iran should be increased to reduce the currently very high out-of-pocket payments in the health system. In both countries, the distribution of resources, especially human resources, should be modified by designing some incentives. Increasing the share of generic drugs in Portugal will have a positive impact on cost control in the drug sector. It seems necessary to develop programs to strengthen the health information system in both countries.

The Effectiveness of Employee Performance Appraisal System in Health Sector: Evidence from Iranian organizations

Introduction: Performance appraisal is a formal process to review and improve the organizational performance of employees regularly. Despite the appropriate organizational frameworks for performance appraisal, they are not apparently addressing the operational realities of health care organizations. This study thus aimed to examine the effectiveness of the current performance appraisal system of employees at Tehran University of Medical Sciences (TUMS) from the perspective of employees. Methods: The data were collected from 504 TUMS employees using researcher-developed questionnaire following the validation. It consisted of 46 questions covering such various dimensions as performance expectations, communication of performance objectives to employees, self-assessment, performance metrics, surveyors, and performance appraisal results. ANOVA, t-test, Post hoc and Tukey statistical tests were used during analysis process by SPSS 22. Results: The performance appraisal system was not found as effective as expected from the employees’ perspective and the scores for all its dimensions dropped below the average. The overall performance appraisal score was 2.71 (out of 5). There was also a significant correlation between the employees’ education and organizational job group and the score of performance appraisal (p<0.0001). Conclusion: The current appraisal system according to the results is not well functioning. Therefore, it seems necessary to make urgent changes. The lack of active participation from employees and managers in performance appraisal development process, and the subsequent low motivation to improve their performance seems to be a persistent challenge. A fairly desirable solution might be to decentralize the appraisal processes rendering more authority to managers and supervisors along with empowering managers.

Paramedical staff's knowledge, attitude, and performance about nosocomial infection controls at hospitals: A cross-sectional survey in Iran

BACKGROUND

Nosocomial infections usually occur 48 hours after admission to the hospital or up to 72 hours after discharge from the hospital. They lead to an increase in mortality and health costs. The purpose of this study is to measure the knowledge, attitude, and performance of paramedical staff about nosocomial infection control.

MATERIALS AND METHODS

This cross-sectional study was conducted in Tehran hospitals in 2019. A valid and reliable questionnaire was used to collect data. The questionnaires were distributed among 405 randomly selected paramedical staff at 25 hospitals in Tehran. The data were analyzed using SPSS18.

RESULTS

The mean scores of paramedical staff's knowledge, attitude, and performance in terms of nosocomial infection control were 11.2 ± 2.2 (good), 21.7 ± 3.7 (good), and 49.2 ± 9.4 (good) respectively. A statistically significant relationship was obtained between paramedical staff's work experience and type of hospital and their knowledge, attitude, and performance in terms of nosocomial infection control (P <0.05). In addition, a statistically significant relationship was found between gender, age, education, and, employment type and nosocomial infection control performance (P <0.05).

CONCLUSIONS

The knowledge, attitude, and performance of paramedical staff about nosocomial infections in Tehran hospitals were good. Education, continuous supervision, and provision of the necessary equipment are needed for improving the paramedical staff's knowledge, attitude, and performance in terms of nosocomial infections.

Developing a hospital accreditation model: a Delphi study

BACKGROUND

Hospital accreditation (HA) is an external evaluation of a hospital's structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program.

METHODS

This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country's health system, university professors in the fields of health policy and management across the country.

RESULTS

A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers ("Management and leadership", "Planning", "Education and Research", "employee management", "patient management", "resource management", and "process management") and three are the results ("employee results", "patient and society results" and "hospital results"). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model's total scores respectively. Then, about 150 accreditation standards were written and verified.

CONCLUSIONS

A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.

Taxonomy of effective strategies to reduce unnecessary caesareans: a systematic review

Background

The increasing trend in unnecessary caesarean sections has caused maternal and neonatal health concerns worldwide. Various medical and non-medical interventions have been designed and implemented to reduce caesarian section overuse. However, their efficacy is questionable.

Aims

This study aimed to identify and classify effective interventions to reduce unnecessary caesarian sections.

Methods

We searched EMBASE, MEDLINE, Web of Knowledge and Scopus databases for articles, using appropriate search strategies, up to 2 June 2020. Overall, 7951 identified articles were screened and assessed using a valid quality assessment checklist. Finally, 109 eligible studies were included in this review. Thematic content analysis was used to identify and classify the effective interventions.

Results

Overall, 188 effective caesarian section reduction measures were identified. They were categorized into 45 actions, 16 intervention groups and 6 WHO building blocks, including "governance and leadership", "financing", "health workforce", "medical products and technologies", "information" and "service delivery". Using qualified and competent staff, intra-partum services, and oversight were the most commonly applied interventions to reduce unnecessary caesarian sections.

Conclusions

A taxonomy of effective strategies to reduce unnecessary caesarian sections was developed in this study. A holistic approach is crucial to addressing the new epidemic of unnecessary caesarian section. Multiple interventions based on the underlying causes of caesarian section overuse should be designed and implemented at local and global levels.

Prevalence of Poor Diabetes Self-Management Behaviors among Ethiopian Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis

Background

Diabetes has no cure so far, but appropriate self-management contributes to delay or control its progression. However, poor self-management by diabetic patients adds to disease burden. The pooled prevalence of overall, and its main components of poor self-management among Ethiopian diabetic patients remain elusive. Hence, this study aimed to determine the prevalence of poor diabetes self-management behaviors among diabetic patients in Ethiopia.

Method

by using different combinations of search terms, we accessed articles done until February 15, 2020 through Pubmed, Scopus, Web of Science and Embase databases. Newcastle-Ottawa quality assessment scale was used for quality assessment, and STATA version 14 software along with the random-effects model was employed for statistical analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA.) guideline was followed to report the results.

Result

Twenty-one studies with 7,168 participants were included in this meta-analysis. The overall pooled prevalence of poor self-management behavior among diabetic patients in Ethiopia was 49.79% (95% CI: 43.58%, 56.01%). Based on subgroup analysis, the estimated magnitudes of poor self-management by regions were 68.58% in Tigray, 55.46% in Harari, 54.74%, in Amhara, 40.90%, in SNNPRS and 37.06% in Addis Ababa. The worst (80.91%) and relatively better (24.65%) self-management components were observed on self-blood glucose monitoring and medication adherence, respectively.

Conclusion

One in two diabetic patients in Ethiopia had poor self-management. Thus, we strongly recommend to the ministry of health and universities to train diabetes health educators, and the health facilities to deliver tailored diabetes health education.

Iran hospital accreditation standards: challenges and solutions

OBJECTIVE

The purpose of this study was to identify the challenges of Iranian hospital accreditation standards and provide solutions.

DESIGN

A qualitative research design was used in this study. Open and semi-structured interviews were conducted in 2018. Thematic analysis was used to analyse qualitative data.

SETTING

Public, private, semi-public, charity and military hospitals in Tehran, Iran.

PARTICIPANTS

A pluralistic evaluation approach was employed and 151 participants including policy makers, hospital management and staff, accreditation surveyors and university professors participated in this study.

RESULTS

Challenges of hospital accreditation standards were grouped into two groups: standards development process and standards content. Lack of an independent standards development committee, insufficient expertise of committee members, inconsistencies among the standards' constructs, inappropriate standard classification, ambiguity of standards, unmeasurable standards, vague and inflexible scoring system, and inability to use some standards were the main challenges of Iran hospital accreditation standards. Establishing a scientific committee consisting of representative from hospitals, health insurance companies, professional and scientific associations and universities for standard development, training the committee members, and utilizing hospital's feedback will help address these problems.

CONCLUSION

Iran's hospital accreditation standards face challenges that prevent them from achieving their goals, that is, improving the quality, safety, effectiveness and efficiency of hospital services. Necessary measures should be taken to solve these problems.

The Magnitude, Types, and Roles of Social Support in Diabetes Management among Diabetics' in Southern Ethiopia: a Multilevel, Multicenter Cross-Sectional Study

INTRODUCTION

Lifelong medical management is the main intervention to reduce diabetes-related morbidities and premature deaths; yet, social support can be a vital intervention to improve diabetics' health. Therefore, this study aimed to determine the magnitude, types, and role of social support in diabetes management in southern Ethiopia.

METHODS

A multi-stage systematic sampling was applied to recruit 634 adult diabetics from the three-tiered healthcare system in the region. We proportionally distributed the sample size between randomly selected ten health-care facilities across the hierarchy. Pretested questionnaires and checklist; Epi-Info, and SPSS software used for data collection; entry, and analyses, respectively, and the statistical significance was determined at a P-value ≤0.05.

RESULTS

A total of 240 females and 356 males completed the study, and the overall magnitude of the social support was 50.20% [95% CI: 46.19%, 54.21%], and it was categorized into non-material and material with 44.13% [95% CI: 40.14%, 48.12%] and 34.23% [95% CI: 30.42%, 38.04%] magnitudes, respectively, and social support was left to the patients' families and friends whereas formal institutions and the public sectors were rarely offering when the patients needed it. Though sex, educational level, and health-care hierarchy were not significantly associated with the social support, residence, some occupations, presence of diabetic family members, acute medical conditions, blood glucose level, compliance to medical follow-ups, treatment adherence, and taking anti-diabetic drugs a day before the current visit to health-care facility were all statistically significantly associated with social support.

CONCLUSION

One of every two adult diabetic patients in southern Ethiopia was receiving any social support, and social support for diabetic people reduces medical follow-ups absenteeism, improves treatment adherence, glycemic level controlling, and helps lifestyle modifications. Therefore, to keep diabetic people healthy and achieve diabetes management goals, the Ethiopian healthcare system, institutions, and concerned stakeholders should strengthen the social support for diabetic patients.

Quality management effects on operating theater's productivity: a participatory action research

Purpose

The operating theater (OT) is resource-intensive, costly and assuring its productivity is a high priority. This study aimed to examine a quality management model's effects on a hospital's OT productivity.

Design/methodology/approach

The participatory action research approach was used for the intervention. A multidisciplinary quality improvement team was formed. The team improved OT operational processes using an eight-step quality management model. OT’s key performance indicators such as surgical cases, surgical cancellation, bill deductions, successful cardiopulmonary resuscitation, patients' complaints and employees' job satisfaction were collected before the intervention and compared with those of after intervention to determine the efficacy of the quality management model.

Findings

Applying a quality management strategy increased surgical patients' number by 14.96%, reduced surgery operations cancellation by 14.6 %, and decreased bill deduction by 44.9%. Besides, successful cardiopulmonary resuscitation increased by 21.17%, patients' complaints reduced by 61.5% and, finally, staff satisfaction increased by 15.6 %. Improved OT productivity resulted in improved financial performance. As a result, the OT revenue has risen by 68.8%.

Originality/value

This study highlights that implementing the right quality management model properly enhances hospitals' productivity. It also offers suggestions on how to implement a quality management model successfully in a hospital setting.

Impact of food insecurity and malnutrition on the burden of Non-communicable diseases and death in Ethiopia: A situational analysis

BACKGROUND

Currently, Ethiopia is undergoing an epidemiological transition. Consequently, NCDs are becoming an increasingly important public health problem in the country. Furthermore, the country has faced a high level of food insecurity.

METHODS

We conducted a comprehensive review based on published articles from 2010 to 2018 and WHO reports on food insecurity, malnutrition and their impacts on the burden of NCDs death in order to obtain a deeper understanding of the seriousness of the NCDs cause of deaths in relation to food insecurity and malnutrition. In addition, policy for protecting vulnerability and the implementation of SDGs on food insecurity, malnutrition, and NCDs were also discussed. The results of this review highlight the progress that was made in the overall condition of food insecurity, nutrition, and diseases in the country.

RESULTS

The finding shows that there has been large burden of recurrent food insecurity, which could be due to malnutrition that might be associated to inconsistent rainfall distribution and also the experience of violent conflict in recent periods. However, the prevalence of undernourishment was declined from 75% in 1990s to 32% in 2015 though the numbers indicate a marginal reduction. But unexpectedly still the child mortality rate of under-five that results from malnutrition accounts about 57% of all children deaths. As the result of malnutrition, obesity is recognized as the determinants for a number of NCDs such as diabetes, cancer, and cardiovascular diseases. Communicable diseases seems the only identified health problem in the country, however; the burden of NCDs is facing major aspects. Hence, NCDs like cardiovascular diseases and diabetes, currently, are among the leading causes of death among adults, which is responsible for 39% of deaths in the country in 2015 while the risk of premature NCDs mortality was reached about 15.2%. Of these deaths, 4% was due to cancer and 9% was related to other NCDs such as obesity and nutrition-related cases. Therefore, food insecurity has a high-flying impact in early death from chronic health conditions and the cause of undernutrition that leads to an augmented susceptibility and decreased flexibility to NCDs as a result of compromised nutrition.

CONCLUSION

In order to sustain the economic growth, reduce poverty and achieving food security, the Ethiopian government has started discourse at high level of agenda hoping to avoid recurrent violent conflict, food insecurity and famine by targeting urban low-income households and empowering youth and women.

Client satisfaction on Emergency department services and quality of emergency medical care in Ethiopia: A systematic review

BACKGROUND

The utilization of the emergency department to provide an emergency medical services is crucial for the communities who need an urgent medical care that is associated with various cases. This aim of this review was to describe the client satisfaction on the services of Emergency department and the quality of emergency medical care in Ethiopia.

METHOD

We searched peer-reviewed published articles related to clients' satisfaction on emergency department services and the quality of emergency medical care between January 2000 and December 2017. The articles were retrieved from databases of PubMed, Scopus, Ovid, Google Scholar, MEDLINE, EMBASE and ScienceDirect. Furthermore, studies published in other language than English was excluded.

RESULTS

A total of 2094 participants: 906 (43%) males and 1188 (57%) females were recruited in those reviewed papers to express their satisfaction on the service and the quality of emergency medical care of the Emergency department. Based on the study findings, majority 1177 (56%) of the participants were satisfied by emergency outpatient department (OPD) services. The majority 1018 (83%) of the participants were satisfied with the manner that was showed by the staffs working at the Emergency OPD. In similar manner, the satisfaction level of the participants in the Emergency OPD towards the accessibility of the emergency care services, courtesy of the staffs, quality of the services, physical environments, and existence of good communication with services provider were 72%, 97%, 81.5%, 55%, and 66%, respectively while 97.2% of them were dissatisfied with their privacy. On the other hand, 76% of the participants were satisfied with the service provided in the radiology section and other laboratory work.

CONCLUSION

This study finding shown that there was the variety of client perception on the emergency department and its quality care. Therefore, Emergency outpatient department should be raised progressively further by health care managers, governmental executives, EMS directorate, and others to address the efficient attribute of deprived value of health care and continuity of care delivery system being tied with new policy in Ethiopia.

Evaluation results of national hospital accreditation program in Iran: The view of hospital managers

BACKGROUND

Accreditation programs have a crucial role in improving the safety and effectiveness of hospital services. Many factors contribute to achieve accreditation goals. This study evaluated the national Iranian hospital accreditation program from the view of hospital managers in Iran.

METHODS

The study was conducted in 2015 using a validated questionnaire designed to collect feedback concerning accreditation processes and impacts. In total, 547 managers were surveyed using a stratified random sampling method. A 5-degree scale Likert from totally disagree=1 to totally agree=5 has been used for the evaluation. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Approximately half of hospital managers were satisfied with the accreditation standards and surveying methods. The reason for their dissatisfaction was the high number of measures (2.38). The main challenges to the accreditation method were reported inadequate surveyor training (2.94) their satisfaction with the infrastructure was low because of a lack of hospital resources. Nonetheless, the accreditation program was perceived as being successful in improving patient safety (3.80), patient compliance (3.72), and error reduction (3.53).

CONCLUSION

An effective accreditation program requires reducing the number of standards and making them clearer as well as the infrastructure for the implementation of accreditation such as sufficient and sustainable funds, enough human resources and equipment should be provided. Appropriate surveyors should be selected and trained professionally to ensure inter-rater reliability among them.

Developing a Hospital Disaster Risk Management Evaluation Model

Purpose

Disasters are increasing worldwide and hospitals should be prepared to respond well to such disasters. An effective hospital disaster risk management program saves peoples’ lives, reduces damage to the hospital properties and assures hospital service continuity. This article aimed to develop and verify a Hospital Disaster Risk Management Evaluation model (HDRME).

Methods

A mixed-method explanatory sequential approach was used to develop and verify the HDRME model. The first draft of the HDRME model was introduced through a comprehensive literature review of major databases (i.e., PubMed, Scopus, Web of Science, and Science Direct), using appropriate keywords. Furthermore, 18 in-depth individual interviews were conducted with well-known experts in DRM to identify more HDRME constructs, sub-constructs, and standards. Then, three rounds of Delphi were conducted with 22 experts in hospital disaster risk management to verify the proposed model.

Results

The proposed HDRME consists of eight constructs, including seven enablers (management and leadership; risk assessment; planning; prevention and mitigation; preparedness; response, and recovery) and one result (key performance results). These constructs were further broken into 27 sub-constructs. The enablers and results scored 85% and 15% of the model’s total scores.

Conclusion

A comprehensive conceptual framework for the evaluation of hospital disaster risk management was introduced and verified. Standards and measurable elements can be embedded in this conceptual model to measure a hospital’s preparedness in disasters and accordingly, corrective actions can be taken to strengthen the hospitals’ responses to the disasters. However, the proposed model should be validated in a hospital setting through implementation.

Conflict and conflict management in hospitals

PURPOSE

Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences.

DESIGN/METHODOLOGY/APPROACH

This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19.

FINDINGS

Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers' personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager's age, work experience and management experience.

PRACTICAL IMPLICATIONS

The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals.

ORIGINALITY/VALUE

This is the first study conducted in Iran examining the level of conflict, its types and identifying managers' dominant conflict resolution strategies at front line, middle and top management levels.

Perceptions of leadership, motivation, structure, and assurance for implementation of emergency medical services in Ethiopia: Perspectives of emergency medical services case teams based on focus group discussions

BACKGROUND

The research was assessed the Ethiopian Emergency Medical Services Case teams' and officers views on Emergency Medical services in Ethiopia. The aim of study was to present the point of views, prospect and priorities of Emergency medical services case teams and its coordinator along some main dimensions of emergency medical services, such as Leadership, Motivation, Structure, and Assurance for implementation.

METHODS

Six focus group discussion were facilitated with EMS case teams, focal persons and FMoH emergency medical services case teams from December to August, 2017 in all regions chosen of the study. The focus group techniques were used in the study as qualitative research method for examination of viewpoints of case team members towards to the emergency medical care system and overall pre-hospital and at hospital emergency care services. The discussion was addressing the topics of: general aspects of emergency Medical Services (EMS) and which occupations included in EMS; possibilities to importance review EMS issues based on Leadership, Motivation, Structure, and Assurance for implementation of EMS in the country. Finally, thematic analysis was used to evaluate data sets which collected during the focus group discussion.

RESULTS

There were 6 focus groups in total: an Emergency medical services case teams, officers, Directorates, and integrated disease prevention and control program coordinators groups in each of the regional, city Administration Health Bureau and Federal Ministry of Health in Ethiopia. Findings of the thematic analysis were summarized along the following dimensions: Leadership, Motivation, Structure, and Assurance for implementation. The result shown that lack of resources, shortage of training, lack of professionals and community awareness on EMS, immaturity of EMS strategic plan and lack of revision, workload as a result of limited skilled manpower, lack of partnerships and collaboration on EMS and lack of research and community services evidence are among factors affecting the quality EMS and continuity of the program at various health care facilities at the regional and national levels.

CONCLUSION

The study shows views of the Ethiopian Emergency Medical Services Case teams' and officers in Emergency Medical services in Ethiopia. The participants were considered determining factors of the EMS were rather similar among the participated regional, city Administration Health Bureau and Federal Ministry of health. Nonetheless, there was some degree of difference among those participated institutes. Especially, as a national level, Ethiopian Ministry of Health is exists only one emergency medical service directorate that leading the whole national activities. Therefore, EMS program need to respond to the challenges by respondents to articulate emergency medical services policies appropriate to Ethiopia, including the pre-hospital, at hospital care system and Ambulance services with more reformed professional skills and case team work at country level including all regions, Zone, Woreda (Districts) and other related sectors.

Emergency medical services in Ethiopia: Drivers, challenges and opportunities

BACKGROUND

Ethiopia has a well established health care system but lacks significant improvements on emergency medical services and suffers a shortage of equally initiative among all regional states and city administration of Ethiopia. This study aimed to examine the drivers, challenges, and opportunities of Emergency Medical Services (EMS) and to identify new evidence for future policy making in Ethiopia.

METHOD

A narrative review of the literature related to EMS was undertaken to describe the drivers, challenges, and opportunities for EMS in Ethiopia from July, 2000 to September, 2018. The search was done from four relevant electronic databases: MEDLINE, Science Directs, Scopus and PubMed by using Google Scholar and Google with key search words used mainly as "Emergency Medical services in Ethiopia". The inclusion criteria were an original study or review studies involving Emergency Medical Services in Ethiopia. Among the available papers, the relevant articles were selected while the irrelevant ones were excluded.

RESULTS

There was lack of trained emergency medical providers and misdistribution of trained professionals, immaturity of the program, lack of partnership and stakeholders and lack of motivation towards Emergency medical services. Emergency medical services hamper significant problems similar to other African countries that required being addressed in Ethiopia context for achieving the program and in order to obtain intended outcomes for the country.

CONCLUSION

A long-term discussion is needed to further improve the services system in various health care facilities. An Emergency Medical services policy making and analysis framework is needed to make quality emergency medical care at Emergency department in hospitals and outside the hospitals.

Prevalence, pattern, magnitude and associated factors of trauma in the Emergency Department at Health Institutes in Ethiopia: A systematic review

BACKGROUND

Trauma is one of the important public health problems that causes significant economic and social crisis with more than 10% of all disease cases are associated with it. We aimed to identify and describe the prevalence, patterns, magnitude and associated factors of trauma in the Emergency Department at Health Institute in Ethiopia.

METHODS

In this systematic review, we searched for peer-reviewed and grey literature publications reporting the prevalence, pattern, magnitude and associated factors of trauma between 2000 and 2019. The documents which recruited are directly related to trauma and emergency department. In this regard, we searched databases of PubMed, Elsevier, Science directed, MEDLINE, and Google scholar by using Google as searching engine. Furthermore, publication with secondary data and not in English was excluded.

FINDINGS

A total of 9,768 injured participants were included in the studies, of which 71.2% (6950) were males. Among the injured participants, 53.4% of cases were living in Addis Ababa followed by Gondar and Jimma with 20.3% and 11.3% cases, respectively. Severe road traffic accident, occupational injury, and surgical patients were among the major risk factors of trauma. The mortality rate of the trauma case fatality was reached about 4%. The majority of the studies (37.5%) analyzed the pattern and magnitude of trauma among patients seen at emergency outpatient department of health institutes in Ethiopia. The largest percentage of studies (62.5%) relied on systematic random sampling. Thirty eight percent of the reviewed studies were utilized retrospective approaches to address the research questions. An completed the registry forms and/or Kampla Trauma Score (KTS), which accounted for 37.5% of articles on prevalence, pattern, magnitude and associated factors of trauma in the emergency was the most commonly used strategy. The majority (75%) of the reviewed studies were used both descriptive statistics and bivarate and multivariate logistic regression for data analysis. The majority 6950 (71%) of the participants who have been included in those reviewed articles were male and 2818 (29%) were female by gender. Meanwhile, the majority 5 (62.5%) of reviewed studies had included < 1000 injured persons.

CONCLUSION

The degree and types of injuries in different hospitals in Ethiopia was considerably high and its casualty is also under predictable. Therefore, a variety of actions including policy decision should be implemented in order to minimize the incidence of trauma at department of emergency care center in the country.

The success of strategic planning in health care organizations of Iran

Purpose Although strategic planning promised to boost organizational performance, many health care managers found it difficult to implement it successfully. The purpose of this paper is to investigate the success of strategic planning in health care organizations of Iran. Design/methodology/approach This descriptive and cross-sectional study was conducted in 2016 using a valid and reliable questionnaire completed by 99 health care managers in Tehran province, Iran. Findings Strategic planning was positively related to organizational performance including employees' and patients' satisfaction and organizational productivity. However, strategic planning was moderately successful in enhancing organizational performance of Iranian health care organizations (score of 2.84 out of 5). The most and least success was observed in the planning and employee management constructs of organizational performance. Process management, organizational culture and customer management constructs had the most effect on the success of strategic plans in health care organizations. Practical implications Strategic planning is effective and provides a clear focused direction for health care organizations. Understanding the success factors of strategic planning would enable managers to develop more effective methods for developing, implementing and evaluating strategic plans in health care organizations. Originality/value This paper highlights the relationship between strategic planning and organizational performance and offers suggestions on how to develop and implement strategic plans to achieve higher organizational performance.

Leadership challenges in health care organizations: The case of Iranian hospitals

Background: Effective leadership is a vital component of health care systems and has an extensive range of functions in improving organizational effectiveness and efficiency. This study aimed at exploring leadership challenges encountered by leaders in Iranian hospitals. Methods: This qualitative study was conducted on a purposeful sample of 27 members of hospital management team in Tehran using face-to-face semi-structured interviews and in-depth interviews. Thematic analysis was used to analyze and report the data. Results: In this study, 5 main themes emerged upon the challenges of leadership in health care organizations as follow: organizational structure (complexity, centralization, and bureaucracy); human resources (the number and distribution of human resources, staff empowerment, and education, motivational mechanisms, and staff diversity); work nature (sensitivity, stress and tension, customer diversity, and team- oriented); leaders (knowledge and skills, appointment, superiors and colleagues, and time); and context (regulations and programs, cultural issues, social issues, and economic issues). Conclusion: The results of this study shed some light on the leadership challenges in a culturally specific developing country. The results also proved the importance of using educated leaders who are capable of understanding, analyzing, and dealing with such complex challenges.

Rationing in health systems: A critical review

Background: It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes. Methods: The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis. Results: Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles. Conclusion: This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.

Impact of Merger and Acquisition on University Performance

PURPOSE

Merger and acquisitions (M&A) widen access to higher education, improve quality of teaching and research, and increase efficiency of higher education institutions. Three big medical universities in Iran merged in 2010. The purpose of this study was to highlight the impact of this acquisition on the performance of Tehran University of Medical Sciences.

METHODS

This qualitative study was conducted using semi-structured in-depth interviews with 60 participants from April 2015 to November 2015. Purposeful sampling was used to recruit participants. Data analysis was performed using MAXQDA software (V. 10).

FINDINGS

The reasons for acquisition of IUMS by TUMS were to enhance the position of TUMS worldwide, and to increase its efficiency. The acquisition improved the organization and management of the newly formed TUMS, enhanced its academic position and market recognition. However, the achieved benefits did not come without shortcomings and unanticipated consequences.

CONCLUSION

The merger and acquisition in higher education has some advantages and disadvantages. A well planned and carefully implemented M&A gives cutting edge to the higher education institutes.

Essentials of total quality management: a meta-analysis

PURPOSE

The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation.

DESIGN/METHODOLOGY/APPROACH

A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010.

FINDINGS

A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes.

RESEARCH LIMITATIONS/IMPLICATIONS

The review was limited to articles written in English language during the past 30 years.

PRACTICAL IMPLICATIONS

From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations.

ORIGINALITY/VALUE

Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.

Factors influencing healthcare service quality

BACKGROUND

The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context.

METHODS

Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations.

RESULTS

Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers.

CONCLUSION

This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

Patient choice of a hospital: implications for health policy and management

PURPOSE

The purpose of this study was to identify the most important influencing factors in choosing a hospital by a patient.

DESIGN/METHODOLOGY/APPROACH

This study involved a mixed research design. Focus groups and in-depth individual interviews were conducted with patients to explore reasons for choosing a hospital. In addition, this study involved survey-based research on the patient choice.

FINDINGS

Type of the hospital, type of the service, word of mouth, cost of services, the health insurance programme, location, physical environment, facilities, providers' expertise and interpersonal behaviour, and reputation of the hospital influenced patients' choice of a hospital. Doctor recommendations and health insurance programme were the main reasons for choosing a hospital for inpatients and outpatients respectively.

PRACTICAL IMPLICATIONS

Identifying and understanding key factors that influence a patient choice of a healthcare setting helps managers and policy makers invest their resources in those critical areas and improve those aspects of their services to attract more patients.

ORIGINALITY/VALUE

This article contributes to healthcare theory and practice by developing a conceptual framework for understanding the factors that influence a patient choice of a healthcare setting.

Why TQM does not work in Iranian healthcare organisations

Purpose

– Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran.

Design/methodology/approach

– This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation.

Findings

– TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers’ about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers’ and employees’ commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively.

Practical implications

– Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence.

Originality/value

– Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

Strategic collaborative quality management and employee job satisfaction

BACKGROUND

This study aimed to examine Strategic Collaborative Quality Management (SCQM) impact on employee job satisfaction.

METHODS

The study presents a case study over six years following the implementation of the SCQM programme in a public hospital. A validated questionnaire was used to measure employees' job satisfaction. The impact of the intervention was measured by comparing the pre-intervention and post-intervention measures in the hospital.

RESULTS

The hospital reported a significant improvement in some dimensions of job satisfaction like management and supervision, organisational policies, task requirement, and working conditions.

CONCLUSION

This paper provides detailed information on how a quality management model implementation affects employees. A well developed, well introduced and institutionalised quality management model can improve employees' job satisfaction. However, the success of quality management needs top management commitment and stability.

Why TQM programmes fail? A pathology approach

Purpose

– Implementing total quality management (TQM) is not without difficulties and achieving its promised benefits is not easy. The purpose of this paper is to identify the barriers to TQM successful implementation.

Design/methodology/approach

– A literature review has been done to explore the major reasons for the failure of TQM programmes.

Findings

– An examination of 54 TQM empirical studies identified 54 obstacles to successful TQM implementation. There are both theoretical and practical difficulties in applying TQM in organisations. An ineffective TQM package, inappropriate TQM implementation methods and an inappropriate environment for implementing TQM are the main reasons for TQM failure. The most frequently mentioned reasons for TQM implementation failures include insufficient education and training, lack of employees’ involvement, lack of top management support, inadequate resources, deficient leadership, lack of a quality-oriented culture, poor communication, lack of a plan for change and employee resistance to the change programme.

Research limitations/implications

– The review was limited to articles written in English language during the past 30 years (1980-2010).

Practical implications

– TQM does deliver better performance when an appropriate model of TQM is appropriately implemented in a supportive environment. The findings of this paper provide managers with a practical understanding of the factors that are likely to obstruct TQM implementation. Managers should overcome these barriers to achieve the TQM benefits.

Originality/value

– Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

The impact of top management turnover on quality management implementation

INTRODUCTION

The purpose of this study was to investigate the impact of top management turnover on Strategic Collaborative Quality Management (SCQM) implementation in healthcare organizations. The role of top management turnover in the process and impact of the SCQM model was investigated using a case study of a public hospital.

METHODS

Both qualitative and quantitative methods were used for data collection.

RESULTS AND DISCUSSION

Top management turnover is a major threat to the long-term success of the SCQM intervention and makes it very difficult to sustain its benefits. Successful quality management implementation needs supportive and committed leadership and management. Top management stability encourages long-term planning and commitment to pursuing long-term objectives.

CONCLUSION

This paper has highlighted the critical role of top management stability during the course of quality management implementation.