Identifying factors affecting about outsourcing in paraclinical services: a systematic review of literature

Objective: Outsourcing refers to the transfer of services or functions to an outsider supplier, which controls them through a contract or cooperative. The main problem of senior managers in health organizations is determining the services which should be outsourced. The present study seeks to identify the factors that affect decision about outsourcing.Methods: We systematically searched relevant databases including Pub Med, Scopus, Science Direct and Web of Science databases using terms “Outsourcing AND Decision Making OR Policy AND health OR hospital OR health care OR health services OR healthcare”. Studies were identified and screened in accordance with the preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) published in English or Farsi, determining factors that affect making decision about outsourcing a health organization services.Results: The search retrieved (2585) citation of which 14 studies were eligible. Across the eligible articles,10 overarching themes including 40subthemes that affectdecision maker to outsource a service or not, emerged.Conclusions: Results of this study offer evidence for a comprehensive approach todesign and implement a strategic planthat can be used as guidance for policy makers, micro and macro healthcare authorities and managers, and other stakeholders in this area to select and apply the best strategies to make outsourcing in the best possible way.Keywords: Outsourcing, Health Services, Effective factors, Health Organizatio

Developing of the appropriateness evaluation protocol for public hospitals in Iran

Background: Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems. Objectives: This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran. Patients and Methods: The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients� medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses. Results: Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92, while the specific appropriate agreement and specific inappropriate agreement were > 88 and > 83, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively. Conclusions: The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context. © 2015, Iranian Red Crescent Medical Journal

Determinant criteria for designing Health benefit package in selected countries

Health benefit package described as primary health interventions that provided with government using general funds for all regardless their financial ability. This study was aimed at determine appropriate pattern for Iran using comparative survey of Health benefit package in various countries. A review exploration was done, scholars was selected population of both developed and developing countries, required information was also extracted by articles, searches and reports of reliable sources and date were analyzed by SPSS, in brief. The vast majority frequencies was respectively allocated to accessibility (40.7%), cost- effectiveness (29.6%), prioritize, efficacy and cost (22.2%). most countries located in WHO African region were selected cost-effectiveness and accessibility, WHO southeast Asia region were selected, coverage, prioritize, efficacy and quality and finally most WHO Europeans region were elected effectiveness and services costs for including services in Health benefit package. According to most Health benefit package designer emphasis on criteria including accessibility and costeffectiveness, to design Health benefit package for Iran, these criteria must be noticed

Customer focus level following implementation of quality improvement model in Tehran social security hospitals

Purpose - The key factor for the success of total quality management programs in an organization is focusing on the customer. The purpose of this paper is to assess customer focus level following implementation of a quality improvement model in social security hospitals in Tehran Province. Design/methodology/approach - This research was descriptive-comparative in nature. The study population consisted of the implementers of quality improvement model in four Tehran social security hospitals. The data were gathered through a checklist addressing customer knowledge and customer satisfaction. Findings - The research findings indicated that the average scores on customer knowledge in Shahriar, Alborz, Milad, and Varamin hospitals were 64.1, 61.2, 54.1, and 46.6, respectively. The average scores on customer satisfaction in Shahriar, Alborz, Milad, and Varamin hospitals were 67.7, 65, 59.4, and 50, respectively. The customer focus average scores in Shahriar, Alborz, Milad, and Varamin hospitals were 66.3, 63.3, 57.3, and 48.6, respectively. The total average scores on customer knowledge, satisfaction and customer focus in the investigated hospitals proved to be 56.4, 60.5, and 58.9, respectively. Originality/value - The paper is of value in showing that implementation of the quality improvement model could considerably improve customer focus level. © Emerald Group Publishing Limited

Lived Experience of Afghan Refugees in Iran Concerning Primary Health Care Delivery

Objective:Access to primary health care (PHC) is very important for refugees. The aim of this study was to illuminate lived experience of Afghan refugees in Iran regarding PHC delivery.Methods:This qualitative study was conducted in 2016-2017 by using the content analysis technique. Data were collected through individual deep interviews with Afghan refugees who lived in Iran. The data were analyzed by using a method by Graneheim and Lundman.Results:Four main categories and 12 subcategories were emerged, including (1) challenges before PHC delivery: large number of children, high service cost, not having medical insurance, access to health centers, appointment to get services, simultaneity of breastfeeding, and pregnancy; (2) challenges during PHC delivery: understanding Iranian words, health care provider's behavior, delay in getting service in PHC centers; (3) challenges after delivery PHC: referral patient, high costs of paraclinics; and (4) free and good services.Conclusion:Our results showed that Afghan refugees have several challenges in every stage of PHC delivery. Awareness of such problems can help medical personnel improve delivery of service to Afghan refugees, as well as using trained Afghani nurses to serve the refugees. © 2019 Society for Disaster Medicine and Public Health, Inc

Authority Delegation in Boyerahmad Health Centers through Model to Combine Suggestions System and Delphi Method 2012

Background & aim: Authority delegation means to transmit part of organization`s manager and leader`s special authorities and executive duties, regardless its root to subordinates and heads of units and related offices to speed up implementing affairs and organizational purposes quickly and on time. The purpose of this study was to inspect authority delegation in health centers of Boyerahmad district through using model to combine suggestions (to identify process) and Delphi method (expert`s opinions) . Methods: This cross-sectional study was implemented in two stages at first stage, research community was authorities of Boyerahmad health centers (58 persons), their suggestions about requested processes to delegate were gathered by total count through open questionnaires and in second stage, which was Delphi, suggestions gathered from previous stage judged by 30 experts. Data of both stages analyzed by help of Chi-square, correlation coefficient tests. Results: Findings showed that 73.85% of suggestions were able to be delegated, based on expert`s opinion. 40% of suggestions were in domain of official, 36.92% financial and 23.08% hygienic. 88% less than 6 years management background. 20.69% had no academic studies and only 27% were general physicians. Conclusion: By participation of environmental management levels, several processes may be specified and identify cases which are possible to delegate them executively using Delphi (expert`s opinion) and this model can be used as a trust worthy method to delegate authority for decentralization. Key words: Participation Management, Health centers, Authority delegatio