The Obstacles of Outsourcing in Educational Hospitals: A Qualitative Study

Introduction: Outsousing is a key strategy toward improving performance and financial system of hospitals. The aim of study was to determine the obstacles of outsourcing in university hospitals in Ahvaz City, Iran. Method: This qualitative study was performed to determine the obstacles of outsourcing in university hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences, in year 2016. Research population included all hospital managers, employees, and contracting experts. 23 participants were selected as samples purposefully. Data were gathered and concluded using framework analysis method; and were analyzed using content analysis method. Results: The obstacles of outsourcing were extracted and reported in format of 4 themes and 16 subthemes. Main themes were as “legal obstacles”, “financial obstacles”, “organizational/structural obstacles”, and “managerial obstacles”. Moreover, participants mentioned the benefits of outsourcing as “increasing the quality of services”, “organizational downsizing”, and “increasing the profit”. Conclusion: The results of study showed that the hospitals’ outsourcing faced serious problems in legal, financial, organizational/structural, and managerial aspects. Identification of these problems could be useful in solving them. Keywords: Hospitals, Outsourced services, Contracts, Qualitative researc

The Relationship of Job Stress and Job Satisfaction with Organizational Commitment in Environmental and Occupational Health Staff Working in Alborz and Ahvaz Jundishapur Universities of Medical Sciences

Background & Objectives: Environmental health professionals are among the most important sources of health system in the health sector. Issues such as job stress and job dissatisfaction can have an adverse effect on organizational commitment of health personnel. The purpose of this study was to investigate the relationship of job stress and job satisfaction with organizational commitment in environmental and occupational health professionals working in Alborz and Ahvaz Jundishapur Universities of Medical Sciences. Methods: This cross-sectional, descriptive-analytical study was performed on 238 occupational health and environmental health staff. Data were collected using Osipow Job Stress Scale, Ellen Meyer's Organizational Commitment, and Susan Job Satisfaction questionnaires. In this study, t-test, two way ANOVA and linear regression analysis were used to determine the factors affecting organizational commitment. Data were analyzed through SPSS statistical software version 22. Results: The majority of the studied subjects were women (75.5% of environmental health staff and 81.5% of professional occupation staff). Among the dimensions of organizational commitment, continuous commitment obtained the highest score among employees of Environmental Health (30.19 ± 6.15) and Occupational Health (27.55 ±7.49). Job satisfaction had a strong significant relationship with the three dimensions of organizational commitment (P<0.01). Conclusion: Through teaching stress management skills and increasing job satisfaction in these occupational groups, organizational commitment could be improved. Key­words: Job Stress, Organizational Commitment, Job Satisfaction, Environmental Health, Occupational Health, Staff Citation: Torabipour A, Emamyanfard SM, Veysi Sheykhrobat M, Jafarinia M. The Relationship of Job Stress and Job Satisfaction with Organizational Commitment in Environmental and Occupational Health Staff Working in Alborz and Ahvaz Jundishapur Universities of Medical Sciences. Journal of Health Based Research 2019; 5(2): 215-33. [In Persian

Factors affecting family physicians’ drug prescribing: a cross-sectional study in Khuzestan, Iran

Background: Rational prescription is a considerable issue which must be paid more attention to assess the behavior of prescribers. The aim of this study was to examine factors affecting family physicians’ drug prescribing. Methods: We carried out a retrospective cross-sectional study in Khuzestan province, Iran in 2011. Nine hundred eighty-six prescriptions of 421 family physicians (including 324 urban and 97 rural family physicians) were selected randomly. A multivariate Poisson regression was used to investigate potential determinants of the number of prescribed drug per patient. Results: The mean of medication per patient was 2.6 ± 1.2 items. In the majority (91.9%) of visits a drugs was prescribed. The most frequent dosage forms were tablets, syrups and injection in 30.1%, 26.9%, and 18.7% of cases respectively. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics were 29.7% and 17.1% of prescribed drugs respectively. The tablets were the most frequent dosage forms (38.6% of cases) in adult’s patients and syrups were the most frequent dosage forms (49% of cases) in less than 18 years old. Paracetamols were popular form of NSAIDs in two patients groups. The most common prescribed medications were oral form. Conclusion: In Khuzestan, the mean of medication per patient was fewer than national average. Approximately, pattern of prescribed drug by family physicians (including dosage form and type of drugs) was similar to other provinces of Iran

Factors affecting the relationship between physician and patient in Ahvaz Community Health Centers

Background and purpose: The patient-physician relationship is a cornerstone of a good primary healthcare. This study was aimed to study the factors affecting the relationship between physician and patient in Ahvaz community health centers. Materials and Methods: In this cross-sectional study, two-hundred participants were randomly selected from 14 community health centers in Ahwaz, 2016. Data were collected using a valid Patient-Doctor relationship questionnaire (PDRQ-9). A total score of 9-45 was considered to assess communication skill of doctors. Data were analyzed using SPSS.20 Software. Results: The results showed that the total mean and median score of physician-patient relationship was slightly higher than moderate (mean=28.58 and median=26 out of 45). The highest score (3.36 out of 5) was related to the item &quot;I can talk to my doctor&quot;. The lowest score (2.95 out of 5) was related to the item &quot;My doctor is dedicated to help me.&quot; Linear regression analysis shows that the waiting time for receiving services had a negative impact on the patient-doctor relationship. By increasing the waiting time for receiving services, patients' satisfaction from communication with their physicians is decreased (B = -0.112; P = 0.041). Conclusion: The researchers concluded that the relationship between physician and patient in the studied health centers was moderate. It is necessary to develop managerial techniques to reduce waiting time of patients in order to improve the relationship between physicians and patients

Quality of Physician Service in Ahvaz Community Health Centers in 2016

Introduction and purpose: The quality of service is an important factor in improving the satisfaction of clients referring to community health centers and the primary health care system. The aim of this study was to determine the quality of physician services of community health centers in Ahvaz, Iran, during 2016. Methods: This cross-sectional study was conducted on 200 patients referring to physicians at 14 community health centers. The participants were selected through a random sampling technique. Data were collected using Quality of Service questionnaire (Servqual), which evaluates the quality of services in five dimensions (22 questions). Results: In this study, 73% of the patients were female and the mean age was 32.8±8.6 years. The mean of the waiting time for the service was 11.09±10.8 min and the mean of visit time was 5.92±3.9 min. The findings showed that the most desirable aspect of the quality of the physician services was "assurance". The weakest aspect of quality was "responsiveness” dimension. Conclusion: Among the dimensions of service quality, responsiveness and tangibility need improvement. Health managers should strengthen these dimensions with effective interventions in order to increase patient satisfaction

Factors Affecting Community Health Volunteers’ Motivation to Participate in Health Programs in Comprehensive Health Service Centers

Introduction:  Community health volunteers link people and health workers and they voluntarily contribute to community health. Given the importance of the engagement of volunteers in promoting health programs and improving the quality of care provided, this study aimed to explore the experience and perceptions of community health volunteers of comprehensive health service centers in the western regions of Ahvaz to identify the most critical factors motivating their participation in health programs. Methods: This qualitative study was conducted in 2017 on community health volunteers in comprehensive health service centers in western Ahvaz. The data were collected through semi-structured in-depth interviews conducted face-to-face with 35 community health volunteers. The conventional qualitative content analysis approach was used to analyze the collected data. Results: Data analysis revealed 302 primary codes, 27 subthemes, and ten main themes. The ten main themes extracted in this study, including the physical context, organizational context, social context, climatic context, cultural context, increasing health knowledge, material factors, psychological factors, social factors, and spiritual factors, constituted the factors affecting the community health volunteers’ motivation to participate in health programs. Conclusion: Community health volunteers’ motivation to participate in health programs is influenced by factors such as physical context, organizational context, social context, climatic context, cultural context, increasing health knowledge, material factors, psychological factors, social factors, and spiritual factors. Thus, failure to pay attention to these factors will reduce the community health volunteers’ incentives to promote health programs, decrease volunteers’ cooperation with centers, reduce the quality of care provided, and ultimately waste the funds spent on volunteers’ training and preparation

Priorities of Research in Health Management, Economic, and Policy Fields: A Qualitative Study in Iran

Background: Effective and efficient use of health system resources requires prioritization of research issues. The aim of this study was to determine research priorities in the fields&nbsp; of health management, economic, and policy. Methods: This qualitative study was conducted based on content analysis method in 2015. The population included 30 health managers, experts, and teachers of health economic, management, and policy at national level. Data were collected through a semi-structured interview. Then, results were categorized based on different themes and domains.&nbsp; Results: After taking all comments into account, 89 topics were determined as research priorities. These topics included: 42 topics in health services management field, 24 topics in health economics field, and 23 topics in health policy field. Conclusions: The results showed that research priorities of health services administration, health economic, and health policy fields were compatible with the current problems and challenges of Iranian health system. &nbsp

Investigating Delay Causes in Patients\' Discharge in Educational Hospitals of Ahvaz Jundishapur University of Medical Sciences from Nurses and Physicians\' Perspective, 2016

Background: Delay in patient's timely discharge can affect the efficiency of beds, outcomes of treatment and hospital indicators. The aim of this study was to determine delay causes in the discharge of patients in educational hospitals of Ahvaz Jundishapur University of medical sciences from nurses and physicians' perspective, 2016. Methods: The population of this analytic and cross-sectional study consisted of physicians and nurses in 3 educational hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. In this study, 90 physicians and 275 nurses were randomly selected from these hospitals. Data were collected using self-made questionnaire. The data were analyzed by SPSS 20 software using descriptive statistics (mean, standard deviation) and analytic statistic tests (independent t-test and ANOVA). Results: According to the results of the study, in hospitals A and B, &ldquo;Financial unaffordability with the mean scores of 3.29 &plusmn; 0.95 and 3.36 &plusmn; 1.70 was the most important cause of delayed discharge, respectively. However, in hospital C, &ldquo;Delay recording and sending information by healthcare department&rdquo; with the mean score of 3.87 &plusmn; 0.71 was the most important cause of delay in discharge (p < 0.05) from the nurses and physicians' perspectives. In nurses' point of view, &ldquo;Financial unaffordability&rdquo; (3.24 &plusmn; 1.41) and in physicians', point of view &ldquo;delay in sending settlements by pharmacy and laboratory&rdquo; (3.15 &plusmn; 0.70) were the most important reasons for delay in patients&rsquo; discharge. Conclusions: Based on the findings of this study, providing supportive mechanisms for patients, developing insurance and monitoring the optimal performance of hospital units can reduce the delay in timely discharge of patients; since delay in discharge can increase patients' dissatisfaction, reduce hospital beds efficiency and defect hospital indicators

Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals

Introduction: Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. Methods: To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. Results: The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. Conclusion: The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals