The Relationship between Management Styles and Change and Innovation Skills of Administrators in Teaching Hospitals of Shiraz University of Medical Sciences

Background: With regard to novel plans in the health sector, including “Health Sector Evolution” and changes of hospitals’ issues, change and innovation skills are considered essential for hospital administrators. This study aimed to determine the relationship between management style and change and innovation skills of administrators in Teaching Hospitals of Shiraz University of Medical Sciences in 2009. Methods: This was a cross-sectional and descriptive-analytical survey. Study samples were 9 managers and 135 headquarter staff of hospitals affiliated to Shiraz University of Medical Sciences. Data were collected using the management style questionnaire of Rensis Likert and questionnaire of change and innovation skills. Data were analyzed through SPSS16 and using descriptive statistics (frequency, percentage and mean) and analytical statistics (t-test and ANOVA .( Results: Most hospital administrators of Shiraz University of Medical Sciences had consultative management style. The majority of headquarter staff were in the age group of 20-40 years. There was a significant relationship between change and innovation skills of hospital administrators and their management styles (P<0.001). Conclusion: It seems that in order to implement the change and innovation plans in hospitals, implementing a successful participatory management style is very effective, because with honest participation, the organizational goals will be more achievable. Keywords: Management style, change and innovation skills, hospital administrators, headquarter staf

Addressing Health Insurance Deductions through an Interventional Study: the Case of a Large Central Hospital

Objective: A large proportion of hospitals’ private income is provided by insurance organisations. Hospitals in Iran face various problems in terms of insurance deductions from insurance organisations resulting from inefficient performance by both the hospitals and the insurers. These problems necessitate more specific cost control in this area. This research assesses the causes of insurance deductions by using the Failure Mode Effects Analysis (FMEA) technique, and addresses the issues resulting in deductions by providing some interventions through the Pareto technique. Design: The 10-step pattern of FMEA was implemented for assessing the main causes of insurance deduction in this study. Setting: Data was collected from deduced amounts by three main/largest contracting party insurance organisations (e.g. the Social Security Insurance Organisation, Medical Services Insurance Organisation and Armed Forces Medical Services Insurance Organisation of Namazi Hospital, a large healthcare provider in the South of Iran, in 2014. Findings: Sixty-five potential failure causes were identified, of which 26 were related to the anaesthesia unit, 23 were related to the surgery room unit and 16 were related to the hospitalisation unit. Deductions in the anaesthesia and hospitalisation units and the surgery room were reduced after intervention programs by 14.42%, 57.76%, and 51.52%, respectively. Conclusions: Using the FMEA technique in a large healthcare provider in Iran resulted in identifying the main causes of insurance deductions and provided intervention programs in order to increase the efficiency and productivity of healthcare services. Abbreviations: FMEA – Failure Mode Effects Analysis; RPN – Risk Priority Number

Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran

Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year.This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups.The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million).T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority

Distribution of nursing workforce in the world using Gini coefficient

Abstract Introduction Unequal Access to human resources for health, reduces access to healthcare services, worsens the quality of services and reduces health outcomes. This study aims to investigate the distribution of the nursing workforce around the world. Methods This is a descriptive-analytical study, which was conducted in 2021. The number of nurses and world populations was gathered from World Health Organization (WHO) and The United Nations (UN) databases. The UN has divided world countries based on the Human Development Index (HDI) into four categories of very high, high, medium and low HDI. To investigate the distribution of the nurses around the world, we used the nurse population ratio (per 10,000 population), Gini coefficient, Lorenz curve and Pareto curve. Findings On average, there were 38.6 nurses for every 10,000 people in the world. Nations with the very high HDI, had the highest nurse/population ratio (95/10,000), while the low HDI nations had the lowest nurse/population ratio (7/10,000). Most nurses around the world were females (76.91%) who were in the age group of 35–44 (29.1%). The Gini coefficient of nations in the each four HDI categories varied from 0.217 to 0.283. The Gini coefficient of the nations between the four HDI categories was 0.467, and the Gini coefficient of the whole world was 0.667. Conclusion There were inequalities between countries all over the world. Policymakers should focus on the equitable distribution of the nursing workforce across all local, national and regional levels

The study of urban family physicians performance and its related factors in the south of Iran

Introduction: The Family Physician Program is one of the most important plans for increasing the equitable access and affordable health services. This study aimed to examine the performance of Urban Family Physicians and associated factors in the third year of its implementation. Method: A cross-sectional study was conducted on all Family Physicians (31 persons) working in the private and public polyclinics and clinics in the Firoozabad, from October to December 2014. The population of the study consisted of all the physicians (31 persons) who were involved in the Family Medicine Program. The main instrument for data gathering was a standard questionnaire developed by Ministry of Health and Medical Education (MOHME). Validity and reliability of the questionnaire have been confirmed by MOHME. The questionnaire had four parts including medical equipment, informing the patients, referral system rules, and protocols. The data were analyzed using SPSS statistical software, version 16, through appropriate statistical tests including Independent T-test, Pearson Correlation, One sample T-test, in a significance level of<0.05. Results: Findings of the study showed that there was not a significant association between performance of physicians and equipment (77.20 ± 22.80). Their performance based on informing patients (81.59±16.69), protocols (82.42±12.05), and total performance (82.41±13.42) was good. Their performance in terms of referral system (69.35 ±16.15) was weak. There were not any association between the performance and marital status, age, career, and sex. In contrast, there was a significant relationship between nativity and performance so that the performance of native physicians was better. Conclusion: The Urban Family Physician is an outstanding step for improving the public health but its successful implementing needs to develop an appropriate solution for employing the native physicians. It seems that applying various incentives and employing the native physicians in terms of their ability and training them about the importance of referral systems in public health will be helpful

Investigation of Disorders and Problems caused by Shift Work in Selected Nurses of Public-Educational Hospital of Shiraz University of Medical Sciences, 2015

Background: Shift work as a social phenomenon is one of the effective factors on operation of health workers which can have significant impacts on their health. Hence, the current study was conducted to determine the effect of shift working on health problems and the risk factors causing these disorders among nurses. Methods: This cross-sectional study was carried out on 189 nurses selected randomly from Shahid Namazi and Shahid Faghihi hospitals. The data collection tool was the &quot;Survey of Shift Worker&quot; standard questionnaire. Data were then analyzed by SPSS 16 software using Pearson coefficient of correlation test. Results: The results showed that the highest prevalence of problems caused by shift work was related to individual, family, and social life disorders. Moreover, the compulsory selection of shift work system has reduced job satisfaction (p = 0.001). Conclusion: Based on the findings, shift working could be associated with physical complications such as cardiovascular diseases and disturbances in circadian rhythm, as well as mental disorders in nurses. Therefore, it is necessary for nursing authorities to plan shifts more precisely regarding factors such as employees' age and job experience

Development and Usability Evaluation of a Web-Based Health Information Technology Dashboard of Quality and Economic Indicators

Introduction: Strategic dashboards, including hospital economic monitoring systems, play a major role in analyzing data and making decisions. As the health system is a multidimensional ecosystem, decision-makers and healthcare officials must gather and integrate information from numerous health information systems to monitor and direct healthcare centers. This study aims to develop and usability evaluation of a health information technology dashboard in Iran that utilizes qualitative and economic indicators. Material and Methods: This study was conducted in four phases. It included extracting the requirements of the system through the focus group technique. Based on these results, a comprehensive economic dashboard was developed. Then, the system’s usability is evaluated from the perspectives of experts and end-users by two scales of Nielsen and USE, respectively. Results: The dashboard was developed on the web and different access levels were defined for users according to their roles. This dashboard provides the ability to integrate information from different systems at the national level for decision-makers. The results of usability evaluation from users' point of view showed that it has a good level of usability. Furthermore, evaluation results revealed that aesthetic aspects and simple design and clarity of system status (0%), privacy (1.49%), "visibility and clarity of the system" and "adaptation between the system and the real world" (2.98%), have the fewest design errors. With 14 problems (20.89%), "recognition rather than remembering" and "compliance with uniformity and standards" have the highest frequency of problems. Conclusion: The development of an extensive integrated economic health dashboard, based on usability principles that are suitable for its stakeholders regardless of their specialty and granted access level, is welcomed by the health economist, hospital managers, and the ones who have an active role in monitoring and coordinating hospitals or even in greater scales such as national wide decision makers

Key performance indicators in hospital based on balanced scorecard model

Introduction: Performance measurement is receiving increasing verification all over the world. Nowadays in a lot of organizations, irrespective of their type or size, performance evaluation is the main concern and a key issue for top administrators. The purpose of this study is to organize suitable key performance indicators (KPIs) for hospitals’ performance evaluation based on the balanced scorecard (BSC). Method: This is a mixed method study. In order to identify the hospital’s performance indicators (HPI), first related literature was reviewed and then the experts’ panel and Delphi method were used. In this study, two rounds were needed for the desired level of consensus. The experts rated the importance of the indicators, on a five-point Likert scale. In the consensus calculation, the consensus percentage was calculated by classifying the values 1-3 as not important (0) and 4-5 to (1) as important. Simple additive weighting technique was used to rank the indicators and select hospital’s KPIs. The data were analyzed by Excel 2010 software. Results: About 218 indicators were obtained from a review of selected literature. Through internal expert panel, 77 indicators were selected. Finally, 22 were selected for KPIs of hospitals. Ten indicators were selected in internal process perspective and 5, 4, and 3 indicators in finance, learning and growth, and customer, respectively. Conclusion: This model can be a useful tool for evaluating and comparing the performance of hospitals. However, this model is flexible and can be adjusted according to differences in the target hospitals. This study can be beneficial for hospital administrators and it can help them to change their perspective about performance evaluation

Relationship between Family-Work and Work-Family Conflict with Organizational Commitment and Desertion Intention among Nurses and Paramedical Staff at Hospitals

Background: High turnover intention rate is one of the most common problems in healthcare organizations throughout the world. There are several factors that can potentially affect the individuals’ turnover intention; they include factors such as work-family conflict, family-work conflict, and organizational commitment. The aim of this research was to determine the relationship between family-work and work-family conflicts and organizational commitment and turnover intention among nurses and paramedical staff at hospitals affiliated to Shiraz University of Medical Sciences (SUMS) and present a model using SEM. Methods: This is a questionnaire based cross-sectional study among 400 nurses and paramedical staff of hospitals affiliated to SUMS using a random-proportional (quota) sampling method. Data collection was performed using four standard questionnaires. SPSS software was used for data analysis and SmartPLS software for modeling variables. Results: Mean scores of work-family conflict and desertion intention were 2.6 and 2.77, respectively. There was a significant relationship between gender and family-work conflict (P=0.02). Family-work conflict was significantly higher in married participants (P=0.001). Based on the findings of this study, there was a significant positive relationship between work-family and family-work conflict (P=0.001). Also, work-family conflict had a significant inverse relationship with organizational commitment (P=0.001). An inverse relationship was seen between organizational commitment and turnover intentions (P=0.001). Conclusion: Thus, regarding the prominent and preventative role of organizational commitment in employees’ desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase people’s organizational commitment must be considered by health system managers more than ever