A critique of the hospital services provision in Iran after implementing Health Sector Evolution Plan: A case report

Background and aims: Public sector in Iran is responsible for providing whole primary health care and approximately 85 of the second and third level services. Following the previous programs, and in order to improve health system performance, Iranian Ministry of Health and Medical Education launched Health Sector Evolution Plan of Iran (HSEP) in 2014 aimed to reduce patients’ cost, improve quality, and provide equal access for all. Methods: We examined the achievement of these objectives through reporting a case and comparing current and past situation. The data related to the case were collected by interview and surveying patient documents. Published articles were considered as a base to compare some indices before and after the plan. Results: Our case was a Ph.D. student who sought out health care for his wound treatment. Total treatment expenses were 195 and many medical supplies were used. Waiting time and visit length were calculated 345 minutes and 1 minute, respectively. Paying an amount of money equivalent to almost 57 of his salary and too long waiting time to receiving short visit are in contrast to the primary objectives of HSEP and show no improvement in these indices compared with prior to the plan. Conclusion: With regard to increasing financial resources through HSEP (70) compared with the same time before HSEP, it is necessary to manage these funds properly to achieve objectives more effective and efficient than the current ones

Health care managers’ perspectives on the sources of evidence in evidence-based hospital management: A qualitative study in Iran

Background: Evidence-based management (EBMgt) has been developed as a management framework for improving the quality of management decisions. To use that, we need to identify the source of evidence in decision-making.  Therefore, the purpose of this study was to identify the sources of evidence in managing hospitals. Methods: Qualitative methods were used to explore the sources of evidence and to identify hospital managers’ attitudes towards evidence-based management. A series of semi-structured interviews (n=48), with a purposive sample of 48 participants, were conducted in 2016. Also, four focus group discussions (FGDs) were conducted with health managers and specialists in the field of management. A questionnaire was used for collection of demographic characteristics and managers’ perspectives. Results: Six main themes emerged from the interviews including: scientific and research evidence, facts and information of hospital, political-social  development plans, managers’ professional expertise and ethical-moral  evidence. Also, the results showed that the majority of participants believed to use the evidence-based hospital management (95.83%). Conclusions: Our study suggested that a full evidence-based hospital manager someone who is using all the sources of evidence for making hospital decisions. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and to make the best decision in the process of evidence-based decision making.  Keywords: Evidence-based management, management decisions, hospital  managers, health secto

Barriers, Facilitators, Process and Sources of Evidence for Evidence- Based Management among Health Care Managers: A Qualitative Systematic Review

BACKGROUND: Evidence-based management (EBMgt) improves managerial decisions as a bridge from theory to practice. For reason that it has a critical impact on organization performance. The purpose of this study was to identify factors affecting EBMgtamong managers.METHODS: The following electronic databases were used: PubMed, Web of Science, Cochrane, ProQuest, Embase and Scopus. In addition, we searched Google Scholar, Emerald, Academy of Management (AOM), and the website for the Center nfor Evidence-Based Management (CEBMa) for articles related to EBMgt. We used data sources published up to September 2017, without language restriction. We appraised the methodologicalquality of studies using the checklists of SRQR and MMAT. The synthesis involved interpretative analysis based on the principles of meta-synthesis.RESULTS: Of 26,011 identified studies, 26 met the full inclusion criteria. Of the 26 studies assessed, the frequency of qualitative studies and mixed-methods were 20 and 6, respectively, and the quality of 3 studies was weak. A total of 23 studies from 7 countries were included: Canada (n=8), USA (n=6), Australia (n=4), UK (n=3), Iran (n=1, Brazil (n=1); none were from Africa. Meta-synthesis findings of 23 studies identified four main factors: facilitators (5 main themes), barriers (5 main themes), sources of evidence (4 main themes), and the process of decision making in EBMgt (1 main theme).CONCLUSIONS: EBMgt is crucial to improve the quality of management decisions, and hence, to improve service delivery, effectiveness and efficiency. Furthermore, to increase the benefit and utilization of EBMgt, training organizations and research institutes must more actively involve managers in setting research plans

Barriers to Medication Adherence among Hypertensive Patients in Deprived Rural Areas

BACKGROUND: Poor adherence to medication regimen leads to poor health outcomes, increased medical costs and increased death rate due to hypertension. The aim of this study was to evaluate baseline barriers to medication adherence among hypertensive patients in deprived rural areas.METHODS: A cross-sectional study was conducted on 238 hypertensive patients living in deprived rural areas of Iran. Data were collected using a questionnaire consisting of demographic information, Morisky medication adherence scale and the barriers to medication adherence that were reliable and valid.RESULTS: The results of the study showed that medication adherence was significantly decreased and had a significant positive correlation with gender and economic status, while it had a negative correlation with age. Medication Adherence had a positive correlation with the duration of hypertension, while it had a negative correlation with the number of medications used and concurrently with other diseases.CONCLUSIONS: Based on the present study it can be concluded that enhanced knowledge about illness and treatment in rural communities is improves the medical adherence. Financial supports along with the reduced number of prescribed drugs are also found to be the determining factors in the medical adherence.&nbsp

Evaluating visit quality in plan of health sector evolution in Iran: A local survey from Tabriz

Background and aims: Quality of visit services is a decisive aspect of patient-physician communication that its inadequacy can negatively influence the diagnosis efficiency. The aim of this study was to survey visit quality at provincial level during plan of health sector evolution in Tabriz. Methods: A sample of 540 patients who referred to the outpatient clinics (Sheikh Al Raeis of Tabriz Province) in North West of Iran was randomly selected. Data were collected by a researcher-made checklist and summarized using descriptive statistical methods. Results: The average visit time was found to be 8.52 minutes, which is significantly lower than the minimum average of 15 minutes approved by the Iranian Ministry of Health and Medical Education (MOHME). The average of waiting time was found to be 101.57 minutes for patients. The results showed that the structural quality was found to be 51.36, process quality was found to be 62.69 and outcome quality was found to be 50.82. Conclusion: Visit length was shorter than other developed and developing countries. If the consultation process in health care delivery to patients is incorrect or incomplete, the following process will be without quality and security. This study showed that visit time is short and waiting time is very long

Using the Methodology of Systematic Review of Reviews for Evidence-Based Medicine

Systematic Review of Reviews without abstract. Authors' invited you to read the whole review article since it is short

Nurses’ Perspectives on the Impact of Marketing Mix Elements (7Ps) on Patients’ Tendency to Kind of Hospital

BACKGROUND: Marketing mix (7Ps) is a critical concept in healthcare management and health marketing. Hence, this study was conducted to investigating the role of 7Ps on patients’ disposition to the kind of hospital from nurses’ perspectives.METHODS: A cross-sectional study design was used in 2015. The study was conducted in one state in Iran (Mazandaran). The statistical population included nurses (n=235) in public and private hospitals were selected randomly through the list. Data were collected by questionnaire and were analyzed using SPSS software (version 22).RESULTS: The results showed that 38.6 percent of nurses were males and the others (61.4 percent) were females. Their mean age was 31.0±7.1 years, and the majority of them belonged to the 30-40 age group. The mean work experience of them was 11.42±6.5years. The findings showed that there were significant differences between nurses’ perspectives in public and private hospitals about the effect of 7Ps elements on patients’ tendency to the public and private hospitals (p<0.05).CONCLUSIONS: According to the results, the officials of public hospitals should take more attention to the elements like product, place, promotion, people, physical assets and process management more than the past because these elements cause that the patients are disposed to the private hospitals while the government make more investment in public hospitals

An Evidence-Based Framework for Evidence-Based Management in Healthcare Organizations: A Delphi Study

BACKGROUND: Evidence-based management (EBMgt) is a growing literature concept in management sciences which claims that management decision-making must be based on the best available evidence. The aim of this paper is to present and provide an evidence-based framework for EBMgt to improve decision-making in healthcare organizations.METHODS: A two-round Delphi survey was used to collect the factors affecting EBMgt. Purposive and snowball sampling methods were used in both rounds. In round 1, we conducted a systematic review and a series of semi-structured interviews (n=45). In round 2, a specific questionnaire with four main parts was designed. The experts (n=21) were asked to rate on a 9-point Likert scale the importance of each factor. The data was collected through Google Forms (n=11) and paper forms (n=10).RESULTS: Participants were mostly men (73%). Overall, 126 factors were selected in round 1. Factors were classified into 4 categories: facilitators, barriers, the sources of evidence and EBMgt process that consisted of 48, 46, 22 and 10 factors, respectively. In round 2, based on median scores, many factors (n=114) were found to be very important. Only, 12 factors have a median score of less than 3 and were excluded from the study. Finally, 114 factors were confirmed.CONCLUSIONS: Confirmed factors played significant roles in affecting the practice of EBMgt among healthcare managers. We tried to facilitate interaction between these factors in the framework. Depending on the type of problem, using six steps of EBMgt process, managers will select the best evidence among six sources of evidence.KEYWORDS: Evidence-based management, evidence-based framework, healthcare organization

Survey on waiting time and visit time in plan of health sector evolution in Iran: A case study in Tabriz

Background and aims: Visit quality is a crucial component of patient-physician interaction that its inadequacy can negatively influence the diagnosis and treatment efficiency. The waiting time and visit length are important determinants of quality in the outpatient care setting. Thus, the aim of this study was to determine waiting time and visit length and to compare them before Implementation of health sector evolution in Iran. Methods: A cross-sectional study was conducted during autumn 2014. A sample of 540 patients who referred to the outpatient clinics of Sheikh Al Raeis of Tabriz Province (North West of Iran) were randomly selected and surveyed. Data were collected by the collection tools and analyzed using descriptive statistical methods. Results: The average visit time and standard deviation were 8.52 min and 3.14 respectively, which is significantly lower than the minimum average of 15 min approved by the Iranian Ministry of Health and Medical Educations (MOHME). Average of waiting time was 101.57 min for patients. The result showed that visit time was shorter than standard (7.5 min per patient) of health sector evolution in specialties of general Surgery, ophthalmologist, ENT, orthopedics and pediatrics. Also, the variables such as: number of visits, age of physicians, experience of physicians, men physicians, working shift of afternoon influenced on visit time significantly. Conclusions: The starting points of health care delivery to patients are consultations. This study showed that visit time is short and waiting time is very long. But, it seems that implementation of health sector evolution and plan of visit quality improvement led to increased visit time

A Hospital Performance Assessment Model Using the IPOCC Approach

BACKGROUND፡ Developing a practical model to assess hospital performance improves the quality of services and leads to patient satisfaction. This study aims to develop and present such a model using the IPOCC (Input, Process, Output, Control and Context) approach.METHODS: This study used a mixed-method research. The statistical population of the qualitative part included 27 experts who were purposefully selected and the sampling process was continued by the snowball method until the data saturation was reached. The quantitative part included 334 managers at differentlevels within a hospital, who were selected by a random sampling method based on Cochran's formula.RESULTS: The hospital evaluation model has 5 dimensions with 20 factors: input (human, financial, physical, information and equipment), process (treatment, para-clinical, prevention, management, and leadership processes), outcome (patient, staff and community outcomes and key performance index), control (internal control, external control), context (hospital culture,hospital status, the role of evaluators and community conditions). The value of chi-square was 4689.154, the degree of freedom was 2385, and the ratio of chi-square to the degree of freedom in the model was 1.966, which is an acceptable value. The values obtained from CFI, GFI, and IFI fit indices were acceptable. The SRMR index was 0.1130.CONCLUSIONS: Using a performance assessment model along with the IPOCC approach evaluates hospital processes and the output obtained from the proper implementation of these processes in all areas. The areas include the hospital provided services like the control and context, or the traditional perspectives like physical, human, financial, and equipment resources