Financial and Economic Criteria for Evaluating the Performance of Pharmacies

Improving the economic performance of pharmacies need to economic and financial indicators. Despite this necessity, economic and financial performance indicators have not been identified comprehensively in the pharmacy setting. Thus the aim of this study is to determine the economic and financial performance assessment criteria of the pharmacies by specialist’s point of view. This study is a qualitative study in which experts and professional’s point of view were gathered by focus group discussion. 15 health system experts were selected by purposive sampling approach. Data from focus group discussions (FGD) were analyzed by thematic analysis method. Twelve main themes in two scopes were obtained to assess the economic and financial performance of the pharmacy by review of specialists view. These themes are waste rate, profitability, cost control, financial management, economic and political issues, pharmacist, doctor, medical insurance, management system, pharmaceutical companies, cultural issues and public or private administration system of pharmacy.Based on the results of this study, the most important criteria to evaluate the financial and economic performance of pharmacies were identified. These results can be used for to economic and financial performance evaluation of pharmacies

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

Socioeconomic Status and Coronary Heart Disease

Background: Iran has undergone a remarkable demographic transition over the last threedecades. Socioeconomic status (SES) indicators including education, income, and occupationare associated with coronary heart disease (CHD) risk factors, morbidity, and mortality. Theaim of the present study was to describe demographic and socioeconomic characteristics, theirassociation to the diseases, and to explore the predictive risk of CHD in Tabriz, the fourthlargest city in Iran and the capital of East Azerbaijan Province.Methods: This cross-sectional descriptive study was carried out to explore and analyze thecurrent SES status of CHD patients. The study was conducted in Tabriz and all patients(n=189) refereed to the Central Referral Hospital for cardiac patients (Shahid Madani Hospital)from 2009 to 2010 were considered. A researcher structured questionnaire with 15 questionswas used to collect data. Descriptive statistics were used to describe the basic SES featuresof the CHD patients and data analysis was done using SPSS ver. 16.Results: Less educated participants were more susceptible to CHD. Regarding to occupationalstatus, housewives and retired men were in higher risk of CHD than the rest of the people.Studied patients also reported to be mostly from urban areas that were living in apartmentcomplexes.Conclusion: In line with some international research evidence the study results suggested thatpeople from lower/middle social classes were in greater CHD risk than higher social classes.This epidemic might be halted through the promotion of healthier lifestyles and the support ofenvironmental and policy changes

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

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

The Relationship between Organizational Justice Perception and Self- efficacy in Staff of a Selected Educational Hospital: a case study

Background & Objectives: Hospitals are one of the important components in a health care system and have significant role in health of humans. Organizational justice shows the perception of fairness and equality in the workplace by staff and affects their behavior. This study examines the relationship between organizational justice perception and self-efficacy in employees of a selected hospital of Tabriz/ Iran. Methods: This was a cross-sectional descriptive- analytic study performed on 156 employees of one of the selected hospitals of Tabriz University of Medical Sciences. Chen, Gully & Eden Self-efficacy questionnaire and Rego and Cunha organizational justice questionnaire were used as data collection tools. Data analysis was done through SPSS23 and using analytic statistical tests such as Spearman correlation, Chi-Square and regression. Results: There was a significant positive relationship between dimensions of organizational justice and self- efficacy (P<0.01). Also, based on the results of regression analysis, information justice was a stronger predictor of self- efficacy. Eventually, the elements of procedural, interactions and information justice could predict 14% of variations of self- efficacy. Conclusion: Since dimensions of organizational justice affect employees' self- efficacy, hospital managers should find appropriate strategies for improving organizational justice in order to increase self- efficacy and ultimately the performance of their employees. Key¬words: Distributive justice, Procedural Justice, Interactional Justice, Informational Justice, Self efficacy, Staff, Educational Hospital Citation: Janati A, Chegini Z, Gholizadeh M, Naseri N, Ahmadi Z. The Relationship between Organizational Justice Perception and Self- efficacy in Staff of a Selected Educational Hospital: a case study. Journal of Health Based Research 2017; 3(2): 127-13

The Perspectives of Head Nurses and Managers of Private and Public Hospitals of Tabriz City about Social Responsibility

Background & Objectives: Social responsibility is one of the most important elements of the organizations' existential philosophy, especially organizations such as hospitals. This study was conducted to evaluate the perspectives of the managers and head nurses of public and private hospitals in Tabriz/ Iran about social responsibility. Methods: This cross-sectional descriptive study was performed on 57 head nurses and managers working in public and private hospitals in Tabriz selected by census method in 2016. Data collection tool was a four-part questionnaire including 24 questions for assessing the status of social responsibility in the hospital. Data analysis was performed through SPSS 21 software. Results: From the perspectives of our subjects in public and private hospitals, patients were the most important group affecting organizations' activities (mean scores: 3.73 and 1.82 respectively), approaching to international standards was the most important motivator (mean scores: 3.23 and 3.70 respectively) and attention to suppliers was the most important focus area (mean scores: 3.76 and 3.51 respectively). Conclusion: According to the obtained results, most managers and head nurses, based on the type of hospital working in it, had a different conception of social responsibility. Therefore, it is suggested to provide the required trainings in relation to the necessity of establishing social responsibility in hospitals, regardless of the type of hospital. Key¬words: Public hospital, Private hospital, Social responsibility, Managers Citation: Gholizadeh M, Janati A, Mousazadeh Y, Amirshakeri F, Narimani MR. The Perspectives of Head Nurses and Managers of Private and Public Hospitals of Tabriz City about Social Responsibility. Journal of Health Based Research 2017; 3(3): 203-216

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

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

Health economic evaluation of home and hospital-based care in T2D patients on insulin therapy

Background: Type 2 Diabetes is a main concern of public health in  contemporary world with remarkable mortality, delayed complications and  health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for  hospital services is care at home. Therefore, this study was aimed to evaluate  the cost-effectiveness of home-based and hospital-based diabetes care. Methods: A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2  diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated  hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. Results: The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was  cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. Conclusions: The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.  Keywords: Cost-effectiveness, type 2 diabetes, insulin therapy, home care, hospital care