Hospital performance and clinical leadership: New evidence from Iran

Purpose: There is growing interest in the potential need for clinical involvement in leadership and managementof hospitals. Most studies of clinical leadership use US and European data. This paper contributes the first evidence for the country of Iran. It examines three different forms of hospital system: public, private and social security organisation, and these include teaching and non-teaching hospitals. This study adds to a small but growing literature that examines the possible value of ‘expert’ clinical leaders. Method: This study uses data from 72 general hospitals in the city of Tehran. The data were collected for years 2015 and 2016. Data Envelopment Analysis (DEA) is used in this study to assess hospital performance. Hospitals’ chief operating officers are divided into two groups: clinicians (the majority of whom are physicians) and non-medically trained managers. Findings: The average performance scores for hospitals with clinical managers and non-clinically trained managers areequal to 96.68±5.50 and 89.78±7.20 respectively (P <0.001). Performance is thus higher under clinical managers. Outcome differences are observed in each of the three types of ownership, and in teaching and non-teaching hospitals. The advantage in performance-score varies, when comparing the clinically led institutions and managerially led institutions, by between 5 and 10 points on a 0-100 scale. These differences remain after regression-equation adjustment for other influences. Practical implications: Succession planning and targeted leadership development is made more efficient with greater awareness about the kinds of leaders and managers that enhance organizational performance

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

Knowledge, Attitudes, and Practice towards Occupational Health and Safety among Nursing Students in Gaza Strip, Palestine

Health and safety in the workplace are critical components in healthcare institutions. Unsafe working conditions are among the causes of poor&nbsp; quality of care and burnout. This study aims to assess the knowledge, attitudes, and practice of occupational health and safety among nursing&nbsp; students at Al-Israa University. Methods: In this cross-sectional study, a structured online questionnaire was distributed from March to May 2021. Of the 350 eligible students, 219&nbsp; students answered the questionnaire (Response rate=62.6). Data were analyzed using the statistical software IBM-SPSS version 22. Descriptive&nbsp; statistic, Independent- samples T-Test, and ANOVA tests were used. Results: The majority of participants were female (81.7%) and studying in a diploma program. 21% of nursing students have experienced a needle&nbsp; stick injury. The mean scores for knowledge, attitudes, and practice were (M±SD:78.2% ±12.9, M±SD:80.6% ±7.1, and M±SD:81.2% ±7.6) respectively.&nbsp; In terms of knowledge, attitudes, and practice the mean scores were statistically significant between nursing students who attended a safety&nbsp; precautions course and those who didn not (P-value &lt;.05). In terms of attitudes, the mean scores were statistically significant between diploma and&nbsp; bachelor students (P-value =.026).In terms of practice, the means scores were statistically significant between males and females (P-value =.017),&nbsp; nursing students who had experience with needle sticks and those who didn’t (P-value =.015). Conclusion: The authors recommend that clinical&nbsp; training departments and universities continue to offer occupational health and safety courses and training for health science students. Since the&nbsp; training had a positive impact on the students' practices.&nbsp

Experiences of critical care nurses fighting againstCOVID‐19: A qualitative phenomenological study

Aim: This study sought to describe the experiences of critical care nurses caring for patients infected by coronavirus disease 2019 (COVID‐19). Design: A qualitative phenomenological design was used. Methods: We enrolled 15 nurses who provided care for patients infected by COVID‐19 purposively and through snowballing, using a phenomenological approach in critical care units of Iran's public hospitals between May and June 2020. The semi‐structured interviews were carried out either via face‐to‐face or telephone and were analyzed using the 7‐step method of Colaizzi. Results: The experiences of nurses caring for patients infected with COVID‐19 were categorized into four challenges, including psychological (eight subthemes), organizational (six subthemes), social (six subthemes), and professional (five subthemes). In general, based on the current classification, there seems to be a mixture of positive and negative effects on the psychological, social, and professional challenges and the negative effect only on the organizational challenges. Conclusions: Positive and negative emotions and experiences have coexisted for the critical care nurses since the COVID‐19 outbreak. Emotional support and psychological counseling play an important role in maintaining nurses' optimal mental health during the COVID‐19 crisis. Adequate protective equipment, financial and nonfinancial supports, effective communication, training and hiring of staff, and appropriate work shifts are also required to reduce nurses' negative experiences when providing care for the affected individuals

Perceived risk of infection and death from COVID-19 among community members of low- and middle-income countries: A cross-sectional study [version 1; peer review: awaiting peer review]

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic

The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators

Background: Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. Methods: A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 �strongly disagree� to 5 �strongly agree�. In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. Results: The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. Conclusions: The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits. © 2018 John Wiley & Sons, Ltd