Futures of elderly care in Iran : A protocol with scenario approach

This study is the first author’s PhD Thesis, which has been supported by Iran University of Medical Sciences (IUMS_SHMIS: 65/2014). The authors would like to make special thanks to all participants for their kind contributions to this project and are also grateful to Dr. Mohammad Azmal and Dr. Hesam Seyedin for their insightful comments on the earlier manuscript.Peer reviewedPublisher PD

Organisational failure and turnaround process in NHS hospital trusts.

Since 1997, public services improvement has been at the centre of the national policy agenda in the UK. The greater visibility of poor quality and performance has led to an increasing interest among policy makers, health care managers and clinicians in understanding the processes by which underperforming organisations can 'turnaround' their situation. The aim of this thesis is to contribute to a wider understanding of organisational failure and turnaround processes in the public sector, particularly health care organisations. A conceptualisation was carried out concerning organisational failure and the turnaround process in the for-profit sector in relation to a range of theoretical frameworks and models. As a result, the 'stages' theory was selected as a conceptual framework with which to organise and interpret the findings of the empirical part of the study. A comprehensive review was conducted to examine the findings of empirical studies regarding the processes of organisational failure and turnaround across a range of public services. The review showed insufficient empirical studies in this field in the health sector. The review concluded that a range of both external and internal factors contributed to organisational failure and various triggers were identified, which initiated the process of change. A range of turnaround interventions were identified including reorganisation, retrenchment and repositioning strategies. A qualitative case study of a purposefully sampled hospital Trust, involving semistructured interviews (57 interviewees from different organisations) and a review of background documents were carried out to explore the symptoms and causes of organisational failure, factors that triggered the process of change, and the perceived effectiveness of a variety of turnaround interventions. Symptoms of organisational performance failure were identified, including financial deficit, lack of good external relationships, inability to meet core targets, lack of clear management systems and low staff morale. These markers had not been taken seriously by the previous senior management team. Symptoms of failure reflected the presence of secondary and primary causes of failure. Poor managerial leadership, poor financial control and performance management, lack of an open culture, distraction by two large projects and the lack of clinician engagement were perceived as internal causes of failure and the high level of policy changes within the NHS as the key external cause. The level of 11 _ ._~ ~ .'Â?Â? _ Â? .......... Â? .. , ... -...t:.- Â? deprivation in the area was also thought to have had a negative impact on performance. The replacement of the Chief Executive Officer and executive members of the Board and the public reporting of poor performance and external investigation reports were perceived as the main triggers for change. The Trust's managers were able to develop and implement their action plan and turnaround performance without receiving direct intervention from external organisations. The interventions deployed within the Trust may be classified under three key categories: i) Reorganisation (replacement of the Chief Executive Officer and executive members of the board, internal restructuring and increased involvement of clinical staff in the management of the organisation, and an increased focus on performance management); ii) Retrenchment which aimed to stabilise the crisis situation using tight financial control and focus on main performance targets); iii) Repositioning strategies which aimed to sustain performance improvement by attempting to change organisational culture, better stakeholder management and external relationship and developing new vision. Several unintended consequences of turnaround interventions (e.g. distortions of clinical priorities and presence of stress and anxiety among staff) were identified. The findings of this study make a significant contribution to our understanding of organisational failure and the turnaround processes and reinforce and expand those of recent studies in the public sector, particularly in health care

A qualitative study of the current situation of elderly care in Iran : what can we do for the future?

This study is part of the first author's PhD dissertation (17 Goharinezhad S. Foresight of elderly care in Iran: a scenario approach. PhD dissertation. 2016; Tehran, Iran: Iran University of Medical Sciences. [Google Scholar]) in Iran University of Medical Sciences, School of Health Management and Information Sciences (IUMS_ SHMIS: 65/2014). The authors would like to make special thanks to all participants for their cooperation to this study. The authors would also like to thank all reviewers who helped improve the manuscript.Peer reviewedPublisher PD

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG , supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities

The experience of implementing the board of trustees’ policy in teaching hospitals in Iran: an example of health system decentralization

Background: In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods: We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results: Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion: The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization policies in the past and their outcomes were overlooked, while the context was not prepared appropriately and key stakeholders, particularly the government, did not support the decentralization of Iran’s health system

Designing a Tool for Evaluation of the Outsourcing Process in Laboratories of Non-educational Hospitals

Background: Outsourcing, as one of the most recently used tools in the field of healthcare management, has an important role in improving the efficiency and quality of health services. The objective of the present study was to design a tool for evaluation of the process of outsourcing in laboratories of non-educational hospitals. Methods: This applied study was conducted as mixed methods and in two qualitative and quantitative steps. In the first step, through reviewing the existing literature and documents published abroad and in Iran relating to the research subject, a check list for evaluation of the process of laboratories’ outsourcing was prepared. In the second step, using a close questionnaire, 46 selected experts were asked to give their opinions about the content and face validity of the proposed check list. Finally, Lawshe's Content Validity Ratio and Excel software were used to analyze data. Results: The final check list about evaluating the process of out sourcing laboratories at non-educational hospitals included the following 5 dimensions: proving the necessity of laboratories outsourcing (9 questions), selecting the undertakers (13 questions), negotiating and finalizing the contract (10 questions), implementing the contract (5 questions) and evaluating the undertakers’ performance (8 questions). Conclusion: Given the importance of outsourcing laboratories, providing education related to the implementation and evaluation of this process form its beginning until end, in periodic training courses for university’s managers and staff is highly recommended. Keywords: Outsourcing, Evaluation tool, Laboratory, Non-educational hospital, Content Validit

The Relationship between Organizational Entrepreneurship and Communications Network in Health Deputy of Ahvaz University of Medical Sciences

Background & Objectives: Effective communication can be considered as the foundation of modern organizations and effective organizational communication can provide an appropriate context for organizational entrepreneurship. This study investigated the relationship between organizational communications network and organizational entrepreneurship in Vice-Chancellor for Health Affairs in Ahvaz University of Medical Sciences. Methods: This descriptive-analytical and cross-sectional study was conducted in 2015. Statistical population of the research was all staff of Vice-Chancellor for Health Affairs in Ahvaz University of Medical Sciences (n=106), of whom, 90 ones returned their questionnaires. Data gathering was done using the questionnaire of organizational communication network including 14 questions and the questionnaire for organizational entrepreneurship including 31 questions. Scoring was done using 5-item Likert scale. Data analysis was performed through SPSS16 and using t-test, ANOVA and correlation coefficient. Results: Mean score of communication network was 3.28 and mean score of organizational entrepreneurship was 3.13. The results showed a significant direct relationship between organizational communications network and entrepreneurship (P <0.001). Conclusion: According to the results of the present study, having an efficient communications network in organization makes the organization potentially entrepreneur. Therefore, organizations should try to create friendly and collaborative relationships among all staff through holding educational programs. Key¬words: Organization, Communications network, Organizational entrepreneurship, Health Vice-chancellor ¬Citation: Khodayari-Zarnaq R, Ravaghi H, Fadayi Dehcheshme N, Sanadgol A, Mobasseri K. The Relationship between Organizational Entrepreneurship and Communications Network in Health Deputy of Ahvaz University of Medical Sciences. Journal of Health Based Research 2017; 3(1): 39-49

Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran

Background & Objectives: Due to the lack of evidence about the most cost-effective thrombolytic drug in the treatment of acute myocardial infarction with the ascension of the ST segment, this study was conducted to evaluate the cost effectiveness of tenecteplase, as a new medicine, versus Reteplase in the treatment of acute myocardial infarction patients with the ascension of the ST segment in Iran. Methods: This study was a type of health technology assessment study. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE databases (from March1980 to March 2017) by using related keywords for finding cost-effectiveness, safety and economic studies. The qualities of studies were independently assessed by STROBE checklist and data were extracted using Cochrane data extraction form. Results: Three studies were eligible for inclusion and all three were of high quality. Mortality had been compared between Tenecteplase and Reteplase. The results of two studies with 781 samples had showed the same efficacy for Tenecteplase and Reteplase in regard to mortality rate. According to the cost-effectiveness analysis, Reteplase is more cost effective than TNKase (250 $versus 537.49$). Conclusion: Reteplase, due to the same safety and effictiveness but lower cost, is preferred to Tenecteplase and considering the current economic conditions of Iran, it is recommended to be used in the treatment of acute myocardial infarction patients with the ascension of the ST segment. Keywords: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation Citation: Bashzar S, Tourani S, Nikfar S, Ravaghi H, Habibi M. Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran. Journal of Health Based Research 2018; 4(1): 51-62

Analyzing the Role of Religion and Religious Institutions in Policymaking on AIDS in Iran

For downloading the full-text of this article please click here.Background and Objective: HIV is a social phenomenon whose investigating needs to take culture, traditions, and religious beliefs of the society into account. Given that, the aim of this study is examining the role of religion in policies made to control AIDS in Iran.Method: This qualitative study adopted the content analysis technique with inductive approach in which 30 policymakers, key informants, stakeholders and AIDS patients were given semi-structured interviews and also 21 documents on related policies were analyzed considering factors influencing AIDS policymaking. Then, the data were analyzed using framework method and MAXQDA. In this study, the ethical issues were all considered and the authors declared no conflict of interest.Results: After coding, approximately 300 primary codes were extracted. These codes were checked again and then categorized into three areas: the functions of religion and its preventive and encouraging factors in the related policies; different roles of the clergy as religious authorities, politicians and advisors; and the way religious institutes and organizations play their roles in AIDS policymaking process.Conclusion: Religion and its corresponding ideology have critical encouraging and preventive functions in implementing plans for control and prevention of AIDS. Neglecting religious aspects of the Iranian society in policymaking has led to less effectiveness of policies and failure in controlling AIDS.For downloading the full-text of this article please click here