Quarterly Journal of Management Strategies in Health System

Organ Donation and Transplantation Panel: Current Status, Future Challenges

Sara Emamgholipour Sefiddashti — 2025-03-15

There are several treatment methods to treat patients who have lost the normal function of body organs, among which, transplantation is the most effective treatment method. It is important to provide a transplanted organ to perform this operation. The current situation is such that there is a significant difference between the supply and demand of the transplanted organ. Transplant organ trafficking exists almost everywhere in the world, and most of the victims, who entered this path due to lack of awareness of the consequences, especially with the motive of financial gain, regret their work if they survive. In order to balance this market, countries should develop their processes and health systems in such a way that the supply of transplanted organs (from living or deceased donors) increase legally. Otherwise, through strategies such as black market, human trafficking and organ trafficking, the balance will be established. The index of organ donation from living donor and deceased donor per one million people in Iran has a significant distance from the standard and ideal situation. Therefore, strategies and actions should be planned and implemented at the micro and macro level by following the example of successful countries to manage this issue.

Designing the model of organizational civilization in the health system (case study: Amirkabir Arak Hospital)

Ali Naderi — 2025-03-15

Background: Today, the health system is facing numerous challenges and issues that can be overcome by utilizing the principles of organizational civilization. Organizational civilization includes cultures that provide the necessary background for regular and purposeful training of human resources to improve service delivery and obtain win-win benefits. Despite its great importance, there is still no complete understanding of the different dimensions of the concept of organizational civilization in the health system. Therefore, the aim of the present study is to design the model of organizational civilization in the health system.

Methods: This research is fundamental in terms of its purpose and is classified as an exploratory mixed research. In order to design the research model, the grounded theory method was used, and this research was conducted in two stages including qualitative stage using the grounded theory method and quantitative stage using the structural equation modeling method. In the qualitative stage, in-depth interviews were conducted with experts in the health system who were selected by purposeful sampling method. The interviews with the experts continued until theoretical saturation was reached, and after 14 interviews, the interviews were stopped. The model designed using the structural equation modeling method was validated with Smart PLS ₄ software. Moreover, in the quantitative stage, the statistical population included 136 managers and experts of Amirkabir Hospital in Arak, who were surveyed using a questionnaire. In addition, the sample size calculated by Cochran method was 101 people using simple random sampling method.

Results: A paradigm model was designed with 6 categories of variables including causal factors, central phenomenon, strategies, intervening factors, contextual factors, and consequences. Also, 5 main categories and 15 subcategories as well as 4 strategy categories were identified for the organizational civilization variable, based on which the research model was created. The main categories identified for the central phenomenon (organizational civilization) included virtueism, valueism, rationalism, idealism, and utilitarianism. Findings of the structural equation modeling fit also showed that the structure and variables of the model are approved. In addition, the values of the coefficient of determination for the central phenomenon variable were calculated as 0.681, strategies as 0.710, and consequences as 0.729, which are appropriate values and indicate that the variables of the model have been identified correctly.

Conclusion: The phenomenon of organizational civilization can be a practical and efficient concept in the health system that will lead to more orientation of this sector towards human, value, and ethical issues and creation of valuable results including improving efficiency and effectiveness in the health sector and ensuring the interests and satisfaction of stakeholders and society.

Identifying Solutions for Capacity Building of Health Sector Non-Governmental Organizations

Mohanna Rajabi — 2025-03-15

Background: Capacity building or capacity development in Non-Governmental Organizations (NGOs) helps them to perform their tasks more effectively, achieve objectives, improve performance, and adapt to changing conditions, thereby contributing to their more effective role in promoting community health. This study aimed to identify strategies and solutions for capacity building in health-related NGOs in Iran.

Methods: This exploratory qualitative study was conducted between 2021 and 2022. Data were collected through 24 semi-structured in-depth interviews with individuals working in government health-related organizations and health NGOs. The participants were selected non-randomly and through purposeful sampling with maximum diversity. The collected data were analyzed using content analysis methods by MaxQDA₁₀.

Results: Based on the analysis of the interview data, 11 strategies for capacity building in health-related NGOs in Iran were identified. These include having a strategic plan, organizational restructuring of NGOs, operational and financial transparency, human resource supply, gaining support from the community, government, and related organizations, forming a database of NGOs, networking among NGOs, and introducing NGOs to the community, universities, and research centers. These strategies were categorized into 5 main themes including planning, organizing, transparency and accountability, resource management, and advertising and networking.

Conclusion: To succeed and play a more effective role, health-related NGOs need to enhance and develop their capacities. Focusing on improving planning methods, organizing, transparency and accountability, resource management, and advertising and networking are the main strategies for capacity building in health-related NGOs in Iran.

Forecasting the Demand of Medical Tourists in Yazd Using Artificial Neural Network

Hamidreza Fallah Tafti — 2025-03-15

Background: Medical tourism is one of the newest types of tourism and predicting the demand of medical tourists for a society is one of the most important prerequisites of the tourism industry to provide the necessary infrastructure so that we can maximize the future of this income-generating industry. Therefore, in order to better develop the medical tourism industry, the purpose of this research is to predict the demand of medical tourists in Yazd using artificial neural network.

Methods: The present quantitative study was conducted in the summer and fall of 2023. Field study method was used to collect data. The statistical population of this study was medical tourists referring to 4 government hospitals in Yazd city during 2015-2022. In this study, medical indicators of hospitals in question and other medical indicators of Yazd city, such as the number of patient admission beds, the number of pharmacies, the number of health centers, etc., were examined with respect to the spread of the coronavirus disease from late 2019 to late 2021. The effective indicators in this study were first identified and using the proposed artificial neural network model, the number of medical tourists for the next year in Yazd city was predicted. For further investigation, time series methods were also used.

Results: Using the conducted surveys, the number of medical tourists entering Yazd city was predicted in different months of 2023. Moreover, to check the accuracy of predictions in the artificial neural network, the prediction was also done with the time series model. The results of this study revealed that the error rate of training data in artificial neural network and time series model was 0.000618 and 0.011131, respectively, as well as 0.013346 and 0.0531902 for test data, respectively, indicating the superiority of the proposed method.

Conclusion: By taking advantage of the forecast of the demand for medical tourists, it is possible to attract more tourists by providing the necessary and real infrastructures for medical tourists and homogenizing the current and required urban facilities, which will lead to an increase in income and economic and social development of the city.

Examining the Importance of Factors Related to the Incidence of Administrative Corruption from the Perspective of the Staff of Shahid Sadougi University of Medical Sciences, Yazd

Hasan Jafari — 2025-03-15

Background: The existence of administrative corruption in universities is one of the serious challenges that can have widespread negative effects on the educational, research, and social systems. The present study aimed to determine the importance of factors affecting the occurrence of administrative corruption from the perspective of administrative staff at Shahid Sadoughi University of Medical Sciences in Yazd.

Methods: The present applied, quantitative, and cross-sectional study was conducted in 2023. The sample size was 260 individuals, selected through stratified random sampling. The instrument used was a standard questionnaire in the form of a five-point Likert scale. For data analysis, descriptive statistics such as mean, standard deviation, and frequency, as well as t-test and ANOVA were used.

Results: Based on the findings, the highest mean value was related to organizational factors (4.00 ± 0.49) and the lowest was related to individual factors (3.77 ± 0.57). Moreover, no significant relationship was observed between factors contributing to administrative corruption and demographic factors such as gender, marital status, age gap, and work experience. However, a significant relationship was found between individual factors contributing to administrative corruption and the education level of the study samples.

Conclusion: Based on the results, to reduce administrative corruption, the priority should be improving organizational factors, including transparency in processes, strengthening supervision, and fostering a healthy organizational culture. Moreover, attention to education level and raising individuals' awareness can be effective as complementary factors in reducing administrative corruption.v

Identifying Key Performance Indicators for Health Management of Population, Family, and Schools in the Deputy of Health at Ahvaz Jundishapur University of Medical Sciences

Parvin Mohammadi — 2025-03-15

Background: Reproductive, maternal, neonatal, and child health hold significant potential to enhance the health and quality of life for the current and future generations, thus they are considered the centerpiece of the Sustainable Development Goals (SDGs). Identifying Key Performance Indicators (KPIs) and utilizing them in monitoring health programs is crucial for resource management, service quality enhancement, and satisfaction. This study aimed to identify the KPIs for the health management of the population, family, and schools in the Deputy of Health at Ahvaz Jundishapur University of Medical Sciences.

Methods: This study is an observational research utilizing the Delphi technique. The research population included 50 managers and staff from the health deputy and health networks. Participants were selected using purposive sampling. Initially, a review of literature and organizational documents was conducted to examine all programs related to the management of population, family, and school health, and indicators for each program were extracted separately. Subsequently, over three stages, the opinions and assessments of these individuals were collected and analyzed to reach a consensus on the KPIs. Two Likert scale questionnaires—a three-point scale (inappropriate, no opinion, appropriate) and a nine-point scale—were used to identify and confirm the KPIs. Data analysis was performed using frequency, percentage, and median.

Results: In five health management programs targeting the population, family, and schools, 107 indicators were included the study. The highest number of indicators (over 35 %) in the first Delphi round pertained to maternal health programs. After completing the first round of Delphi, 76 indicators were identified as appropriate by 60 % or more of the participants and entered the second round of Delphi. All 8 indicators for the adolescent, youth, and school health programs advanced to the next round. However, 53.8 % of the indicators related to population and reproductive policies were selected for the subsequent round. Moreover, 8.4 % of the second round indicators (9 indicators) were reviewed in the third round for further experts’ comments, resulting in the approval of 4 key indicators related to the middle-aged and elderly health program as key indicators in this round.

Conclusion: From the total indicators of population health, family, and school health management, 44 indicators were identified and confirmed as KPIs. The middle-aged and elderly health program had the most number of key indicators with 11 indicators, and the adolescent, youth, and school health programs had the fewest number with 6 indicators. Other programs key indicators were equal (9 key indicators for each program). The analysis and evaluation of these indicators by health managers and experts can facilitate effective planning and interventions to improve public health.

Investigating Causes and Factors Affecting the Increase in Rehospitalization Costs in Imam Khomeini Hospital of Ahvaz (2023-2024)

Saeed Bagheri — 2025-03-15

Background: Readmission of patients due to various reasons such as disease return, infection, treatment follow-up, disease severity, as well as the patient's non-compliance with the provided trainings, causes hospital beds to be occupied and increases treatment costs for patients and hospital. The present study was conducted with the aim of investigating causes and factors affecting the increase in rehospitalization costs of patients in Imam Khomeini Hospital of Ahvaz city in 2023-2024.

Methods: The research population in the present descriptive-analytical study included patients who admitted in the hospital in 2023-2024 with the same reason as the previous hospitalization. In this research, 240 patient files were randomly selected as the research sample. The collection tool was a checklist and data analysis was done by descriptive and inferential statistical tests and logistic regression using Stata₁₇ software.

Results: According to the findings of the study, most of the rehospitalization cases (30 %) were related to ophthalmology ward, followed by emergency and urology wards. The most common reason for rehospitalization was disease recurrence (58.33 %). The average cost of rehospitalization was 179,995,040 Rials, which rehospitalization due to infection accounted for 57.78 % of the total costs. Variables of marital status and length of stay more than 5 days had a significant effect in increasing hospitalization costs, and the presence of armed forces insurance had a significant effect in reducing hospitalization costs (p < 0.05).

Conclusion: The most common causes of rehospitalization were disease recurrence, treatment follow-up, infection, and other causes. The ophthalmology, emergency, and urology wards had the most readmission, and most of costs were related to infectious patients. It is suggested that proper training be given to the staff and patients in order to prevent unnecessary referrals and to pay more attention to the follow-up of patients after discharge.Rehospitalization, Costs, HospitalRehospitalization, Costs, Hospital

Identifying and analyzing the interactions of social determinants of health in Iran

Nafiseh Salehnia — 2025-03-15

Background: Although healthcare is a key determinant of health status, in recent years, the role of non-medical factors in health has become more prominent, and policymaking in the field of social determinants of health has been recognized as one of the most important areas for improving community health. This study aimed to identify and analyze social determinants of health in Iran.

Methods: The present study used mixed-methods approach. First, the qualitative approach was conducted using Graneheim and Lundman’s six-step method to analyze the content of 58 sources and identify social determinants of health at the micro level. Subsequently, the quantitative Fuzzy Delphi method and Fuzzy Cognitive Mapping (FCM) were used to determine priorities and interactions. To this end, first, the factors identified by 15 academic and executive experts in the field of health were screened using the fuzzy Delphi method, and then 6 of these experts were purposefully selected to determine the relationships between the factors.

Results: The 83 identified determinants were classified into two categories: individual level with seven subcategories (family status, healthy start to life, childhood development, social gradient, individual behaviors, spiritual and mental health, and lifelong programs); and local level with four subcategories (environmental and chemical, physical environment, urban infrastructure, and social environment). After drawing a fuzzy cognitive map and determining causal relationships between factors, social environment (centrality degree = 12.10) and individual behaviors (centrality degree= 11.43) were found to be the most influential factors.

Conclusion: The findings of this study, by providing a fuzzy map, identified quantitative relationships between factors and helped policymakers understand priorities and linkages between sectors for the development and implementation of health-oriented policies in all sectors.