Quarterly Journal of Management Strategies in Health System

Donors’ Participation the Health System: A Double-Edged Sword

Khatere Khanjankhani — 2024-03-16

The presence of donors in health system, despite its positive results, can also have weaknesses that sometimes act as a double-edged sword in achieving health priorities. In some cases, the needs are considered by donors as unnecessarily the real ones in health system. On the other hand; sometimes, benevolent actions are involved in political intentions and pressures.

In order to eliminate deficiencies, it is necessary to comply with standards, priorities, and real needs of health system in any field. What helps this alignment and action towards goals is using the capacity of scientific evidence. With the help of scientific evidence, the real needs of health sector can be identified and prioritized, and the capacity of donors can be used to meet those needs. Moreover, reforming and re-engineering the processes of benefactors' activities in the field of health, directing benefactors' aid, developing rules and standards, and creating transparency in costs for inter-sectoral coordination are solutions that will help to improve the conditions about this issue.

Factors Affecting Nursing Work Teams: A Cross-Sectional Study in Teaching Hospitals Affiliated with Shiraz University of Medical Sciences

Omolbanin Izadi — 2024-03-16

Background: Nurses, as vital members of healthcare system, play a crucial role in improving society's health, which makes it very important to develop work teams among them. This study aims to investigate the factors affecting nursing work teams in teaching hospitals affiliated with Shiraz University of Medical Sciences in 2022.

Methods: This study was a cross-sectional study conducted in 2022 on a sample of 267 nurses from teaching hospitals affiliated with Shiraz University of Medical Sciences who were selected using simple random sampling and the stratified method proportional to the size. Data collection tool used in this study was a valid and reliable questionnaire comprising 2 parts: nurses' demographic characteristics and 39 items related to factors affecting work teams. Data analysis was performed using SPSS ₂₃ software through Spearman correlation coefficient, Mann-Whitney, and Kruskal-Wallis tests, and finally, multiple linear regression (the Backward method).

Results: The results showed that the dimensions of "team goals" (22.93 ± 5.44) and "personality traits" (8.41 ±1.79) obtained the highest and lowest mean scores, respectively. Furthermore, the results of linear regression analysis showed that the effectiveness of work teams had a significant inverse relationship with the number of shifts (p = 0.034) and a significant direct relationship with employment in the intensive care units (p = 0.032).

Conclusion: Based on the findings, several suggestions can be made to enhance the effectiveness of nursing work teams, including hiring adequate staff to reduce the number of nurses' work shifts, particularly in the intensive care units, ncouraging other hospital wards to follow the example of the work in intensive care units, establishing a system for determining and adjusting nurses' work shifts based on their opinions and priorities, conducting monthly, quarterly, and annual assessment based on attendance and participation in nursing work teams, encouraging more active nurses in this field, and considering various rewards for effective nursing work teams.

Cost and Income Estimation of Burn Intensive Care Units A Case Study in the Armed Forces Hospital

Hassan Barkhordar — 2024-03-16

Background: As one of the most expensive sections of health system, hospitals are of special importance among healthcare service providers, and the management of financial resources in this sector is essential for continuous provision of services. The high cost of the burn department and post-treatment care in the armed forces, which is one of the most needed units of this organization, has led to the financial analysis of the burn department in Chamran Hospital. The main goal of this study is for the policy-makers and managers of the country's health sector to adopt a suitable policy in the debate between quality and cost-effectiveness of establishing a burn unit in the field of health and treatment, so that, in addition to reducing the costs of this sector, they focus on positive external effects, including reducing the psychological pressure on the affected people.

Methods: This cross-sectional and descriptive study analyzed burn department in one of the hospitals affiliated with the armed forces in 2020 and 2021. The required data was collected through the review of all the hospital financial statements and patient payment documents during the period under study, and the income, cost and profitability indicators were calculated and analyzed using Excel software.

Results: Based on the results, the calculated costs in the burn department were more than 62 billion tomans, and the income from hospitalization of patients was about 61 billion tomans. The index of pharmaceutical income to total income was calculated as 0.35, pharmaceutical income to pharmaceutical cost was 0.10, and the ratio of hoteling income to total income was 0.37. Among the cost indicators, the ratio of the cost of medicine and medical supplies to the total costs was 0.31, the energy cost to the total cost was 0.002, the percentage of personnel cost to the total resources was 0.56. Moreover, the profitability index was calculated as 0.97.

Conclusion: According to the results, although the burn department, especially in the armed forces, is not cost-efficient from an economic point of view, from a social point of view and due to the health and treatment mission of the armed forces, which is the efficient support of the armed forces and meeting their needs. Establishing this sector is considered a strategic matter and the optimal use of resources and reduction of unnecessary costs is necessary for cost efficiency. Therefore, the establishment of a systematic system for evaluating financial performance, outsourcing services, providing subsidies, and raising burn tariffs in order to improve the performance of the burn department in government hospitals are the methods proposed in this study to improve financial indicators, productivity, and excellent management in providing services to the patients in the burn department.

Estimating the Number of Department Secretaries Needed in in Hazrat Zainab Hospital Based on Workload Indicator of Staffing Needs in 2023

Nahid Bakhtiary — 2024-03-16

Background: Department secretary position is one of the most important and practical jobs in the hospital, which is often neglected. The secretary of the nursing department is responsible for carrying out all office affairs of the department under the direct supervision of the supervisor; Therefore, proper planning for adequate supply of these forces in hospital departments is very important.

Results: According to the results of the research, at the time of the study in Hazrat Zainab (S) Shiraz Hospital, 13 secretaries were working, and the required number of secretaries in the department was 12.94 based on the WISN; but, since a work measurement was done for each department separately, the result was different in each department.

Conclusion: Results revealed that, in general, there is no shortage of secretaries in hospital departments, and there is no need to recruit new staff; however, in terms of workload, there is no balance between different departments, so it is necessary to balance the workload in different departments through proper planning.

Management and Leadership Requirements in Hospital Service Supply Chain: A Mixed Method Study

Musarreza Mohagheghnejad — 2024-03-16

Background: The supply chain of hospital services is a relatively new and highly challenging field, and it is crucial for relevant officials to possess the necessary skills. The success in this domain relies on the characteristics of managers, their management practices, and their leadership style. This study aims to investigate the requirements of management and leadership in hospital services’ supply chain.

Methods: This study employed a two-stage mixed-methods approach carried out from 2018 to 2021. In the first stage, a qualitative study was conducted using purposive sampling and semi-structured in-depth interviews with 15 experts in various leadership positions. The data collected in this stage were analyzed using framework approach. Subsequently, the primary themes that emerged from the analysis were presented to 8 experts in the form of a questionnaire. The experts' responses were then analyzed to determine the level of agreement on different topics using Delphi method, Kendall's coefficient of agreement, and the mean was compared through SPSS ₂₁.

Results: The experts identified transformationalism, planning capability, crisis management, and creativity as the most crucial factors. Furthermore, there was a high level of agreement regarding the influence of managers (4.62 ± 0.51), maintaining distance from mundane routines (4.50 ± 0.53), and attending to various incidents in hospital services supply chain (4.50 ± 0.53). Considering that Kendall Rank Correlation Coefficient (w) was 0.53 in the first round and 0.72 in the second round and was statistically significant, there was a strong consensus among the expert panel.

Conclusion: According to the results of the present study, it is necessary to pay serious attention to the change in management style and hospital services supply chain, there should be a special focus on the possibility of occurrence or impact of sudden accidents. Also, routine and ineffective actions should be eliminated and the managers and employees should be more creative to improve this chain. Transformational leaders should try to manage the hospital services supply chain by forming specialized teams and using the capabilities of employees with the reasonable use of financial resources and appropriate infrastructures, including information technology.

Investigating the Relationship between Organizational Happiness and Quality of Work Life in Teaching Hospitals of Yazd in 2023

Hasan Jafari — 2024-03-16

Background: A healthy organization is a place which is productive, capable, and efficient enough to deal with the competitive world. The quality of work life is important, not only to improve life at working environment but also the life outside work place; there the present study examines the relationship between organizational happiness and work life in teaching hospitals in Yazd city in 2023.

Methods: This cross-sectional study was conducted in the form of a multi-stage random sampling on 215 people and among the personnel of teaching hospitals in Yazd city. Data collection tool included two standard questionnaires regarding an organizational happiness and the quality of work life. Data were analyzed using descriptive statistics and independent t-student test, one-way ANOVA and Pearson's correlation coefficient test with SPSS ₂₆ software.

Results: The findings indicated that there was no significant relationship between organizational happiness and any of the demographic variables. In addition, only the education variable (p = 0.011) had a significant relationship with the quality of life variable. Pearson's correlation test also showed that there was a positive and significant relationship between all the components of organizational happiness and the quality of work life.

Conclusion: According to the results of this study, it is necessary for managers and officials to consider organizational happiness and its important components in organizations by adopting appropriate strategies and providing necessary conditions for its promotion.

Pathology of the Research Sector in Iran's Health System with a Focus on Future

AliAkbar Haghdoost — 2024-03-16

Background: Strengthening the functions of health research and taking a systematic approach to the development of science and technology are essential for overcoming current challenges in health sector. Therefore, the functional pathology of current research plays a crucial role in highlighting the gap between what is and what should be, thereby illuminating the path of scientific development in health sector with a focus on current challenges.

Methods: This study utilized qualitative exploratory approaches, regarding interviews with experts and expert panel formation, to complement the authors' experiences in the field of research. In this process, relevant national upstream documents, experiences from other countries, and reviews of other documents were used to reinforce and analyze the findings. To adopt a future-oriented approach, the Future Triangle framework was employed to depict the tension between future images, the weight of past experiences, and the pressure of the current time.

Results: The research functions were categorized into seven groups: leadership and guidance, research coordination and policy-making, translating upstream documents policies into operational programs, resource management, performance evaluation and monitoring, empowering the workforce and policy-making based on evidence and pathology. Under each category, strategies for moving away from the current situation were provided.

Conclusion: The main solutions to address the current challenges in the country's health research system include agreement on concepts, a unified vision and stable procedures, strengthening the relationship between different levels of management (inter-ministerial, ministerial, and university), enhancing education and research at the level of medical ministry and universities, establishing appropriate structures for knowledge translation, strengthening national funds supporting the research, reforming the evaluation system, and undertaking a fundamental review of human resource empowerment model.