نشریه راهبردهای مدیریت در نظام سلامت
سال هفتم شماره 1 (پیاپی 23، بهار 1401)

In recent decades, the human development index has become one of the most practical indicators for measuring the level of development in countries. There are several factors that affect the human development index, including health expenditures that increase human development along with manpower and physical capital. The purpose of this study was to investigate the effect of health costs on human development index for the period 2005-18.

The present study examined the effects of health on human development index in different countries. The study population includes 187 countries with 3 types of divisions (continental, oil and income distribution). The data used by the World Bank were collected and analyzed using data panel regression or composite data.

Findings from estimation of models indicated that health expenditures in continents of Europe, South America, Africa and Oceania had a positive and significant effect on human development index. But in Asia, the effect of health expenditure was negative and significant. The effect of per capita Gross Domestic Product (GDP) on the continents of Asia, North and South America, Africa and Oceania had been positive and significant, but it was positive and insignificant in continental Europe. In oil-rich countries, the effect of educational expenditures, GDP per capita on human development index was positive and significant, but the effect of health expenditures was positive and insignificant. Also, the effect of mortality index on human development index had been negative and significant. Similar results had been obtained for non-oil countries, albeit with different coefficients. The percentage of health expenditures, compared with GDP, had a direct and significant relationship with the human development index in countries with relatively equal and relatively unequal income distribution; considering the fact that this value for the group of countries with completely unequal income distribution suggested an insignificant value in the model. The percentage of educational expenditures showed a direct and significant relationship on human development in all income groups, and GDP per capita for all groups with different income distributions had a significant and direct effect on the human development index. Also, the under-5 mortality rate in all groups with different income distributions had an inverse and significant relationship with the human development index.

Results showed a significant effect of health expenditures on improvement of the health status and development of the studied countries except oil countries, North America and countries with unequal income distribution. Furthermore, increasing the cost of health care is an important step in achieving countries' development goals. Therefore, it is necessary for managers and policy makers of the health system to consider the efficiency in allocating health expenditures to different sectors.

Organizational misconduct as a destructive or negative phenomenon has challenged common social values, norms and organizational expectations. Therefore, the study of predictors of organizational misconduct, with the aim of reducing the effect of unpleasant personality traits of employees by directing employees towards behavioral standards, policies and organizational strategies in health care systems seems necessary. Therefore, in this study, dark personality traits and organizational mindfulness were investigated to reduce organizational misconduct.

The present cross-sectional study was conducted with the structural equation modeling approach in 2021. The target population was the staff of the 115 Emergency from Medical Emergency Management Department of Lorestan. The sample size was calculated 217 based on Krejcie-Morgan table. Divergent and convergent validity were used to determine the validity of the structures, and Cronbach's alpha coefficient and combined reliability were used to determine the reliability of the instrument. Data analysis was done using structural equation modeling through SPSS 23 and Smart PLS 3.5 softwares.

Findings showed that dark personality traits with the significant value of 6.232 and path coefficient of 0.401 had a positive and significant effect on organizational misconduct and with the significant level of 8.741 and path coefficient of - 0.455, it had a negative and significant effect on organizational mindfulness. Organizational mindfulness with a significant level of 187.5 and the path coefficient of - 373.0 had a negative and significant effect on organizational misconduct. Moreover, organizational mindfulness with direct impact factor of -0. 455 , indirect impact factor of - 0.373, direct significance level of 5.187, and indirect significance of 8.741 (- 1.96 < t < 1.96) determines the mediating role between dark personality traits and organizational misconduct. The quality of the final research model with GOF index (0.379) had a suitable fit.

Given the significant role of dark personality traits and organizational mindfulness in relation to predicting organizational misconduct of the employees, while identifying and managing these traits, it is suggested that the managers of 115 emergency medical services in Lorestan, prevent the intentional violation of organizational norms by employees through strengthening the organizational mindfulness of employees.

The importance of timing lies on providing services, identifying the current status of service delivery, and determining the workload to improve productivity of the organization and the level of satisfaction of service providers and recipients. The aim of this study is to investigate the timing of patient's workflow, in order to identify the current state of service delivery, and determine the workload in the imaging ward of Shahid Rahnemoun hospital in Yazd.

The present study was descriptive-analytical and cross-sectional-observational, which was conducted in 2021. The sample included 1287 images or graphs from the imaging ward of Shahid Rahnemoun Hospital, during a period of 3 months and during different shifts (morning, evening and night). They were selected using the Krejcie-Morgan method. Frequency, percentage, means, and standard deviation were used to evaluate descriptive statistics.

Results of the study showed that the maximum and minimum mean time calculated for each service was related to the service of hospitalized patients in the radiology unit (22:50 minutes) and operating room patients (2:16 minutes), respectively. Also, the maximum and minimum working hours spent for all services obtained were related to the inpatients in the radiology unit (67747 minutes) and outpatients in the ultrasound unit (243 minutes), respectively.

The timing and workmetry of the activities performed in the hospital's imaging ward, gave the authors a view of the current situation of the workforce and the amount of work done by the imaging ward.

The use of anticipatory behaviors in the organization can cause negative behaviors such as conflict and reduce the positive behaviors in the organization. Therefore, the purpose of this study was to analyze the relationship between perception management and social undermining, and the mediating role of organizational trust and social capital in West Azerbaijan University of Medical Sciences.

This was a descriptive-correlation study. The statistical population was all 23000 medical staff of West Azerbaijan University of Medical Sciences. Considering Cochran's formula, 384 people were selected through convenience sampling method. Data collection instruments were questionnaires regarding perception management, social undermining, social capital, and organizational trust. The validity of the instruments was assessed using convergent and divergent validity. The reliability was evaluated using Cronbach's alpha and the combined foot coefficient. Structural equation model and SPSS 24 and LISREL 8 software were used to analyze the data.

There was a positive and significant correlation between perception management and social undermining (path coefficient 0.58). The correlation between perception management and organizational trust (- 63) and social capital (- 0.84) was negative and significant. The relationship between organizational trust (- 0.48) and social capital (- 0.41) with social undermining of employees is negative and significant. Finally, there was a significant correlation between perception management and social undermining mediated by organizational trust (0.29) and social capital (0.35).

Impression management, by reducing the level of organizational trust and social capital, increases social undermining in West Azerbaijan University of Medical Sciences. The authors suggest that, by identifying and reducing perception management tactics, authorities increase organizational trust and social capital, and consequently, reduce social undermining.

In recent decades, increasing productivity and reducing losses through the improvement of behavioral abnormalities at work has been considered by experts in organizational behavior, especially health researchers. Employee' abnormal behavior is a voluntary behavior that violates important norms of the organization, and thereby, threatens the goodness of the organization, its members, or both. The purpose of this study was to design a model for antecedents and outcomes of behavioral abnormalities of human resources in the Ministry of Health and Medical Education.

This was a cross-sectional study conducted in the summer of 2021. Library and Delphi study methods were used to collect information. Factors were identified and extracted using library studies. Then, experts were asked to determine the importance of each of the identified factors using verbal variables. After that, the verbal variables were converted to triangular fuzzy numbers and the triangular fuzzy mean was decaphasized using the Minkowski formula. Using the fuzzy Delphi method, during 3 stages, experts reached a consensus on the antecedents and outcomes of the abnormal behavior of human resources in the Ministry of Health and Medical Education by experts and developed a model.

A total of 21 factors were identified as antecedents and 13 factors as outcomes of outcomes of the abnormal behavior of human resources. The highest agreement in the field of antecedents was with the component of poverty and livelihood problems and weakness of self-control and the lowest agreement was with the component of meaninglessness of the universe and the imperfect physical condition and socialization, which have been completely eliminated. Migration has been recognized as the least agreed upon factor. In the field of outcomes, the highest agreement was with dissatisfaction and decreased motivation and the lowest was with suicide and sexual harassment.

Considering that poverty and livelihood problems and poor self-control were the most important antecedents of abnormal behavior, authorities can reduce abnormal behaviors of the employees by improving their living conditions and increasing their salaries and benefits, as well as increasing employees' ability to control themselves and improve their self-management skills.

Locations, by creating a sense of comfort and peace or sorrow and distress have a great effect on self-confidence, personality, and personal health. Paying attention to the perceptual indicators of environmental quality can lead to sustainable changes in architectural designs. The aim of this study is to identify perceptual indicators of the environmental quality in medical centers and use these indicators to evaluate the physical-spatial qualities of those centers. The study environment was one the private hospitals in Yazd.

This was a cross-sectional study conducted in 2022 in a private hospital in Yazd. The statistical population includes patients, visitors, carers and staff. 73 users from the pediatric care and hospitalization ward and 47 users from the outpatient ward were selected as the statistical sample through convenience sampling. The data collection tool was a researcher-made questionnaire consisting of 27 questions with 5 Likert scale options and 5 demographic questions, the validity of which was approved by 10 experts in the field of architecture and psychology.  The reliability of the questionnaire was also confirmed by Cronbach's alpha test with a value of 0.75. Questions included 3 dimensions of perceptual indicators regarding the quality of hospital environment. 2 dimensions evaluated the physical aspects of the hospital exterior and interior space of the wards and 1 dimension evaluated social aspects. For statistical analysis, descriptive methods (frequency, mean, etc.) and SPSS 26 software were employed.

The outcome of the percentages obtained regarding the dimension of physical-spatial aspects of the hospital's external spaces, pediatric care and hospitalization ward, the outpatient ward and the socio-functional aspects of hospital spaces, were obtained as + 25, + 38.38, + 44.73, and +36 % respectively.

Based on the results, the outcome of the percentages obtained for the dimensions of the physical-spatial aspects of the hospital's external spaces, pediatric care and hospitalization ward, the outpatient ward and the socio-functional aspects of hospital spaces indicated the favorable status of the dimension from the users' point of view.

Brand can impart a unique meaning of the organization to consumers and create many comparative advantages. This relationship is created through trust, connection, loyalty and emotional commitment to the brand and their impact on advocacy and the development of emotional relationships between the customer and the organization. The aim of this study was to investigate the effect of loyalty to, confidence in and emotional commitment to brand regarding brand advocacy.

This research was applied in terms of purpose and descriptive-survey in terms of data collection method. Data collection tool was a researcher-made questionnaire whose face validity was confirmed by professors and experts.  Convergent validity with a mean variance of more than 0.5 and divergent validity using Fornell and Larker methods were confirmed. Also, the reliability of the instrument was confirmed with the Cronbach's alpha of more than 0.7. The statistical population was patients of Shiraz Namazi Hospital in 2020. After conducting a pre-test and confirming the validity and reliability and determining the variance deviation of the prototype, using Cochran's formula, the statistical sample size was determined to be 300. The final questionnaires were distributed and collected among patients through convenience sampling method. Finally, after data analysis, the conceptual model of the research was fitted using the structural equation model and PLS3 software.

The conceptual model of the research was fitted using various indicators and the results showed that the model has appropriate quality and acceptable validity. Quantitatively, findings indicated that brand confidence of 0.228 had a significant effect on brand advocacy, but emotional commitment and loyalty with a coefficient of 0.049 and 0.007, respectively, had no significant effect on brand advocacy.

Results suggest that brand confidence is achieved by patients through perceived quality, brand credibility and customer-oriented behavior of the hospital staff. Moreover, the influence of reference groups and the social responsibility on the hospital, with the help of confidence in brand, creates emotional commitment in patients.

The health insurance extent of coverage was decided by the Health Insurance Organization in order to manage costs. In this plan, to determine the extent of payment by each medical center, the performance of the year 2017 was considered the base point. Furthermore, it should not cost more than the performance of the year 2017 or 10 % less. This issue had caused challenges in public hospitals; so, the purpose of this study is to explain the challenges of health insurance extent of coverage from the perspectives of the experts from Mashhad University of Medical Sciences and propose solutions.

This was a qualitative study conducted through content analysis method in 2022. In-depth and semi-structured interviews were used to collect data. The research population included experts such as staff and hospital managers, Medical group managers, and insurance managers and experts. It was done through purposeful sampling. Data collection continued until the codes were completed, and finally 17 people were interviewed. In each phase, data analysis and data collection were performed simultaneously, using content analysis method and MaxQDA10 software.

In this study, the 2 main concepts were management challenges (including sub-concepts of motivation, performance evaluation, patient admission, and hospital costs), and planning challenges (including sub-concepts of education, infrastructures, cross-sectional coordination, and foresight).

Based on the findings of this study and the challenges expressed, Health Insurance Organization can take steps toward upgrading the plan by considering the necessary prerequisites and providing solutions such as performance monitoring evaluation system, cost management, training the target groups, and appropriate clarification and announcements.