فهرست مطالب حامد دهنوی

Equity in the health sector means the availability of health services and people's fair access to them, using health services based on need, paying for health services based on financial ability and having an acceptable level of health. Fair distribution of hospital beds increases people's access to health services and improves their health. This research aimed to measure equity in the geographical distribution of hospital beds in Mazandaran province, Iran.

This cross-sectional study was conducted in 2016. the data related to the population of the cities, the number of hospitals and hospital beds in Mazandaran province were obtained from the ministry of health, and the and the Iranian national statistics center. The equity in the distribution of hospital beds in Mazandaran province was calculated using the Gini coefficient and Lorenz curve.

 Mazandaran Province population was 3,283,582 and there were 44 hospitals with 5,149 beds in 2016. There was 1.3 hospital per 100,000 people and 1.6 hospital beds per 1000 people in the Mazandaran Province. About 61% of hospitals in Mazandaran province are over 20 years old and 86% of hospitals have less than 200 beds. Sari, Qaemshahr and Fereidoonkar cities have had the highest hospital beds per population. About 18% of hospitals and 24% of hospital beds in Mazandaran province were in Sari city. The Gini coefficient for hospital bed distribution among Mazandaran counties was 0.28.

The distribution of hospital beds in Mazandaran Province was relatively fair. Equitable allocation of hospital beds particularly in less developed cities is necessary for achieving population health fairness. The distribution of hospital beds in Mazandaran province using the Gini index is almost fair. Fair allocation of health resources, especially in underprivileged cities of the province is necessary.

Health equity is “the availability of health services and people's access to them, using health services based on need, paying for health services based on financial ability and having an acceptable level of health”. Equitable distribution of hospital beds plays a significant role in achieving universal health coverage and improving people's health. This study aimed to measure the equity in the geographical distribution of hospital beds in Tehran province, Iran.

Data for this descriptive and cross-sectional study was collected from the Ministry of Health and the Iranian Statistics Center. All hospitals in Tehran province were included in this study in 2016. Lorenz curve and Gini coefficient were used to calculate the equity of hospital beds distribution using the Excel software.

Tehran province population was 13,267,637 at the study commence. There were 158 hospitals with 25,866 beds in Tehran province in 2016 (1.2 hospital per 100,000 people and 1.9 hospital beds per 1000 people). Tehran, Varamin and Firoozkooh cities had the highest hospital beds per population. Tehran, the capital, had 90% of the total Tehran province hospitals and 95% of the hospital beds. The Gini coefficient for hospital bed distribution among Tehran cities was 0.299.

The distribution of hospital beds in Tehran Province was relatively fair. Equitable allocation of hospital beds particularly in less developed cities is necessary for achieving health equity in access to health resources.

Climate change is a long-term climate variations caused by human activities that alters the composition of the global atmosphere. Climate change is one of the biggest threats to health. Iran's health system should respond to climate change-related health threats. The purpose of this study was to identify the challenges and solutions to build a climate resilient health system for Iran.

This qualitative study was conducted using interpretive phenomenology method and semi-structured interviews with 32 policy makers, managers, experts and researchers from the Ministry of Health, Ministry of agriculture, Ministry of roads and city planning, Environmental protection organization, National meteorological organization, Atomic energy organization, Universities, Associations, and Research institutes. Participants were selected through purposeful and snowball sampling methods. Framework analysis method was used to analyze the data.

Eighty four challenges to the resilience of Iran's health system against climate change were identified, which were grouped into two categories of factors inside the health system, (i.e., governance and leadership; financing; health workforce; facilities, equipment and medicines; health information system; and health services delivery) and factors outside the health system (i.e., political, economic, social, technological, environmental and legal factors). Overall, 91 solutions were identified to solve these challenges and to strengthen Iran's climate resilient health system.

Iran's health system is facing several barriers to be climate resilient. Actions at the macro, meso and micro levels, inside and outside the health system should be carried out to increase the adaptability and resilience of the Iranian health care facilities.

Strategic planning aligns organizations’ resources to achieve their mission and long-term objectives and goals. At the moment, a comprehensive strategic plan in the field of Ergonomics is one of the academic and industrial priorities in Iran to achieve a superior scientific position and ultimately meet the real needs of society. Therefore, this study was conducted to develop a strategic plan for Ergonomics from 2021 to 2025.

This study was conducted using a participatory action research strategy in 2021. In this regard, the strategic planning committee consisting of 18 professors, specialists, and Ph.D. students in the Ergonomics and occupational health engineering fields was formed. The committee evaluated the internal and external environment of the Ergonomics using a strength, weaknesses, opportunities, and threats (SWOT) matrix and a researcher-developed checklist through several regular weekly sessions. Then, general and specific goals, and possible measures to achieve the goals were identified.

According to SWOT analysis, Ergonomics major is in the “hold and maintain” position which consisted of organizational architecture, quality management, market management, and cost management. In the proposed action plan, a total of 57 specific goals in six areas were extracted including education, research, specialized services in ergonomics, improving faculty member/employees/students’ satisfaction, and improving community satisfaction with ergonomic services. To achieve these goals, 124 related actions were also predicted.

Achieving Ergonomics major perspective will be possible by using the goals identified in this study, the proper implementation of the predicted objective-specific measures, planning to reach the maximum use of the opportunities, and minimizing challenges due to the major weaknesses.

Strategic management involves determining the organization’s direction, preparing a strategic vision and mission statement, and providing the basis for growth, profitability, and production. It also includes the inclusion of employee safety and health programs throughout the organization. The existence of a strategic plan for the scientific and practical strengthening of occupational health and safety is one of the country’s academic and industrial priorities. The purpose of this study is to present a strategic plan for developing the specialized field of occupational health and safety engineering in Iran.

The current study is a collaborative action research study that was conducted in 2021. The strategic planning committee consisted of 20 professors, experts, and doctoral students. Over the course of 14 weeks, they held regular weekly meetings, collected information from inside and outside the organization, analyzed the organization’s internal and external environment, and identified its strengths, weaknesses, opportunities, and threats. Based on this analysis, the committee determined the organization’s mission, perspective, values, and general and specific goals for 2021-2024. They also identified the necessary measures to achieve these goals and developed an operational plan to improve the performance of the specialized field of occupational health and safety.

Conducting this applied research led to the strategy of internal and external analysis of the specialized OHS field, determining the direction of the basic strategy, mission, perspective, values, and general goals. Finally, seven specific goals and 286 actions were determined to improve the performance of OHS. The SWOT analysis of OHS’s internal and external environment identified 27 strengths, seven weaknesses, 26 opportunities, and 12 threats. According to the results of the SWOT matrix, the strategic position of the OHS field is to implement preventive strategies and maintain existing conditions.

This plan aligns with the 4-year OHS plan. In developing the program, attention has been paid to the documents and policies of upstream organizations. The strategic position of occupational health and safety engineering is a prudent strategy. In this situation, strategies for maintaining existing conditions can be applied. Therefore, it is suggested to reduce the weaknesses of OHS as much as possible and increase its strategic capabilities by focusing on prudent strategies. From the second year of implementing the strategic plan, the OHS field can gradually focus on developing activities.

Objective (s):

Critical success factors (CSF) are a set of limited factors that, when applied and reinforced in an organization, give competitive advantage. The purpose of this study was to identify the critical success factors of hospitals in Tehran province.

This qualitative research was conducted by phenomenological method. Semi-structured and in-depth interviews were used to collect data. The interviewees included 93 senior, middle and front-line managers working in 30 hospitals in Tehran province. Data analysis was performed by thematic analysis method using MAXQDA software.

A total of 51 critical success factors were identified for hospitals, which were classified into 8 main themes and 22 sub-themes. Key themes include management and leadership, planning, organizational learning, organizational culture, employee management, patient management, resource management, and process management. Transformational leadership, plan-oriented, organizational trust, the presence of renowned physicians, patient satisfaction, and the availability of resources and facilities were key factors in the success of hospitals.

Hospital managers should strengthen these critical success factors. Their application increases the possibility of achieving organizational goals and achieving competitive advantage.

Approximately 85% of Iranian hospitals are general hospitals. Considering the limitation of resources, improvement of hospital efficiency is an absolute necessity. Efficiency, as the output-input ratio, indicates the use of the lowest amount of inputs to produce the greatest amount of outputs. The aim of this study was to determine the efficiency of general hospitals in Iran and identification of the factors affecting the efficiency of the hospitals.

In this cross-sectional and descriptive study we used the Pabon Lasso model and three performance indicators. i.e., bed occupancy rate (BO), the average length of stay (ALS), and hospital bed turnover (BT) to determine the efficiency of the Iranian general hospitals in 2017. Data were analyzed by SPSS software and charts were drawn using Power BI software.

There were 834 general hospitals with 108257 beds in Iran in 2017. The average BO, ALS, and BT were 62.8%, 2.6 days, and 93 times respectively. Only 15% of the general hospitals were located in zone III of the Pabon lasso model and had acceptable efficiency (high BO and BT). Factors such as hospital ownership, type, size, age of hospital building, and staff number were significantly related to hospital efficiency. Private and social security hospitals, non-teaching hospitals, and hospitals with 100-200 beds and 2-4 staff per bed had more efficiency in comparison to the teaching hospitals.

Because of the low efficiency of most general hospitals policymakers and senior managers should take necessary measures for the improvement of the efficiency of the hospitals.

Hospital accreditation is a systematic external evaluation of a hospitalchr('39')s structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.

This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.

There were 834 general hospitals with 108,275 active beds in Iran in 2018. The Iranian general hospitals had an average bed occupancy of 62.8%, an average patient length of stay of 2.6 days, and an average bed turnover of 93.4 times. Almost 15.3% of the hospitals performed well and were located in area 3 of the Pabon Lasso chart. About 36.1% and 48.6% of the hospitals had moderate and low efficiency, respectively. Approximately, 74% and 21% of hospitals had the accreditation status of 1 and 2, respectively. There was a significant relationship between the degree of accreditation of hospitals with their bed occupancy, bed turnover and bed turnover interval.

The efficiency of public hospitals is low. A hospital accreditation grade is related to some of its efficiency indicators. Low efficiency and waste of resources will reduce the effectiveness of hospital and, consequently, its accreditation grade. Accordingly, the hospitalchr('39')s revenue will decrease and therefore, the hospitalchr('39')s productivity and accreditation grade will decrease and the hospital will be in a vicious cycle. Strengthening hospital accreditation standards and their proper implementation will increase the efficiency of hospitals.

Health equity means having fair access to needed healthcare services, paying healthcare costs according to payment capacity, and enjoying the highest achievable standard of health. Equitable distribution of hospital beds increases people’s access to health services, which in turn improves their health status. This study aimed to examine the equity in the distribution of hospital beds in Semnan Province, Iran.

Data for  this descriptive and cross-sectional study were obtained from the Ministry of Health and the Iranian Statistics Center. The study population consisted  of  all  Semnan  Province hospitals in 2016. The equity in the distribution of hospital beds was evaluated using the Lorenz curve and the Gini coefficient. Excel software was used for data analysis.

The population of Semnan province was 702,360 in 2016. There were 11 hospitals with 1,485 beds in this province in 2016. There were 1.6 hospitals per 100,000 population and 2.1 hospital beds per 1000 population in the Province. Shahroud, Semnan, and Damghan cities have had the highest hospital beds per 1000 population. About 36% of hospitals and 51% of hospital beds were in the city of Shahroud. The Gini coefficient for hospital bed distribution in the Semnan province was 0.28.

The distribution of hospital beds in Semnan Province was fair. Equitable allocation of hospital beds, particularly in less developed cities, is necessary for achieving fairness in population health. Health policymakers and managers should take measures to improve equity in access to hospital beds.

Health equity is “having fair access to healthcare, utilizing it according to actual needs, paying for it based on financial capacity and finally, having an acceptable level of health”. Health equity is an underlying principle of the universal declaration of human rights. Equitable distribution of hospital beds increases people’s access to healthcare services and as a result, improves their health status. This study aimed to examine the equity in the geographic distribution of hospital beds in Tehran city, Iran.

The data for this descriptive and cross-sectional study were obtained from the Ministry of Health and the Iranian statistics center in April 2019. All hospitals in Tehran city were included in this study. Lorenz curve and the Gini coefficient were used to measure the equity in the geographic distribution of hospital beds. Excel software was used for data analysis.

Tehran city had a population of 8,693,706, and 142 hospitals with 24,535 beds in 2016. There was 1.6 hospitals per 100,000 people and 2.8 hospital beds per 1000 people in this city. Nearly half of the hospitals were private (49%) and the remaining were public or semi-public. About 77% and 23% of hospitals were general and specialized respectively. Almost half of the hospitals are more than 40 years old.  The average number of beds in hospitals was 173. The Gini coefficient was 0.619 for hospital bed distribution among Tehran districts. Districts 6, 12 and 3 have had the highest hospital beds per 1000 people. Districts 6 had 23% of the total hospitals and 24% of the hospital beds.

The geographic distribution of hospital beds in Tehran city is not equitable. Hospital services should be accessible based on actual need rather than on the ability to pay. Achieving health equity is a prerequisite of universal health coverage. Hence, healthcare policymakers should reduce or eliminate the existing disparities and inequalities in access to hospital beds.

Objective (s): 

Traditional health surveillance systems usually publish reports of infectious disease outbreaks 1 to 2 weeks after onset. The Google Trends shows people search information with a one-day delay. These data can be used to identify and manage epidemics of infectious diseases. The aim of this study was to predict the Covid-19 epidemic using the Google Trends.

This descriptive cross-sectional study was conducted in February 2021. Google Trends data was used to determine how much attention was paid to COVID-19. Data on COVID-19 deaths were obtained from the Iran Ministry of Health. Data were collected and reviewed in the period from February 22, 2020 to January 20, 2021. Data were analyzed using Excel and SPSS soft wares.

Simultaneously with the announcement of incidence of COVID-19 in Iran on February 20, the society’s sensitivity to COVID-19 has increased and the search rate for COVID-19 in Google has reached its maximum. Three waves of COVID-19 outbreak have been observed in Iran by the end of December 2020. These three waves were similarly observed in Google trends. In all three COVID-19 waves, the peak of Google search occurred 10 to 20 days before the peak of the number of deaths.

The Google Trends can detect the COVID-19 outbreak quicker. Google search data can be used as a complement to the infectious disease surveillance system.

Equity in the health system is “peoplechr('39')s access to the health services according to their needs, paying for healthcare based on the financial ability, and having an acceptable level of health”. Equitable distribution of hospital beds plays an important role in achieving the goal of universal health coverage. The purpose of this study was to evaluate equity in the geographical distribution of hospital beds in Khuzestan Province.

Data from the Ministry of Health and the statistics center of Iran were used for this descriptive and cross-sectional study. Hospitals of Khuzestan Province in 2016 formed the research community. The equity in the distribution of hospital beds has been measured using the Lorenz curve and the Gini coefficient. Excel software was applied for data analysis.

Khuzestan Province had a population of 4,710,509 and 54 hospitals with 7,014 active hospital beds in 2016. There were 1.1 hospitals per hundred thousand population and 1.5 hospital beds per thousand population in the province. The cities of Ahwaz, Karun, and Masjed Soleiman had the most hospital beds per people. About 30% of hospitals and 51% of hospital beds were in Ahvaz. The Gini coefficient of distribution of hospital beds in the cities of Khuzestan was 0.33.

The distribution of hospital beds in Khuzestan province using the Gini index was relatively fair. Policymakers and senior health managers should take measure to improve equity in the access of people to hospital beds.

Health equity as a health system objective means having fair access to needed healthcare services, paying healthcare costs according to payment capacity and enjoying the highest achievable standard of health. Equitable distribution of hospital beds increases people access to health services and as a result improves their health status. This study aimed to examine the equity in distribution of hospital beds in Zanjan Province, Iran.

Data for this descriptive and cross sectional study was collected from the Ministry of Health and Iranian Statistics Center. All hospitals in Zanjan province were included in this study in 2016. The Gini coefficient was used to measure the equity of hospital beds distribution. Excel software was used for data analysis.

The population of Zanjan province was 1,057,461 and there were 12 hospitals with 1,538 beds there in 2016. There were approximately1.13 hospitals per 100,000 population and 1.45 hospital beds per 1000 population. Zanjan, Abhar and Khorramdareh counties have had the highest hospital beds per 1000 people. About 42% of hospitals and 72% of hospital beds were located in Zanjan city, the capital. The Gini coefficient for hospital beds distribution among Zanjan counties was 0.26.

The distribution of hospital beds in Zanjan Province was relatively fair. Equitable allocation of hospital beds particularly in less developed cities is necessary for achieving population health fairness.

Public-private partnership (PPP) in constructing and operating hospitals is a good strategy to provide high quality services to people at lower cost for the government.  However, PPP is facing several challenges. The objective of this research was to identify and explore the PPP challenges in building Moheb Yas hospital in Tehran, Iran.

A qualitative approach was used for this case study in 2018. In-depth semi-structured interviews were conducted with 24 key stakeholders, managers and employees who were involved in PPP initiative implementation using purposive and snowball sampling methods. Thematic analysis approach was used for data analysis.  

Moheb Yas hospital was built in the yard of a public hospital (Co-location PPP) by the private entity. Then, the public hospital was moved into the private hospital. The new hospital was transferred to the government after one year owing to some challenges. These challenges include an inappropriate PPP model, low government capacity and competency in PPP, low trust in private partner, difficulty in funding the project, demolishing the old building, applying for hospital licences, merging two public and private hospitals, and difficulties in equipping the new hospital with human and physical resources.

The PPP was not successful in this case. Although PPP initiatives have benefits for the health system, but, it comes with numerous challenges especially in developing countries owing to disparate goals, incentives, and management practices of public and private sectors. The research findings provide useful insights for policy makers and senior managers in health systems in similar countries about the main barriers of PPP initiatives in the health sectors.

Equitable distribution of health system resources and hospital beds is crucial for an acceptable level of health for all the people of the country. The aim of this study was to examine the equity in distribution of hospital beds in Iran.

In this descriptive and cross sectional study data were collected from Ministry of Health and Medical Education and Iranian statistics Center. The study population consisted of all Iranian hospitals in 2016. The equity in the distribution of hospitals’ beds was evaluated using the Lorenz curve and Gini coefficient. Excel software was used for data analysis.

Iranian population was 79,926,270 and there were 930 hospitals with 118,894 beds in 2016. (1.2 hospitals per 100,000 population and 1.5 hospital beds per 1000 population). Yazd, Semnan and Tehran provinces had the highest hospital beds per 1000 population. About 17% of the total hospitals and 22% of the hospital beds were located in Tehran. The Gini coefficient for hospital bed distribution among Iranian provinces was 0.107. Distribution of the hospital beds was equitable in Alborz and Yazd provinces and inequitable in North Khorasan, Sistan & Baluchestan and Charmahal & Bakhtiary provinces.

The distribution of hospital beds among Iranian provinces has been fair. However, hospital beds were not distributed equitably among the cities in the provinces and were concentrated in the capital cities of the provinces of the country. Healthcare policymakers should take appropriate measures to reduce inequality in the distribution of hospital beds.

Public private partnership (PPP) is a good strategy to increase the capacity and efficiency of the public sector and to deliver high quality healthcare services to the community at a lower price for the government. However, there are several challenges related to PPP in Iranian health sector. Moheb-Yas hospital is one of the few hospitals built with the PPP method in Iran. The purpose of this study is to identify, explore, and explain the challenges of PPP in Moheb Yas hospital operations.
Methods This case study was carried out in 2018 using semi-structured interviews, documentation, archival records, and direct observation. Twenty-four key stakeholders involved in the establishment and operations of the hospital were purposefully selected and interviewed. Content analysis was used for data analysis. Moheb-Yas hospital PPP faced legal, structural, human related, cultural and managerial challenges. These challenges include vague and unclear model of partnership, political changes, insufficient supportive regulations and rules, design and built problems, limited utilization of the hospital capacity, lack of long term funding, employees’ low job security, unequal employees’ compensation, cultural differences, insufficient conflict management and resolution, management turnover and lack of participative management. The PPP experience in Moheb-Yas hospital was unsuccessful. Political support, stable economic condition, establishing a PPP unit, strong leadership, proper planning, trust and mutual responsibility are necessary for the success of PPP in the health sector.

Objective (s):  Evaluation of hospital performance helps improve the quality of services, and enhance patients’ health outcomes and satisfaction. This study aimed to evaluate Iranian hospitals’ performance using a systematic review of the last two decades of the literature. A systematic review was conducted to find empirical research publications on Iranian hospitals’ performance between 1997 and 2018. Six electronic databases and two search engines were examined using appropriate key words. Bibliography section of the retrieved papers and related journals were also assessed for papers that were not indexed in the databases yet. All retrieved papers were assessed using a checklist before analysis. In all 2570 publications were identified. Of these 162 empirical studies were reviewed. Studies on evaluation of hospital performance mainly focused on the efficiency dimension and less attention was paid to the effectiveness indicators. In most studies, data envelopment analysis and Pabon Lasso methods were used. Hospitals’ efficiency was reported low to moderate. Some studies used systemic models such as European Foundation of Quality Management and Malcolm Baldrige models for hospital evaluation. In these studies, the results’ scores were lower than the enablers’ scores. Bed occupancy, lengths of stay, bed turnover interval and mortality rate was the most frequently used indicators in evaluating hospitals. Hospital performance studies mainly used non-systemic models and focused more on efficiency aspect of the performance. Systemic and comprehensive models should be considered for hospital performance evaluation.

Clinical Governance now selected as a model to improve the quality of health care services in hospitals of Iran. in recent years Army hospitals have made good progress in implementing this model، but over several years there is no appropriate tool for assessing clinical governance in the country. First، researcher studid books and paper related to the subject and do a search on the Internet and with content analysis provide the necessary framework then provided draft validate by the panel of experts with Lavashh method. After the questionnaire used to assess the four Army’s hospitals. provided questionaire has eight areas; commitment to quality، clinical effectiveness، risk management، patient centerdness، staff management، information management، learning and clinical audit and has three dimention; infrasructure، deploy and results. Evaluation results show that hospitals in most areas are on average or closer to average Conclutions: The results show that a more coherent plan is needed to improve clinical governance conditions in armys hospitals.