mohammadhossein mehrolhassani

Various studies have highlighted the usefulness of environmental scanning in assessing commu-nity needs and developing programs and policies. We aimed to find the most practical model of using such scanning in the healthcare literature.

We conducted a scoping review based on the PRISMA guideline to ensure a comprehensive and systematic approach in 2023. To develop a comprehensive search strategy, we worked with experienced librari-ans and the research team. We then completed a search of five electronic databases, including Web of Science, PubMed, Scopus, Cochrane, and Embase databases. Two independent reviewers screened titles, abstracts, and full-text articles to select studies that met our inclusion criteria. The data was then analyzed and presented in a tabular format to facilitate easy interpretation and understanding.

We retrieved 7243 articles from various databases and sources. After removing 2755 articles due to duplication, we excluded 4380 more articles during the title and abstract screening phase. In the full-text review process, we ruled out an additional 103 articles. Finally, only 5 articles that were directly relevant to the study were included. The model that Bednar and colleagues have in their article is the latest model. Most studies pro-pose six main steps to conduct an environmental survey in the healthcare system.

Since the most important task of managers and policy makers of the health system is to make decisions, they can use our proposed model to collect, analyze and interpret data, identify important patterns and trends so that they can make evidence-based decisions. 

 This study investigated the quality of inpatient care provided to Afghan immigrants in Iran during the COVID-19 pandemic (February 2019 to March 2021). For this purpose, the services received by Afghan immigrants were compared with those received by Iranian citizens.

 Two emergency services (traumas with 8080 victims and 8,686 patients hospitalized with severe COVID-19 infection) were taken into consideration. The records of all patients, including the Afghan immigrants, in two referral hospitals in Kerman were reviewed, and the main variables were the length of hospitalization (LoH), intensive care unit (ICU) admission rate, and death rate. Quantile regression, multiple logistic regression, and Cox regression were used to analyze the data.

 The median and interquartile range of LoH for Afghan and Iranian nationals admitted due to traumas were 3.0±4.0 and 2.0±4.0, respectively (P<0.01). Moreover, the chance of Afghan nationals being admitted to the ICU (38%, odds ratio=1.38; 95% confidence interval [CI]=1.12; 1.69) and the hazard of death (60%, hazard rate=1.60; 95% CI=1.03; 2.49) were higher compared to Iranian nationals, which is statistically significant. However, no significant differences were observed between the COVID-19 patients from the two nationalities in terms of the median LoH, the odds of being admitted to the ICU, and the hazard of death due to COVID-19.

 Afghan nationals admitted to the hospital due to traumas were more likely to be admitted to ICUs or die compared to Iranian citizens. It seems that Afghan patients who had traumas went to the hospitals with more serious injuries. There was no difference between Afghan and Iranian patients in terms of COVID-19 consequences. Following the findings of this study, it seems that justice in treatment has been fully established for Afghan patients in Iran.

There is a close relationship between mental health and psychosocial problems in disaster settings, as well as overlap in the support provided for these problems. Therefore, public health officials need to understand the burden of behavioral health conditions among survivors and the needs of the affected community. This study aimed to develop a mental health minimum data set for an electronic disaster registry system to provide timely, essential, and accurate information to personnel on the ground and policymakers to design a disaster response and develop an action plan rapidly.

The present study is a mixed‑method (sequential exploratory) study. In the qualitative phase, a literature review and semi‑structured interviews with experts were conducted to generate an item pool for the mental health response in disasters. In the quantitative phase the quantitative content validity, content validity ratio and content validity index were used.

proposed data elements, 85 data elements were confirmed according to the opinion of experts and categorized into two main parts, pre-disaster part with three sections; including region profile, mental health local background, regional mental health committee affairs, and post-disaster parts with five sections including disaster information, information of mental health teams, mental health status, mental health interventions, and mental health need assessment.

Collecting this minimum data set is critical for helping policymakers and healthcare providers prevent, control, and manage the mental health impacts of disasters during the response phase. Besides facilitating and promoting disaster prevention and response programs and measures.

Given the importance of the emergency department in providing prompt and high-quality services, the emphasis on lean management has increased to minimize non-value-added and wasteful activities within a process. The aim of the study was to determine the process of patient flow and identify opportunities for its improvement using the Six Sigma method as one of the most important subsystems of lean management, in the emergency department of the selected teaching hospital in Kerman.

Methods & Materials: 

The current research is a sequential mixed-method study conducted in 2022 within the cardiovascular and neurological emergency department in Kerman. The Six Sigma method, specifically the DMAIC approach consisting of four steps, was employed in conjunction with spaghetti charts to implement lean management principles. The research population included 180 patients referred to the cardiovascular and neurological emergency department. The data were collected using researcher-developed forms, and Excel software version 2013 was used to analyze the data.

By examining the processes and using the spaghetti chart, the main problems contributing to prolonged patient admission time in the cardiology and neurology emergency department were identified. The implementation of a strategy involving the presence of admission staff during triage for level 1 to 3 patients will eliminate the additional distance and time required for patient admission.

The use of lean thinking principles in the emergency department with the implementation of Lean Six Sigma and Spaghetti Chart by streamlining the service process, will result in improving patient flow, providing timely quality services, reducing service delivery time, and ultimately increasing patient satisfaction.

Context: 

In recent years, environmental scanning has attracted noteworthy attention within health research in healthcare organizations harnessing this technique to perform their operations.

 This study aimed to compare environmental scanning models and provide a model for Iran’s health system.
Evidence Acquisition: This qualitative and comparative research employed an applied purpose in four stages: description, interpretation, juxtaposition, and comparison. The primary data collection tool was comparative tables to gather data by reviewing articles, documents, and books using scientific databases. The collected information was analyzed by the Beredy method.

 The most significant models were presented by countries including Singapore, Canada, Iran, and the United States. Most health environmental scanning studies were conducted in countries such as Canada, Australia, the United States, and England. Notably, esteemed researchers such as Albright, Daft, Xue Zhang, Choo, Costa, and Nezhadi introduced influential environmental scanning models.

 Environmental scanning is a powerful tool in decision-making and strategic planning for organizations, fundamentally impacting their survival and progress. The healthcare system’s general model for environmental scanning is presented in five steps. Based on the results, the environmental scanning model can enable managers and strategic teams to identify risks, opportunities, constraints, and threats and determine suitable strategies for organizational growth and success.

The dynamic and systemic planning and targeting in the health system require attention to all the system's components and investigation of their causal relationship in order to form a clear view and image of it. Therefore, the present study was designed with the aim of identifying the comprehensive dimensions of the system within a specific framework.  

Key components in the health system were identified through the scoping review method. For this purpose, 61 studies with selected keywords were extracted from international databases, including Scopus, Web of Science, PubMed and Embase, and Persian language databases including Magiran and SID. Inclusion and exclusion criteria in this study were languages, time range, repeated studies, studies related to the health system, appropriateness of studies with the subject and purpose of the present study and the method used. The content of the selected studies and extracted themes were analyzed and categorized in the Balanced Scorecard (BSC) framework.  

In health system analysis, key components were divided into 18 main categories and 45 categories. Also, they were categorized according to the BSC framework into five dimensions of population health, service delivery, growth and development, financing, and governance & leadership.  

For health system improvement, policymakers and planners should consider these factors in a dynamic system and a causal network.

Coronavirus disease‑2019 (COVID‑19) pandemic can aggravate the health problems in slum areas. The present study intends to examine the challenges of health protection of slum’s residences during the COVID‑19 pandemic with the Social Determinants of Health perspective, in Kerman city in Iran.

The present study was a qualitative content analysis. Data were collected by purposeful sampling in‑depth and semi‑structured interviews with 16 people. The interviews were conducted (from October to December 2020) with the local representatives of the slum’s residents, health‑care workers, managers of facilitation offices, and welfare social service centers that are located in slum areas (Interview’s guide is attached). The textual material from the interviews was entered into the MAXQDA software and directed content analysis was used to analyze the data.

Data analysis led to the identification of 4 categories (Sociocultural, Situational, Economical, and Physical environment) and 12 subcategories: Sociocultural: lack of awareness, begging culture, low trust in disease control programs, low bottom‑up planning, and increasing violence; Situational: decreasing donors’ activities and canceling important meetings; Economical: unemployment, decreasing in income, and increasing limitations of many institutions in providing resources; and Physical environment: inadequate space and inappropriate conditions in some houses and alleys for people protection against Corona viruses.

Slum residents have faced many challenges during the COVID‑19 pandemic. These challenges can affect the health of slum and other urban dwellers. Multidisciplinary thinking and actions are needed. Increase awareness and engagement slum residents in control disease programs should be considered.

Palliative care plays an essential role in improving the quality of life of patients suffering from chronic and incurable diseases; therefore, it seems necessary to remove barriers in improving palliative care. The present systematic review aims to describe the current status of palliative care, and determine the challenges of palliative care services.

In this systematic review study, we searched Scopus, Magiran,SID,Cochran,Embase, PubMed, Web of Science, and Google Scholar databases. Also, we retrieved articles published in English and Persian during 2000 to 2021. The keywords include "hospice care," palliative care," "health care," "terminal care," "end of life care," and palliative medicine". All retrieved articles were screened in three stages, namely review of titles, abstracts, and full texts. Meanwhile, we analyzed data based on the WHO 2018 framework and deductive-inductive approach.

A total of 3497 articles were found. After reviewing these articles, we were able to selecte 48 articles. Data were extracted and categorized according to four functions, namely service delivery, stewardship, resources generation, and financing. Service delivery had four themes, and nine sub-themes; stewardship had two themes and five sub-themes; resource generation had three themes and nine sub-themes; and financing had one themes and three sub-themes.

Findings of the present study can help policymakers improve the infrastructure and resources, as well as processes of palliative care that can consequently lead to an improvement in the outcomes of palliative care. Also, solving the challenges of palliative care requires strengthening the health systems so that they will be able to design and implement appropriate policies

The Covid-19 pandemic created a situation in which managers had to make decisions in a short period of time and also created challenges for them. One of the most important challenges in this situation was the provision of manpower. As the prevalence of Covid-19 increased, the number of patients referred to hospitals increased and the workload of staff multiplied. Lack of standard equipment for personal protection and constant fatigue and exhaustion of medical staff due to high workload led to a decrease in their level of immunity and safety, and a large number of hospital staff became infected with Covid-19. The purpose of this study is to provide the scenarios and strategies that were used to meet the challenge of providing and maintaining medical staff during Covid-19 in Afzalipour Hospital in Kerman, as experience to other managers of medical centers and hospitals.

Current Health care delivery systems are not effective for the elderly. Countries with high elderly populations are expected to design special models to serve their elderly population. The aim of this study is to investigate the models of health care delivery to the elderly in different countries.

The present study is a systematic review based on PRISMA standard guidelines. The search for related studies was conducted in electronic databases (Cochran Library, Scopus, PubMed, Embase, Web of Science) and the Google Scholar search engine without time limits until May 2019. Keywords were extracted based on MeSH strategies. At first, 16243 articles were found. After the screening phase (elimination of duplicated articles, title screening, abstract screening, and full-text screening) 19 articles remained. Two articles deleted after text appraisal using the CASP checklist. In the next stage, after reviewing the gray literature and reviewing the references of remaining articles, three new articles were added (Included studies = 20). 

Twenty articles (models) corresponding to the study objectives were finally extracted. These models are limited to nine countries and most have local scopes. These models mainly use a case manager, an intra- or inter-disciplinary team, and an elderly assessment tool in their structure. In addition to the use of an information system, these models provide a wide range of services to the elderly.

Most of the models mentioned are local models. Smaller models to become applicable at the national level, they need to be reviewed and evaluated by policymakers and experts. Given the inefficiency of current systems in providing services to the elderly, it is recommended that countries use an integrated model of health care provision for the elderly.

Estimation and analysis of household expenditure patterns can always be considered as one of the most suitable tools to raise awareness of policy makers. The aim of this study was to investigate shares of different parts of Iranian household expenditures with emphasis on health care cost.

This descriptive study was conducted by using raw data about households expenditure obtained from Iran statistical center (1392-1396). The household expenditure patterns of 6 subcategories were analyzed. The share of health care expenditures on the basis of income quintiles were reviewed before and after Iran’s health hransformation program (1392-1396). Excel 2010 and Stata 14 softwares were used for data analysis and drawing the charts.

In urban households, the cost of housing and in rural households cost of food and clothing had the highest shares in  household expenditures. The costs of education in both groups of urban and rural households had the lowest share in household expenditures. The share of health care expenditures in urban and rural households has increased in the study years and after IHTP in all quintiles. Except for the fifth quintile in urban households, the results were similar.

The results showed significant alterations in the household expenditure pattern. The shares of health care expenditure after the IHTP has increased, indicating that the program has not been successful to achieve the goal of household financial protection.

Infection prevention is a basic issue in the dental profession and the transmission of infectious diseases is an important issue in dentistry. The present study was performed to evaluate the risk of infection transmission by students in the restorative department of the School of Dentistry using the Six Sigma model.

This cross-sectional study was performed in the first three months of 2016. The subjects of the study consisted of 265 dentistry students in the restorative department of the dental school, 30 of whom were randomly selected as the sample. Data were collected using a standard checklist. Using the fish bone diagram, the causes and the most important defects were identified and the Six Sigma model was used to analyze the quality of the process.

Fifty-nine defects were detected in the restorative department. The most important defects which were identified as the first three factors, respectively, were: the lack of skills, experience and education of dental students in infection control, not washing of hands by dentists before wearing latex gloves, and not pressing the water and air poar for 15 seconds before use for each patient.

The results of the study showed that knowledge of students about infection control is insufficient and there is a need for more education with strict supervision in this field.

Reproductive health (RH) in adolescents and youth, as one of the critical components of population health policies, plays a pivotal role in preventing risky behaviors and achieving a healthy and productive generation for the future society. Thus, this study aimed to explore the challenges of RH in adolescents and youth in Iran.

Using a purposeful sampling method with maximum variation, semi-structured in-depth interviews were held with eighteen key informants in the field of RH. A Snowball sampling strategy was deployed to identify the participants. The multi-dimensional PRECEDE-PROCEED model of health promotion was used as a guiding framework for the topic guide. The transcribed interviews were coded and analyzed using thematic analysis.   

Three main themes of decision-making system, lifestyle, as well as social and epidemiological issues, were emerged from the interviews. We also explored six themes, including the knowledge and expertise about RH, policy-making and management system, environmental factors, individual factors, family and social anomalies, and epidemiological status of RH. Furthermore, twenty-five sub-themes were extracted from the main themes, which represented the challenges. Lack of understanding of the issues and absence of a coherent intellectual system that provides a collaboration of different systems in policy-making were fundamental and dominant challenges of RH for adolescents and youth in Iran.

To meet these challenges, we require an integrated and coherent system of policy-making with a reliance on scanning individual, environmental, social, and epidemiological changes that influence RH.

Resource generation in health system provides mechanisms for training efficient and effective workforce and supplies facilities and equipment for delivering health services. Iran’s Health Transformation Plan is one of the major reforms implemented in 2014 designed to realize the scientific authority of the country among the countries in the region in horizon 2025 (Solar Year 1404). Therefore, the state of function of resource generation in the areas of education, research, and infrastructure suitable for provision of health services may provide valuable policy implications for informed decision-making. Therefore, the status of resource generation in the areas of education, research and infrastructure (focusing on human resources and medicine as two expensive and effective drivers) from the lens of productivity and equity can provide invaluable policy implications for informed decision-making. The function of resource generation in the three areas of education, research, and infrastructures of human resources and medicine in health system encounters many challenges in terms of productivity and equity. In this perspective paper, besides assessing these challenges in the light of available research evidence, it has been tried to identify these and aimed to suggest several policy recommendations in these areas for improving evidence-based policymaking.

Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran.

The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews.

The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system.

The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly.

Different factors affect Iranchr('39')s health care financing system, and regardless of this impact, the future of this system will face fundamental challenges. In this environment, a health system is successful if it is able to anticipate the effects of these factors in the future of health care financing and preplan appropriate interventions towards health care financing system. The present study aims to identify these factors and trends.

This study compiled a round view of the experts on the subject, with a future studies approach through a qualitative method. To collect data, a deep and semi-structured interview was performed. The results of the interviews were analyzed using content analysis method, and the primary and secondary themes were extracted using the Micmac software.

A total of 71 variables were identified in the form of 12 groups with titles of stewardship, service provision, resource gathering, purchasing and resource allocation, sociocultural, technological, environmental, economic, political, and managerial, and laws and values. Four variables, including distant-service provision, administrative bureaucracy, administrative focus and corruption, low-support decision-making, economic blockade, and sales of oil were among the influential factors and drivers.

The findings showed Iranchr('39')s financing system is relatively stable but fragile and 3 areas of technology, politics, and economics have the most impact on structuring Iran’s financing system.

The main objective of medical education development centers is to improve the quality of medical education. However, after more than two decades since the formation of these centers, they are still facing numerous challenges.

Given the importance of these centers, this study was conducted to identify their challenges.

A qualitative study was carried out in 2013 on 40 managers of Iranian medical education development centers. Data was collected during a national conference held in Tehran in the form of a questionnaire and analyzed using content analysis.

Key challenges of the centers were identified to be resource shortage, continuous modifications in policies, weak management, structural problems, lack of communication, regulatory problems and centralization in decision making. The key challenges were divided into 17 sub-challenges.

Although decades have passed since the formation of medical education development centers, they are still facing serious challenges. To unveil the true potential of these centers in improving the quality of education, integrated interventions were addressed in this study to help reduce identified challenges.

Waiting time is one of the factors affecting patients' satisfaction with the quality of services, therefore, reducing the waiting time has an essential role in the improvement of services and clients' satisfaction. The present study was performed to study the client patients waiting time in referral restorative dentistry department of dental clinic using Six Sigma model.

In this descriptive study, 300 patients who referred to the restorative dentistry department of dental clinic, were included. Finally, 30 subjects were selected using random sampling method. Data were collected by waiting time measurement forms and researcher-made checklists. To determine the process quality, six sigma model was used. Finally, data were analyzed using SPSS version 16.

The highest mean waiting time belonged to the oral diseases department (mean=31 min) and the lowest one belonged to the examination unit of restorative dentistry department (mean=15 min). The most important factors extending the waiting time were simultaneous entrance of patients (mean=4.6 min), lack of medical students' skill and experience (mean=4.2 min), lack of employees and integration of reception unit with cash desk (mean=4 min), respectively.  

Therefore, by analyzing reception process, appropriate management, and using Six Sigma model, waiting time will reduce, clients' satisfaction will increase, and the quality of services will improve.

Accurate economic forecast has important effects on governmental policy and economic planning, and it can help policymakers to make decisions for future and create new infrastructures for the development of new forecasting methods. This study calculated total health expenditure, public health expenditure and out of pocket (OOP) payment for 2016-2020. 

Autoregressive Integrated Moving Average Process (ARIMA) is one of the most important forecasting models. In this study, five-year values were forecasted using EViews8 software according to health expenditures in Iran from 1971 to 2015.

Applying annual data for total health expenditure, resulted in the ARIMA (1,1,1) model being the most appropriate to predict these costs. The results of this study indicate that total health expenditures will reach from about 1228338 billion IRR in 2016 to 2698346 billion IRR in 2020 and the amount of out of pocket (OOP) will become more than 41% of total health expenditure in 2020.

Total health expenditures in 2020 will become more than two halves in 2016. These expenditures indicated there is a need for continued governmental support of this sector during the upcoming years.

According to census 2011, general fertility rate in Iran was 1.6 children. The United Nations published a low population growth scenario for Iran in 2010, and if Iran continues to experience population replacement and does not have a plan to balance it, it will experience a population of 31 million, with a high percentage of elderly people in the next 80 years. This study was conducted to identify the causes of a decrease in population growth rate.

This was a secondary study conducted by reviewing the scientific texts, papers, and upstream documents. The upstream documents contain all national documents related to population decline in Iran. Causal layered analysis (CLA) was used for data analysis.

The 9 most important identified causes for a decrease in population were litany (child mortality, maternal mortality, diseases burden, fertility rate, marriage squeeze, abortion, marriage age, high-risk behaviors, and badly supervised and neglected children. Also, 5 causes in structural layer were urbanization, education rate, economic participation rate and unemployment rate, new structures, a change in family structure, and intergenerational gap. Moreover, three causes in discourse layer included welfare, materialism, individualism, and 2 causes in metaphor layer were changing the perception of life and family formation, and women as workforce.

It seems that the decrease in population growth in Iranian society is less the result of social planning and population control and more the result of the value and structural changes that have been occurred due to modernization in the society. It is recommended that policymakers primarily address the discourse and metaphor layers to solve the problems.

Pre-marriage counseling program, an educational intervention launched in 1993, makes the married couples familiar to maternal health issues. In order to improve the performance of this program, it is necessary to examine the various dimensions of this program. Therefore, the present study was designed and implemented to evaluate the pre-marriage counseling program. In this narrative review study, the use of standard key words, articles indexed in the databases of PubMed, Web of Science, Scopus, SID, BarakatKNS (IranMedex) and Magiran by the end of April 2017 were reviewed. Finally, the full text of 56 articles was examined, and the content of these articles was classified according to the quality assessment framework of Donabedian in three dimensions, including structure, process, and outcome of this program. After categorizing the results of the articles based on the Donabedian’s framework, 21, 8 and 41 articles were related and classified in structure, process and outcome, respectively. Most of the studies conducted between 2001 and 2011 were mostly cross-sectional, and the highest number of articles was in the outcome dimension. Structural dimension was subdivided into four sub-categories including educational content, human resources, facilities, and information resources. Then the process was sub-divided into training and counseling mechanism and eventually the outcome. In the dimension of the structure, the assessment of the educational materials' contents was poor. In the dimension of the process, the duration of training should be increased. In the outcome dimension, the level of participants' knowledge and attitude about sexual health, reproductive health and sexually transmitted diseases was assessed moderate to weak

Prioritization and resource allocation are the most important processes in managing and developing each organization. Given the high turnover and cost of hospitals in health system, this study aimed to provide a model for financial resource allocation with the Goal Programming (GP) in Afzalipour teaching medical center in Kerman.
This mixed method and case-study study was conducted in Afzalipour teaching medical center located in Kerman, south-eastern of Iran. Participating key informants and operation research experts, twelve focus group discussions (FGDs) were developed to extract a goal programming model. Then, the hospital accounting data were collected from 2010- 2013 according to the extracted model. The WinQSB software was used for running the model.
The findings of this study showed that the share of personnel costs of this hospital was 72% which 28% was devoted to fee-for-service (FFS) and contractual services, current and other costs were 6%, 2%, and 12%, respectively. However, the findings of goal programming model showed that the optimum and satisfactory amount of personnel costs must be 66%, 14% of which were allocated to the FFS cost. The share of contractual services, current and other costs must be 15%, 2%, and 17%, respectively.
The results showed that resource allocation in the hospital follow merely the accounting perspective rather than optimum and satisfactory ones. It is suggested in order to achieve the optimum values, the board of trustees should be institutionalized in practice; moreover, the outsourcing services should be addressed more. Therefore, personal costs which include a large part of costs can be reduced.

The main resources of health care are allocated to hospitals. However, resource bottlenecks are a challenge faced by health systems around the world, especially in developing countries such as Iran. Inefficiencies in resource allocation can increase the constraints in double fold. Therefore, the present study was conducted to determine the allocation of financial resources in one of the hospitals of the board of trustees, Afzalipour Medical Center, Kerman, Iran.
Review of documents, two deep interviews and five focus group discussions with eleven experts were used to collect data in the present qualitative study. Participants were members of the board of trustees and representatives of the financial department of the hospital. Data were then analyzed using content analysis method.
Based on the present study, four main themes and ten sub-themes were identified, with main themes including decision-making reference, process, criteria and factors influencing decision-making. In this regard, there was no clear process and criteria for allocating resources at this center, and allocation of resources was done based on a reactive approach, response to critical situations, political currents and financial bottlenecks. Contrary to the potential capacity of the structure of board of trustees, in practice, headship and management played a key role in allocating financial resources.
The process of allocating financial resources in the investigated hospital follows a less rational approach and coincided with the chaos theory and the garbage can model of decision-making in the governmental bureaucratic structure. The governmental bureaucratic structure and the board of trustees structure (decentralization) in contrast to each other have led to a disorder, where the lack of transparency in determining goals, criteria and document performance have also exacerbated this disorder. In this regard, the oil-related budget has stabilized the inappropriate allocation of resources.

Development in health is not possible without progress of science. Rapid changes in the various areas make the future health system more complex and risky. Therefore, foresight of health sciences is very important.

This futures studies was conducted in 4 steps; also, literature and documents review, statistics and information review, focus group discussions, working group, and scenario planning were used. Cause level analysis was used for data analysis and syntactic as main frameworks.

The findings in legal health sciences documents revealed that the value system was not defined clearly and coherently and that logical linkage among myths, discourse, and social structural layers was ambiguous. In trend analysis, 24 trends were recognized; however, political and economic streams were strong, independent, and uncertain factors which created 4 main scenarios although the social and environmental factors divided them into 16 subscenario tunnels. Postmodern discourse in probability scenarios will be dominant and science will be understood as tools for generation of wealth. University structure will be decentralized and transformed into similar R&D to join the health industry, and our quantitative growth (articles, disciplines, and students) in health sciences will decrease.

If the current trends (probability scenarios) continue, we will move to an undesirable situation. The main challenge in this regard is the lack of a unique and dominant discourse in health sciences based on the Islamic Republic of Iran doctrine. Therefore, in this study, shifting the paradigm by a new approach and discipline in the health sciences is suggested.

A responsibility of the family physician (FP) and one of the four aspects of the delivery of primary care services is continuity of care (COC). This study aimed to determine the COC of health care in urban health centers.
Between September 2015 and March 2016, we conducted a cross‑sectional study using Primary Care Evaluation Tool questionnaires with multistage stratified cluster sample of FPs (n = 141) and patients (n = 710) in two provinces in Iran, Fars and Mazandaran. The questionnaires contained essential dimensions of COC: Informational, interpersonal, and longitudinal COC.
Almost all FPs had a computer. The FPs hadn’t kept their patients’ medical records routinely. The software had some problems, so the FPs couldn’t produce lists of patients based on their health risk and they couldnt monitor their population. Almost 88% of FPs have written referral letters for all referred patients but 57% of them got medical feedback from specialists. About 80% of patients’ consultation times were up to 10 min. 29% of FPs knew the past problems and illnesses of the patients. From 40% to 50% of the patients stated that their FPs asked them for their desire about prescribed medicine and gave clear explanation about their illnesses. On average, patients visited their doctor 5.5 times during the previous year. Generally, patients and FPs in Mazandaran could summarize their experiences better than Fars in most topics of COC.
It seems that after 3 years of using urban FP program in two pilot provinces, there were still some problems in COC. Strengthen software program, introducing incentives for FPs, and promoting patients’ responsibility can be used by policy‑makers when they seek to enhance COC.