نشریه راهبردهای مدیریت در نظام سلامت
سال پنجم شماره 4 (پیاپی 18، زمستان 1399)

Competency is a set of job-related knowledge, skills, personality traits, interests, and experiences that enable the holder to perform tasks and responsibilities at an above-average level. Since the Holy Quran and hadiths emphasize the principle of selecting the most competent people according to specific characteristics and skills, there is a need to define the needed competencies for selecting efficient and capable managers. Based on this, the general and specialized competencies of managers were extracted from the valuable sources including the Quran and Nahj al-Balagha.

In this qualitative developmental study, the qualitative content analysis research method was conducted to investigate the texts of the Holy Quran and Nahj al-Balagha using a Quranic-narrative approach to extract the characteristics of competent managers.

After extracting all concepts (354) and classifying them, we finally achieved 21 competencies and placed them in consecutive classifications (3 stages of codification, preparation, and summarization) in 2 groups of general and specialized competencies.

According to the Islamic criteria in selecting managers of an Islamic society, these competencies should be considered using a systemic approach.

 The public sector of the health care system provides justice and access for all people who need more specialized services through the referral system. If the challenges of the referral system are not identified and addressed promptly, the system will not be efficient and effective. The purpose of this study was to rank the reasons for non-referral of outpatient level 1 to level 2 in the electronic referral system of Golestan province in 2019.

 In this descriptive and cross-sectional study, 431 outpatients participated from the pilot hospitals of the e-referral system in Golestan province, who did not refer to the level 2 specialist despite that an appointment was set by the system. The participants were selected using a stratified random sampling method. Data were collected using a questionnaire and analyzed by descriptive statistics and Friedman test in SPSS 23 software.

 The most important reasons for patients who were not  referred from level 1 to level 2 in the electronic referral system included the presence of a trusted and familiar physician, inability to pay the visit of a specialist, and high cost of transportation from home to the designated specialist, respectively. The gender of the specialist physician and lack of guidance on referral to the specialist physician were indicated by the referral center. Patients ranked the reasons of not referring to the specialist differently (P < 0.001).

 The current status can be improved by increasing the public confidence in specialized physicians working in the electronic referral system and making the specialized services free for the poor patients. Furthermore, raising the patientchr('39')s awareness about using Level 2 specialized services through the mass media can help patients to benefit from these services.

Optimal management of food services in hospitals plays an important role in their performance, accelerating the patients’ recovery and increasing the level of patient satisfaction. The purpose of this study was to design a model for food service management in Iranian hospitals.

Methots:

This descriptive correlational study was carried out using structural equation modeling. Simple random sampling was performed and the study participants were selected among  hospital managers, nutrition experts, and environmental health experts in a hospital management conference in Tehran in September 2018. The measurement tool was a researcher-made questionnaire with confirmed construct validity and corroborated reliability through Cronbachchr('39')s alpha. For data analysis, exploratory factor analysis and confirmatory factor analysis were performed via SPSS 21 and AMOS 22 software.

Based on the obtained model, 5 main factors affecting the management of food service sector were identified, including: health and safety factors, satisfaction factors, food waste factors, monitoring and control factors, and mechanism factors. Among these, health and mechanism factors with coefficients of 0.874 and 0.612 had the highest and the lowest effect in the management of food services in Iranian hospitals, respectively.

According to the obtained model, various factors are effective in food management that should be considered in hospital planning. Based on this, the food health and safety dimensions are of particular importance.

Identification of the current employment status provides useful information for policy makers and decision makers of the education system in order to plan for determining the admission capacity of students, the conditions of graduate’s recruitment, and the employment condition of various fields. The aim of this study was determining the career destiny of healthcare management major from the perspective of graduates.

This descriptive-analytic and cross-sectional study was conducted in the second half of 2018 on 108 graduates of healthcare management at Shahid Sadoughi University of Medical Sciences, Yazd. Participants entered the study by census method and the data collection tool included a standard career destiny questionnaire. Statistical analyses were performed by SPSS 16 using descriptive (Frequency, Mean, Standard deviation, Percentage) and analytical (independent t-test, ANOVA, Pearson correlation coefficient test) statistics.

The mean score of career destiny in the present study was 3.04 ± 0.65. Of career destiny constructs, the highest and the lowest average scores were related to the specialized and professional abilities (3.69 ± 0.65 (and creating the necessary facilities for employment by the university (2.59 ± 0.63), respectively. A statistically significant relationship was found between the following dimensions: specialized and professional abilities with marital status (P = 0.046), creating the necessary facilities for employment by the university (P = 0.031), appropriateness of the curriculum and professors education with employment (P = 0.047), role of university environment and entrepreneurship skills (P = 0.034) with the variable of age, and appropriateness of the curriculum and professors education with the participants’ employment and grade point average (GPA) (P = 0.029).

It is suggested to provide employment opportunities for graduates in the field of healthcare management at different levels of the health system, educational objectives, curriculum content, clerkship, and internship courses. Furthermore, the curriculum of this field of study should be revised based on the countrychr('39')s labor market needs and the educational centers should play a more prominent role in introducing their graduates’ capabilities to the health labor market.

Due to limited resources, efficiency is very important to maximize resources for hospitals. Time-Driven Activity-Based Costing estimates costs and provides valuable information to increase efficiency. Therefore, the cost of COVID-19 in the hospitals affiliated with Kashan University of Medical Sciences was investigated using this method.

In this cross-sectional and retrospective study, the statistical population included all patients (n = 3129) with COVID-19 hospitalized in the Seyed Al-Shohada hospital (88 beds) and Shagid Beheshti hospital (700 beds) selected via census method during March and April 2020. Data collection was conducted through review of litreture (library method field); and review of accounting documents, direct observation of activities related to the treatment of patients, interviews with top managers for timing of receiving services by patients (field method). The descriptive statistics including means and frequency tables was reported and time-driven activity-based costing was conducted. Data analyses were performed using Excel software.

Findings showed that the cost of one bed night for COVID19 patients was 22,866,669 Rials in Shahid Beheshti hospital and 30,554,405 Rials in Seyed Al-Shohada hospital and was 23,672,447 Rials for both hospitals in total. The cost of treatment of COVID19 by time-driving costing method was higher than the tariff approved by the Supreme Insurance Council.

Due to the difference between the cost of treatment of COVID-19 and the tariffs, it is necessary to calculate the bed night of these patients based on the tariffs of special wards. Moreover, due to the high cost of these patients, it is necessary to make appropriate policies for allocating beds in the hospitals affiliated to the University of Medical Sciences.

Part of the major health costs is related to outpatient care. Since the costs of diagnosis and treatment are increasing rapidly and increasingly, this study was conducted to determine the referral burden and cost of outpatient care of patients covered by the Rural Insurance Fund before and after the implementation of the electronic referral system in Golestan province.

This was a cross-sectional and descriptive study conducted based on the information collected from the specialized clinics of all hospitals and offices of specialized and sub-specialized physicians, imaging centers, laboratories, physiotherapy, radiotherapy, and pharmacies in public and private sectors of Golestan province in the first 6 months of 2017 and 2016 . The study was a census and included the information of all patients covered by the Health Insurance Fund who referred to the second level to receive services. To collect the required data, the existing information systems and documents of the General Directorate of Health Insurance and Excel software were used.

The number of visits to the specialists in the public and private sectors decreased by 23.2 % and 32.6 % in the first 6 months of 2017 compared to the same period in 2016 in all funds and rural funds, respectively. The number of visits to the specialists in the private sector decreased by 53.2% and 93% in the first 6 months of 2017 compared to the same period in 2016 in all funds and rural funds, respectively. The cost of visits in the public and private sectors decreased by 23.6 % and 48 % in all funds, respectively. In rural funds, the costs reduced by 30.6 % and 91.2 % in the public and private sectors, respectively.

According to the results, the capacity of electronic health records and the continuation of services to patients covered by family physicians should be improved throughout the country. Consequently, the unnecessary costs will be reduced, as one of the important goals of the referral system.