Evaluation of the primary health care expansion program with public-private partnership in slum areas from the perspective of stakeholders: a qualitative study

BACKGROUND

Today, economic and social determinants of health in slum settlements are at the policymakers' center of attention. Iran has had an excellent experience in the Primary Health Care Program. This study aimed to evaluate the Primary Health Care Expansion Program with public-private partnerships in slum areas of Iran from the perspective of stakeholders in 2022.

METHODS

This qualitative study was conducted using the framework content analysis method. Participants were 17 experts and health managers involved in The Primary Health Care Expansion with Public-Private Partnerships in the suburban areas at the medical universities of Khorasan Razavi province in the east of Iran, who were selected through purposive sampling via snowball method. For data collection, a semi-structured interview was done and framework content analysis was used for data analysis and results categories based on the SWOT.

RESULTS

The study identified 23 main themes and 112 sub-themes, which were then grouped into four main categories - strengths, weaknesses, opportunities, and threats using the SWOT model.

CONCLUSION

Results of the study showed the internal and external factors affecting Primary Health Care Expansion with Public-Private Partnerships in suburban areas. This situational analysis can help health policymakers to better understand the performance of health facilities.

Assessment of UV radiation effects on airborne mucormycetes and bacterial populations in a hospital environment

Infections, such as mucormycosis, often result from inhaling sporangiospore present in the environment. Surprisingly, the extent of airborne Mucormycetes sporangiospore concentrations remains inadequately explored. This study aimed to assess the influence of UV radiation on microbial populations and Mucormycetes spore levels within a hospital environment in northern Iran. A comprehensive dataset comprising 298 air samples collected from both indoor and outdoor settings was compiled. The culture was conducted using Blood Agar and Dichloran Rose Bengal Chloramphenicol (DRBC) culture media, with Chloramphenicol included for fungal agents and Blood Agar for bacterial. Before UV treatment, the average count of Mucormycetes ranged from 0 to 26.4 ± 25.28 CFU m-3, fungal agents from 2.24 ± 3.22 to 117.24 ± 27.6 CFU m-3, and bacterial agents from 29.03 ± 9.9 to 359.37 ± 68.50 CFU m-3. Following UV irradiation, the averages were as follows: Mucormycetes ranged from 0 to 7.85 ± 6.8 CFU m-3, fungal agents from 16.58 ± 4.79 to 154.98 ± 28.35 CFU m-3, and bacterial agents from 0.38 ± 0.65 to 43.92 ± 6.50 CFU m-3. This study, notably marks the pioneering use of UV light to mitigate Mucormycetes spore counts and bacterial agents in northeastern Iran, contributing to the advancement of environmental health and safety practices in hospital settings.

Explaining the challenges of resources management and its underlying factors in COVID-19 era in Iran: a qualitative study

BACKGROUND

Identifying factors affecting health costs can contribute to formulating the best policies for controlling and managing health costs. To this end, the present study aimed to analyze resource wastage and identify the factors underlying it in COVID-19 management in Iran's health sector.

METHOD

This qualitative content analysis study was conducted in Iran's health sector. The participants were 23 senior, middle, and operational managers in the health sector. The data were collected through semistructured interviews with the managers. The participants were selected using purposive, quota, and snowball sampling techniques. The interviews continued until the data were saturated. The collected data were analyzed using MAXQDA software (version 10).

RESULTS

Following the data analysis, the factors affecting the wastage of health resources were divided into 4 themes and 13 main themes. Vaccines, diagnostic kits, medicines, and human resources were the main factors underlying resource wastage. The identified main themes were open and unused vials, nonuse of distributed vaccines and their expiration, excess supply and decreased demand for vaccines, expiration of diagnostic and laboratory kits and their quantitative and qualitative defects, and the large number of tests. Inefficiency and the expiration of COVID-19 drugs, poor drug supply and consumption chain management, inaccuracy in inventory control and expiration dates, disorganization and inconsistency in the distribution of healthcare staff, low productivity of the staff, and failure to match the staff's skills with assigned tasks in selected centers were identified as the most important causes of resource wastage.

CONCLUSION

Given the limited health funds and the increased healthcare costs, effective preparation and planning and making reasonable decisions for unexpected events can minimize unnecessary costs and resource wastage, which requires some revisions in attitudes toward COVID-19 management in the healthcare sector.

Why healthcare providers are not vaccinated? A qualitative study during the COVID-19 pandemic in Iran

BACKGROUND

Vaccination has been effective in controlling contagious diseases, especially among high-risk groups such as medical staff. Their unwillingness to be vaccinated might adversely affect individual and public health. This study aimed to explore the factors related to the refusal of COVID-19 vaccines among health service providers.

METHODS

A qualitative study was conducted on 28 healthcare providers in Mashhad, Northeast of Iran from March to June 2022. The method of data collection was face-to-face interviews. The purposive method was used for sampling. Data collection continued until the saturation was reached. To analyze the data, the content analysis method was applied, and Maxqda (version 10) software was used.

RESULTS

By analyzing interview transcripts, six themes and ten sub-themes were extracted. Factors that explained employees' reluctance to be vaccinated against COVID-19 were the opinion of peers, lack of trust in vaccines, fear of vaccination, mistrust to the government and health authorities, low perceived risk of coronavirus disease, and the contradictions of traditional and modern medicine in their approach to controlling the disease.

CONCLUSIONS

Among healthcare workers, concerns about the side effects of vaccines were the most influential factors in refusing vaccination. Providing reliable information about vaccines and their safety is key to increasing the trust of health workers in vaccination and facilitating its acceptance.

Economic Burden of Vision Loss and Eye Disorders in Iran

Background

Globally, population growth and ageing are expected to increase the risk of vision impairment for more people. Eye disorders impose heavy social and economic burdens on communities through increased poverty, reduced quality of life, and decreased employment. We aimed to calculate the economic burden of eye diseases in Iran.

Methods

Prevalence-based and top-down cost estimation methods were used with a sociological approach. Data were collected from the Northeastern Ophthalmology Center Institute for Health Assessment, and Evaluation, besides the 2017 census. Eye diseases were classified according to the ICD10. Data were analyzed using Excel 2016 software.

Results

Survey data were collected from 19,113 patients with vision loss and eye disorders. The average cost of vision loss/eye disorders was estimated to be $250.3. The findings indicated that the economic burden of visual diseases was $2,844 million a year, with direct medical costs comprising 87% (66% of inpatient and 21% of outpatient) and direct non-medical and indirect costs estimated at 6% and 7%, respectively. Furthermore, 72.8% of direct medical costs was paid by insurance companies, 20.6% by patients, and 6.6% by the government.

Conclusion

Eye diseases and vision loss in Iran, as in other countries, are costly for the health system and society. Instituting effective policies and measures to address this rising burden should be a national priority. Another suggestion in this area would be to focus on preventive care and policies such as health education, highlighting the role of reorientation of health services and advocacy (for policies that promote eye health), where relevant.

Detection of SARS-CoV-2 in the indoor air and surfaces of subway trains in Mashhad, Iran

INTRODUCTION

Millions of passengers around the world are concerned with the possibility of SARS-CoV-2 contamination on public transportation. Therefore, this study aimed to investigate the presence of SARS-CoV-2 virus in indoor air and subway surfaces in Mashhad.

METHODS

In this study, air and surface sampling were done at two times in the morning (7-8:30 a.m.) and evening (3:30-5 p.m.), simultaneously in two wagons for men and women in line 1 of Mashhad Metro in March 2021 to detect the virus and measure the concentration of particulate matter. Totally, 30 air and 30 metro samples were collected and examined by reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

The results showed that three and two cases in the air and surface samples were infected with the SARS-CoV-2 virus, respectively. There was a significant relationship between the mean concentration of suspended particles PM1 (particulate matter smaller than 1 μm) with PM2.5 (particulate matter smaller than 2.5 μm) and PM10 (particulate matter smaller than 10 μm) (p < 0. 05). There was also a significant relationship between the mean concentration of suspended particles PM2.5 and PM10. The results showed that the mean PM2.5 measured in the indoor air of the Mashhad metro wagon had a significant relationship with WHO and US EPA and national standards, and its value was higher than the standards (p < 0.05). The average particle concentrations of PM1, PM2.5, and PM10 were equal to 40.46, 42.61, and 48.31 μg/m3.

CONCLUSION

According to the results of the pollution detected in this study, COVID-19 may be transmitted by air and environmental surfaces. Our study emphasizes the need for continuous assessment of the presence of the virus in public transportation. Detection of viral RNA in subways indicates the necessity of adequate disinfection in public settings, strictness in disinfection methods, strengthening of educational activities for sanitary measures, physical spacing plan, and increasing ventilation of wagons.

The assessment of health system responsiveness from the viewpoints of COVID-19 patients

BACKGROUND

Pandemics such as Corona are currently major health concerns worldwide. Health system responsiveness to the medical and non-medical needs of patients during pandemics is essential. This study aimed to examine hospitals' responsiveness to Corona patients.

METHODS

This descriptive and analytical research had a cross-sectional design. The study population included Corona patients discharged from 17 public hospitals of Mashhad University of Medical Sciences, Iran, in the spring of 2021. WHO questionnaire for health system responsiveness was used to collect data. 413 patients participated in the study who were selected by random classified sampling. To analyze the data, descriptive statistics, including frequency, and deviation, and to examine the relationship between variables, Kruskal-Wallis and Mann-Whitney tests were used.

RESULTS

In this study, one-third participants were in the age range of 31 to 40 (32.6%). The ability of 277 (70.5%) participants to pay treatment costs was very low, and low. 380 (96.7%) of the respondents had basic health insurance and 101 (25.7%) had supplementary insurance. In general, respondents evaluated the responsiveness of hospitals as 75.6. The highest score was related to confidentiality, and the lowest to prompt attention. There was no significant relationship between the total response score with demographic information.

CONCLUSION

The responsiveness of studied hospitals to Corona patients was adequate. However, there was dissatisfaction with the lack of timely treatment and medication. Moreover, the most important dimension of responsiveness was dignity. Healthcare providers need to pay attention to different aspects of responsiveness and improving the quality of and access to health services during pandemics and disasters.

Comparison of pay-for-performance (P4P) programs in primary care of selected countries: a comparative study

BACKGROUND

Pay for performance (P4P) schemes provide financial incentives or facilities to health workers based on the achievement of predetermined performance goals. Various P4P programs have been implemented around the world. There is a question of which model is suitable for p4p implementation to achieve better results. The purpose of this study is to compare pay for performance models in different countries.

METHODS

This is a descriptive-comparative study comparing the P4P model in selected countries in 2022. Data for each country are collected from reliable databases and are tabulated to compare their payment models. the standard framework of the P4P model is used for data analysis.

RESULTS

we used the standard P4P model framework to compare pay for performance programs in the primary care sector of selected countries because this framework can demonstrate all the necessary features of payment programs, including performance domains and measures, basis for reward or penalty, nature of the reward or penalty, and data reporting. The results of this study show that although the principles of P4P are almost similar in the selected countries, the biggest difference is in the definition of performance domains and measures.

CONCLUSIONS

Designing an effective P4P program is very complex, and its success depends on a variety of factors, from the socioeconomic and cultural context and the healthcare goals of governments to the personal characteristics of the healthcare provider. considering these factors and the general framework of the features of P4P programs are critical to the success of the p4p design and implementation.

Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents

OBJECTIVES

Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran.

METHODS

Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority.

RESULTS

Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources.

CONCLUSIONS

Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.

Evaluation of errors related to surgical pathology specimens of different hospital departments with a patient safety approach: a case study in Iran

BACKGROUND

Most surgical specimen errors occur in the pre-analysis stage, which can be prevented. This study aims to identify errors related to surgical pathology specimens in one of the most comprehensive healthcare centers in Northeast Iran.

METHODS

The present study is descriptive and analytical research conducted cross-sectionally in 2021 at Ghaem healthcare center in the Mashhad University of Medical Sciences on the basis of a census sampling. We used a standard checklist to collect information. Professors and pathologists evaluated the validity and reliability of the checklist using Cronbach's alpha calculation method of 0.89. We analyzed the results using statistical indices, SPSS 21 software, and the chi-square test.

RESULTS

Out of 5617 pathology specimens studied, we detected 646 errors. The highest number of errors is the mismatch of the specimen with the label (219 cases; 3.9%) and the non-compliance of the patient's profile in the specimen sent with the label (129 cases; 2.3%), and the lowest errors are the inappropriate volume of the fixator(24 cases; 0.4%), and they accounted for insufficient sample size (25 cases; 0.4%). Based on Fisher's exact test results, there was a significant difference between the proportion of errors in different departments and months.

CONCLUSION

Considering the frequency of labeling errors in the stage before the analysis in the pathology department, the use of barcode imprinted in specimen containers, the removal of the paper request for pathology, the use of radio frequency chip technology, the use of the rechecking system and improving communication in different departments can be effective in reducing these errors.

A survival analysis approach to determine factors associated with non-retention of newly hired health workers in Iran

BACKGROUND AND AIM

One of the main tasks of the healthcare human resource management is to maintain and retain professional staff. The high level turnover of professional staff may reduce the quality of healthcare service delivery. Therefore, this study investigated the factors associated with the turnover of the newly recruited healthcare professionals using survival analysis method in Iran.

MATERIALS AND METHODS

This historical cohort analysis comprised 6811 employees who began working at Mashhad University of Medical Sciences between 2005 and 2020. Employees recruited at any of the university's units between the years 2005 to 2019 were included. We used appropriate descriptive indices and Log-rank test and the Cox proportional-hazards model to assess the staff turnover. A significance level of 0.05 was used for all tests.

RESULTS

The findings of the survival analysis showed that the probability of turnover in one year, two years, and five years of employment were 0.12, 0.16, and 0.27. Based on the findings of the Log-rank test, the probability of turnover in entire of the study period was not statistically different between male and female (p = 0.573), and likewise between employees with healthcare occupations and non-healthcare occupations (p = 0.351). Employees whose current workplace and birthplace were not similar had a significantly higher probability of turnover (p < 0.001). Accordingly, the Cox regression result showed, the risk of turnover for the singles was 1.22 times higher than the married. For the Ph.D degree was 3.23 times higher compared to those with a diploma or an associate degree, and for a bachelor's or master's degree was 2.06 times more likely to change their workplace than those with a diploma or an associate degree.

CONCLUSION

Policies promoting the recruitment of native-born professionals, given priority to the married candidates than single ones, and/or recurring candidates to pledge to stay in the locality of recruitment site can increase the staff retention and reduce the costs of staff turnover including re-hiring, initial and on-the-job training, accommodation, and other extra living consumptions away from home and family.

Occurrence and types of medication error and its associated factors in a reference teaching hospital in northeastern Iran: a retrospective study of medical records

BACKGROUND

Medication errors are categorized among the most common medical errors that may lead to irreparable damages to patients and impose huge costs on the health system. A correct understanding of the prevalence of medication errors and the factors affecting their occurrence is indispensable to prevent such errors. The purpose of this study was to investigate the prevalence and types of medication errors among nurses in a hospital in northeastern Iran.

METHODS

The present descriptive-analytical research was conducted on 147 medical records of patients admitted to the Department of Internal Medicine at a hospital in northeastern Iran in 2019, selected by systematic sampling. The data were collected through a researcher-made checklist containing the demographic profiles of the nurses, the number of doctor's orders, the number of medication errors and the type of medication error, and were finally analyzed using STATA version 11 software at a significance level of 0.05.

RESULTS

Based on the findings of this study, the mean prevalence of medication error per each medical case was 2.42. Giving non-prescription medicine (47.8%) was the highest and using the wrong form of the drug (3.9%) was the lowest medication error. In addition, there was no statistically significant relationship between medication error and the age, gender and marital status of nurses (p > 0.05), while the prevalence of medication error in corporate nurses was 1.76 times higher than that of nurses with permanent employment status (IRR = 1.76, p = 0.009). The prevalence of medication error in the morning shift (IRR = 0.65, p = 0.001) and evening shift (IRR = 0.69, p = 0.011) was significantly lower than that in the night shift.

CONCLUSION

Estimating the prevalence and types of medication errors and identified risk factors allows for more targeted interventions. According to the findings of the study, training nurses, adopting an evidence-based care approach and creating interaction and coordination between nurses and pharmacists in the hospital can play an effective role in reducing the medication error of nurses. However, further research is needed to evaluate the effectiveness of interventions to reduce the prevalence of medication errors.

Socio-economic determinants of attendance at diabetes self-management education program: using Andersen’s behavioral model

Background

Diabetes self-management education is an effective factor for improving outcomes and quality of life in patients with diabetes. However, little information is available on the factors associated with participation or non-participation in self-management education programs in people with diabetes. The aim of this study was to explore the factors affecting on the attendance of patients with diabetes in the diabetes self-management education program.

Methods

A cross-sectional study was conducted in 2019 on 384 patients with diabetes referred to the main comprehensive health centers of Mashhad, Iran. All patients were linked with a diabetes self-management education program that lasted three months and involved 12 sessions. We explore the factors affecting on attending in diabetes self-management education program using Andersen’s behavioral model. Data for independent variables (predisposing, enabling, and need factors) were gathered at the beginning of the training program using registration forms. Dependent variable (attendance of patients with diabetes in the training program) was checked at the end of the program. Univariate and multivariate analysis were done with SPSS v.25.

Results

The results of this study showed that women were less likely to participate in the self-management education program than men (OR=0.414; P<0.05). Also, age, travel time, health status and years with diabetes have negative significantly correlated with participation in the education program (P<0.05). The study showed that patients with diabetes aged≥65 were less participated in the training program than those ≤40 (OR=0.159; P<0.05). Also, patients who lived farther than 40 min away from training center were less likely to participate for this program than patients that live in an area<20 min away from training center (OR=0.196; P<0.05). Odds of attending in training program for patients with poor health status was less than patients with excellent health status (OR=0.282; P<0.05). Participation in training program were low in patients with more than 5-year diabetes duration compared to less than 1 year (OR=0.176; P<0.05).

Conclusion

The implementation of the classes at the right time and online, Reduce the distance between people and the place of the class, providing facilities and providing infrastructure may be appropriate to involve women and the elderly.

Explaining the challenges of hospitals admitting COVID-19 patients from the perspective of managers (a qualitative study)

BACKGROUND

Crises are often unavoidable events that occur around the world. Hospitals play an important role in treating patients and preventing extensive injuries in times of crisis, requiring adequate preparedness. In order to design a proper planning system, it is essential to be aware of the challenges of hospitals during a crisis. The purpose of this study was to explain the challenges of hospitals admitting COVID-19 patients in the city of Mashhad, Iran, from the perspective of their managers.

MATERIALS AND METHODS

This study employed a qualitative approach, using the method of conventional content analysis and was conducted from May to July 2020. A purposive sampling method was used to recruit the senior managers of hospitals admitting COVID-19 patients in Mashhad. The interviews were conducted face to face, with open-ended questions following an interview guide based on semi-structured questions, and continued until data saturation was reached. Data were analyzed using Atlas Ti software.

RESULTS

After the implementation of the interviews, first 665 initial codes were extracted from the data, and after removing the overlapping sequences, a total of 115 codes were obtained. Three categories (organizational challenges, extra organizational challenges, and challenges related to information domain), 13 sub-categories, and 33 codes were extracted from the content analysis of the interviews. The main themes propounded in the field of challenges of COVID-19 referral hospitals in Mashhad were organizational challenges, extra organizational challenges, and information domain challenges.

DISCUSSION

The results of this study showed that the hospitals admitting COVID-19 patients in Mashhad faced many challenges. To improve the quality of services in postcrisis phase, replacing hospitals' equipment, revising curriculums at medical universities, staff retraining, recruiting skilled human resources, and creating a supportive community context are necessary.

CONCLUSION

For sure, the COVID-19 crisis will not be the last one, we have to be prepared for the bigger health crisis.

The lost productivity cost of absenteeism due to COVID-19 in health care workers in Iran: a case study in the hospitals of Mashhad University of Medical Sciences

Background

Human resources management plays an important role in social development and economic growth. Absence from work due to health problems can make obstacles to the growth of economy. This study conducted aimed to estimate the absenteeism costs of COVID-19 among the personnel of hospitals affiliated to Mashhad University of Medical Sciences in Mashhad, Iran.

Methods

This cross-sectional study was conducted between February 19, 2020, and September 21, 2020. The absenteeism costs were calculated using the human capital approach. Finally, we applied the linear regression to assess the impact of variables on the lost productivity of absenteeism due to COVID-19 among the personnel of hospitals affiliated to Mashhad University of Medical Sciences.

Results

The results of this study showed that 1958 personnel had COVID-19. The total of absenteeism days in our study were 32,209 days, with an average of 16.44 absenteeism days. Total costs due to absenteeism were estimated to be nearly $1.3 million, with an average of $671.4 per patient. The results of regression model showed that gender (male), age (> 50 years), employment Type (non-permanent) and monthly income had a positive relationship with the absenteeism cost. Also, there are a negative significant relationship between absenteeism cost with job (physicians) and work experience.

Conclusions

Absenteeism costs of COVID-19 in the hospitals of Mashhad University of Medical Sciences represent a significant economic burden. The findings of our study emphasize the emergency strategies to prevent and control COVID-19 among the healthcare workers. It can decrease the economic impacts of COVID-19 and improve human resources management during the COVID-19 pandemic.

The Most Important Social Determinants of Slum Dwellers' Health: A Scoping Review

Objectives

Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants.

Methods

This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness.

Results

Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers.

Conclusions

This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements’ residents due to the common characteristics of slums around the world, especially in developing countries.

Assessment of Patient Safety Culture Among Doctors, Nurses, and Midwives in a Public Hospital in Afghanistan

INTRODUCTION

The first step to improve the safety of patients in hospitals is to evaluate safety culture. Therefore, the patient safety culture in doctors, nurses and midwives should be reviewed regularly. The aim of the study was to determine the current state of patient safety culture among physicians, nurses and midwives at the Estiqlal Hospital in Kabul to promote an effective safety culture.

METHODS

This cross-sectional descriptive study was conducted from January to March 2020 among doctors, nurses, and midwives at the Esteqlal Specialized Hospital in Kabul. In that study, the data were collected through a survey of hospital. Among the 267 employees invited to participate, 267 (100%) completed the surveys. Descriptive statistics have been used to adjust frequency distribution tables and inferential statistics to identify differences in variable relationships. The independent sample T-test and one-way 'ANOVA ' were used to check variations between groups, and SPSS version 25 was used for data analysis.

RESULTS

The findings of this study have shown that organizational learning and non-punitive response to errors have had the highest and lowest scores. Eight out of 12 dimensions of patient safety culture scored lower. Four dimensions of patient safety culture scored the highest. Overall, patient safety culture dimensions were low and poor (44%). This means the patient safety culture at the hospital was poor.

CONCLUSION

The safety culture of the patients at the hospital was inappropriate, particularly in the eight dimensions of the patient safety culture, immediate intervention was necessary. The study emphasizes the creation of a desirable organizational climate, the need for staff involvement in various levels of decision-making, the creation of a culture of error reporting and recognizing the causing factors, and promoting a patient safety culture.

Prevalence of Ever Self-Reported Asthma and Associated Factors among University Students in Iran: A Population-Based Study

Background:

Asthma is a chronic inflammatory airway disease with regressive episodic symptoms. This study aimed to assess the prevalence of asthma ever (lifetime prevalence of asthma) and the associated factors among newly entered students in public universities in Iran.

Methods:

This population-based cross-sectional study was part of the “Mental and Physical Health Assessment of University Students in Iran.” The target population included all newly admitted students (N = 151,671) in 74 public universities in 28 provinces (out of the 31 provinces) in Iran. STATA version 12 was used for calculating the descriptive statistics. Univariate and multivariate logistic regression models were employed to identify relationships between asthma and socioeconomic variables. The level of significance was set at 95% confidence interval.

Results:

Of a total of 79,277 participants, 55.23% (n = 43,785) and 44.77% (n = 35,492) were female and male, respectively. The prevalence of ever asthma among studied student was 1.89%. Of all the participants with asthma, 88.43% (85.49%–90.84%) were nonsmokers. More than 20% of the subjects were physically inactive. The respondents who revealed smoking >10 cigarettes/week were about 1.22 (1.036–1.437) times more likely to suffer from asthma disease (0.017), as compared with those who were not smoking.

Conclusions:

Our study provides valuable information about the prevalence of asthma ever symptoms among university students in Iran. In fact, the results of this study can fill information gaps concerning the affected groups in Iran, and even worldwide.

The design of an estimation norm to assess nurses required for educational and non-educational hospitals using workload indicators of staffing need in Iran

BACKGROUND

One of the effective strategies in the fair distribution of human resources is the use of estimation norm of human workforce. A norm is a coefficient or an indicator for estimating the required human resources in an organization. Due to the changes in the available working hours of nurses in recent years and to use of a standard method, the Iranian Ministry of Health decided to update nursing estimation norm in hospitals in 2014-2015. This study aimed to design a nurse-required estimation norm for educational and non-educational hospitals based on the workload indicator in Iran.

METHODS

This was a descriptive cross-sectional study, carried out from December 2015 to November 2016 in 49 wards in 12 educational and 17 non-educational hospitals in Mashhad, Iran. The wards and hospitals who had the best performance in nursing care quality indicators were selected. Focus group, work study, consensus, interview, and reviewing documents, staff and patient records, and the calculations of modified Workload Indicators of Staffing Needs (WISN) were used to collect the data.

RESULTS

Patient care, cardiopulmonary resuscitation, and transfer out of the hospital were identified as the main activities of holding focus groups. Interviews and reviewing documents led to the identification of 10 factors associated with nurses' available working time. In both educational and non-educational hospitals, the annual working time of all nurses except nurses working in the burn and psychiatric, burn ICU, and pediatric psychiatry wards, which was 1302 h per year, was 1411 h per year. The calculations of the modified WISN method showed that the lowest norm in educational hospitals was for psychiatric, eye surgery, and dermatology wards (0.53) and in non-educational hospitals was for ENT ward (0.57). The highest norm in educational and non-educational hospitals was for burn ICU (3.95) and general ICU (3.07) wards, respectively.

CONCLUSION

The nursing estimation norm in different wards of the hospital varies, considering that the time available to nurses and their workload in different wards and hospitals are different, and each ward has its special norm therefore, a single norm for all wards and hospitals cannot be used for a fair distribution of nurses.

Nurse Staffing Norm in Iran Hospitals: What Features Should be Included for Success?

BACKGROUND

Designing and implementing a model for estimation and distribution of required nurse is one of strategies to prevent unequal distribution of nurses within and between hospitals. The purpose of this research was to determine required features for hospital nursing staff estimation model.

METHODS

We conducted a qualitative study using a Colaizzi analysis approach. We used semi-structure and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in area of policy making in human resources in Ministry of Health, 10 decisions making in employment and distribution of human resources in treatment and administrative chancellors of medical universities, and 12 process owners in hospitals). The data were analyzed using ATLAS.ti software version 6.0.15.

RESULTS

The ten following sub-themes emerged from data analysis: Skill mix and task shifting, work measurement, legal support, stakeholder involvement in designing a model, considering the ward activity, considering type and extent of care patients required, model development by experts predominate in nursing process, considering the nurses availability, considering the capabilities and professional merits of nurses, fitness with social, cultural, and belief of people. The main themes were occupation analysis, planning and policy making, real workload, acceptability, nurses' efficiency, and being a native.

CONCLUSIONS

Given that standardization of nursing staff estimation is announced as one of the challenges in reaching Iran's 20-year vision plan. Hence, design and implementation of a nursing staff estimation model in regard to identified features could be part of priorities in Ministry of Health in Iran.

Barriers against required nurse estimation models applying in Iran hospitals from health system experts' point of view

Introduction

One of the strategies for accessing effective nursing care is to design and implement a nursing estimation model. The purpose of this research was to determine barriers in applying models or norms for estimating the size of a hospital’s nursing team.

Methods

This study was conducted from November 2015 to March 2016 among three levels of managers at the Ministry of Health, medical universities, and hospitals in Iran. We carried out a qualitative study using a Colaizzi method. We used semistructured and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in the area of policymaking in human resources in the Ministry of Health, 10 decision makers in employment and distribution of human resources in treatment and administrative chancellors of Medical Universities, and 12 nursing managers in hospitals). The data were analyzed by Atlas.ti software version 6.0.15.

Results

The following 14 subthemes emerged from data analysis: Lack of specific steward, weakness in attracting stakeholder contributions, lack of authorities trust to the models, lack of mutual interests between stakeholders, shortage of nurses, financial deficit, non-native models, designing models by people unfamiliar with nursing process, lack of attention to the nature of work in each ward, lack of attention to hospital classification, lack of transparency in defining models, reduced nurses available time, increased indirect activity of nurses, and outdated norms. The main themes were inappropriate planning and policymaking in high levels, resource constraints, and poor design of models and lack of updating the model.

Conclusion

The results of present study indicate that many barriers exist in applying models for estimating the size of a hospital’s nursing team. Therefore, for designing an appropriate nursing staff estimation model and implementing it, in addition to considering the present barriers, identifying the norm required features may positively impact on norm acceptance and implementation.

Challenges in the rural family doctor system in Iran in 2013-14: a qualitative approach

BACKGROUND

Family doctor is a medical specialization that provides families and people of all ages, genders and diseases with comprehensive ongoing health services.

OBJECTIVE

The present study wasconducted to describe challenges in the rural family physician program from the perspective of family physician program directors and family doctors in Iran using a qualitative approach.

METHODS

We conducted interviews with 13 family physician program directors and 8 family doctors selected through purposive snowball sampling. The initial in-depth unstructured interviews were reviewed and transformed into semi-structured ones. The data obtained were analyzed in ATLAS.ti using the conceptual framework method.

RESULTS

Nine main concepts (comprehensive planning, medical insurance system, compensation for services, performance evaluation, welfare facilities, recruiting and retaining a workforce, information system, culture-building and financing) and 27 subgroups emerged from the analysis of the data.

CONCLUSION

The main challenges in the family physician program include cultural, economic and environmental factors and work conditions. The implementation of this program can be improved through building a community culture and exercising minor and major modifications.

Active listening: The key of successful communication in hospital managers

Introduction

One of the important causes of medical errors and unintentional harm to patients is ineffective communication. The important part of this skill, in case it has been forgotten, is listening. The objective of this study was to determine whether managers in hospitals listen actively.

Methods

This study was conducted between May and June 2014 among three levels of managers at teaching hospitals in Kerman, Iran. Active Listening skill among hospital managers was measured by self-made Active Listening Skill Scale (ALSS), which consists of the key elements of active listening and has five subscales, i.e., Avoiding Interruption, Maintaining Interest, Postponing Evaluation, Organizing Information, and Showing Interest. The data were analyzed by IBM-SPSS software, version 20, and the Pearson product-moment correlation coefficient, the chi-squared test, and multiple linear regressions.

Results

The mean score of active listening in hospital managers was 2.32 out of 3.The highest score (2.27) was obtained by the first-level managers, and the top managers got the lowest score (2.16). Hospital mangers were best in showing interest and worst in avoiding interruptions. The area of employment was a significant predictor of avoiding interruption and the managers’ gender was a strong predictor of skill in maintaining interest (p < 0.05). The type of management and education can predict postponing evaluation, and the length of employment can predict showing interest (p < 0.05).

Conclusion

There is a necessity for the development of strategies to create more awareness among the hospital managers concerning their active listening skills.

Analysis of Productivity Improvement Act for Clinical Staff Working in the Health System: A Qualitative Study

INTRODUCTION

The productivity of healthcare staff is one of the main issues for health managers. This study explores the concept of executive regulation of Productivity Improvement Act of clinical staff in health.

METHODS

In this study phenomenological methodology has been employed. The data were collected through semi-structured interviews and focus group composed of 10 hospital experts and experts in human resources department working in headquarter of Mashhad University of Medical Sciences and 16 nursing managers working in public and private hospitals of Mashhad using purposive sampling. Findings were analyzed using Colaizzi's seven step method.

RESULTS

The strengths of this Act included increasing spirit of hope in nurses, paying attention to quality of nursing care and decreasing problems related to the work plan development. Some of the weaknesses of Productivity Improvement Act included lack of required executive mechanisms, lack of considering nursing productivity indicator, increasing non-public hospitals problems, discrimination between employees, and removal of resting on night shifts. Suggestions were introduced to strengthen the Act such as increased organizational posts, use of a coefficient for wage in unusual work shifts and consideration of a performance indicator.

CONCLUSION

The results may be used as a proper tool for long term management planning at organization level. Finally, if high quality care by health system staff is expected, in the first step, we should take care of them through proper policy making and focusing on occupational characteristics of the target group so that it does not result in discrimination among the staff.

Situational analysis of human resources in family physician program: survey from iran

Introduction:

Family physician is the increasing efforts to promote physician and other human resources in the health care systems.

Goal:

Investigate Human resources situation of the family physician program in six pilot cities in Khuzestan province in the southwest of Iran.

Methods:

A cross-sectional descriptive study was conducted to examine the family physician program in 2011. In this study, 15 healthcare teams in six pilot cities in Iran were assessed. Data was compiled from family physician officer document in vice treatment of Ahwaz University of medical sciences. National instructions of family physician was used to identify current gaps.

Results:

The survey findings indicated that there is a doctor’s shortage about 36% in the health team that deployed in the first level of referral system. Also on the team, the 34% shortage of nurses and 60% shortages of nutrition personnel are seen. Specialists with offices in cities of second referral level, there have not welcomed the program.

Conclusions:

It seems that to facilitate patient access to physicians under contract with family physician program and the referral system in level two and level three, adopting arrangements to attract specialists and improving their maintenance is necessary.