per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 164 164 article Firoz Aslani 1 Mahnaz Afshari 2 No Abstract http://mshsj.ssu.ac.ir/article-1-217-en.pdf No Keywords per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 165 167 article Hosein Ameri 1 Assistant Professor, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Equity in health financing is an important health policy objective worldwide. A health system is fair in the case that its financing is in proportion to the household’s ability to pay. The households are facing Catastrophic Health Expenditure (CHE) when their health expenditure exceeds their ability to pay. The Ministry of Health and Medical Education (MHME) (Iran) has launched reforms in the health sector evolution plan (HSEP) to improve the conditions in Iran’s health system. One of the main objectives of this plan was financial protection of people. In order to achieve its goals, the program tried to expand the population coverage through pre-payment mechanisms, protect the poor and disadvantaged people, design a benefits package, and decide the level of cost sharing by the patients. http://mshsj.ssu.ac.ir/article-1-208-en.pdf Equity Financing Catastrophic health expenditure per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 168 183 article Rozita Firooznia 1 Hossein Dargahi 2 Tohid Jafari-Koshki 3 Zeinab Khaledian 4 Ph.D. student of Healthcare Management, School of Medical Sciences, Islamic Azad University, Semnan Branch, Semnan , Iran Professor, Health Information Management Research Center, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Assistant Professor, Road Traffic Injury Research Center, Department of Statistics and Epidemiology, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran Instructor, School of Medical Sciences, Department of Midwifery, Islamic Azad University, Semnan Branch, Semnan, Iran Background: Maternal health program plays an important role in community health, so this study was conducted to analyze the strategic system of maternal health program evaluation for providing improvement strategies using internal-external environment assessment technique in Iran. Methods: This qualitative study was conducted using the internal-external environment assessment technique. The required data were collected using a qualitative semi-structured questionnaire. The items included the strengths, weaknesses, opportunities, threats, and proposed strategies for improving the performance of the evaluation system. The study experts comprised of 40 health professionals with least 10 years of experience in the maternal health program. They were working in the field of population and family health in the health deputies of Iran medical sciences' universities. The provided points of views by the experts were categorized and reported based on the contents and the internal-external environment assessment matrix was used to develop the strategy.   Results: This study resulted in a comprehensive strategic analysis of the positive and negative points in the internal and external environment of maternal health program evaluation system. The proposed strategies by experts were categorized in 7 main domains under the topics of strengthening the monitoring and evaluation tools, enhancing the monitoring and evaluation process, reforming the clinical information system, establishing a national independent evaluation organization, strengthening the motivation of human resources, enhancing the internal and external coordination, and procuring of the sustainable financial and physical resources. Conclusion: The results indicate that there are important internal weaknesses and external threats in this evaluation system, but they can be overcome by designing and implementing the appropriate promotion strategies. http://mshsj.ssu.ac.ir/article-1-209-en.pdf Maternal health Evaluation Strategy per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 184 200 article Ali Mohammad Mosadeghrad 1 Parvaneh Isfahani 2 Associate Professor, Health Information Management Research Centre, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Assistant Professor, Department of Healthcare Management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran Background: Strategy formulation and implementation in healthcare is challenging. This study aimed to examine strategic planning challenges in Tehran province hospitals. Methods: This study was a cross-sectional study which conducted in 2016. 93 hospital managers participated in the study using census sampling. Data were collected using self-administrated questionnaire with a reliability of 0.85. Data analysis was carried out using descriptive and analytical tests such as Spearman correlation and regression with SPSS 19 software. Results: The mean score of strategic planning implementation barriers in Tehran province hospitals was 2.98 out of 5.00 score. Structural barriers (3.31) and managerial barriers (2.69) were the most and least barriers of strategic planning respectively. Procedural, cultural and technical barriers had the largest impact on strategic planning implementation. Physicians’ participation in strategic planning was low. There was significant statistical correlation between managers’ commitment to strategic planning and employees' involvement in strategy implementation (p < 0.05). Conclusion: Tehran province hospitals encountered many barriers in implementing strategic planning. Hospital managers should overcome these barriers before strategy formulation and implementation. http://mshsj.ssu.ac.ir/article-1-210-en.pdf Strategic planning Challenge Barriers Hospital per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 201 211 article Behrouz Pour Agha 1 Kobra Sharif Kazemi 2 Morteza Sadeghi 3 Assistant Professor, Department of Healthcare Management, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran MSc in Healthcare Management, Abyek Health City Health Network, Qazvin University of Medical Sciences, Qazvin, Iran BSc in Business Administration, Department of Business, School of Management, Payame Noor University, Karaj, Iran Background: Hospitals as one of the most important organizations in the service sector of Iran need creative and innovative managers to survive. We need such managers in today's turbulent environment. In order to have creative and innovative managers, appropriate contexts are required to enable the growth of ideas and bring them to the implementation phase. The aim of this study was to investigate the individual and organizational factors affecting the creativity and innovation of the managers of hospitals in Karaj city, Iran. Methods: The present cross-sectional study was conducted in hospitals of Karaj city, Iran. The sample size consisted of 63 senior managers of public and private hospitals in Karaj using census method. Data were collected by standard questionnaire and analyzed by descriptive statistics using SPSS 16. Results: The most important individual factor affecting managers' creativity was tolerance of ambiguity (having doubt and indecision) in dealing with issues (mean score = 1.73). The most important organizational factor affecting the creativity of managers was decentralization of hospital structure with the mean score of 1.76. Moreover, the most important individual factor affecting managers 'innovation was patience in implementing their new ideas with a mean score of 1.24.  The most important organizational factor in this regard was the flexibility of the payroll system with a mean score of 1.54. Conclusion: In order to promote the creativity of managers, more authority  should be delegated to them. They also should attend the creative thinking courses. Furthermore, the payroll systems should be based on creativity. In order to promote innovation, innovative managers should be supported and appreciated with appropriate material and moral rewards. http://mshsj.ssu.ac.ir/article-1-211-en.pdf Creativity Innovation Hospital per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 212 224 article Zohreh Khalajinia 1 Mina Gaeeni 2 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran Background: The health system reform was implemented with 3 approaches of financial protection of people, creating equity in accessing health services, and improving quality in May 2014. The health care reform, similar to any other plans was faced with some challenges. This study aimed to explain the challenges of health care reform in the area of treatment in Qom city, Iran. Methods: In this qualitative study, purposive sampling was applied to collect the participants. In this regard, 23 service providers (health managers and workers) working in the educational-treatment centers affiliated to Qom University of Medical Sciences and 5 service recipients were selected in 2017-2018. The semi-structured interviews were conducted to collect the required data. Data analyses were performed using conventional content analysis method by MaxQDA 10 software. Results: A total of 5 main themes, including: “economic challenges", “induced demand”, “human resources”, “reform negative outcomes”, and “improper infra-structure” were derived from data analysis. Conclusion: Findings of this study explained the main challenges of health care reform in the area of treatment. Lack of appropriate planning for these challenges will face the implementation of reform with serious problems. Therefore, implementation and continuation of this project require comprehensive support as well as appropriate planning and policy making from the authorities. http://mshsj.ssu.ac.ir/article-1-212-en.pdf Health care reform Challenge Qualitative research per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 225 239 article Mohammad Amin Bahrami 1 Mohsen Pakdaman 2 Leila Chehreghani 3 Ahmad Rahbar 4 Associate Professor, Department of Healthcare Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran Assistant Professor, Health Policy and Management Research Center, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran MSc student in Healthcare Management, Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Assistant Professor، Department of Healthcare Management, School of Public Health, Qom University of Medical Sciences, Qom, Iran Background: The benefits of health services are affected by several factors. The possible consequences of such factors affect the utilization rate of health services and may lead to higher costs of health care induced by the increased use of medical care services. Therefore, this study was conducted to investigate the effect of patient-related factors on the utilization rate of health services among the selected hospitals of Qom city in 2017. Methods: The present cross-sectional descriptive-analytic study was carried out in 2017. Data were collected using Goldberg standard health questionnaire and a checklist completed by 400 patients who referred to the selected hospitals of Qom city. Data were analyzed by Stata 13 and the logistic regression test was run to determine the effect of independent variables (effective factors on the use of services) on the dependent variable (service usage). Later, we analyzed results of the regression tests and investigated the relationship of the independent factors and the demographic information on the use of services. Results: The results of logistic regression tests showed the utilization rate of services by investigating the relationship among demographic, independent, and dependent variables. We found that utilization rate of health services increased by the following factors: older age, female gender, higher number of family members, higher family income, higher education level of the head of household, higher education level of patients, and residence in urban areas of Qom city. Further factors included being native of the city, being under the basic and supplementary insurance coverage, and having poor health status. Moreover, married head of family, employment of family members in the medical care system, near distance to the hospital, and more leaves from work led to more application of services. In addition, patients who spent more days to take the doctor's visit, spent more time in the clinic to visit the doctor, and had longer visit duration by the physician used the services more frequently. Furthermore, utilization rate of services had a statistically significant relationship with the health status of the individual, the marital status of the family head, and the visit duration by the physician. Conclusion: Considering the effective factors on utilization rate of services by patients, health system administrators can analyze the risk factors and make practical suggestions to control and reduce the false use of services by patients and physicians. In this regard, they can implement incentive and punitive mechanisms, create awareness among people about the challenges and risks of the induced demand, change the strategies, modify the insurance payments, rate the level of services for different classes of the society, and maintain the financial resources to meet the needs.   http://mshsj.ssu.ac.ir/article-1-215-en.pdf Demand Health insurance Health care per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 240 248 article Pari Ranjbari 1 Khalil Alimohammadzadeh 2 Seyed Mojtaba Hosseini 3 MSc student in Healthcare Management, School of Management and Social Sciences, North Tehran Branch, Islamic Azad University, Tehran, Iran Associate Professor, Department of Healthcare Management, School of Management and Social Sciences, North Tehran Branch, Islamic Azad University, Tehran, Iran Assistant Professor, Department of Healthcare Management, School of Management and Social Sciences, North Tehran Branch, Islamic Azad University, Tehran, Iran Background: Relationship between physicians and nurses includes the interactive interactions to achieve a common treatment goal, i.e., improving the health and safety of the patient. The present study aimed to investigate the relationship of physician-nurses interaction with the patient safety incidents in Amir-Al-Momenin hospital in Tehran city, Iran. Methods: This applied, analytical, and cross-sectional study was carried out in 2017. The study population consisted of all full-time physicians (N = 45) and nurses (N =186) of Amir-Al-Momenin hospital in Tehran city. They were selected using the census and convenience sampling methods. To collect data, we used a four-part questionnaire including demographic data, physicians' viewpoints about the nurse-physician interaction, nurses' viewpoints about nurse-physician interaction, and patients' safety events. Data were analyzed by SPSS 22 using Fisher exact test. Results: We found that 45 physicians (100 %) and 174 nurses (93.54 %) completed the questionnaires. The physicians reported that the nurse-physician interactions were moderate (80.0 %), good (11.1 %), and bad (8.9 %). However, nurses believed that this relationship was moderate (74.7 %), good (18.4 %), and bad (6.9 %).  A significant relationship was observed between the nurse-physician interaction and patients' safety events in 10 cases of events (p < 0.05).   Conclusion: Patients' safety events can be related to the type of nurse-physician interaction. So, improvement of the nurse-physician interaction should be considered more seriously as an effective factor in patients' safety.   http://mshsj.ssu.ac.ir/article-1-214-en.pdf Physician-Nurse relations Patient safety Hospital per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2018-12 3 3 249 262 article Keivan Rahmani 1 Reza Rezayatmand 2 Niyousha Sadeghpour 3 Mahsa Nikaeen 4 Samira Arabi 5 Yasamin Molavi Taleghani 6 Ph.D. student in Health services Administration, Student Research Committee, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran Assistant Professor, Health Management and Economics Research Center, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran MD student, School of Medical, Isfahan University of Medical Sciences, Isfahan, Iran Post Graduate student, Department of Operative Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran MSc student in Health services Administration, School of Public Health and Safety, Shahid Behshti University of Medical Sciences, Tehran, Iran Ph.D. student of Health services Administration, Health Management and Economics Research Center, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran Background: Rationing is considered as a solution to control the costs and increase the efficiency in using the limited resources of the healthcare system. Therefore, this study was conducted to review the studies carried out on rationing in different countries and to provide suggestion for Iran's healthcare system. Methods: This systematic review was carried out to find the papers published in this regard. To hit this target, we searched the English databases (web of knowledge, PubMed, Scopus, Ovid and Science Direct) using the keywords of "rationing, stewardship, policy making, healthcare, health care, coverage, and services". We selected the related studies and assessed their quality. Authors reached consensus regarding the included studies in order to avoid making errors. Results: We searched the keywords and found 2880 relevant papers. The inclusion criteria were applied and 29 eligible papers were selected finally. A conceptual framework was suggested for rationing at three levels of financing (out of pocket payment, age-based risk assessment, service package, payment to providers), rendering services (evidence-based medicine, duration and the waiting list of services, and medicinal pharmacopoeia), and providing resources (distribution of leveling services, workforce competence, assessment of health technology and pharmaceuticals). Conclusion: Considering the increased health care costs and restrictions of resources for increasing demands, rationing is inevitable. With regard to the proposed conceptual model, the solutions to clarify the rationing policy in the healthcare system of Iran include: creation of information dashboard, implementation of clinical guidelines, homogenization of service packages provided by insurance funds, health technology assessment, and assessment of social preferences. http://mshsj.ssu.ac.ir/article-1-213-en.pdf Rationing Healthcare system Cost decrease