scholarly journals Challenges of Payment Methods in the Iranian Health System and Solutions: A Qualitative Study

2020 ◽  
Author(s):  
Mohsen Barouni ◽  
Leila Ahmadian ◽  
Hossein Saberi Anari ◽  
Elham Mohsenbeigi
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Monitoring And Evaluation ◽  
Payment Systems ◽  
Structured Interviews ◽  
Negative Effects ◽  
Reimbursement Mechanisms ◽  
Policy Cost ◽  
Iranian Health System

Background: The implementation of different reimbursement methods has various positive and negative effects on the health system of different countries. Identifying the challenges of these methods is essential to improve these reimbursement methods and modify them if required. This article aimed to qualitatively assess the challenges of current hospitals' payment systems in the Iranian health system and determine the required solutions for modifying these payment systems. Methods: This qualitative study was conducted in 2019. Semi-structured interviews were conducted recruiting 20 experts including operational, middle and top managers working in three different levels of health systems. Data collection was continued until it reached a saturation point. MAXQDA 10 was used for data analysis. The data content analysis method was used to analyze the data and the themes and categories were determined. Results: The challenges of the payment systems were categorized into four main themes regarding policy, cost, regulatory and functional challenges, and 15 sub-themes. The findings related to the proposed strategies were presented in six main themes consisting of legal solutions, structural reform, cost, quality improvement, service provider and client, and monitoring and evaluation; and 12 sub-themes. Conclusion: This study showed that the health systems in Iran face various structural and procedural challenges in terms of reimbursement mechanisms. Therefore, it is recommended that policymakers pay attention to these challenges before making any changes. Using hybrid payment systems can be one of the proper solutions.

scholarly journals Identifying Economic Resistance Components in COVID-19 Pandemic: The Case of Iranian Health System

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Erfan Kharazmi ◽  
Jamshid Bahmaei ◽  
Shima Bordbar ◽  
Gholamhossein Mehralian ◽  
Peivand Bastani
Keyword(s):  
Health System ◽  
Health Systems ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Economic Resilience ◽  
Step Method ◽  
Statistical Population ◽  
Resistance Components ◽  
Main Determinants ◽  
Iranian Health System

Background: As economic resistance is largely defined as the capacity of an economy to improve or adapt to the effects of unexpected, exterior shocks such as COVID-19 pandemic for health systems, the purpose of this study was to identify the economic resistance components of the Iranian health system during COVID-19 pandemic. Methods: This qualitative study was conducted using the content analysis method from 2020 to 2021. The statistical population of the study consisted of health system experts who are familiar with the subject of resistance economy. Using the snowball sampling method, semi-structured interviews with 30 selected participants were done. The reliability and transparency were determined by Guba and Linkon criteria such as credibility, transferability, confirmability, and consistency, or dependability. Data were analyzed using the Clarke and Braun thematic six-step method. Results: It was found that economic growth, economic stability, justice, and economic resilience, as four main components, affected the economic resistance of the health system in COVID-19 pandemic. Each of these components encompasses a number of sub-components that can help reinforce the health system in two restorative and resilient categories. Conclusions: To the best of our knowledge, a comprehensive study with an exploratory approach was not retrieved to find the main determinants of economic resistance components in COVID-19 pandemic. The present study can greatly contribute to the available knowledge to guide the policymakers for better understanding of the system during unexpected situations and applying the most applied solutions as well. It may help the health systems particularly those who encounter unpleasant macro-trends and unplanned crises, to keep their preparedness and readiness and improve their resilience.

scholarly journals Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Embleton Lonnie ◽  
Shah Pooja ◽  
Gayapersad Allison ◽  
Kiptui Reuben ◽  
Ayuku David ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Cultural Context ◽  
Healthcare Providers ◽  
Children And Youth ◽  
Economic Factors ◽  
Health Coverage ◽  
Socially Constructed ◽  
Prompt Attention

Abstract Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

scholarly journals Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

2020 ◽  
Vol 5 (4) ◽  
pp. e002272 ◽  
Author(s):  
Dell D Saulnier ◽  
Hom Hean ◽  
Dawin Thol ◽  
Por Ir ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health System ◽  
Health Systems ◽  
Public Health System ◽  
Health Needs ◽  
Structured Interviews ◽  
The Public ◽  
Pregnancy And Childbirth ◽  
Childbirth Care

IntroductionResilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.MethodsEight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.ResultsThe theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.ConclusionsThe community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods.

scholarly journals What Are the Sources and Negative Effects of Assistant Principals’ Work Intensification?

SAGE Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 215824402110475
Author(s):  
Ramazan Cansoy ◽  
Muhammet Emin Türkoğlu ◽  
Abdullah Balıkçı
Keyword(s):  
Qualitative Study ◽  
Social Relationships ◽  
Assistant Principals ◽  
Structured Interviews ◽  
Work Family Conflict ◽  
Negative Effects ◽  
Work Habits ◽  
Social Events ◽  
Work Intensification ◽  
Work Family

This study sought to provide an understanding of the sources of work intensification and its effects on assistant principals in Turkey, and the coping strategies they use. The participants of this qualitative study were a sample of 18 assistant principals. The current qualitative study was based on semi-structured interviews. Data analysis was performed through descriptive and content analysis. This study revealed that assistant principals had work intensification related to heavy paperwork, a variety of administrative affairs, a variety of tasks, school size, and lack of experience. Assistant principals’ work intensification caused negative psychological and physical health, work-family conflict, limited social relationships, and a decrease in professional commitment. Assistant principals spent time with their families, engaged in task sharing, received support from colleagues, took part in various social events, planned work habits and managed priorities to reduce the negative effects of work intensification.

scholarly journals Future Challenges of Nursing in Health System of Iran

2021 ◽  
Author(s):  
Salman Barasteh ◽  
Maryam rassouli ◽  
Mohammad Reza Karimirad ◽  
Abbas Ebadi
Keyword(s):  
Nursing Education ◽  
Health System ◽  
Universal Health Coverage ◽  
Monitoring And Evaluation ◽  
Health Coverage ◽  
Structured Interviews ◽  
Framework Analysis ◽  
The Future ◽  
Future Challenges ◽  
Universal Health

Abstract Background: Nursing development is considered as one of the most important ways to achieve the universal health coverage and sustainable develop goals in different countries. Nursing in Iran has the potential to provide services at all levels of universal health coverage. Therefore, planning for nursing in Iran needs to recognize the future challenges. This study aims to explore the future challenges of nursing in the health system of Iran from the view of expertsMethods: In this qualitative study, 11 semi-structured interviews were conducted with nursing experts by purposive sampling in 2017-2018. Interviews were recorded and transcribed and framework analysis method were used to analysis the data.Results: The results showed that a favorable future requires planning in three areas of nursing governance challenges, including centralized nursing stewardship, policy-making and legislation, monitoring and evaluation, and cooperation and communication with other institutions, inadequacy of professional development with social demands, including community-based nursing, nursing upgrades with disease patterns, expanding home care, expanding care centers, and use of technology, the challenge of human resource management, including nursing education tailored to the needs of the community, empowering nursing managers, recruiting and retaining nurses, and specialized nursing.Conclusions: A favorable future requires establishing a coherent nursing government, professional developing of nursing based on social demands, and enhancing human resources in line with the emerging needs of the future.

scholarly journals Evaluating and strengthening the health system of Curaҫao to improve its performance for future outbreaks of vector-borne diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Vaitiare Mulderij-Jansen ◽  
Izzy Gerstenbluth ◽  
Ashley Duits ◽  
Adriana Tami ◽  
Ajay Bailey
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
Entomological Surveillance ◽  
Vector Borne Diseases ◽  
System Building ◽  
Vector Borne ◽  
Dutch Caribbean ◽  
Health System Building Blocks

Abstract Background Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks. Methods From November 2018 to December 2020, a multi-method qualitative study was performed in Curaçao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data. Results This study’s data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance). Conclusions This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases. Graphical abstract

scholarly journals The Limbo Atmosphere in operating room settings Caused by Disruptive Behaviors: A Qualitative Study

2020 ◽  
Author(s):  
Sahar Mirzaei ◽  
Marzieh Pazokian ◽  
Foroozan Atashzadeh-Shoorideh ◽  
Seyed Amir Hosein Pishgooie
Keyword(s):  
Qualitative Study ◽  
Operating Room ◽  
Disruptive Behaviors ◽  
University Hospitals ◽  
Structured Interviews ◽  
Negative Effects ◽  
Team Working ◽  
Operating Room Nurses ◽  
Great Pressure ◽  
And Performance

Abstract Background Operating room nurses are one of the groups frequently expose to Disruptive Behaviors in different situations in the operating rooms that have different impacts on them and their performance. Recognition of DBs and their effects can help to offer strategies for better management of these behaviors. This study aimed to explore the experiences of Iranian operating room nurses regarding Disruptive Behaviors in operating room settings.Methods This is a descriptive qualitative study conducted in university hospitals in Tehran. The data were collected by deep semi-structured interviews with a total number of 17 operating room nurses selected purposefully. Finally, the data were analyzed with the conventional content analysis approach.Results Five categories were extracted from the study, including "activity in a poisonous atmosphere", "role subtraction", "escape to a safe margin", "adaptation to stay calm", and "Indirect confrontation". Finally, a theme was "struggle in a limbo Atmosphere caused by Disruptive Behaviors".Conclusion Under great pressure of surgeon’s Disruptive Behaviors, operating room nurses were struggling to maintain their balance and performance at possible. Considering the effect of Disruptive Behavior, it seems necessary to take training measures for improving team-working in operation room settings. Besides, monitoring and follow-up such behaviors according to negative effects is necessary.

scholarly journals How Do Health Systems Address Patient Flow When Services Are Misaligned With Population Needs? A Qualitative Study

2021 ◽  
Author(s):  
Sara Kreindler ◽  
Zaid Aboud ◽  
Stephanie Hastings ◽  
Shannon Winters ◽  
Keir Johnson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Patient Flow ◽  
Comparative Method ◽  
System Level ◽  
Flow Problems ◽  
Systemic Problems ◽  
System Issue ◽  
Population Capacity

Background: Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and population needs, requiring fundamental system redesign. However, little is known about health systems’ approaches to population–capacity misalignment, and guidance for system redesign remains underdeveloped. Methods: This qualitative study, part of a broader investigation of patient flow in urban Western Canada, explored health-system strategies to address or prevent population–capacity misalignment. We conducted in-depth interviews with a purposive sample of managers in 10 jurisdictions across 4 provinces (N = 300), spanning all healthcare sectors and levels of management. We used the constant comparative method to develop an understanding of relevant strategies and derive principles for system design. Results: All regions showed evidence of pervasive population–capacity misalignment. The most superficial level of response – mutual accommodation (case-by-case problem solving) – was most prevalent; capacity (re)allocation occurred less frequently; population redefinition most rarely. Participants’ insights yielded a general principle: Define populations on the basis of clusters of co-occurring need. However, defining such clusters demands a difficult balance between narrowness/rigidity and breadth/flexibility. Deeper analysis suggested a further principle: Populations that can be divided into homogeneous subgroups experiencing similar needs (eg, surgical patients) are best served by narrow/ rigid models; heterogeneous populations featuring diverse constellations of need (eg, frail older adults) require broad/ flexible models. Conclusion: To remedy population–capacity misalignment, health system planners should determine whether clusters of population need are separable vs. fused, select an appropriate service model for each population, allocate sufficient capacity, and only then promote mutual accommodation to address exceptions. Overreliance on case-by-case solutions to systemic problems ensures the persistence of population–capacity misalignment.

scholarly journals Donors' Participation in Iran's Health System: Challenges and Solutions

2021 ◽  
Author(s):  
Ali Mohammad Mosadeghrad ◽  
Maryam Tajvar ◽  
Fatemeh Ehteshami
Keyword(s):  
Health System ◽  
Health Sector ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Senior Managers ◽  
Department Of Health ◽  
The Social ◽  
The Right ◽  
Iranian Health System

Background: Philanthropic activities play an important role in health systems. Donors contribute to financing, generating resources, and providing healthcare services in Iranian health system. However, they face many challenges. This study aimed to identify barriers to donors' participation in the Iranian health system and to provide solutions. Methods: This qualitative study was performed using semi-structured interviews with 38 donors and 26 policymakers and managers in the social affairs department of health ministry and medical universities in 2018. In addition, document analysis was performed and the relevant data were extracted. Thematic analysis was used for data analysis. All ethical considerations were followed in this research. Results: Insufficient structures, poor communications, low trust, ineffective working processes, bureaucracy, insufficient senior managers’ support, weak legal support and poor monitoring were the most important challenges for donors’ participation in the Iranian health system. Effective donor participation in the health system requires the creation of an appropriate system including the right structures, processes, culture, and management. The necessary changes must be planned, led and monitored to promote donors’ participation in healthcare. A conceptual model was developed to strengthen donors’ participation in the health system. Conclusion: Iranian donors face structural, procedural, cultural, and managerial challenges when financing the health system, generating resources, and providing health services. Policymakers and managers should tackle these challenges and adopt strategies to reinforce donors' participation in the health system. Planning, organizing, leading, monitoring, evaluation, transparency, accountability, and a commitment to meet donors’ needs are necessary for successful philanthropy initiatives in the health sector.

Perspectives on healthcare providers’ role in health promotion among cancer survivors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24037-e24037
Author(s):  
Karina I. Halilova ◽  
Nataliya V. Ivankova ◽  
Laura Q. Rogers ◽  
Maria Pisu ◽  
Fontaine R. Kevin ◽  
...  
Keyword(s):  
Health Promotion ◽  
Cancer Survivors ◽  
Health System ◽  
Health Systems ◽  
Cancer Survivorship ◽  
Cancer Care ◽  
Healthy Lifestyle ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
Web Based

e24037 Background: To further integrate health promotion into cancer survivorship care, we explored multilevel perspectives on potential roles healthcare providers could have in promoting uptake of web-based healthy lifestyle programs among cancer survivors. Methods: In developing the Aim, Plan, and Act on Lifestyles (AMPLIFY) Survivor Health diet and exercise web-based program, we conducted 10 focus groups with 57 cancer survivors and 27 individual semi-structured interviews with stakeholders representing advocacy groups (e.g., cancer survivorship support foundations; n = 8), cancer organizations (e.g., industry, health system; n = 11), and survivors’ supportive partners (n = 8). Verbatim transcripts were analyzed by multiple coders using inductive thematic analysis with NVivo 12. Results: Survivors (49% female; 40% African-American, mean age 63.7 years) and stakeholders (60% female) stated that healthcare provider and health system recommendation and support are vital for ensuring acceptance and use of web-based healthy lifestyle programs by cancer survivors. Survivors expressed that physician’s (e.g., oncologist, other physician) recommendation and support would motivate them to join and participate. Supportive partners also endorsed the importance of provider recommendations and the key role of health system support (e.g., reminders in doctor’s office, hospitals, web-based portal, and endorsement from cancer centers). Advocacy group representatives underscored the importance of data-driven support for the effects of such programs as critical for promotion. Moreover, technology supported continuous cancer care (e.g., physician communication and feedback) were seen as critical for sustained participation. Stakeholders from cancer organizations suggested survivors in need could be identified and referred during assessments in various cancer care clinics. This group also emphasized the need to integrate evidence-based healthy lifestyle recommendations into continuing medical education, medical board certifications, support and referrals into existing standard of cancer care, and to involve other key stakeholders and larger scale health systems in promotion. Conclusions: Healthcare providers and health systems have important roles in promoting and sustaining participation in web-based healthy lifestyle programs among cancer survivors. Further work developing, testing, and refining strategies to enhance their role in promoting the acceptability and uptake of healthy lifestyle programs by cancer survivors are needed.

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