Social Stigma: A New Challenge for the Health System in the Control and Management of Covid-19

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The Deadly Nature of the Virus Depression: Iranian Medical Staff Battling COVID-19

Background: COVID-19, which began in December 2019 in China, can have a broader impact on individuals' mental dimensions. Meanwhile, the medical staff battling this epidemic are more at risk of mental and emotional problems. This study aimed to examine the level of stress, anxiety, and depression and their relationship with the level of knowledge of medical staff battling in COVID-19 pandemic treatment. Methods: This descriptive-analytical study was conducted on 641 medical staff using an online platform to design the questionnaire, and its link was placed in different groups of social networks all over the country in which the medical staff battling COVID 19 were members. Statistical analysis was performed by SPSS 25 and Kolmogorov-Smirnov test, independent samples t-test, independent one-way analysis of variance, and chi-square. Results: Higher knowledge about COVID-19 was associated with younger age, clinicians, and nurses. Moreover, females were more knowledgeable in terms of support; while males were more reliable in washing hands and disinfecting wet places. Based on the categorical version of psychological factors, the majority of cases had severe stress ( 39.80 % ), normal depression ( 48.50 % ), and normal anxiety ( 57.30 % ). Finally, it was found that married participants had more knowledge about COVID-19, but knew less about its fatality. Conclusion: Studies have shown negative psychological experiences caused by COVID-19 in nurses, including negative emotions, such as fatigue, discomfort, helplessness due to high-intensity work, anxiety, and worry about family members.

Customer Lifetime Value of Supplementary Health Insurance: An Analytical Model

Background: With the number of insurance customers growing, insurance companies are trying new ways to retain customers and streamline communication channels to avoid loss of revenue. The present study set out to develop a model for a reliable analysis of customer lifetime value. Methods: The present study was exploratory mixed method in design. The study took place in Jundishapur University of Medical Sciences, located in Ahvaz, Iran. A total of 402 insurance experts and university staffers participated in the study. A cross-sectional data collection was done using semi-structured interviews (n = 22) and a questionnaire (n = 380). The latter was validated via a panel of content area experts, criterion-dependent validity (second-order confirmatory factor analysis), and divergent validity (cross-sectional load test and Fornell-Laker). Cronbach's alpha and combined reliability were - 0.8 and 0.8, respectively. A structural equation approach was employed to analyze data using Smart PLS software. Results: Customer loyalty with an impact factor of 0.60 and T-statistic of 5.79, profitability with an impact factor of 0.55 and T-statistic of 3.75, customer co-creation with an impact factor of 0.28, and T-statistic of 2.7 have been identified as dimensions of customer lifetime value. Conclusion: Measuring customer lifetime value to implement various strategies requires a deep understanding of such value dimensions as loyalty, profitability, and value creation.

Evaluation of Inpatient Surgical Wards' Performance at the Hospitals Affiliated with Tehran University of Medical Sciences in 2018

Background: Surgery wards account for a significant portion of hospital costs, followed by patient costs. Improving surgery wards' performance plays a major role in enhancing the accountability and efficiency of the hospital. This study aimed to evaluate the performance of inpatient surgical wards at the hospitals affiliated with Tehran University of Medical Sciences(TUMS). Methods: A descriptive, cross-sectional, retrospective study was performed at all hospitals affiliated with TUMS in 2018. To measure the efficiency of these wards, three indicators have been considered; bed occupancy rate, the average length of stay, and bed turnover. Data have been analyzed using Excel software based on the Pabon Lasso model . Results: Among the 15 active surgical departments, 5 (33.31 %) were categorized in quadrant three, including ophthalmology, obstetrics and gynecology, vascular and trauma surgery, plastic surgery, and infertility department. The oral and maxillofacial surgery and general surgery departments were the poorest in their performance and located in quadrant one. Ten surgical wards out of 38 (26.33 %) have reported a satisfactory performance. Conclusion: Understanding and comparing the performance of clinical departments is also useful in making decisions for standardizing the patterns of health services delivery, evidence-based management in health care centers, and enhancing accountability in the health system. It is suggested that managers revise the departments in the inefficient area to reduce the number of inefficient departments or attract more patients by marketing, diversifying services, and increasing the quality of services.

The Effect of Health Transformation Plan on Out-of-Pocket Payments of the Hospitalized Patients in Hamedan, Iran

Background: Out-of-Pocket (OOP) payment is categorized among the critical indicators of health system financing. Given the high hospitalization costs of the hospitals, the ministry of health has attempted to implement Health Transformation Plan (HTP) in Iran to reduce OOP. The purpose of this paper is to show the effects of HTP on OOP payments of the hospitalized patients in Hamedan, Iran. Methods: This descriptive-analytical study was carried out on 587 patients in the educational hospitals of Hamedan. The data obtained before and after implementing the HTP was from 2013 to 2015. Data analysis was performed using SPSS16. Results: In this study, each patient's expenditures increased by 32.2 % in 2015, compared to before the implementation of the HTP. Therefore, the health insurance organization's coverage of OOP payments decreased to 8.3 % of the total costs by a 20.2 % reduction in 2015, compared to before the implementation of the plan. Conclusion: According to the study, HTP and government health subsidies were adequate, but the total hospitalization costs had an upward trend in all funds.

Social Capital and Educational Performance of Students: The Mediating Role of Entrepreneurial Behavior

Background: Nowadays, most organizations, including universities, are subject to significant changes. Thus, in order to adapt themselves successfully with such variations, they need skillful, innovative, self-confident, and entrepreneurial individuals. Accordingly, this study was conducted to predict medical university students' educational performance based on the existing social capital and their entrepreneurial behavior. Methods: A cross-sectional study was done in 2019 based on Structural Equation Modeling (SEM) among 260 students of Qazvin Medical University. To collect information, three standard questionnaires, including Nahapiet and Ghoshal (1998) social capital questionnaire, the entrepreneurial behavior questionnaire of Leon Dice, and the entrepreneurial performance questionnaire of Zamptakis and Vasilis Mustakis (2007), were used. After entering data in AMOS software, the associations between variables were analyzed by structural equation modeling. Results: Findings revealed that social capital and entrepreneurial behavior were influencing factors on the educational performance of students. The direct and indirect effects of social capital on educational performance (path coefficients: 0.798 and 0.44 respectively) were affirmed (P-value < 0.05). Conclusion: Promoting social capital, innovation, and entrepreneurial behavior among university students can improve the educational performance of students. Thus, applying effective strategies to create trust in the education system and designing new approaches to use motivational methods in strengthening students' sense of creativity and innovative capabilities can effectively contribute to the improvement of their educational performance.

Correlation Between Health Literacy and Quality of Life Among the Elderly: The Community Versa Nursing Home

Background: Enhancing health literacy may improve health-related quality of life. Given the more educational programs in nursing homes, this study aimed to determine the relationship between health literacy and the quality of life among the elderly living in nursing homes and those living with their families in Ahvaz, Iran. Methods: This descriptive-analytical cross-sectional study was conducted in 2017. The research population was the elderly in Ahvaz city, Iran. This population consisted of two groups, those living in nursing homes and those who do not. There were 62 samples. Random cluster sampling was used to select the participants. The data collection tools included a demographic questionnaire as well as Test of Functional Health Literacy in Adults (TOFHLA) and LEIPAD questionnaires. The data were analyzed by independent t-test, Mann-Whitney test, Spearman correlation, and Chi-square test using SPSS 19. Results: The mean health literacy of the elderly living in nursing homes estimated to be relatively desirable (3.60 ± 0.77) and the mean health literacy of the elderly not living in nursing homes was estimated to be relatively undesirable (2.30 ± 0.83). The quality of life was estimated to be moderate for both groups, the mean score for nursing homes was 2.65 ± 0.37 and for the community was 2.98 ± 0.52. Simple regression indicated that appraisal and decision, among the subscales of health literacy, are predicting factors for quality of life in the elderly. Conclusion: Using self-help groups and the participation of the elderly in decision making as well as designing educational programs for identifying the accuracy of health information of the media and encouraging them to share health knowledge with others can ultimately improve quality of life in the elderly.

Satisfaction Level with the Health Transformation Plan in Iran: A Systematic Review

Background: The Health Transformation Plan (HTP) had been one of the most significant recent reforms in the Iranian health system. Notwithstanding, it has strengths and weaknesses that should be assessed. One of the most important aspects of assessing programs is the people and the personnel's satisfaction. Consequently, this study has reviewed studies that have measured satisfaction with HTP. Methods: In this systematic review, databases of Web of Science, Scopus, PubMed, Google Scholar were searched until May 2019. The Ministry of Health website, and the National Institutes of Health Research website were also searched. All studies that evaluated HTP satisfaction were included. Data were collected and analyzed utilizing a data extraction form and reported by narrative review. Results: 20 studies were included that were conducted in the period 2014 to 2017. The overall results of the studies indicate that nurses and physicians have not been satisfied with HTP, while retaining physicians in disadvantaged regions and patients have been approximately satisfied with HTP. Only three before and after studies have been conducted, and the rest studies are related to after HTP. Two before and after studies concluded that patients and nurses 'satisfaction is decreased and one study concluded that mothers' satisfaction is increased. Nurses and physicians dissatisfaction was due to the causes such as increasing the number of clients, injustice in payments, unbalanced workload and salary and other working conditions. Conclusion: Influential, comprehensive, and national studies, including satisfactory before- and after-studies, are still not available to draw definite conclusions about public and employee satisfaction with HTP. It appears that despite the expensive cost of HTP and relative satisfaction of patients, the government did not meet all the demands of nurses and some physicians.

Assessing Cost of Quality in a Medical Device Division of a Training Hospital: A Case Study in Iran

Background: Cost of Quality is an approach that helps organizations evaluate the extent to which their resources are used to prevent poor quality activities, assess the quality of provided services, or evaluate the number of resources that are wasted due to the internal and external failures occurring in a system. The research objective was to measure the Cost of Quality(CoQ) in a medical device division of a hospital in Qazvin, Iran. Methods: We performed a qualitative study in the medical device division in a public hospital affiliated with Qazvin University of Medical Sciences, Iran in 2020. To measure and report the (CoQ) in the division, the Prevention-Appraisal-Failure (PAF) model was used. Data were collected through document review, semi-structured interview, and group discussion, which were entered into the Excel software to calculate their distribution and frequencies using the descriptive statistics method. Results: Among different cost categories, the highest amount of expenditures belonged to internal and external failure costs. Results also revealed that several factors were responsible for the failures, including lack of knowledge of personnel about the proper use of medical devices; failure to periodically perform calibration on due dates; lack of adequate supervision; stress and work pressure among employees; and lack of managerial commitment toward the importance of preventive maintenance. Conclusion: In order to decrease the number of failures occurring in a working system, it is required to increase personnel's knowledge about the proper use of medical devices, perform calibration of devices on due dates, increase managerial commitment toward preventive and quality appraisal activities and apply systematic supervision.

Factors Influencing Outsourcing Services in Iranian Medical Centers: A Systematic Review

Background: Identifying the key factors effective on outsourcing can play a significant role in helping healthcare decision makers to present solutions to improve the outsourcing situation. This study was conducted in order to systematically review the factors influencing the decision making to outsource the services of Iranian medical centers. Methods: Data was collected through searching for keywords in Google Scholar, PubMed, Scopus, Web of Science, Science direct, Magiran, SID and Irandoc databases from January 2010 to December 2020. Also, the quality of the studies was measured and verified by three experts utilizing the Strobe checklist. Researchers classified results achieved by the study. Results: 10 articles were selected that responded to the study's questions. 44 components in seven dimensions including (economic and financial components, components of laws and regulations (legal), components of supervision and control, components of service type, components of executive capability of the organization, components of the external environment of the organization and components human resources) were recognized on the decision to outsource services in medical centers in Iran. Conclusion: olicy makers at the decision-making level and managers at the executive level should consider the efficient components and dimensions before deciding to execute outsourcing in units according to the wanted structure, process and consequences, and then make the needed decision regarding the implementation.