Structural challenges in the health domain of the health system reform: A qualitative study
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Cited by 3 publications
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Electronic referral system policy analysis: a qualitative study in the context of Iran
Background: Referral system is among the key elements of primary health care that leads to enhanced efficiency, reduced costs, reduced waiting time, and patients’ enhanced access to more specialized services. The present study was aimed at analysing the policies of the electronic referral (e-Referral) system in Iran. Methods: This qualitative study was conducted based on Walt and Gilson’s policy triangle and Kingdon’s models. Data were collected through document analysis and 51 semi-structured interviews with managers at various levels, experts, family physicians, specialist physicians, and patients. Document analysis was performed by content analysis method, and interview analysis was performed through framework analysis method in Atlas.ti 8. Results: The e-Referral system was launched with the aim of equitable access to services and to benefit from better management of health resources. Valid scientific evidences were used to formulate policies. Numerous meetings were held with domestic and foreign stakeholders at the provincial, city, and rural levels. The implementation of the programme followed a bottom-up approach, and the main obstacles to the implementation of the programme included the change of senior managers of the health system and their not being fully aware of the importance of the programme, inadequate allocation of financial resources, and unwillingness of some patients to follow the referral system. Conclusions: The policy triangle framework, while explaining the components of the e-Referral system programme, revealed the obstacles to the proper implementation of the programme. In order to ensure that the programme goes on continuously and successfully, it is essential to create the necessary determination and commitment on the part of the minister of health and medical education and senior managers of the health system, earmark resources for the programme, improve resource allocation with insurance management, reform the payment system, plan to raise public awareness, and attract community participation.
Electronic referral system policy analysis: a qualitative study in the context of Iran
Background: Referral system is among the key elements of primary health care that leads to enhanced efficiency, reduced costs, reduced waiting time, and patients’ enhanced access to more specialized services. The present study was aimed at analysing the policies of the electronic referral (e-Referral) system in Iran. Methods: This qualitative study was conducted based on Walt and Gilson’s policy triangle and Kingdon’s models. Data were collected through document analysis and 51 semi-structured interviews with managers at various levels, experts, family physicians, specialist physicians, and patients. Document analysis was performed by content analysis method, and interview analysis was performed through framework analysis method in Atlas.ti 8. Results: The e-Referral system was launched with the aim of equitable access to services and to benefit from better management of health resources. Valid scientific evidences were used to formulate policies. Numerous meetings were held with domestic and foreign stakeholders at the provincial, city, and rural levels. The implementation of the programme followed a bottom-up approach, and the main obstacles to the implementation of the programme included the change of senior managers of the health system and their not being fully aware of the importance of the programme, inadequate allocation of financial resources, and unwillingness of some patients to follow the referral system. Conclusions: The policy triangle framework, while explaining the components of the e-Referral system programme, revealed the obstacles to the proper implementation of the programme. In order to ensure that the programme goes on continuously and successfully, it is essential to create the necessary determination and commitment on the part of the minister of health and medical education and senior managers of the health system, earmark resources for the programme, improve resource allocation with insurance management, reform the payment system, plan to raise public awareness, and attract community participation.
PurposeA physician–nurse relationship is a complex, professional and shared-decision-making process, which is an important predictor of high-quality patient care. The purpose of this paper is to explore the attitude of the physician–nurse relationship in Southern Lebanon hospitals.Design/methodology/approachA descriptive institutional cross-sectional study was conducted among different departments of three hospitals in Southern Lebanon using a validated Jefferson Scale of Attitude.FindingsIn sum, 89 physicians and 245 nurses accepted to participate. The nurses’ mean age was 32 and the physicians’ was 44. The mean score was found to be 46 for all participants, with significantly higher scores noted among nurses compared to physicians (48 vs 43, respectively) and higher scores among females compared to males (48 vs 46, respectively). However, the study scored no significant difference in relation to the degrees attained by nurses and the participants’ years of experience. The majority had agreed that the shortage in the nurses’ staff affects proper patient care delivery. One fourth of the physicians disagreed that nurses should be considered as a collaborator and colleague. Therefore, more work is required to improve this collaboration.Research limitations/implicationsThere is a complex relationship normally displayed by physicians and nurses, which cannot be easily interpreted and analyzed. Physicians and nurses may have given socially desirable responses while filling the questionnaire. Even more, this study was conducted in Hospitals in Southern Lebanon, and it would be nice to extend this study to include further hospitals in other regions in Lebanon as well.Practical implicationsNurses had higher scores toward collaboration, with females scoring higher than males. However, overall scores are considered to be lower compared to other countries. Thus, more efforts should be done on improving this communication among nurses and physicians, through promoting inter-professional undergraduate and postgraduate education training toward more effective communication.Social implicationsQuality of patient care would be improved if more work is done on improving the collaboration between physicians and nurses, and this was shown to be required as per study results.Originality/valueThere is a gap in literature assessing this important topic which is the collaboration and attitude of nurses and physicians toward their relationship in Lebanon. It is extremely important that efforts should be taken in order to determine the type of nurse–physician relationship in every local context as this relationship affects quality of patients’ care.
Iran's Health Transformation Plan; Main Issues and Opportuni-ties for Improvement: A Systematic Review
Background: The Health Transformation Plan (HTP), as the latest reform of Iran's health system, has been implemented gradually in several phases to facilitate the achievement of universal health coverage. We aimed to identify the achievements and challenges of the HTP from the beginning of its implementation in Iran health system. Methods: In this qualitative systematic review, English papers were searched in PubMed, Scopus, Web of science, and Google Scholar search engines in addition to Persian databases such as Magiran and SID from 2014-2020. The Mixed-Methods Appraisal Tool (MMAT) checklists were used to assess the quality of the studies. Study selection, quality assessment, data extraction, and data analysis were done independently by two people. For analyzing the data, the Framework Analysis Method, based on the health system function framework of the WHO, was used. Results: Overall, 32 papers were included based on the inclusion criteria. The results were divided into four main themes: stewardship, financing, resource generation and service delivery, and20 sub-themes in the form of achievements and challenges. Regulatory and standardization, service packages, medical equipment and supplies, and the quality of health services were more repetitive. Considering the challenges of HTP, purchase process, motivational factors, and health services capacity were more repetitive. Conclusion: The administrative challenges in the implementation of the HTP have prevented the sustainability of the outcomes and their main goals. The use of strategic dynamic planning, anticipating sustainable financial resources, and strengthening the monitoring mechanisms could lead to further achievements.
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