Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Leadership and Leadership Development in Healthcare Settings – A Simplistic Solution to Complex Problems?
227
229
EN
Ruth
McDonald
Manchester Business School, University of Manchester, Manchester, England, UK
ruth.mcdonald@mbs.ac.uk
10.15171/ijhpm.2014.101
There is a trend in health systems around the world to place great emphasis on and faith in improving ‘leadership’. Leadership has been defined in many ways and the elitist implications of traditional notions of leadership sit uncomfortably with modern healthcare organisations. The concept of distributed leadership incorporates inclusivity, collectiveness and collaboration, with the result that, to some extent, all staff, not just those in senior management roles, are viewed as leaders. Leadership development programmes are intended to equip individuals to improve leadership skills, but we know little about their effectiveness. Furthermore, the content of these programmes varies widely and the fact that many lack a sense of how they fit with individual or organisational goals raises questions about how they are intended to achieve their aims. It is important to avoid simplistic assumptions about the ability of improved leadership to solve complex problems. It is also important to evaluate leadership development programmes in ways that go beyond descriptive accounts
Leadership,Evaluation,Training
https://www.ijhpm.com/article_2900.html
https://www.ijhpm.com/article_2900_9ec3c78071a3db80e84ffba34aba34b4.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Iran’s Shift in Family Planning Policies: Concerns and Challenges
231
233
EN
Mohammad
Karamouzian
0000-0002-5631-4469
School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Regional Knowledge Hub, and WHO Collaborating
Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman
University of Medical Sciences, Kerman, Iran
karamouzian.m@gmail.com
Hamid
Sharifi
0000-0002-9008-7618
Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
sharifihami@gmail.com
Ali Akbar
Haghdoost
0000-0003-4628-4849
Regional Knowledge Hub, and WHO Collaborating
Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman
University of Medical Sciences, Kerman, Iran
ahaghdoost@gmail.com
10.15171/ijhpm.2014.81
Iran’s significant success in implementing Family Planning (FP) during the past 25 years, has made it a role model in the world. The Total Fertility Rate (TFR) in Iran has dropped from 6.5 in 1960 to 1.6 in 2012, which is well below the targeted value of 2.2 for the country. Iran’s success story, however, did not merely root in the implementation of FP programs. In other words, families’ strong tendency to limit fertility and delayed marriages had an undeniable role in decreasing the TFR. On the other hand, Iranian policy-makers are very concerned about such a decrease and have recently restricted access to contraception, while outlawing any surgery that reduces fertility. This paper, tries to highlight the pros and cons of such restrictive policies, and argue that the policy-makers might be jeopardizing the success of Iran’s FP program by overestimating its role in the TFR reduction rate.
Family Planning (FP),Total Fertility Rate (TFR),Health Policy,Population Control,Iran
https://www.ijhpm.com/article_2880.html
https://www.ijhpm.com/article_2880_fc16f7ccf79a8804b57ad1a5b1d639d3.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Evaluation of Board Performance in Iran’s Universities of Medical Sciences
235
241
EN
Haniye
Sajadi
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
hsajjadi@sina.tums.ac.ir
Mohammadreza
Maleki
Department of Health Services Management,
School of Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran
maleki@mohme.gov.ir
Hamid
Ravaghi
Department of Health Services Management,
School of Management and Information Sciences, Iran University of Medical
Sciences, Tehran, Iran
ravaghih@gmail.com
Homayoun
Farzan
Ministry of Health and Medical Education, Tehran, Iran
hfarzann@yahoo.com
Hasan
Aminlou
Ministry of Health and Medical Education, Tehran, Iran
aminlou@yahoo.com
Mohammad
Hadi
Chancellor Office , Isfahan University of Medical Sciences, Isfahan, Iran
hadi@mui.ac.ir
10.15171/ijhpm.2014.86
Background <br />The critical role that the board plays in governance of universities clarifies the necessity of evaluating its performance. This study was aimed to evaluate the performance of the boards of medical universities and provide solutions to enhance its performance. <br /> <br />Methods <br />The first phase of present study was a qualitative research in which data were collected through face-to-face semi-structured interviews. Data were analyzed by thematic approach. The second phase was a mixed qualitative and quantitative study, with quantitative part in cross-sectional format and qualitative part in content analysis format. In the quantitative part, data were collected through Ministry of Health and Medical Education (MoHME). In the qualitative part, the content of 2,148 resolutions that were selected by using stratified sampling method were analyzed. <br /> <br />Results <br />Participants believed that the boards had no acceptable performance for a long time. Results also indicated the increasing number of meetings and resolutions of the boards in these 21 years. The boards’ resolutions were mostly operational in domain and administrative in nature. The share of specific resolutions was more than the general ones. <br /> <br />Conclusion <br />Given the current pace of change and development and the need to timely respond them, it is recommended to accelerate the slow pace of improvement process of the boards. It appears that more delegation and strengthening the position of the boards are the effective strategies to speed up this process.
Governing Board,Task Performance,Evaluation,Academic Medical Centers
https://www.ijhpm.com/article_2885.html
https://www.ijhpm.com/article_2885_4525d3a5141d07b9fd3400f8394170f6.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Household Financial Contribution to the Health System in Shiraz, Iran in 2012
243
249
EN
Zahra
Kavosi
Department of Health Services Management, School of Management and
Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
ramin_hayati2010@yahoo.com
Ali
Keshtkaran
Department of Health Services Management, School of Management and
Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
khammarnia@sums.ac.ir
Ramin
Hayati
Student Research Committee, Shiraz University of Medical Sciences, Shiraz,
Iran
ramin.hayati202@gmail.com
Ramin
Ravangard
Department of Health Services Management, School of Management and
Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
m.khammarnia@gmail.com
Mohammad
Khammarnia
0000-0002-3759-5875
Student Research Committee, Shiraz University of Medical Sciences, Shiraz,
Iran
m_khammar1985@yahoo.com
10.15171/ijhpm.2014.87
Background <br />One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs) to the health system. <br /> <br />Methods <br />The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS) questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression. <br /> <br />Results <br />The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP) payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure. <br /> <br />Conclusion <br />It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.
Household Financial Contribution (HFC),Health System,Catastrophic Health Expenditure,Fair Financial Contribution Index (FFCI)
https://www.ijhpm.com/article_2886.html
https://www.ijhpm.com/article_2886_44cd3cd3380f6c1a0ad244c5775beb89.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Impact of Socio-Economic Status on the Hospital Readmission of Congestive Heart Failure Patients: A Prospective Cohort Study
251
257
EN
Atefeh
Noori
Research Centre for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
atefeh.noori@gmail.com
Mostafa
Shokoohi
0000-0002-3810-752X
Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,
Iran
shokoohi.mostafa2@gmail.com
Mohammad Reza
Baneshi
0000-0002-6405-8688
Research Centre for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
rbaneshi2@gmail.com
Nasim
Naderi
Cardiac Electrophysiology Research Center, Rajaee Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
naderi.nasim@gmail.com
Hooman
Bakhshandeh
Cardiac Intervention Research Center, Rajaee Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
5- hooman_abkenar@yahoo.com
Ali Akbar
Haghdoost
0000-0003-4628-4849
Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,
Iran
ahaghdoost@gmail.com
10.15171/ijhpm.2014.94
Background <br />The aim of this study was to examine the impacts of multiple indicators of Socio-economic Status (SES) on Congestive Heart Failure (CHF) related readmission. <br /> <br />Methods <br />A prospective study consisting of 315 patients without the history of admission due to CHF was carried out in Tehran during 2010 and 2011. They were classified into quartiles based on their SES applying Principal Component Analysis (PCA), and followed up for one year. Using stratified Cox regression analysis, Hazard Ratios (HRs) were computed to assess the impact of SES on the readmission due to CHF. <br /> <br />Results <br />During the 12 months follow-up, 122 (40%) were readmitted at least once. HR of lowest SES patients vs. the highest SES patients (the fourth versus first quartile) was 2.66 (95% CI= 1.51–4.66). Variables including abnormal ejection fraction (<40%), poor physical activity, poor drug adherence, and hypertension were also identified as significant independent predictors of readmission. <br /> <br />Conclusion <br />The results showed low SES is a significant contributing factor to increased readmission due to CHF. It seems that the outcome of CHF depends on the SES of patients even after adjusting for some of main intermediate factors.
Iran,Re-Hospitalization,Congestive Heart Failure,Socio-Economic Status (SES),Equity,Factor Analysis
https://www.ijhpm.com/article_2893.html
https://www.ijhpm.com/article_2893_8b6df031648a24824ce05a8eb76d100c.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Predictors of Language Service Availability in U.S. Hospitals
259
268
EN
Melody
K.
Schiaffino
0000-0002-5917-7383
San Diego State University, San Diego, CA, USA
mschiaffino@sdsu.edu
Mona
Al-Amin
Suffolk University, Boston,
MA, USA
malamin@suffolk.edu
Jessica
R.
Schumacher
University of Wisconsin-Madison, Madison, WI, USA
jrschumacher@wisc.edu
10.15171/ijhpm.2014.95
Background <br />Hispanics comprise 17% of the total U.S. population, surpassing African-Americans as the largest minority group. Linguistically, almost 60 million people speak a language other than English. This language diversity can create barriers and additional burden and risk when seeking health services. Patients with Limited English Proficiency (LEP) for example, have been shown to experience a disproportionate risk of poor health outcomes, making the provision of Language Services (LS) in healthcare facilities critical. Research on the determinants of LS adoption has focused more on overall cultural competence and internal managerial decision-making than on measuring LS adoption as a process outcome influenced by contextual or external factors. The current investigation examines the relationship between state policy, service area factors, and hospital characteristics on hospital LS adoption. <br /> <br /><br />Methods <br />We employ a cross-sectional analysis of survey data from a national sample of hospitals in the American Hospital Association (AHA) database for 2011 (N= 4876) to analyze hospital characteristics and outcomes, augmented with additional population data from the American Community Survey (ACS) to estimate language diversity in the hospital service area. Additional data from the National Health Law Program (NHeLP) facilitated the state level Medicaid reimbursement factor. <br /> <br /><br />Results <br />Only 64%of hospitals offered LS. Hospitals that adopted LS were more likely to be not-for-profit, in areas with higher than average language diversity, larger, and urban. Hospitals in above average language diverse counties had more than 2-fold greater odds of adopting LS than less language diverse areas [Adjusted Odds Ratio (AOR): 2.26, P< 0.01]. Further, hospitals with a strategic orientation toward diversity had nearly 2-fold greater odds of adopting LS (AOR: 1.90, P< 0.001). <br /> <br /><br />Conclusion <br />Our findings support the importance of structural and contextual factors as they relate to healthcare delivery. Healthcare organizations must address the needs of the population they serve and align their efforts internally. Current financial incentives do not appear to influence adoption of LS, nor do Medicaid reimbursement funds, thus suggesting that further alignment of incentives. Organizational and system level factors have a place in disparities research and warrant further analysis; additional spatial methods could enhance our understanding of population factors critical to system-level health services research.
Limited English Proficiency (LEP),Healthcare Quality,Language Access,Health Disparities,Hospitals
https://www.ijhpm.com/article_2895.html
https://www.ijhpm.com/article_2895_56c83dabc2209dcea0d88888a19e6cd8.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Cross-National Diffusion of Mental Health Policy
269
282
EN
Gordon
C
Shen
School of Public Health, Yale University, New Haven, CT, USA
gordon.c.shen@uth.tmc.edu
10.15171/ijhpm.2014.96
Background <br />Following the tenets of world polity and innovation diffusion theories, I focus on the coercive and mimetic forces that influence the diffusion of mental health policy across nations. International organizations’ mandates influence government behavior. Dependency on external resources, namely foreign aid, also affects governments’ formulation of national policy. And finally, mounting adoption in a region alters the risk, benefits, and information associated with a given policy. <br /> <br />Methods <br />I use post-war, discrete time data spanning 1950 to 2011 and describing 193 nations’ mental health systems to test these diffusion mechanisms. <br /> <br />Results <br />I find that the adoption of mental health policy is highly clustered temporally and spatially. Results provide support that membership in the World Health Organization (WHO), interdependence with neighbors and peers in regional blocs, national income status, and migrant sub-population are responsible for isomorphism. Aid, however, is an insufficient determinant of mental health policy adoption. <br /> <br />Conclusion <br />This study examines the extent to which mental, neurological, and substance use disorder are <br />addressed in national and international contexts through the lens of policy diffusion theory. It also adds to policy dialogues about non-communicable diseases as nascent items on the global health agenda.
Policy Diffusion,New Institutionalism,Mental Health
https://www.ijhpm.com/article_2897.html
https://www.ijhpm.com/article_2897_9d9f73776c91351ba21ca264cf884c2c.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Improving Maternal and Child Healthcare Programme Using Community-Participatory Interventions in Ebonyi State Nigeria
283
287
EN
Chigozie
Jesse
Uneke
0000-0003-4718-2182
Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine Ebonyi State University, Abakaliki, Nigeria; and Health Policy and Systems
Research Project (Knowledge Translation Platform), Ebonyi State University, Abakaliki, Nigeria
unekecj@yahoo.com
Chinwendu
Ndukwe
National Agency for the Control of AIDS, Abuja, Nigeria
nducd@yahoo.co.uk
Abel
Ezeoha
Department of Banking and Finance, Ebonyi State University, Abakaliki, Nigeria
aezeoha@yahoo.co.uk
Henry
Urochukwu
Department of Social Mobilization and Disease Control, National
Obstetrics Fistula Centre, Abakaliki, Nigeria
henryuchukwu@yahoo.co.uk
Chinonyelum
Ezeonu
Department of Paediatrics,
Ebonyi State University, Abakaliki, Nigeria
ctezeonu@gmail.com
10.15171/ijhpm.2014.91
In Nigeria, the government is implementing the Free Maternal and Child Health Care Programme (FMCHCP). The policy is premised on the notion that financial barriers are one of the most important constraints to equitable access and use of skilled maternal and child healthcare. In Ebonyi State, Southeastern Nigeria the FMCHCP is experiencing implementation challenges including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure, and poor staff remuneration. Furthermore, there is less emphasis on community involvement in the programme implementation. In this policy brief, we recommend policy options that emphasize the implementation of community-based participatory interventions to strengthen the government’s FMCHCP as follows: Option 1: Training community women on prenatal care, life-saving skills in case of emergency, reproductive health, care of the newborn and family planning. Option 2: Sensitizing the community women towards behavioural change, to understand what quality services that respond to their needs are but also to seek and demand for such. Option 3: Implementation packages that provide technical skills to women of childbearing age as well as mothers’ groups, and traditional birth attendants for better home-based maternal and child healthcare. The effectiveness of this approach has been demonstrated in a number of community-based participatory interventions, building on the idea that if community members take part in decision-making and bring local knowledge, experiences and problems to the fore, they are more likely to own and sustain solutions to improve their communities’ health.
Maternal,Child, Healthcare,Community-Participation,Nigeria
https://www.ijhpm.com/article_2890.html
https://www.ijhpm.com/article_2890_b6a528dd525dc3887da38b6a510956aa.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Some Notes on Critical Appraisal of Prevalence Studies; Comment on: “The Development of a Critical Appraisal Tool for Use in Systematic Reviews Addressing Questions of Prevalence”
289
290
EN
Thomas
Harder
Immunization Unit, Robert Koch Institute, Berlin, Germany
hardert@rki.de
10.15171/ijhpm.2014.99
Decisions in healthcare should be based on information obtained according to the principles of Evidence-Based Medicine (EBM). An increasing number of systematic reviews are published which summarize the results of prevalence studies. Interpretation of the results of these reviews should be accompanied by an appraisal of the methodological quality of the included data and studies. The critical appraisal tool for prevalence studies developed and tested by Munn et al. comprises 10 items and aims at targeting all kinds of prevalence studies. This comment discusses the pros and cons of different designs of quality appraisal tools and highlights their importance for systematic reviews of prevalence studies. Beyond piloting, which has been performed in the study by Munn et al., it is suggested here that the validity of the tool should be tested, including reproducibility and inter-rater reliability. It is concluded that studies as the one by Munn et al. will help to establish a critical understanding of methodological quality and will support the use of systematic reviews of non-intervention studies for health policy making.
Evidence-Based Medicine (EBM),Risk of Bias,Methodological Quality,Critical Appraisal Tools,Prevalence Studies
https://www.ijhpm.com/article_2898.html
https://www.ijhpm.com/article_2898_25364c2a0d159eeac6be4c83fbce0446.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
Public Participation: More than a Method?; Comment on “Harnessing the Potential to Quantify Public Preferences for Healthcare Priorities through Citizens’ Juries”
291
293
EN
Annette
Boaz
Faculty of Health, Social Care and Education, St George’s, University of
London and Kingston University, London, UK
a.boaz@sgul.kingston.ac.uk
Maria
Stuttaford
Faculty of Health, Social Care and Education, St George’s, University of
London and Kingston University, London, UK
maria.c.stuttaford@warwick.ac.uk
Mary
Chambers
Cardiff University, Cardiff, UK
m.chambers@sgul.kingston.ac.uk
10.15171/ijhpm.2014.102
While it is important to support the development of methods for public participation, we argue that this should not be at the expense of a broader consideration of the role of public participation. We suggest that a rights based approach provides a framework for developing more meaningful approaches that move beyond public participation as synonymous with consultation to value the contribution of lay knowledge to the governance of health systems and health research.
Public Participation,Human Rights,Methods,Values,Consultation
https://www.ijhpm.com/article_2901.html
https://www.ijhpm.com/article_2901_2d0d6fdcd02d8d379955de55dc594fee.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
5
2014
10
01
“Mind the Gap” in Reporting the Outdated Statistics
295
296
EN
Babak
Moazen
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
babak.moazen@gmail.com
Farimah
Rezaei
Obstetrics and Gynecologist, Shahid Beheshti Hospital, Esfahan University of Medical Sciences, Esfahan, Iran
farezaei99@gmail.com
Masoud
Lotfizadeh
Department of Community Health, Sharekord University of Medical Sciences, Shahrekord, Iran
masoud_lotfizadeh@yahoo.com
Mohammad
Darvishi
Infectious Diseases and Tropical Medicine Research Center (IDTMRC),
AJA University of Medical Sciences, Tehran, Iran
mo_darvishi@yahoo.com
Farshad
Farzadfar
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
farzadfar3@yahoo.com
10.15171/ijhpm.2014.97
Substance-Related Disorders,Methadone,Therapeutics,and Publication Error
https://www.ijhpm.com/article_2894.html
https://www.ijhpm.com/article_2894_c0ef1bac9a31cf56fee43b4d19271caf.pdf