Implementation of the Promoting Normal Birth Program in Iran - A Qualitative Study.

Normal birth is still highly valued, but the majority of pregnancies end with medical interventions or caesarean section. Rates of normal birth have been declining steadily over the past 20 years in Iran, despite the evidence of the benefits to mother and baby. According to the World Health Organization, the standard rate for caesarean is 10-15%. In 2013, Iran Ministry of Health introduced the “Promoting Normal Birth Program”. This study examines the views of experts about factors affecting the implementation of “Promoting Normal Birth Program”.METHODSA qualitative study with framework analysis was used to determine the factors affecting implementation of the “Promoting Normal Birth Program” by examining views of 15 gynaecologists, anaesthesiologists, midwives and managers in 2018 at Zabol Medical Sciences University. Professionals participated with informed consent in this study. Data was collected from individual and group semi-structured interviews to reach saturation. MAXQDA 12 was used for analysis.RESULTSSeven categories were identified: (1) Leadership of Ministry, (2) Education, (3) Create Culture for a Normal Birth, (4) Optimization and Pleasure of Birth, (5) Normalization: The Essence of Birth and Midwifery, (6) Support, and (7) Empowerment.CONCLUSIONSThese findings create a challenge for education, performance and health policies. In order to achieve program goals and improve women's health, the following actions are recommended- provide adequate infrastructure and financing to improve the birth environment, increase midwifery force, and promoting the culture of Normal birth, especially through the education for community, women, and caregivers, correcting rules and guidelines and detailing job descriptions and professional status.

Factors affecting patient safety: a qualitative content analysis

Background: Patient safety is one of the main components of good-quality health services. The main objective of this study is to explore the most effective factors relating to patient safety in Iran. Methods: This qualitative study was done using content analysis. Data were collected using semi-structured interviews. Through purposive sampling, 14 participants were selected by experts who were familiar with the patient safety friendly hospital program. Interviews were recorded and then analyzed by framework analysis using MAXQDA software. Results: Of 2,474 initial codes, 10 main themes and 53 sub-themes were identified, including importance of human resources; organization and management; interactions and teamwork; medication; equipment and physical environment; patient-related factors; patient safety and quality improvement; the importance of documentation; assessment and monitoring; medical errors; barriers and challenges. Conclusion: Factors affecting patient safety can be divided into two groups: facilitators and barriers. Hospitals can improve the implementation of patient safety standards, reduce the adverse events and enhance patient safety by strengthening facilitating factors, such as providing human resources, adequate medical equipment and facilities, increasing employee participation in quality improvement programs, improving staff training, communicating with patients and their families, and addressing the existing challenges and barriers

[ relationship between organizational health and organizational citizenship behavior in hospitals affiliated to Tehran university of medical sciences in 2010]

Focus on organizational health could ensure the future success of any organization. Considering the fast changing conditions of hospitals and the necessity of effectiveness, employees are required who can show voluntary behavior towards the organization and customers. Therefore, this study mainly aims to survey the relationship between organizational health and organizational citizenship behavior in selected hospitals of Tehran University of Medical Sciences [TUMS]. This cross-sectional, descriptive-analytic study was conducted in 2010. The population of the study comprised the entire staff of TUMS selected hospitals. In total, 312 employees were selected. The researchers gathered their data using questionnaires of organizational health and organizational citizenship behavior. For data analysis, both descriptive statistics [percentage, mean, standard deviation and variance] and inferential statistics [Pearson correlation and regression] were applied. The data were analyzed using SPSS18 software. The correlation between the organizational health and five dimensions of organizational citizenship behavior [Conscientiousness, Altruism, Helping Behavior, Civil Virtue, Sportsmanship, and Courtesy] was significant [p = 0/0001]. Given this significant correlation between organizational health and organizational citizenship behavior, organizations can make improvements in employees' behavior. This can be achieved by creating harmony among members and through continuous improvement and growth

[Study of payment methods to doctors in the referral system in selected countries and suggestions for Iranian social security organization- direct medical service provision]

Payment method is one of the most important control knobs in the health system. All organizations that mobilize funds for health sector must be decided: who should be paid? Why this money should be paid to them? And how much should be paid? So the main purpose of this study is to identify different methods of paying to the doctors in referral system of selected countries, and ultimately providing some suggestions for Iranian social security organizations- direct medical service provision. This was a comparative study designed in 2008. First we studied theoretical issues and analyzed them within the framework of the current situation. Then we conducted a comparative study to find some solutions for it. Then we validated selected suggestions using by Delphi technique. Most selected countries use a combination of methods to pay to the physicians. Usually for employed physicians in insurance organizations, salary makes a large part of doctor`s income. In countries where GPs play the role of gatekeeper, the per capita payment method has a special room. In American Health Maintenance Organizations [HMOs], based on employment or contractual relationship, they pay physicians by one of three "Per Capita", "Salary Monthly" or "Prepayment". In addition to Salaries [if any employment relationship], specialists usually receive some fees for their Services widely. Bonus payment in exchange for quality indicators is considered as a recently developed payment method for both GPs and specialists, but due to wide infrastructures, it needs accurate designing and plenty of arrangements