[ situational analysis of human resources in Iranian hospitals affiliated with ministry of health in 2008]

Hospitals are known as one of the main health care providing organizations. Increasing expenditures is claimed to be one of the most serious problems in hospitals. In this context, economic analyzing is very essential for health system evidence based decision making. We aimed to collect and analyze the hospital resources and this article specially is going to clarify the human resources arrangement in hospitals affiliated with ministry of health. This is an Applied Cross Sectional study, which was performed on 139 hospitals in 2009. We were going to collect the data from all Iranian hospitals affiliated with MOHME. In this regard, an expert's panel defined some inclusion criteria and finally 139 out of 530 hospitals were selected. Nine online questionnaires were used to collect data. We categorized the hospitals on the basis of bed numbers, being educational or non educational and locating in poor or rich areas [A: below 50 beds, B: 51-150 beds, C:151-300 beds and D: above 300 beds]. We analyzed the data using SPSS software. In 139 hospitals, there were 23674 active beds and 48238 personnel [2.04 personnel per each bed]. Our data showed that 48.4 percent of personnel had an under-associate degree, 40% had bachelor degree and the rest had higher degrees. Nurses and midwives were 48.1 percents of all personnel. Average bed occupancy rate was 57.8% and the lowest bed occupancy rate was belonged to the under 50 bed hospitals [31.4%]. The ratio of clinical personnel in teaching hospitals [71.1%] was higher than the non-teachings [70.4%]. This ratio was higher in rich areas [71.2%] compared to the poor areas [68.7%]. The proportion of number of personnel per bed in teaching hospitals [2.09] was higher than non-teaching hospitals [1.9]. This proportion was lower in rich areas [2.02] than the poor areas [2.17]. The density of logistic personnel was higher [29.1]than the other personnel. The high density of logistic personnel is a sign of low efficiency in selected hospitals. Despite of increasing ratio of clinical personnel to total number of personnel, the ratio of medical personnel per beds was decreasing and this can be a sign of low quality and effectiveness. Big hospitals have a better bed occupancy rate compared to small ones

[Qualitative assessment of dimensions and degree of autonomy granting to university hospitals]

The aim of this study was to determine the key organizational dimensions that influence the autonomy of university hospitals and the level of granted autonomy in each dimension. Six hospitals were randomly selected from those affiliated with three medical universities of Tehran, Iran and Shahid Beheshti. In this qualitative study, we interviewed 27 hospital managers [response rate of 82%]. The semi-structured interview guide was developed based on the results of four initial in-depth interviews and the organizational reform model of the World Bank. We used the framework method for the analysis of qualitative data. Nine themes were identified as the key factors influencing hospital autonomy: decision right in strategic management, decision right in human resources management, decision right in financial management, decision right in physical resources management, product market exposure, procurement market exposure, financial residual claim, governance arrangements and accountability mechanisms, and social functions of the hospitals. Limited decision rights in strategic, human resources, and physical resources management were granted to hospitals. Hospitals were not the financial residual claimant, but were exposed to competitive product market. Autonomy was limited regarding the procurement market. Governance systems were hierarchical and accountability mechanisms were supervisor-supervisee oriented. Some of the social functions of the hospitals were defined, but the expenses of these functions were not totally reimbursed by the government and the insurance industry. The autonomy granted to the hospitals is unbalanced and paradoxical. More decision rights should be granted for management of strategic, human resources and physical resources as well as hospitals entry to the procurement market. Hospitals need to be the financial residual claimant. The hierarchical administrative systems should be transformed to cooperative ones. Instead of supervisor-supervisee oriented control measures, Ministry of Health and Medical Education needs more regulatory mechanisms for controlling hospitals' performance and social functions