ABSTRACT
Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice [DP], i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services.
Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons.
Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age.
Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 [standard deviation 0.33] hours full-time equivalent [FTE] on health care service delivery. Specialists with DP had long service delivery time [beta = 0.427]. Female specialists [beta = 0.049] and full-time specialists [beta = 0.082] spent less time on health care service delivery. Permanent specialists had higher FTE [P < 0.001] and as the population increases, FTE increases [P < 0.05].
Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Surgeons , Hospitals , Professional PracticeABSTRACT
European Foundation for Quality Management [EFQM] model is a widely used quality management system [QMS] worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation [INPHE] based on those of EFQM. This cross-sectional study was conducted in 2012 on a sample of emergency departments [EDs] affiliated with Tehran University of Medical Sciences [TUMS], Iran. The standard questionnaire of EFQM [V-2010] was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings. The average assessment score of the EDs based on the INPHE and EFQM model were largely different [i.e. 86.4% and 31%, respectively]. In addition, the variation range among five EDs' scores according to each model was also considerable [22% for EFQM against 7% of INPHE], especially in the EDs with and without prior record of applying QMSs. The INPHE's assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs' scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs' [such as EFQM] strengths, given the results emanated from its comparison with EFQM seems indispensable