RESUMEN
Objective: To perform a systematic review of the properties and results of the studies that their approaches are lean management in emergency departments and the factors which influence on their performance
Method: The necessary information in the first stage was collected by searching these keywords: "Lean principles" "Lean Six Sigma", "Lean Process", "Lean thinking", "Lean Methodology", "Toyota Production System lean processing", "lean techniques", "emergency department", "emergency medicine", "emergency room" and "emergency care". And in the next stage the keywords such as "lean management" and "emergency" was collected from SID, Medlib, IranDoc, Google Scholar, MagIran, IranMedex data bases. For extracting the data data-extracting forms was prepared. The information we got from the forms was organized in information-extracting forms and was analyzed manually. The diagrams were drawn in Excel: 2010
Results: Finally, 26 essays have been included. Most of the studies were accomplished in Canada and U.S.A. only in one of the cases, the authors used the control group. Each of these terms, "lean techniques" and "lean principals", with five times repetitions had the highest frequency. The most important team of implementation of lean management included: hospital management team or the manager of Emergency department, physicians, nurses, staffs and external counselors. Generally, 51 indicators were studied which among them the length of stay and the timing had the most frequency. After implementation of lean management, almost all studied indicators have significantly improved. 14 barriers, 14 facilitators and 10 effective factors were recognized in implementing the lean management
Conclusion: According to the studies, responsibility of organization's senior management and his/her supports; increasing the knowledge of the characteristics and dimension of lean among the providers of health service; and decreasing the resistance and consulting with external counselors can have great effect on the success of lean management
RESUMEN
Background: equity in distribution of resources is considered as an important priority in health care systems. Equitable distribution of obstetrics and gynecology [Ob/Gyn] services in the country level is critical in maternal and neonatal health for qualitative promotion of maternal care in pregnancy, delivery, and post-delivery periods
Objective: the present study aimed at determining regional disparity of obstetrics and gynecology services and its association with children and infants mortality rates
Materials and Methods: this was a descriptive-analytical study conducted in 2015 to investigate distribution of Ob/Gyn services using three indicators of number of nursing and midwifery personnel, total Ob/Gyn specialists, and total delivery beds among 30 provinces of the country. Equity criteria in the present study included population, normal vaginal deliveries, cesarean sections, and total deliveries. Data were gathered using a researcher-made form and Stata 12 was used to calculate Gini coefficient. The association of Ob/Gyn services with children and infant mortality rates was investigated using SPSS package and linear regression test
Results: the lowest Gini coefficient was observed in distribution of nursing and midwifery personnel in delivery wards in terms of vaginal delivery [0.38 from 1] and the highest value was related to distribution of Ob/Gyn specialists in terms of vaginal delivery [0.73 from 1]. Infant mortality was significantly associated with number of nursing and midwifery personnel in delivery wards, and total number of Ob/Gyn specialists
Conclusion: considering new population policies in Iran and increased fertility rate, it is recommended to facilitate accessibility of the required services for the women, particularly those of reproductive age
RESUMEN
To analyze the process of priority setting at different levels of Iran's health system. In this qualitative study, 19 Experts of different levels of health system were interviewed. The semi-structured interview guide was designed based on literature review and four initial in depth interviews. Framework analysis method was used for the analysis of qualitative data. Eight themes and 22 sub-themes regarding health priority setting were identified: Health priority at macro-level; Priority setting between and within medical universities; Priority setting criteria; Measuring costs and outcomes; Resource shift; Public participation; and Resource allocation decision rule. Health sector share of public budget was unrealistic and was based on historical patterns. Political factors and lobbying influenced resource allocation between and within medical universities. Resource allocation was mainly structure based and health factors were least influential. Although resource shifting was possible within programs but it was impossible within them, Public participation in priority setting was not sufficient and systematic, decision making on resource allocation was mainly based on needs and judgment. Some priority setting activities are in progress, but they do not tend to be either comprehensive or systematic. In order to improve priority setting, developing an approach which enables stakeholders' involvement is suggested