Influential factors of out of pocket payments for health care in Iran: A foresight approach using the cross impact analysis.

OBJECTIVE: To identify and explain the interactions and network of the relationship between influential factors of out-ofpocket payments for health services. METHODS: This futures study was conducted in 2015 in Iran, and comprised experts of various sectors. At first, key factors and driven forces of out-of-pocket payments were detected; then, the factors were collected in the form of a square-matrix questionnaire; and completed based on impact of each factor on the occurrence probability of others, with collective agreement, so the role of any factor in forecasting out-of-pocket status in future was identified by cross-impact analysis. MicMac software was used for data analysis. RESULTS: As many as 35 factors were identified which affected out-of pocket payments. The factors were categorised in four main roles, i.e. influencing, two-sided, dependent and independent. Some economic factors which had a higher impact on other system factors were influencing factors; they were the most critical components because the system changes were dependent on them. In contrast, some factors related to organising the health system were depending factors and were affected by the least changes in other factors. There are 10 factors in this group. These factors were mainly related to the utilisation of health services by a special look to the part of delivery (public or private). CONCLUSIONS: Policymakers should consider interactions and influencing network of out-of-pocket payment factors and should understand how a change in one factor can have a series of changes.

Effective factors on improving the quality of hospital services in south of Iran.

OBJECTIVE: To determine the quality of service being provided in a hospital in southern Iran and to evaluate it from patients' perspective. METHODS: The cross-sectional study was conducted at a general university hospital in Shiraz, southern Iran, in two phases in 2015. The first phase comprised a survey based on SERVQUAL method-ServQual stands for Service Quality- and collected data from hospitalised patients. In second stage Decision Making Trial and Evaluation (DEMATEL) technique was employed to prioritize quality factors identified in first stage to suggest action. The second phase comprised experts who determined the relationship between 5 quality aspects and 14 criteria in line with DEMATEL matrixes. SPSS 16 was used for data analysis. RESULTS: Of the 208 subjects in the first phase, 103(49.5%) were men and 105(50.5%) were women. The second phase had 12 experts from among the senior nursing staff. In all the five aspects of service quality, the hospital was not able to meet the expectations of the patients (p<0.001). DEMATEL analysis indicated responsiveness as the most important element for improving service quality, followed by reliability, empathy, assurance and tangibility. CONCLUSIONS: The authorities running the hospital needed to eliminate the negative gap and improve service quality by taking necessary measures.

The relationship between managers' leadership styles and emergency medical technicians' job satisfaction.

BACKGROUND/AIMS: Leadership plays a crucial role in many professions, especially in challenging positions such as emergency medical service jobs. The purpose of this study was to explore the relationship between managers' leadership styles and emergency medical technicians' job satisfaction. METHOD: This is a descriptive and cross-sectional study that was carried out in 2010. The research population included 21 managers and 87 emergency medical technicians working in 23 stations in Isfahan city, Iran. The main tools used for data accumulation were the Multiple Leadership Questionnaire for evaluating leadership styles and the Job Descriptive Index for measuring job satisfaction levels. Also, the Pearson correlation analysis test was used to evaluate the relationship between leadership style and job satisfaction. RESULTS: Among both managers and technicians, the highest mean score related to the transformational management style, whereas the lowest mean score related to the laissez-faire management style. Moreover, a significant relationship (P<0.01) was found between the transformational and transactional leadership styles and job satisfaction. However, no significant relationship was observed between the laissez-faire management style and job satisfaction. CONCLUSION: Considering the importance of job satisfaction in medical emergencies, it is recommended that health sector policy makers should provide the groundwork for implementing the transformational leadership style to enhance job satisfaction of the medical emergency staff.