Strategies to promote patient-centeredness within the healthcare industry: A grey-based multicriteria decision making methods.

RATIONALE: The international policy agenda has recently advocated for the development of patient-centeredness in healthcare service delivery. Consequently, various stakeholders in the healthcare systems have expressed a vital need for identifying strategies and tools that can enhance patient-centeredness. AIMS AND OBJECTIVES: The objective of this paper was to prioritise and benchmark the strategies that can improve patient-centeredness in healthcare service delivery. METHOD: We employed a multi-stage research scenario that consisted of two phases: a phase including of a scoping review to identify the current strategies to improve patient-centeredness (PC); And, a phase including of a multicriteria best-worst method to assign weights to PC principles, and a questionnaire administered to a sample of experts for benchmarking the strategies derived from the literature using the Grey Multi-Attributive Border Approximation Area Comparison (MABAC-G) method. RESULTS: The most important principle of patient-centeredness was deemed to be access to care, while telehealth tools and Electronic Health Information Systems were respectively suggested as the most efficacious platforms for promoting patient-centeredness. CONCLUSION: We recommend that administrators and policy makers in the healthcare industry prioritise the implementation and research of strategies such as telehealth tools and electronic health information systems to enhance access and patient-centeredness in the healthcare systems.

Comparing the clinical and economic efficiency of four natural surfactants in treating infants with respiratory distress syndrome.

Surfactant therapy has revolutionized the treatment of respiratory distress syndrome (RDS) over the past few decades. Relying on a new method, the current research seeks to compare four common surfactants in the health market of Iran to determine the best surfactant according to the selected criteria. The research was a cross-sectional, retrospective study that used the data of 13,169 infants as recorded on the information system of the Iranian Ministry of Health. To rank the surfactants used, the following indicators were measured: re-dosing rate, average direct treatment cost, average length of stay, disease burden, need for invasive mechanical ventilation, survival at discharge, and medical referrals. The CRITIC (criteria importance through intercriteria correlation) method was used to determine the weight of the indicators, and MABAC (multi-attributive border approximation area comparison) was used to prioritize the surfactants. Based on the seven selected indicators in this research (re-dosing rate, average length of stay, direct medical cost per one prescription, medical referral rate, survival at discharge, disability-adjusted life years, number of newborns in need of invasive mechanical ventilation) and using multi-criteria analysis method, Alveofact was identified as the worst surfactant in infants with either more or less than 32 weeks' gestation. So that some criteria were worse in Alveofact group infants than other groups; for example, in the comparison of the Alveofact group with the average of the total population, it was found that the survival rate at discharge was 57.14% versus 66.43%, and the rate of re-dosing was 1.63 versus 1.39. BLES (bovine lipid extract surfactant) was the best alternative for infants more than 32 weeks' gestation, whereas Survanta was identified as best option for infants with less than 32 weeks' gestation. Curosurf showed an average level of functionality in the ranking. This study advises the policy makers in the field of neonatal health to increase the market share of more effective surfactants based on this study and other similar studies. On the other hand, neonatal health care providers are also advised to prioritize the use of more effective surfactants if possible, depending on the clinical conditions and desired improvements.

A Fuzzy BWM-TOPSIS Framework for Identifying and Prioritizing Measures to Overcome Obstacles to the Regionalization of Iranian Healthcare Services.

Background: One of the most effective strategies to improve the access of community members to health services is to regionalize health services. The purpose of this study is to examine and prioritize measures that could help to counteract obstacles and problems in implementing the regionalization of healthcare in Iran. Methods: The study relied on a mixed research method, including qualitative and quantitative phases. First, by conducting semi-structured interviews and analyzing them through qualitative content analysis, the obstacles and measures were identified. In the quantitative phase, the obstacles identified were weighted using the fuzzy best-worst method (FBWM), and the measures were then prioritized through the fuzzy TOPSIS (FTOPSIS) method. Results: The obstacles were categorized into four main dimensions: "infrastructural," "political," "human resources," and "managerial." Among the 15 obstacles identified, "absence of performance guarantees" was the most important obstacle, while "insufficient education" was the least important obstacle to the regionalization of healthcare services in Iran. Meanwhile, the following eight measures that could help to overcome the obstacles were extracted from the interviews: "conducting a needs assessment," "providing clinical guidelines," "employing specialized human resources," "reinforcing the referral system," and "preparing electronic health records," "enhancing education and information dissimilation," "building executive support," and "providing cost-effective equipment and technology." "Employing specialized human resources" was also the most effective measure to overcome the obstacles. Conclusions: Iranian healthcare policy-makers can use the empirical findings of this investigation to accelerate the implementation of Iran's regionalization plan to improve the access of community members to healthcare services.

Development of a model for predicting hospital beds shortage and optimal policies using system dynamics approach.

BACKGROUND: Policymakers use simulation-based models to improve system feedback and model the reality of the problems in the system. This study uses the system dynamics approach to provide a model for predicting hospital bed shortages and determine the optimal policy in Shiraz, Southern Iran. METHODS: This study was designed based on Sterman's system dynamic modeling (SDM) process. Firstly, we determined the main variables affecting bed distribution using a mixed qualitative and quantitative study which includes scoping review, expert panel, Delphi, and DANP. Then, dynamic hypotheses were designed. Subsequently, we held several expert panels for designing the causal and stock-flow models, formulating and testing a simulation model, as well as developing various scenarios and policies. RESULTS: Dynamic modeling process resulted in four scenarios. All of the scenarios predicted a shortage of national hospital beds over a 20-year time horizon. Then, four policies were developed based on the changes in the number of beds and capacity of home care services; finally, the optimal policy was determined. CONCLUSIONS: Due to the high cost of setting up hospital beds, developing and supporting cost-effective home care services, strengthening the insurance coverage of these services, and improving the quantity and quality of community care, considering the real needs of the community could be considered as an optimal option for the future of the city.

Comparison of Health Status Indicators in Iran with the Eastern Mediterranean Countries Using Multiple Attribute Decision-Making Methods.

Background: Improving public health is the main goal of healthcare systems across the world. Healthcare policymakers often use comparisons between different healthcare systems to better position their country and use the outcome to develop novel strategies to improve their own public health. The present study aimed to compare the health status indicators in Iran with those of the Eastern Mediterranean (EM) countries using the multiple attribute decision-making (MADM) methods. Methods: A descriptive-analytical study was conducted in 2021 at Shiraz University of Medical Sciences, Shiraz, Iran. Data on the ranking of health status indicators in EM countries were obtained from the annual publications of the World Health Organization, World Health Statistics (2016-2020). As part of the MADM mathematical models, the "criteria importance through intercriteria correlation" (CRITIC) model was used to assign weights to health status indicators. In addition, the "multi-criteria optimization and compromise solution" (VIKOR) model was used to rank the EM countries. Results: The results showed that Bahrain and Somalia ranked first and last on health status indicators, respectively. Iran was ranked fifth among the EM countries. However, while Iran has a better status on all indicators than the mean value of all EM countries, there is a significant gap between the health status in Iran compared to the top-ranked countries. Conclusion: Health care strategies adopted by top-ranked countries, such as Bahrain and Qatar, can be used by Iran and other EM countries as a model to improve their healthcare system.

Identification and Prioritization of Critical Factors Affecting the Performance of Iranian Public Hospitals Using the Best-Worst Method: A Prospective Study.

Background: In the ever-changing healthcare environment, policymakers and managers need a comprehensive evaluation system to accurately identify and prioritize factors affecting hospital performance. The present study aimed to identify and rank critical factors affecting hospital performance using the best-worst method (BWM). Methods: A cross-sectional study was conducted during 2016-2019 to identify and prioritize factors affecting the performance of Iranian public hospitals using the BWM. Initially, the content validity ratio (CVR) was used to screen the identified factors. Then, using a linear programming formula, a pairwise comparison between the best/worst criterion with all other identified criteria was performed. Results: The most important internal factor was efficiency, and its associated indicators were mainly related to financial factors. Among all external factors, the most prominent were economic, legal, and political factors, which were negatively affected by budgeting policies and the payment system. A megatrend was also identified in the form of a national health insurance system as well as a shift from employer-based to government-subsidized insurance coverage. Conclusion: External factors (economic and political) had a greater impact on the performance of public hospitals than internal factors (efficiency and effectiveness). A preprint of this study was published at https://www.researchsquare.com/article/rs-453223/v1 with doi: 10.21203/rs.3.rs-453223/v1.

Selecting the most suitable organizational structure for hospitals: an integrated fuzzy FUCOM-MARCOS method.

BACKGROUND: Previous studies mentioned four organizational structures for hospitals, which are budgetary, autonomous, corporate, and private. Nevertheless, healthcare decision-makers are still required to select the most organizational structure specific to their circumstances. The present study aims to provide a framework to prioritize and select the most suitable organizational structure using multicriteria decision-making (MCDM) methods in Iranian hospitals. METHODS: First, a multicriteria decision-making model consisted of the respective criteria, and alternatives were developed. The pertinent criteria were identified through a systematic literature review. The coefficient weights of the identified criteria were then calculated using FUCOM-F. Finally, organizational structures were prioritized in accordance with the identified criteria using FMARCOS. RESULTS: The findings reveal that income is the most significant criterion in selecting organizational structures for hospitals whereas the number of outpatient visits is the least important. Also, the private structure is the most appropriate, and budgetary style is the least suitable organizational structure for Iranian hospitals. CONCLUSION: Providing a framework in order to select the most appropriate organizational structure could help managers and policymakers of the healthcare sector in Iran and other countries, mainly similar developing countries.

Alternative Water Resources Selection to Supply Drinking Water in Flood Disasters by Multicriteria Decision-Making Techniques (DANP and VIKOR).

Background: Emergency is generally caused by natural disaster and infectious disease outbreaks, or it is man-made. Floods are natural phenomena that generally appear in multiple parts of the world. Flooding is one of the most destructive naturally occurring environmental hazards and can cause public, infrastructural, and environmental damage. The purpose of this study is to select alternative water resources for supplying Bandar Abbas in flood disasters by multicriteria decision-making techniques. Methods: Information required includes possible water resources alternative for flood, quantitative and qualitative characteristics of the water resources, climatic circumstances, and demographic information used in organizations data and previous studies. After selecting and proposing water resources alternative for Bandar Abbas in flood, the subcriteria were weighed applying DANP (DEMATEL-ANP) techniques and water resources were prioritized with the VIKOR technique. According to the network structure and internal and external dependence of the criteria and subcriteria, the advantages of DANP in calculating weights have been used to adapt to more real-world problems. The VIKOR technique was developed for multicriteria optimization of complex systems. Results: After reviewing and extracting the criteria from various studies, 9 main criteria and 44 subcriteria were defined to select water resources in disasters and emergencies. According to field studies and related organizations' information, the proposed water resources for Bandar Abbas to use in flood disasters include humidity, sea (Persian Gulf), Sarkhoon plain, and wastewater treatment plant of Bandar Abbas. Conclusion: Results showed that the optimal water resources for Bandar Abbas in flood disasters are the sea and wastewater treatment plant effluent (after advanced treatment). The study proposed appropriate model to select optimal water resources for various natural disasters in different geographical areas. This model can help officials and decision-makers to plan for drinking water supply from disaster-prone areas before disasters occur.

Evaluation of the World Countries Health Referral System Performance Based on World Health Organization Indicators Using Hybrid Multi-Criteria Decision-Making Model.

OBJECTIVES: Primary healthcare will not be effective unless there is a proper referral system. In contrast, comparing the performance of healthcare systems provides an opportunity for policy makers to determine the status of the country's healthcare system compared with their international counterparts. Therefore, we ranked the countries in terms of indicators affected by the referral system. METHODS: This study was conducted in 2020. In the first phase, which was to determine the indicators affected by a country's referral system, data were collected by the Delphi method, and therefore, 13 indicators with a content validity ratio equal to or greater than 0.42 were selected. In the second phase, the data of 13 indicators selected in the first phase were extracted from the 2018 and 2019 World Health Organization reports. The weight of the indicators was calculated based on the Decision-Making Trial and Evaluation Laboratory method-based Analytic Network Process (DANP) and Shannon's entropy, and the VIekriterijumsko KOmpromisno Rangiranje (VIKOR) method was used to rank the countries. SPSS 24 and Excel 2013 software were used for data analysis. RESULTS: Switzerland, Germany, and Sweden ranked first, second, and third, respectively. In all the 3 countries, there are no mandatory gatekeeping systems. Physicians, especially general practitioners, are the core of primary healthcare, and in all the 3 countries, there is a uniform and coherent health financing system that is either based on mandatory health insurance (Switzerland and Germany) or taxes (Sweden). India had the lowest ranking. CONCLUSIONS: It seems that the study of the health system of the countries that have obtained higher rankings can indicate their efforts in establishing a gatekeeping system, family physician program, and appropriate financing system. Therefore, other countries can study successful countries and copy them as a model to improve their health system.

Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method.

BACKGROUND: Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME. OBJECTIVES: This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them. METHODS: In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM). RESULTS: Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components. CONCLUSION: The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.

A comprehensive environmental scanning and strategic analysis of Iranian Public Hospitals: a prospective approach.

OBJECTIVES: This study was conducted to provide a strategic direction to public hospitals in Iran via environmental scanning in order to equip hospitals to plan and perform proactively and adapt with the everchanging environment. RESULTS: A mixed method study including in-depth interview and survey were used to determine influential environmental factors based on PESTLE (political, economic, social, technological, legal and environmental) and Douglas West framework to determine the effectiveness and feasibility of factors. Issues identified at micro environmental level were over prescription, inequality in distribution of healthcare services and high demands for luxurious health services. Issues identified at the macro environmental level were related to changes in disease patterns, inappropriate hospital budgeting, economic sanctions, government corruption and healthcare centralization. In order to tackle the issues identified, it is paramount to enhance bed distribution management, improve strategic policies for a more equitable payment system, and enhance the efficiency and effectiveness of services by implementing a strategic inventory control. Furthermore, the considerable impact of economic sanctions on financial resources of Iranian hospitals should not be ignored.

Ranking of Iranian provinces based on healthcare infrastructures: before and after implementation of Health Transformation Plan.

BACKGROUND: Health Transformation Plan (HTP) was occurred in 2014 to improve access and equity and reduce out of pocket payments in Iranian Health Care System. In this regard the aim of this study is evaluating and ranking the service provider's infrastructures among the country provinces as an indicator of equity before and after implementation of the HTP. METHODS: This cross sectional study is conducted in 2017. The study population included 31 provinces of the country. Data related to 4 years from 2012 to 2016 were included from the data bases of Ministry of Health and Medical Education as well as the statistics yearbook of the country. The obtained results of multi-criteria decision-making methods were analyzed as well. SPSS18 and Excel2013 software were used for data analysis. RESULTS: Based on the VIKOR method, in 2012, Mazandaran, Tehran and Fars provinces and in 2013, the provinces of Tehran, Fars and Isfahan ranked from first to third respectively. Similarly after HTP, in 2015, the provinces of Tehran, Khorasan Razavi and Fars and in 2016 the provinces of Tehran, Fars and Khorasan Razavi have ranked from first to third respectively. Paramedic, dentist, pharmacist, medical institutions and hospital bed had a significant difference before and after the implementation of Health Transformation Plan, so that the number of these indicators increased after implementation of the HTP (P value < 0.05). CONCLUSIONS: According to the results, there are many differences between the provinces and these disparities have not decreased significantly after HTP. Consequently, it is suggested to the health sector policy makers to make regional plans and allocate the budget of HTP, based on the status of the provinces. In addition, responding to these inequalities requires a transparent and systematic approach to provide the budget for allocating to the population, health needs, and the lack of development and geographical isolation of regions.

Identifying and Prioritizing Effective Factors on Outsourcing in Public Hospitals Using Fuzzy BWM.

The outsourcing of health services has gained prominence over the past decades. Because numerous factors affect outsourcing in the field of health services, identifying and prioritizing these factors is specifically important. This study sought to identify and prioritize the factors affecting outsourcing, and to propose a model for the effective outsourcing of hospital services in Shiraz, Iran. The study drew on an exploratory mixed research method. In the first stage, all the criteria affecting the outsourcing of activities in hospitals were identified through the theoretical framework, a literature review, and interviews with hospital experts. Next, the criteria were finalized and prioritized using the fuzzy best-worst method (BWM). Following the literature review, 34 criteria for outsourcing were identified based on the studies explored and the interviews with the experts; the criteria were categorized into seven dimensions including "strategy", "management", "economy", "quality", "security and keeping patients' records", "service", and "agility." These dimensions formed the final outsourcing model of hospitals in Shiraz. Finally, the fuzzy BWM analysis revealed that "security and keeping patient's records" had the highest priority in outsourcing-related decision-making. The findings can help hospital managers make the right decision concerning the outsourcing of hospital services. The dimensions found in this research might also have been identified in other models, although this study was different in that it concentrated on the criteria in the specialized area of hospital management, while identifying the importance and weights of all the criteria involved.

A comprehensive map of the evidence on the performance evaluation indicators of public hospitals: a scoping study and best fit framework synthesis.

INTRODUCTION: Key performance indicators are essential navigation tools for hospitals. They provide managers with valid information enabling them to identify institutional strengths and weaknesses and improve managerial performance. In this study, the synthesis of evidence relating to hospital performance indicators was carried out by means of a field review and the indicators were analyzed through the Best Fit Method. METHODS: The five-step approach of Arksey and O'Malley was used as follows: selection of the research question; search for related studies; selection and refinement of the studies; synthesis and tabulation of key information; derivation of the related summary and report. Applying the Best Fit Framework Synthesis Method, the initial themes and subthemes were created and a model of public hospitals performance evaluation finally generated. RESULTS: Forty-nine studies were considered eligible to form part of the synthesis. The final model included the efficiency/productivity, effectiveness and financial themes. The efficiency/productivity sub-themes incorporated human resources indicators, hospital beds, costs, operating room productivity, emergency rooms, ICU, radiology, labs, technology and equipment productivity. Other sub-themes relate to general indicators such as BOR, ALS, number of outpatients and hospitalized patients. Financial themes included profit, revenue, cash flow, cost, investment, assets, debt and liquidity. Concerning effectiveness, the indicators were categorized in terms of access (equity), safety, quality and responsiveness. The accountability indicators were classified into patient-centeredness, staff orientation, and social responsibility. CONCLUSION: Hospital performance management is a multi-dimensional issue, each dimension having its own significance. Based on the evidence, indicators are dependent on the evaluation model employed, the evaluation objective, and the views of executive managers and participants in the study. Selection of the most appropriate indicators is therefore key to a comprehensive performance evaluation system.

Evaluating the health system financing of the Eastern Mediterranean Region (EMR) countries using Grey Relation Analysis and Shannon Entropy.

BACKGROUND: Sufficient and sustainable financing of the health system is essential for improving the health of the community. The health systems financing of the EMR countries is facing the challenge. Assessment and ranking of healthcare financing can help identify and resolve some challenges of health systems. So, the aim of this study is to evaluate and rank the condition of the health sector financing in the EMR countries. METHODS: This study was a cross-sectional study. The data was of secondary type, extracted from the official WHO and World Bank data. The six healthcare financing indicators in a 10-year interval (2005-2014) in 19 EMR countries analyzed using Grey Relation Analysis and Shannon Entropy. RESULTS: On average, the countries in the EMR region spent 4.87% of their GDP on the health sector. Jordan and Qatar allocated the highest (8.313) and the lowest (2.293) percentages of their GDP to the health sector, respectively. The results showed That Qatar was in a better condition than other EMR countries during 2005-2014 in terms of the health system financing and earned the first rank. After that, the UAE and Kuwait were ranked second and third. CONCLUSIONS: There is a lot of inequality among the EMR countries in terms of health financing. However, our findings confirmed that only increasing the total health expenditure in a country would not improve its financing status compared to other countries, but it also depends on financing methods.