Inequality in the distribution of resources in the health sector before and after the Health Transformation Plan in Qazvin, Iran.

BACKGROUND: The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman-Herfindahl index (HHI). METHODS: This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017. Demographic data pertaining to the cities were obtained from the statistical yearbooks of the Statistical Center of Iran, while information regarding the healthcare workforce was extracted from QUMS records. The analysis utilized two key measures, namely the Gini coefficient and the HHI, to assess the fairness of resource distribution. Data analysis was performed using Microsoft Excel 2016 and the Stata statistical software. RESULTS: The highest number of GPs, specialists, and subspecialists was observed in 2014, 2017, and 2017, respectively, while the lowest number was recorded in 2016, 2011, and 2015, respectively. From 2011 to 2017, the Gini coefficient for GPs ranged between 0.61 and 0.63. Among specialists, the lowest Gini coefficient value was observed in 2015 (0.57), while the highest was recorded in 2017 (0.60). The Gini coefficient for subspecialists remained constant at 0.52 from 2011 to 2017. The HHI revealed a high concentration of GPs in the cities of Qazvin province. Although the disparity gradually decreased in the specialties of eye, ear, nose, and throat, and pediatrics, the concentration still persists in Qazvin. In general surgery, the index value is low, indicating some level of inequality. In anesthesia and neurology, the index value decreased after the HTP and reached 5700; however, achieving equality (below 1000) still requires further efforts. No significant change in the index was observed after the HTP in specialties such as neurosurgery, rehabilitation, and nuclear medicine. Subspecialists also exhibited a concentration in the city of Qazvin. CONCLUSION: Based on the analysis of the Gini and HHI, it is evident that the distribution of GPs has not undergone significant changes following the implementation of the HTP. The Gini coefficient, which ranges from 0.4 to 0.6, indicates a high to complete level of inequality in the distribution of specialists and subspecialists. Moreover, the HHI exceeds 1000, reflecting a concentration of resources in specific areas. As a result, the HTP has not yet achieved its goal of ensuring a fair distribution of human resources. To address this issue, it is recommended to redesign distribution policies, including the allocation of physical health resources, such as specialized hospitals, beds, and medical equipment. Additionally, increasing student admissions in specialized and subspecialized fields and implementing tariff incentives can contribute to a more equitable distribution of resources. By aligning distribution policies with the principle of fairness, the healthcare system can better address the issue of resource distribution.

The relationship between patient safety culture and adverse events in Iranian hospitals: a survey among 360 nurses.

BACKGROUND: Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran. METHODS: The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables. RESULTS: The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events. CONCLUSION: This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.

The relationship between succession and intellectual capital with entrepreneurship in hospitals.

BACKGROUND: The hospital environment is very dynamic and faces many internal and external changes. Healthcare knowledge and technology are developing at a swift pace. This study investigated the relationship between succession and intellectual capital with entrepreneurship at the Qazvin University of Medical Sciences hospital, Iran. METHODS: The number of employees working in six hospitals was 2256, and according to Morgan's table, the required number of samples was 331. We distributed three hundred sixty-five questionnaires considering 10% of sample loss. We used a multi-stage stratified sampling method. In the first stage, each hospital was considered a stratum. After that, occupational groups were considered the next stratum within each hospital, and based on the ratio, the required number of samples for each occupational group was randomly selected. We used the Sobel test to investigate the mediating role of intellectual capital and the structural equation model to fit the research model. RESULTS: Succession aspects, including culturalization, meritocracy, job promotion path, and the role of senior managers, have a positive and significant effect on intellectual capital. Succession is only effective on intellectual capital and does not affect the personnel's entrepreneurship directly or through intellectual capital. CONCLUSION: Conducting training classes and intervention programs and using localized succession models can create a suitable platform for increasing organizational creativity and entrepreneurship, motivating the hospitals' personnel, and increasing intellectual capital.

Healthcare workers exposure risk assessment in the context of the COVID-19: a survey among frontline workers in Qazvin, Iran.

BACKGROUND: Healthcare workers perform various clinical procedures for COVID-19 patients facing an elevated risk of exposure to SARS-COV-2.This study aimed to assess the healthcare workers' exposure to COVID-19 in Qazvin, Iran in 2020. METHODS: We conducted this descriptive-analytical study among all healthcare workers on the frontline of exposure to COVID-19 in Qazvin province. We entered the participants into the study using a multi-stage stratified random sampling method. We utilized a questionnaire, "Health workers exposure risk assessment and management in the context of COVID-19 disease", designed by the World Health Organization (WHO) to collect data. We analyzed data using descriptive and analytical methods with SPSS software version 24. RESULTS: The results showed that all participants in the study had occupational exposure to the COVID-19 virus. So of 243 healthcare workers, 186 (76.5%) were at low risk and 57 (23.5%) at high risk of COVID-19 virus infection. Also, from the six domains mentioned in the questionnaire, health workers exposure risk assessment and management in the context of COVID-19 disease, the mean score of the domain of the type of healthcare worker interaction with a confirmed COVID-19 patient, the domain of health worker activities performed on a confirmed COVID-19 patient, the domain of the adherence to infection prevention and control (IPC) during health care interactions, and the domain of the adherence to IPC when performing aerosol-generating procedures in the high-risk group were more than the low-risk group. CONCLUSION: Despite strict WHO guidelines, many healthcare workers are exposed at contracting COVID-19. Therefore, healthcare managers, planners, and policymakers can revise the policies, provide appropriate and timely personal protective equipment, and plan for ongoing training for staff on the principles of infection prevention and control.

Measuring inequality in the distribution of health human resources using the Hirschman-Herfindahl index: a case study of Qazvin Province.

BACKGROUND: Achieving equity in the distribution of health services is one major goal in the health system. This study aimed to determine equality in distributing health human resources (physicians) in the Qazvin University of Medical Sciences before and after the Health Transformation Plan (HTP) based on the Hirschman-Herfindahl index (HHI). METHODS: In this descriptive-analytical study, the statistical population was general practitioners (GPs), specialists and subspecialists in the Qazvin University of Medical Sciences from 2011-to 2017. We extracted demographic statistics of the cities from the Statistical Center of Iran. Physicians' statistics were obtained from the Curative Affairs Deputy at the Qazvin University of Medical Sciences. We assessed inequality using the HHI. RESULTS: The highest number of GPs was in 2014, and specialists and subspecialists were in 2017. The lowest number of GPs, specialists, and subspecialists were in 2016, 2011 and 2015. The HHI for GPs in 2011-2017 was between 4300 and 5200. The lowest concentration for specialists before the HTP plan was the cardiologist with 3300, and after the HTP, the internal specialist with 3900. Also, the numerical value of this index for all subspecialty physicians after the HTP was 10,000, the highest level of concentration. CONCLUSION: The values obtained from the HHI index indicate the high concentration and disproportionate and inequitable distribution of human resources in the health sector in this province. The number of specialists in some cities is still much less than acceptable, and some cities even have shortcomings in the critical specialists.

Role of Organizational Climate in Job Involvement: A Way to Develop the Organizational Commitment of Nursing Staff.

Employees are the most valuable assets of an organization; therefore, it is very important to understand their behavior. In this regard, the present study was carried out in order to examine the effect of organizational climate on job involvement among nurses working in the teaching hospitals of Qazvin Province, Iran. The present descriptive analytical study was done in 2017. To randomly select a specific proportion of nurses from each of Qazvin teaching hospitals, stratified sampling was used. In total, 340 nurses were selected. Data were collected using 3 questionnaires: Halpin and Kraft Organizational Climate Questionnaire, Job Involvement Questionnaire (Kanungo), and Allen and Myer Organizational Commitment Questionnaire. For data analysis, confirmatory factor analysis and structural equation modeling were used applying AMOS-24 software. The results of path analysis showed the effect of organizational climate on the nurses' job involvement. Moreover, organizational climate influenced organizational commitment through the mediation of job involvement. According to values obtained for degree of freedom based on chi-square, goodness-of-fit index, root mean square error of approximation, and comparative fit index were in the defined range; therefore, the validity of the conceptual model was approved. Based on the results of the present study, managers of health organizations can achieve their goals by understanding the organizational climate of the hospitals and its effect on the employees' job involvement and discovering strategies needed for organizational commitment improvement.