Prioritization of Hospital Information System’s Executive Barriers to Patient Payment Reduction and Visitation Quality Improvement Packages of Health System Reform Plan from the Perspectives of Users and Experts in Hospitals of Yazd

Background: Healthcare facilities are dependent on hospital information systems due to the high volume and variation of information in different fields. These systems are a prerequisite for effective and high-quality healthcare provision in hospitals. Objectives: The present study intended to prioritize the executive barriers to these systems in patient payment reduction and visitation quality improvement packages of the health system reform plan (HSRP) from the perspectives of users and experts in selected university hospitals of Yazd, Iran, in 2019. Methods: The population of this descriptive-analytical study included 110 participants, including experts of information technology (IT) unit, hospital managers, and personnel of the administrative and medical units dealing with the hospital information system. The data collection tool was a researcher-made questionnaire based on similar studies, the validity of which was evaluated by a committee of experts. Also, the reliability of the questionnaire was investigated and confirmed before the study using the Cronbach’s alpha method and a sample of 30 participants. Data analysis was performed using SPSS software version 21. Results: Among the six barrier dimensions, the highest mean score belonged to the professional factors (3.46 ± 1.03), followed by human barriers (3.44 ± 0.83). Among professional barriers, the lack of motivation of the personnel in IT learning and get training on the IT-related skills had the highest mean score of 3.67. Conclusions: According to the results, outsourcing such services and special budget allocation for hardware and software update and support, holding conferences, and provision of practical training in this field are suitable strategies for better implementation of such systems.

The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia

Background It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. Methods In NSW—the largest populational jurisdiction in Australia, and over three times the size of the UK—the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a ‘core’ part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of ‘doorways’. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. Conclusions In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets—emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general.

Study of the Effect of Health System Reform Plan Administration on the Satisfaction Level among Medical Doctors and Nurses in Tabriz State Hospitals, East Azerbaijan, Iran

Having three orientations, the Health System Reform Plan (HSRP) has been administered to financially support and protect people, provide fair health services and promote the quality of health services. To be unsatisfied about health and medical services brings undesirable outcomes. The present investigation aimed to study the effect of Health System Reform Plan (HSRP) on the satisfaction level among medical doctors and nurses of Tabriz state hospitals, East Azerbaijan province, Iran in a period from 21th February; 2015 to 22th June; 2015. Statistical population included those patients who referred to Tabriz state hospitals. We used stratified sampling method. To collect data we used questionnaire being presented to the samples after assessing its validity and reliability. We also utilized descriptive and inferential statistics in a way that we used descriptive method to classify, summarize and interpret of obtained data. Then after demonstrating the abnormality of data by Kolmogorov-Smirnov test we used linear and multiple regressions to test research hypothesis and effect from the perspective of inferential method. Obtained results confirmed the research hypothesis and explained that the administration of HSRP affected medical doctors’ level of satisfaction. Also, according to the results of multiple regression tests, doctors and nurses’ satisfaction level was placed at the top of most affected issues from HSRP.

Universal Health Coverage Development in Thailand: How Global Ideas and a National Medical Professional Movement Made a Difference

Background: Universal health coverage is endorsed as the global development agenda in the 2015 SDGs for global achievement by 2030 and is expected to build national policymaking agendas. Common research often focuses on national processes in the first place. For example, accounts of Thailand's health system development mostly emphasise domestic factors and influences rather than the linkage of external/global health ideas. The paper questions how external/global health ideas influence national health policymaking and the linkage between them in achieving Thailand's universal health coverage policy.Methods: A qualitative method was employed to capture complex and historical narratives of the national medical professional movement for Thailand's health system reform through the lens of a global social policy approach for exploring external and global health ideas transfer. Moreover, the actor- and policy entrepreneur approaches would be employed to investigate national health policymaking and examine how ideas from the external and global levels have improved national equity in health. Results: The research locates the narratives on global ideas and practices that influence a national health system reform. This highlights the impact/role of global ideas on national professional movements, i.e. the rural doctor movement in Thailand mobilising the health system reform for all. The study found that national equity in health could not be achieved without external/global health ideas transfer. Such a case of national universal health coverage achievement in Thailand happened with the effort of the rural doctor movement and individual agency as policy entrepreneurs in translating external/global ideas and practices for their movement and mobilisation. The case contributed to a better understanding of the global process regarding ideas and practices that can be transferred directly and indirectly to the national level. Conclusions: Global ideas transfer can also happen in different aspects such as it can be seen the ideas transfer from developed to developed countries; from developed to developing countries. Besides, the author witnessed that the IOs ideas can also be transferred to developing countries or reverse, and again, between developing countries themselves.

Designing a Comprehensive Evaluation Model for Health Reform Plan in Iran

Background: The present study aimed to design a comprehensive model to evaluate the health system reform plan so the indicators of this model can lead to the health reform plan's effectiveness. Hence, this plan's effective factors, including policymakers and managers, suppliers, and clients, were identified and explained. Methods:According to the practical purpose and nature of the research, the combined/mixed research method was used, in 2018-2019. For the qualitative phase, the Delphi technique was used in exploratory interviews, and quantitative methods were used to collect data through a questionnaire. In the quantitative phase, 400 employees of 10 hospitals were selected by stratified random sampling; and in the second section, 300 clients were randomly selected in two hospitals with the highest and lowest evaluation scores in the previous phase. Content analysis method and Delphi technique were used for classification and analysis of qualitative data, and SPSS Ver.22, AMOS Ver.24 and Expert Choicev24 were used for data description and dimensions and indices' weight extraction. Dimensions under consideration include the financial, social responsibility, growth and learning, citizens and client, and internal process fields. Results: The components with the highest and lowest weight and impact on the effectiveness of the plan were identified in the following dimensions: financial field, Social responsibility field, growth and learning field, citizens and client field, internal process field, including weights 0.266, 0.244, 0.202, 0.164, 0.124, respectively. Conclusion: Given the results, the components, indicators, dimensions, and levels of the model designed, the comprehensive evaluation of the Health System Reform Plan in Iran (CEHSRP-IR) with the normal mean was confirmed by the statistical population, and this model can be used in all organizations implementing this plan.

Adapting results-based financing to respond to endogenous and exogenous moderators in Zimbabwe

PurposeThis study examines key adaptations that occurred in the Zimbabwean Results-Based Financing (RBF) programme between 2010 and 2017, locating the endogenous and exogenous factors that required adaptive response and the processes from which changes were made.Design/methodology/approachThe study is based on a desk review and thematic analysis of 64 policy and academic literatures supplemented with 28 multi-stakeholder interviews.FindingsThe programme experienced substantive adaption between 2010 and 2017, demonstrating a significant level of responsiveness towards increasing efficiency as well as to respond to unforeseen factors that undermined RBF mechanisms. The programme was adaptive due to its phased design, which allowed revision competencies and responsive adaptation, which provide useful insights for other low-and-middle income countries (LMICs) settings where graduated scale-up might better meet contextualised needs. However, exogenous factors were often not systematically examined or reported in RBF evaluations, demonstrating that adaptation could have been better anticipated, planned, reported and communicated, especially if RBF is to be a more effective health system reform tool.Originality/valueRBF is an increasingly popular health system reform tool in LMICs. However, there are questions about how exogenous factors affect RBF performance and acknowledgement that unforeseen endogenous programme design and implementation factors also greatly affect the performance of RBF. As a result, a better understanding of how RBF operates and adapts to programme level (endogenous) and exogenous (external) factors in LMICs is necessary.