چالش‌های روابط ستاد دانشگاه علوم پزشکی و بیمارستان‌های وابسته: مورد مطالعه یکی از دانشگاه‌های مستقر در تهران
محورهای موضوعی : -مدارک پزشکی
فرید ابوالحسنی
1
,
آزاده سیاری‌فرد
2
,
لاله قدیریان
3
,
مژگان فرشادی
4
,
فاطمه رجبی
5
1 - دانشیار طب داخلی، مؤسسۀ ملی تحقیقات سلامت، گروه آناتومی دانشکده پزشکی دانشگاه علوم پزشکی تهران، تهران، ایران
2 - استادیار پزشکی اجتماعی، مرکز تحقیق و توسعۀ سیاست‌های دانشگاه علوم پزشکی تهران، تهران، ایران
3 - استادیار پزشکی اجتماعی، مرکز تحقیق و توسعۀ سیاست‌های دانشگاه علوم پزشکی تهران، تهران، ایران
4 - کارشناس مدیریت خدمات بهداشتی و درمانی، مرکز تحقیق و توسعۀ سیاست‌های دانشگاه علوم پزشکی تهران، تهران، ایران
5 - دانشیار پزشکی اجتماعی، مرکز تحقیق و توسعۀ سیاست‌های دانشگاه علوم پزشکی تهران، تهران، ایران
کلید واژه: ارتباطات سازمانی, دانشگاه علوم پزشکی, بیمارستان, صف, ستاد, چالش,
چکیده مقاله :
مقدمه: ناکارآمدی ارتباطات بین دانشگاه علوم پزشکی و بیمارستان‌های آموزشی وابسته آن، می‌تواند در مدیریت بیمارستان و کارکردهای مختلف آن مانند ارائه خدمات، آموزش و پژوهش مشکلاتی ایجاد کند. این مطالعه به‌منظور درک دقیق این ارتباطات و نیز چالش‌های موجود از دیدگاه ذی‌نفعان مختلف در یکی از دانشگاه‌های علوم پزشکی مستقر در شهر تهران، انجام شد. روش پژوهش: در این مطالعه کیفی، برای جمع‌آوری داده‌ها، ۳۳ مصاحبه حضوری نیمه‌ساختارمند و یک بحث گروهی متمرکز انجام شد. شرکت‌کنندگان از طریق نمونه‌گیری هدفمند و گلوله برفی، از بیمارستان‌های آموزشی و واحدهای ستادی انتخاب شدند. برای تحلیل داده‌های مصاحبه‌ها از روش تحلیل محتوای قراردادی و نرم‌افزار تحلیل کیفی MAXQDA استفاده شد. کدزنی و طبقه‌بندی کدها توسط دو پژوهشگر به صورت مستقل انجام شد. یافته‌ها: از چالش‌های موجود در ارتباطات بیمارستان‌ها و واحدهای مختلف ستادی دانشگاه، ۱۲۷۵کد به دست آمد که پس از دسته‌بندی‌های مفهومی، به ۱۴ ساب‌تم و ۴ تم اصلی تصمیم‌گیری و سیاست‌گذاری، تأمین منابع، نظارت و ارزیابی و جریان اطلاعات طبقه‌بندی شدند که همه این تم‌ها زیرمجموعۀ یک تم محوری به نام یکپارچگی قرار گرفتند. نتیجه‌گیری: تحلیل وضعیت موجود و چالش‌های ناشی از آن، لزوم بازنگری ارتباطات بین بیمارستان‌های آموزشی با واحدهای ستادی دانشگاه را نشان داد. این بازنگری باید به سمت کاهش تمرکزگرایی و افزایش قدرت تصمیم‌گیری در بیمارستان‌ها در ابعاد مختلف باشد. بدیهی است با توجه به مسئولیت اجتماعی و لزوم پاسخگویی دانشگاه و بیمارستان‌ها به انتظارات آموزشی و نیازهای درمانی جامعه، باید نقش حاکمیتی و نظارتی ستاد دانشگاه به خوبی مشخص و به درستی اجرا گردد.
Introduction: The relationship between medical universities and teaching hospitals is a challenging issue. Lack of appropriate relations can create challenges in hospital management and its various functions, such as providing services, education and research. Therefore, this study was conducted to understand the current challenges of the relationship a university of medical sciences using different stakeholders' perspectives. Methods: For data collection, 33 semi structured in-depth interviews and one focused group discussion were conducted. The participants were selected through targeted and snowball sampling, from educational hospitals and university departments. Qualitative content analysis method using qualitative analysis software, MAXQDA, was used for analyzing data. Coding and classification of codes were done by two researchers independently. Results: After conceptual categorization, the obtained categories were turned into 14 sub-themes and 4 main themes of “decision and policy making”, “resource provision”,” supervision and evaluation” and “information flow”. All these themes are subsets of the main “unity” theme. Conclusion: analysis of the condition and related challenges emphasized the need for a revision of the relationships between educational hospitals and university departments. According to scientific evidence, this reform should focus on decentralization in order to increase hospitals decision-making power in different aspects. Obviously, due to social responsibility of university and hospitals and the necessity of their accountability to educational expectations and therapeutic needs of the community, the university governance and supervision role should be well defined and implemented correctly.
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2- Marandi A. The integration of medical education and health care system in the Islamic Republic of Iran: a historical overview. Iranian Journal of Medical Education, 2001; 1: 8-11.
3- Bagheri Lankarani K, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Med J Islam Repub Iran, 2013; 27(1): 42-9.
4- Mehrdad R. Health System in Iran. JMAJ, 2009; 52(1): 69-73.
5- Petersdorf RG, Wilson MP. The Four Horsemen of the Apocalypse, Study of Academic Medical Center Governance. Jama, 1982; 247(8): 1153-61.
6- Hastings DA, Crispell KR. Policy-making and governance in academic health centers. Medical Education, 1980; 33(4): 8.
7- Schimpff SC, Rapoport MI. Ownership and governance of university teaching hospitals: let form follow function. Acad Med, 1997; 72(7): 576-88.
8- Allison RF, Dalston JW. Governance of University-Owned Teaching Hospitals. Inquiry, 1982; 19: 3-17.
9- Barrett DJ. The evolving organizational structure of academic health centers: the case of the University of Florida. Acad Med, 2008; 83(9): 804-8.
10- Karpf M, Perman J, Lofgren R, Melgar S, Butler F, Day Z, et al. Creating an integrated clinical enterprise at the University of Kentucky: the emergence of UK HealthCare. Acad Med, 2007; 82(12): 1163-71.
11- Medicine AoPo. Governance of Teaching Hospitals:Turmoil at The University of Pennsylvania and The Johns Hopkins University. THE AMERICAN JOURNAL OF MEDICINE, 2003; 114: 3.
12- Culbertson RA, Goode LD, Dickler RM. Organizational models for medical school-clinical enterprise relationships. Acad Med, 1996; 71(11): 1258-74.
13- Krippendorff, K. Content Analysis. An Introduction to Its Methodology (3rd ed). California, CA: Sage Publications; 2013: 81-85.
14- Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today, 2004; 24(2): 105-12.
15- Levine AS, Detre TP, McDonald MC, Roth LH, Huber GA, Brignano MG, et al. The relationship between the University Of Pittsburgh School Of Medicine and the University of Pittsburgh Medical Center--a profile in synergy. Acad Med, 2008; 83(9): 816-26.
16- Innovations in health service delivery: the corporatization of public hospitals. Washington, DC: World Bank Group; 2003.
17- Eeckloo K, Van Herck G, Van Hulle C, Vleugels A. From Corporate Governance to Hospital Governance: Authority, transparency and accountability of Belgian non-profit hospitals board and management. Health Policy, 2004; 68(1): 1-15.
18- Chawla M, Govindaraj R, Berman P, Needleman J. Improving Hospital Performance through Policies to Increase Hospital Autonomy: Implementation Guidelines. Boston: United States Agency for International Development (USAID); 1996.
19- Govindaraj R, Obuobi AAD, Enyimayew NKA, Antwi P, Ofosu-Amaah S. Hospital Autonomy in Ghana: The Experience of Korle Bu and Komfo Anokye Teaching Hospitals; 1996.
20- Governing public hospitals, Reform strategies and the movement towards institutional autonomy. European Observatory on Health Systems and Policies; 2011.
21- Holden LM. Complex adaptive systems: concept analysis. Journal of Advanced Nursing, 2005; 52(6): 651-7.
22- Anderson RA, McDaniel RRJ. Managing Health Care Organizations: Where Professionalism Meets Complexity Science. Health Care Management Review, 2000; 25(1): 83-92.
23- Savigny Dd, Adam T, editors. Systems thinking for health systems strengthening: Alliance for Health Policy and Systems Research, World Health Organization; 2009.
24- Jafari M, Rashidian A, Abolhasani F, Mohammad K, Yazdani S, Parkerton P, et al. Space or no space for managing public hospitals; a qualitative study of hospital autonomy in Iran. Int J Health Plann Manage, 2011; 26(3): 121-37.
25- Doshmangir L, Rashidian A, Ravaghi H, Takian A, Jafari M. The experience of implementing the board of trustees' policy in teaching hospitals in Iran: an example of health system decentralization. Int J Health Policy Manag, 2014; 4(4): 207-16.
26- Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy-making [Internet]. Int J Health Plann Mgmt; 2015.
27- De Geyndt W. Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies.Soc Sci Med. 2017 Apr; 179:74-80. doi: 10.1016/j.socscimed.2017.02.038. Epub 2017 Feb 27.
28- Geng J1, Yu H2, Chen Y1, 3. Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy-making. Int J Health Plann Manage. 2016 Apr; 31(2):148-66. doi: 10.1002/hpm.2283. Epub 2015 Feb 10.
29- Xie Y1, Liang D2, Huang J3, Jin J4.Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China.Int J Environ Res Public Health. 2019 Apr 24; 16(8). pii: E1460. doi: 10.3390/ijerph16081460.
30- Hsiao B1, Chen LH2, Wu HT1.Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership.Int J Health Plann Manage. 2019 Jan; 34(1):e602-e616. doi: 10.1002/hpm.2676. Epub 2018 Oct 5.
31- Duran A1, Chanturidze T2, Gheorghe A2, Moreno A1.Assessment of Public Hospital Governance in Romania: Lessons from 10 Case Studies.Int J Health Policy Manag. 2019 Apr 1; 8(4):199-210. doi: 10.15171/ijhpm.2018.120.
_||_1- Marandi A. Integrating medical education and health services: the Iranian experience. Medical Education, 1966; 30: 4-8.
2- Marandi A. The integration of medical education and health care system in the Islamic Republic of Iran: a historical overview. Iranian Journal of Medical Education, 2001; 1: 8-11.
3- Bagheri Lankarani K, Alavian SM, Peymani P. Health in the Islamic Republic of Iran, challenges and progresses. Med J Islam Repub Iran, 2013; 27(1): 42-9.
4- Mehrdad R. Health System in Iran. JMAJ, 2009; 52(1): 69-73.
5- Petersdorf RG, Wilson MP. The Four Horsemen of the Apocalypse, Study of Academic Medical Center Governance. Jama, 1982; 247(8): 1153-61.
6- Hastings DA, Crispell KR. Policy-making and governance in academic health centers. Medical Education, 1980; 33(4): 8.
7- Schimpff SC, Rapoport MI. Ownership and governance of university teaching hospitals: let form follow function. Acad Med, 1997; 72(7): 576-88.
8- Allison RF, Dalston JW. Governance of University-Owned Teaching Hospitals. Inquiry, 1982; 19: 3-17.
9- Barrett DJ. The evolving organizational structure of academic health centers: the case of the University of Florida. Acad Med, 2008; 83(9): 804-8.
10- Karpf M, Perman J, Lofgren R, Melgar S, Butler F, Day Z, et al. Creating an integrated clinical enterprise at the University of Kentucky: the emergence of UK HealthCare. Acad Med, 2007; 82(12): 1163-71.
11- Medicine AoPo. Governance of Teaching Hospitals:Turmoil at The University of Pennsylvania and The Johns Hopkins University. THE AMERICAN JOURNAL OF MEDICINE, 2003; 114: 3.
12- Culbertson RA, Goode LD, Dickler RM. Organizational models for medical school-clinical enterprise relationships. Acad Med, 1996; 71(11): 1258-74.
13- Krippendorff, K. Content Analysis. An Introduction to Its Methodology (3rd ed). California, CA: Sage Publications; 2013: 81-85.
14- Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today, 2004; 24(2): 105-12.
15- Levine AS, Detre TP, McDonald MC, Roth LH, Huber GA, Brignano MG, et al. The relationship between the University Of Pittsburgh School Of Medicine and the University of Pittsburgh Medical Center--a profile in synergy. Acad Med, 2008; 83(9): 816-26.
16- Innovations in health service delivery: the corporatization of public hospitals. Washington, DC: World Bank Group; 2003.
17- Eeckloo K, Van Herck G, Van Hulle C, Vleugels A. From Corporate Governance to Hospital Governance: Authority, transparency and accountability of Belgian non-profit hospitals board and management. Health Policy, 2004; 68(1): 1-15.
18- Chawla M, Govindaraj R, Berman P, Needleman J. Improving Hospital Performance through Policies to Increase Hospital Autonomy: Implementation Guidelines. Boston: United States Agency for International Development (USAID); 1996.
19- Govindaraj R, Obuobi AAD, Enyimayew NKA, Antwi P, Ofosu-Amaah S. Hospital Autonomy in Ghana: The Experience of Korle Bu and Komfo Anokye Teaching Hospitals; 1996.
20- Governing public hospitals, Reform strategies and the movement towards institutional autonomy. European Observatory on Health Systems and Policies; 2011.
21- Holden LM. Complex adaptive systems: concept analysis. Journal of Advanced Nursing, 2005; 52(6): 651-7.
22- Anderson RA, McDaniel RRJ. Managing Health Care Organizations: Where Professionalism Meets Complexity Science. Health Care Management Review, 2000; 25(1): 83-92.
23- Savigny Dd, Adam T, editors. Systems thinking for health systems strengthening: Alliance for Health Policy and Systems Research, World Health Organization; 2009.
24- Jafari M, Rashidian A, Abolhasani F, Mohammad K, Yazdani S, Parkerton P, et al. Space or no space for managing public hospitals; a qualitative study of hospital autonomy in Iran. Int J Health Plann Manage, 2011; 26(3): 121-37.
25- Doshmangir L, Rashidian A, Ravaghi H, Takian A, Jafari M. The experience of implementing the board of trustees' policy in teaching hospitals in Iran: an example of health system decentralization. Int J Health Policy Manag, 2014; 4(4): 207-16.
26- Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy-making [Internet]. Int J Health Plann Mgmt; 2015.
27- De Geyndt W. Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies.Soc Sci Med. 2017 Apr; 179:74-80. doi: 10.1016/j.socscimed.2017.02.038. Epub 2017 Feb 27.
28- Geng J1, Yu H2, Chen Y1, 3. Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy-making. Int J Health Plann Manage. 2016 Apr; 31(2):148-66. doi: 10.1002/hpm.2283. Epub 2015 Feb 10.
29- Xie Y1, Liang D2, Huang J3, Jin J4.Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China.Int J Environ Res Public Health. 2019 Apr 24; 16(8). pii: E1460. doi: 10.3390/ijerph16081460.
30- Hsiao B1, Chen LH2, Wu HT1.Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership.Int J Health Plann Manage. 2019 Jan; 34(1):e602-e616. doi: 10.1002/hpm.2676. Epub 2018 Oct 5.
31- Duran A1, Chanturidze T2, Gheorghe A2, Moreno A1.Assessment of Public Hospital Governance in Romania: Lessons from 10 Case Studies.Int J Health Policy Manag. 2019 Apr 1; 8(4):199-210. doi: 10.15171/ijhpm.2018.120.