الگوی حکمرانی متعالی در نظام سلامت ایران: شناسایی و تحلیل ابعاد مؤثر
محورهای موضوعی : -مدیریت اطلاعات بهداشتی و درمانی
سعید حمزهء
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رضا رستم زاده
2
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ماهرخ لطف الهی حقی
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کریم اسگندری
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1 - گروه مدیریت دولتی، واحد ارومیه، دانشگاه آزاد اسلامی، ارومیه، ایران
2 - گروه مدیریت، واحد ارومیه، دانشگاه آزاد اسلامی، ارومیه، ایران
3 - گروه مدیریت، واحد ارومیه، دانشگاه آزاد اسلامی، ارومیه، ایران
4 - گروه مدیریت دولتی، دانشگاه پیام نور، تهران، ایران
کلید واژه: حکمرانی متعالی, نظام سلامت, اخلاق‌مداری.,
چکیده مقاله :
مقدمه: حکمرانی متعالی در نظام سلامت با تأکید بر ارزش‌ها و اصول بنیادین، نقش متمایزی در ارتقای کیفیت و کارآمدی سیستم سلامت دارد. در همین راستا، این پژوهش با هدف شناسایی و طراحی الگوی حکمرانی متعالی در نظام سلامت ایران و تحلیل ابعاد مؤثر آن انجام شد.
روش کار: این تحقیق به روش آمیخته انجام شده است؛ در بخش کیفی، رویکرد توسعه‌ای و در بخش کمی، رویکرد کاربردی اتخاذ شد. جامعه آماری بخش کیفی شامل مطالب منتشرشده در حوزه حکمرانی نظام سلامت از پایگاه‌های اطلاعاتی معتبر بود و جامعه آماری بخش کمی شامل کارکنان مراکز درمانی سازمان تأمین اجتماعی شمال‌غرب کشور بود که نمونه‌ای 360 نفره از مدیریت درمان استان‌های آذربایجان غربی، آذربایجان شرقی و اردبیل انتخاب شد. ابزار گردآوری داده‌ها در بخش کمی، پرسشنامه محقق‌ساخته با ابعاد استخراج‌شده از تکنیک فراترکیب بود. داده‌ها با استفاده از رویکرد فراترکیب و معادلات ساختاری و نرم‌افزارهای SMART PLS و MAXQDA تحلیل شدند.
یافته‌ها: نتایج نشان داد که حکمرانی متعالی در نظام سلامت شامل 8 بعد اصلی است: توانایی‌های تحلیلی و تصمیم‌گیری، عوامل ارتباطی، زیرساخت، اقدامات استراتژیک، فرهنگ، مشخصه‌های عمومی، عوامل سازمانی/مدیریتی و سیاست‌های سازمانی. آزمون مدل در نمونه آماری بزرگ‌تر نشان داد که ابعاد فرهنگ، عوامل ارتباطی و مشخصه‌های عمومی بیشترین همبستگی را با حکمرانی متعالی در نظام سلامت دارند.
نتیجه‌گیری: یافته‌ها بیانگر آن است که برای تحقق حکمرانی متعالی در نظام سلامت، توجه همزمان و متوازن به تمامی ابعاد ضروری است و غفلت از هر یک می‌تواند دستیابی به اهداف و ایده‌آل‌های این نوع حکمرانی را با چالش مواجه کند. بنابراین، مدیران و سیاست‌گذاران سلامت باید با تمرکز ویژه بر دسترسی برابر به خدمات سلامت، شفافیت و پاسخگویی، و ارتقای اخلاق‌مداری، برنامه‌ها و استراتژی‌های کارآمدی برای تقویت حکمرانی متعالی طراحی و اجرا نمایند.
Background: Exemplary governance in health systems plays a pivotal role in enhancing system performance and ensuring equitable access to health services. This study aimed to design a comprehensive model of exemplary governance in Iran’s health system and analyze its key influencing dimensions.
Methods: This research employed a mixed-methods approach. The qualitative phase followed a developmental objective, while the quantitative phase adopted an applied perspective. The qualitative sample comprised published literature on health system governance from reputable databases. The quantitative phase included 360 employees from healthcare centers of the Social Security Organization in northwestern Iran, selected from the provinces of West Azerbaijan, East Azerbaijan, and Ardabil. Data were collected using a researcher-made questionnaire based on dimensions identified through the meta-synthesis technique. Analyses were performed using the meta-synthesis approach and structural equation modeling via SMART PLS and MAXQDA software.
Results: Findings revealed that exemplary governance in the health system consists of eight main dimensions: analytical and decision-making capabilities, communication factors, infrastructure, strategic actions, culture, general characteristics, organizational/managerial factors, and organizational policies. Structural model testing in a larger sample indicated that the dimensions of culture, communication factors, and general characteristics had the highest correlation with exemplary governance in the health system.
Conclusion: The results emphasize that achieving exemplary governance in health requires balanced attention to all dimensions. Neglecting any dimension may hinder the attainment of governance goals and ideals. Therefore, health managers and policymakers should implement strategies that prioritize equitable access to health services, transparency, accountability, and ethical conduct to strengthen exemplary governance in the health system.
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