بررسی ابعاد خودگردانی بیمارستان‌های دانشگاهی گیلان
محورهای موضوعی : -مدارک پزشکی
سید علی موسی نیای زارع
1
,
امیراشکان نصیری پور
2
,
انیسه نیک روان
3
,
لیلا ریاحی
4
,
کامران حاجی نبی
5
1 - دانشجوی دکتری، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - دانشیار، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
3 - استادیار، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
4 - استادیار، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
5 - استادیار، گروه مدیریت خدمات بهداشتی درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: خودگردانی, اصلاحات سازمانی, تمرکززدایی, بیمارستان,
چکیده مقاله :
مقدمه: منابع نظام سلامت محدود و مصارف آن نامحدود است. بنابراین استفاده از استراتژی صحیح مدیریتی در جهت به حداکثر رساندن کارایی و بهروری سیستم الزامی است. از اینرو این مطالعه با هدف بررسی ابعاد خودگردانی بیمارستان‌های دانشگاهی گیلان انجام شد. روش پژوهش: این مطالعه کیفی در 11 بیمارستان انجام شد. برای جمع‌آوری داده‌ها از راهنمای نیمه ساختاری مصاحبه مدل اصلاحات سازمانی بانک جهانی استفاده گردید. با روش نمونه گیری هدفمند با 28 نفر از مدیران ارشد بیمارستان‌ها مصاحبه شد. از روش تحلیل محتوا برای آنالیز داده‌ها استفاده گردید. یافته‌ها: ابعاد اصلی خودگردانی بیمارستان‌ها شامل حق تصمیم‌گیری در مدیریت استراتژیک، مدیریت منابع مالی، مدیریت منابع انسانی و مدیریت منابع فیزیکی؛ صاحب اختیار مانده مالی؛ مواجهه با بازار تدارکات و محصول؛ کارکردهای اجتماعی و ساختار حاکمیتی و پاسخگویی بودند. حق تصمیم‌گیری در مدیریت استراتژیک، منابع انسانی و فیزیکی محدود بود. بیمارستان‌ها در بازار محصول دارای رقابت بودند ولیکن اختیارشان در بازار تدارکات محدودیت داشت. بیمارستان‌ها با نظام سلسله مراتبی و ساختار پاسخگویی رئیس و مرئوسی، صاحب اختیار مانده مالی خود نبودند. هزینه کارکردهای اجتماعی آنها به طور کامل جبران نمی‌شد. نتیجه‌گیری: اعطای خودگردانی در برخی ابعاد نظیر مدیریت منابع مالی، مواجهه با بازار محصول و کارکردهای اجتماعی پیشرفته‌ایی داشته است ولی در ابعاد مدیریت استراتژیک، مدیریت منابع انسانی، مدیریت منابع فیزیکی، مواجهه با بازار تدارکات و ساختار حاکمیتی و پاسخگویی ناچیز بوده است. در این موارد می‌بایست حق تصمیم‌گیری بیشتری به بیمارستان‌ها واگذار شود.
Introduction: Health system Resources are limited and its expenditures are unlimited. Therefore, Use the management right strategy to maximize efficiency and productivity of system is essential. Hence, this study was performed with aim to investigate the dimensions of autonomy of university hospitals in Gilan. Methods: This qualitative study was conducted in 11 hospitals. Semi-structured interview guide of World Bank organizational reform model was used for data collection. Interviews were conducted with 28 senior hospital managers with Purposeful sampling method. A content analysis method was used to analyze data. Results: The main dimensions the autonomy of hospitals include decision right in strategic management, financial resources management, human resources management, and physical resources management, financial residual claim, procurement and product market exposure, social functions, and governance structure and accountability. Decision right in strategic management, human and physical resources was limited. Hospitals compete in the product market, but their options are limited in the procurement market. The hospitals were not the financial residual claimant despite their hierarchical system and the accountability structure of the head and headquarters. The cost of their social function is not fully compensated. Conclusion: Granting autonomy has improved in some dimensions such as financial resources management, product market exposure, and social functions, but has been poor in strategic management, human resources management, physical resources management, procurement market exposure, and governance structure and accountability. In these cases hospitals should be given more decision-making power.
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2- Arocena P, Garci Prado A. Accounting for quality in the measurement of hospital performance: evidence from Costa Rica. Health Econ. (2007); 16(7): 667-85.
3- Bogue RJ, Hall Jr M, La Forgia GM, Gerard M. Hospital Governance in Latin America. Washington D.C: World Bank 2007.
4. Jafari Sirizi M, Rashidian A, Abolhasani F, Mohammad K, Yazdani SH, Yunesian M, et al. A qualitative study to investigate the extent and degree granting autonomous university hospitals studied. Hakim. 2008; 11(2): 59-71[in Persian].
5. Mohebbifar R, Shoghli AR, Ramzanian M, Khoshnam KH. The Comparison of Financing Share of the Hospitals of Zanjan University of Medical Sciences During the Fourth Economical, Social and Cultural Development Plan. Hesabdari Salamat. 2012; (1): 5-20. [in Persian].
6-Castao R, Bitran RA, Giedion U. Monitoring and Evaluating Hospital Autonomization and Its Effects on Priority Health Services. Partners for Health Reformplus, Abt Associates, 2004.
7- WHO. Regional Health Systems Observatory, Health Systems Profile- Islamic Republic of Iran. EMRO, WHO; 2002.
8- Ministry of Health and Medical Education. Especificaciones of hospitals in the country. Available at: http://avab.behdasht.gov.ir/hospital. Cited 2018 July 04. [in Persian].
9- Parliament(Majles) of I.R. Iran. The laws of new structure and duties of MOHME. 1988. Available at: http://touse.mohme.gov.ir/pages/all-laws. Cited 2018 July 03. [in Persian].
10- Health Deputy of MOHME. New payment mechanism instructions (fee - for- services).1995. Available at: http://touse.mohme.gov.ir/pages/alllaws. Cited 2018 July 03. [in Persian].
11- Sadaghiani E. Hospital organization and management. 1th Edition. Tehran: Jahan Rayaneh; 1998: 96-115. [in Persian].
12- Secretariat of hospital economical & management reform. Introduction of hospital economical & management reform MOHME. 2003. Available at:http://touse.mohme.gov.ir/ pages/all-laws. Cited 2018 July 04. [in Persian].
13- Ministry of Health and Medical Education. MOHME related laws. Available at: http://touse.mohme.gov.ir/pages/ all-laws. Cited 2018 July 04. [in Persian].
14- Rashidian A, Eccles MP, Russell I. Falling on stony ground a qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care. Health policy 2008; 85: 148-61.
15- Duran A, Chanturidze T, Gheorghe A, Moreno A. Assessment of Public Hospital Governance in Romania: Lessons from 10 Case Studies. Int J Health Policy Manag. 2019; 8(4): 199–210.
16- Jakab M, Harding A, Preker A, Hawkins L. Organizational reform and management of public providers: focus on hospitals: introduction. Washington D.C: The World Bank, 2000.
17- Bossert T, Hsiao W, Barrera M, Alarcon L, Leo M, Casares C. Transformation of ministries of health in the era of health reform: the case of Colombia. Health Policy & Planning 1998; 13 (1): 59-77.
18- Xie Y, Liang D, Huang J, Jin J. Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China. International Journal of Environmental Research and Public Health. 2019; 16(8): 1460.
19- McKee M, Healy J. Hospitals in a changing Europe. Open University Press Philadelphia, 2002.
20- Ozgulbas N, Koyuncugil AS. Financial profiling of public hospitals: an application by data mining. International Journal of Health Planning and Management. Published Online: 2007 May 04.
21- Parliament (Majles) of I. R. Iran. Supreme Audit Court Related Laws. Available at: http://www.dmk.ir/default.aspx. Cited 2018 July 03. [in Persian].
22- Geyndt WD. Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies. Journal of Social Science & Medicine. 2017; 179: 74–80.
23- Kivumbi GW, Nangendo F, Ndyabahika BR. Financial management systems under decentralization and their effect on malaria control in Uganda. Int J Health Plann Mgmt 2004; 19: 31-117.
24- Flessa S. Hospital development plans: a new tool to break ground for strategic thinking in Tanzanian hospitals. European Journal of Health Economists 2005; 6(4): 322- 348.
25- McPake BI. Public autonomous hospitals in sub-Saharan Africa: trends and issues. Health policy 1996; 35: 155-77.
26- Collins D, Njeru G, Meme J. Hospital autonomy: the experience of Keniyatta National Hospital. International Journal of Health Planning and Management 1999; 14: 129-53.
27- Laegreid P, Opedal S, Stigen IM. The Norwegian Hospital Reform: Balancing Political Control and Enterprise Autonomy. Journal of Health Politics, Policy and Law 2005; 30(6): 1027-64.
28- Preker AS, Feachman RGA. Market mechanisms and the health sector in central and eastern Euroup, World Bank technical paper 293. Washington D.C: World Bank, 1996.
29- Barber S, Bonnet F, Bekedam H. Formalizing under-thetable payments to control out-of-pocket hospital expenditures in Cambodia. Health Policy and Planning 2004; 19: 199-208.
30- Rethelyi JM, Miskovits E, Szocska MK. Organizational Reform in the Hungarian Hospital Sector. Institutional Analysis of Hungarian Hospitals and the Possibilities of CorporatizationThe World Bank 2002.
31- Parliament (Majles) of I. R. Iran. The financial and trade off regulations of Medical Universities and Collages. 2007. Available at: http://touse.mohme.gov.ir/ pages/ all-laws.php. Cited 2018 July 03. [in Persian].
32- Chawla M, Govindaraj R. Improving Hospital Performance Through Policies to Increase Hospital Autonomy. Harvard School of Public Health, 1996.
33- Kwon S. Payment system reform for health care providers in Korea. Health Policy and Planning 2003; 18: 84-92.
34- Hennock M. China's health insurance system is failing poor people. British Medical Journal 2007; 335(7627): 961.
35- Ensor T, Savelyeva L. Informal payments for health care in the former Soviet Union: some evidence from Kazakstan. Health Policy and Planning 1998; 13(1): 41.
36- Jakab M, Preker AS, Harding A. The Missing Link? Hospital reform in transition economies. Innovation in Health Services Delivery: The Corporatization of Public Hospitals 2003.
37- Jafari M, Habibirad A, Pourtaleb A, Salarianzadeh MH. Health system organizational reform in governing Iranian public hospitals: A content analysis to comprehend the barriers in Board of Trustees' hospitals. Int J Health Plann and Manage. 2018; 33 (2): 612-620. [in Persian].
38- 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 Manage. 2015; 4 (4): 207-216. [in Persian].
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1- Preker AS, Harding A. Innovations in Health Service Delivery: The Corporatization of Public Hospitals. World Bank Publications, 2003.
2- Arocena P, Garci Prado A. Accounting for quality in the measurement of hospital performance: evidence from Costa Rica. Health Econ. (2007); 16(7): 667-85.
3- Bogue RJ, Hall Jr M, La Forgia GM, Gerard M. Hospital Governance in Latin America. Washington D.C: World Bank 2007.
4. Jafari Sirizi M, Rashidian A, Abolhasani F, Mohammad K, Yazdani SH, Yunesian M, et al. A qualitative study to investigate the extent and degree granting autonomous university hospitals studied. Hakim. 2008; 11(2): 59-71[in Persian].
5. Mohebbifar R, Shoghli AR, Ramzanian M, Khoshnam KH. The Comparison of Financing Share of the Hospitals of Zanjan University of Medical Sciences During the Fourth Economical, Social and Cultural Development Plan. Hesabdari Salamat. 2012; (1): 5-20. [in Persian].
6-Castao R, Bitran RA, Giedion U. Monitoring and Evaluating Hospital Autonomization and Its Effects on Priority Health Services. Partners for Health Reformplus, Abt Associates, 2004.
7- WHO. Regional Health Systems Observatory, Health Systems Profile- Islamic Republic of Iran. EMRO, WHO; 2002.
8- Ministry of Health and Medical Education. Especificaciones of hospitals in the country. Available at: http://avab.behdasht.gov.ir/hospital. Cited 2018 July 04. [in Persian].
9- Parliament(Majles) of I.R. Iran. The laws of new structure and duties of MOHME. 1988. Available at: http://touse.mohme.gov.ir/pages/all-laws. Cited 2018 July 03. [in Persian].
10- Health Deputy of MOHME. New payment mechanism instructions (fee - for- services).1995. Available at: http://touse.mohme.gov.ir/pages/alllaws. Cited 2018 July 03. [in Persian].
11- Sadaghiani E. Hospital organization and management. 1th Edition. Tehran: Jahan Rayaneh; 1998: 96-115. [in Persian].
12- Secretariat of hospital economical & management reform. Introduction of hospital economical & management reform MOHME. 2003. Available at:http://touse.mohme.gov.ir/ pages/all-laws. Cited 2018 July 04. [in Persian].
13- Ministry of Health and Medical Education. MOHME related laws. Available at: http://touse.mohme.gov.ir/pages/ all-laws. Cited 2018 July 04. [in Persian].
14- Rashidian A, Eccles MP, Russell I. Falling on stony ground a qualitative study of implementation of clinical guidelines' prescribing recommendations in primary care. Health policy 2008; 85: 148-61.
15- Duran A, Chanturidze T, Gheorghe A, Moreno A. Assessment of Public Hospital Governance in Romania: Lessons from 10 Case Studies. Int J Health Policy Manag. 2019; 8(4): 199–210.
16- Jakab M, Harding A, Preker A, Hawkins L. Organizational reform and management of public providers: focus on hospitals: introduction. Washington D.C: The World Bank, 2000.
17- Bossert T, Hsiao W, Barrera M, Alarcon L, Leo M, Casares C. Transformation of ministries of health in the era of health reform: the case of Colombia. Health Policy & Planning 1998; 13 (1): 59-77.
18- Xie Y, Liang D, Huang J, Jin J. Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China. International Journal of Environmental Research and Public Health. 2019; 16(8): 1460.
19- McKee M, Healy J. Hospitals in a changing Europe. Open University Press Philadelphia, 2002.
20- Ozgulbas N, Koyuncugil AS. Financial profiling of public hospitals: an application by data mining. International Journal of Health Planning and Management. Published Online: 2007 May 04.
21- Parliament (Majles) of I. R. Iran. Supreme Audit Court Related Laws. Available at: http://www.dmk.ir/default.aspx. Cited 2018 July 03. [in Persian].
22- Geyndt WD. Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies. Journal of Social Science & Medicine. 2017; 179: 74–80.
23- Kivumbi GW, Nangendo F, Ndyabahika BR. Financial management systems under decentralization and their effect on malaria control in Uganda. Int J Health Plann Mgmt 2004; 19: 31-117.
24- Flessa S. Hospital development plans: a new tool to break ground for strategic thinking in Tanzanian hospitals. European Journal of Health Economists 2005; 6(4): 322- 348.
25- McPake BI. Public autonomous hospitals in sub-Saharan Africa: trends and issues. Health policy 1996; 35: 155-77.
26- Collins D, Njeru G, Meme J. Hospital autonomy: the experience of Keniyatta National Hospital. International Journal of Health Planning and Management 1999; 14: 129-53.
27- Laegreid P, Opedal S, Stigen IM. The Norwegian Hospital Reform: Balancing Political Control and Enterprise Autonomy. Journal of Health Politics, Policy and Law 2005; 30(6): 1027-64.
28- Preker AS, Feachman RGA. Market mechanisms and the health sector in central and eastern Euroup, World Bank technical paper 293. Washington D.C: World Bank, 1996.
29- Barber S, Bonnet F, Bekedam H. Formalizing under-thetable payments to control out-of-pocket hospital expenditures in Cambodia. Health Policy and Planning 2004; 19: 199-208.
30- Rethelyi JM, Miskovits E, Szocska MK. Organizational Reform in the Hungarian Hospital Sector. Institutional Analysis of Hungarian Hospitals and the Possibilities of CorporatizationThe World Bank 2002.
31- Parliament (Majles) of I. R. Iran. The financial and trade off regulations of Medical Universities and Collages. 2007. Available at: http://touse.mohme.gov.ir/ pages/ all-laws.php. Cited 2018 July 03. [in Persian].
32- Chawla M, Govindaraj R. Improving Hospital Performance Through Policies to Increase Hospital Autonomy. Harvard School of Public Health, 1996.
33- Kwon S. Payment system reform for health care providers in Korea. Health Policy and Planning 2003; 18: 84-92.
34- Hennock M. China's health insurance system is failing poor people. British Medical Journal 2007; 335(7627): 961.
35- Ensor T, Savelyeva L. Informal payments for health care in the former Soviet Union: some evidence from Kazakstan. Health Policy and Planning 1998; 13(1): 41.
36- Jakab M, Preker AS, Harding A. The Missing Link? Hospital reform in transition economies. Innovation in Health Services Delivery: The Corporatization of Public Hospitals 2003.
37- Jafari M, Habibirad A, Pourtaleb A, Salarianzadeh MH. Health system organizational reform in governing Iranian public hospitals: A content analysis to comprehend the barriers in Board of Trustees' hospitals. Int J Health Plann and Manage. 2018; 33 (2): 612-620. [in Persian].
38- 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 Manage. 2015; 4 (4): 207-216. [in Persian].