Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
BMC Health Serv Res. 2022 May 28;22(1):712. doi: 10.1186/s12913-022-08104-0.
Primary healthcare with the right structure is the base for any highly efficient healthcare system to achieve better health outcomes at the lowest cost. Challenges of this system, including structural weaknesses, are one of the factors of inefficiency. Therefore, the purpose of this study was to identify challenges of the organizational structure of county health network in Iran.
An exploratory qualitative face-to-face semi-structured interviews were carried out with 21 key informants including experts and managers in Ahvaz-Iran. Purposive sampling method with maximum diversity were used. Interviews were recorded digitally and transcribed verbatim. Interview transcripts were analyzed based on a thematic analysis approach via NVivo-11.
In analysis of the interviews, after removing the duplicate codes and merging similar items, finally 6 main challenges and 56 sub-themes were obtained. The themes of structural challenges included formalization, complexity, centralization, culture, environment, and resources.
Based on the present situation, the challenges in the current organizational structure and a change in the goals and strategies of the healthcare system in Iran, the appropriate structure needs to be designed and implemented at different levels in accordance with the goals and strategies. The separation and independence of health centers management and hospitals (treatment) in the county can provide a basis for understanding the challenges to the provision of health services.
拥有合理结构的基层医疗保健是任何高效医疗体系实现以最低成本获得更好健康结果的基础。该体系面临的挑战，包括结构性弱点，是效率低下的因素之一。因此，本研究的目的是确定伊朗县卫生网络组织结构面临的挑战。
采用探索性定性面对面半结构式访谈，对包括伊朗阿瓦士的专家和管理人员在内的 21 名关键知情人进行了访谈。采用最大多样性的目的性抽样方法。访谈以数字方式记录并逐字转录。使用 NVivo-11 基于主题分析方法对访谈记录进行分析。
在对访谈的分析中，在删除重复代码和合并相似项后，最终获得了 6 个主要挑战和 56 个子主题。结构挑战的主题包括形式化、复杂性、集中化、文化、环境和资源。
根据目前的情况，伊朗医疗保健系统的组织结构面临挑战以及目标和战略发生变化，需要根据目标和战略在不同层面设计和实施适当的结构。县卫生中心管理和医院（治疗）的分离和独立可以为了解卫生服务提供面临的挑战提供基础。
