Hosseini Mohsen Masoumian, Koohpaei Alireza, Ebrahimipour Hossein, Masoumian Hosseini Seyedeh Toktam
Department of E-Learning in Medical Sciences, Smart University of Medical Sciences, Tehran, Iran.
Department of Medicine in Canadian Virtual Medical University, Vancouver, Canada.
EClinicalMedicine. 2024 Oct 5;77:102875. doi: 10.1016/j.eclinm.2024.102875. eCollection 2024 Nov.
Iran's healthcare system is grappling with multifaceted challenges, including financial constraints, staffing shortages, infrastructural deficiencies, legal hurdles, and cross-sectoral coordination issues. The integration of health service management graduates into the healthcare workforce is vital to tackle these obstacles effectively. However, the lack of skilled managers can exacerbate problems, leading to inflated costs, and wasted resources. This study aims to propose policy options to improve the effectiveness of healthcare management graduates in exposure to the challenges of Iran's health system.
The study used a mixed-methods design that combined a scoping review and interviews with academics specializing in healthcare management and hospital management, as well as key informants of the Ministry of Health and Medical Education (MoHME), the vice chancellor and deans of faculties of management and paramedicine (December 1, 2022 to February 30, 2023), and a policy Delphi technique (April 1, 2023 to Jun 30, 2023). In the scoping review, we searched PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC for articles published from the inception of each database until August 10, 2022, with an update on October 6, 2022. The search terms included "health services," "healthcare organizations," "healthcare management," "health management education," "Iran," "challenges," "issues," "policy," "interventions," "policy options," "solutions," "policy-making," "effectiveness," "efficacy," and similar terms. We incorporated scholarly articles that presented instances or resolutions demonstrating the impact of health service management graduates in addressing the issues encountered by Iran's healthcare system. Non-English research papers, except Persian, were excluded due to translation resource limitations. Articles from peer-reviewed journals were included based on their publication type, while conference abstracts, book reviews, commentaries, and editorial pieces were considered for review. In the present study, the first step of the modified Delphi methodology involved conducting interviews and qualitative content analysis. Then, through two rounds of online surveys, the policy Delphi technique engaged experts and stakeholders in reviewing and prioritising policy options.
In the scoping review, our initial search of the main databases retrieved 553 articles, with an additional 14 articles from gray literature and 5 studies from local databases, totaling 572 references. 426 studies remained after removing duplicates and reviewing them. We excluded 339 studies that did not align with our study's objectives, leaving us with 87 articles. We had access to the full text of 63 of these studies and ultimately selected 31 for review and thematic analysis. The study involved 21 participants, with a 100% response rate in the interview phase. In the Delphi phase, 64 experts were invited, with 41 participating in Round 1 (64% response rate) and 32 in Round 2 (78% response rate). The scoping review identified eleven policy options, followed by designing an interview guide and presenting nine more options based on expert insights from the interviews. We evaluated twenty policy options using a 5-point Likert scale and modified Delphi methodology to assess their effectiveness, feasibility, relevance, and acceptance cost. The study produced four policy options that were culturally and ethically appropriate, as well as compatible with the context and target population. These options were: 1) training and capacity building based on Iran's health system model; 2) development of the framework of Entrustable Professional Activities (EPAs) for healthcare management graduates; 3) determining the career pathways of healthcare management graduates and reviewing the job categories approved by the Ministry of Health and Medical Education (MoHME); and 4) providing effective collaboration between healthcare management graduates and professionals, policymakers, and stakeholders for integrated health system improvement.
The study provides evidence-based recommendations for improving the education, training, and professional deployment of healthcare management graduates in Iran.
This work was supported by the National Agency for Strategic Research in Medical Education (NASR) (Grant Number 4020159).
伊朗的医疗保健系统正面临多方面的挑战，包括资金限制、人员短缺、基础设施不足、法律障碍以及跨部门协调问题。将卫生服务管理专业毕业生融入医疗保健劳动力队伍对于有效应对这些障碍至关重要。然而，缺乏熟练的管理人员可能会使问题恶化，导致成本膨胀和资源浪费。本研究旨在提出政策选项，以提高医疗保健管理专业毕业生应对伊朗卫生系统挑战的有效性。
该研究采用混合方法设计，结合了范围审查以及对医疗保健管理和医院管理领域的学者、卫生和医学教育部（MoHME）的关键信息提供者、管理和护理学院的副校长及院长进行的访谈（2022年12月1日至2023年2月30日），以及政策德尔菲技术（2023年4月1日至6月30日）。在范围审查中，我们在PubMed、科学网平台、MEDLINE、Scopus、谷歌学术/学术搜索和教育资源信息中心（ERIC）中搜索了从每个数据库创建到2022年8月10日发表的文章，并于2022年10月6日进行了更新。搜索词包括“卫生服务”、“医疗保健组织”、“医疗保健管理”、“卫生管理教育”、“伊朗”、“挑战”、“问题”、“政策”、“干预措施”、“政策选项”、“解决方案”、“政策制定”、“有效性”、“功效”及类似词汇。我们纳入了展示卫生服务管理专业毕业生在应对伊朗医疗保健系统所遇问题方面的影响实例或解决方案的学术文章。由于翻译资源限制，除波斯语外的非英语研究论文被排除。根据同行评审期刊文章的发表类型将其纳入，同时考虑会议摘要、书评、评论和社论文章进行审查。在本研究中，改良德尔菲方法的第一步涉及进行访谈和定性内容分析。然后，通过两轮在线调查，政策德尔菲技术让专家和利益相关者参与审查政策选项并确定其优先级。
在范围审查中，我们对主要数据库的初步搜索检索到553篇文章，另外从灰色文献中检索到14篇文章，从本地数据库中检索到5项研究，共计572条参考文献。去除重复项并进行审查后，剩下426项研究。我们排除了339项与我们研究目标不符的研究，最终剩下87篇文章。我们能够获取其中63项研究的全文，最终选择31项进行审查和主题分析。该研究涉及21名参与者，访谈阶段的回复率为100%。在德尔菲阶段，邀请了64名专家，第一轮有41名专家参与（回复率64%），第二轮有32名专家参与（回复率78%）。范围审查确定了11项政策选项，随后设计了访谈指南，并根据访谈中的专家见解又提出了9项选项。我们使用5点李克特量表和改良德尔菲方法评估了20项政策选项的有效性、可行性、相关性和接受成本。该研究产生了4项在文化和伦理上合适、与背景和目标人群相适应的政策选项。这些选项是：1）基于伊朗卫生系统模式的培训和能力建设；2）为医疗保健管理专业毕业生制定可托付专业活动（EPA）框架；3）确定医疗保健管理专业毕业生的职业路径并审查卫生和医学教育部（MoHME）批准的工作类别；4）为医疗保健管理专业毕业生与专业人员、政策制定者和利益相关者提供有效合作，以改善综合卫生系统。
该研究为改善伊朗医疗保健管理专业毕业生的教育、培训和专业部署提供了基于证据的建议。
这项工作得到了国家医学教育战略研究机构（NASR）的支持（资助编号4020159）。
