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In the time of the COVID-19 crisis, many physical, psychological and spiritual difficulties are imposed on the front line staff and overshadow their rights, resilience and retention. In addition, the loss of this important organizational resource imposes huge costs on the system. The purpose of this study is systemic review of the influential factors, policies and strategies applied to defend the rights of health-care staff and improve the resilience and retention of health system human resources in the COVID-19 crisis.

This systematic review was conducted in 2021. Data were collected by keyword search in Google Scholar, PubMed, Scopus, Web of Science, Science Direct, Magiran, SID and Irandoc databases until December 2021. In addition, the quality of the studies was evaluated by three experts using the Strobe checklist. The analysis used in this study to categorize the results was thematic analysis.

Factors that cause tension and injustice to employees and also strategies to overcome it and increase their resilience were classified into general categories according to their nature. Factors included factors related to safety, economic and financial, staff characteristics, crisis management characteristics, organizational climate and working conditions. Existing strategies also fall into four categories of physical, psychological and spiritual health promotion strategies; organizational climate and work environment; education and empowerment and economic and financial.

This study is a systematic review of the factors that affect the health workforce rights and resilience of health-care personnel during the COVID-19 crisis. On the other hand, the policies and strategies used in different countries to overcome the difficulties and increase the resilience and retention of health workers have been summarized and can be used in other crises.

The provision of private health-care services by public hospitals is common in Iran. Examining factors associated with patients’ preferences to use private health services and using this knowledge in health planning and policymaking can help expand the use of such services. Thus, this study aims to investigate patients’ preferences for private health services delivered in public hospitals.

Based on a discrete choice experiment from a sample of 375 patients in a public training hospital in Qazvin, northwest city of Iran, the authors evaluated participants’ preference over the health-care attributes affecting their choice to use private health-care services delivered in the hospital. The authors also estimated the marginal willingness to pay to determine the maximum amount a patient was willing to pay for the improvement in the level of each health-care attributes.

The findings revealed that patients were 2.7 times more likely to choose private hospital services when the waiting time was reduced to less than a week. Furthermore, as patients had complimentary insurance coverage, they were over 60% more likely to receive such services from training hospitals. Finally, continuity of care and reduced health-care tariffs were significant factors that increased patients’ preference to choose private services by 52 and 37%, respectively.

Examining factors associated with patients’ preferences to use private health services and using this knowledge in policymaking can help expand such services. The findings affirmed that various incentives, including service quality factors, are required to increase the likelihood of patients choosing private services.

It can be said that the most important function of the health system is to provide health-care services. This directly affects society’s health and justice. To the best of the authors’ knowledge, this study is the first study that has meta-analyzed the percentage of health services utilization among Iranians to answer this question “How much is the percentage of health-care services utilization in Iran?”

This study is a systematic review and meta-analysis conducted in 2020. The literature review was done by searching the databases of Google Scholar, Scopus, PubMed, Web of Science, Science Direct, SID, Magiran and Irandoc from January 2010 to August 2020. Pooled utilization percentage (UP) was estimated by STATA 15 through random-effects meta-analysis with 95% confidence interval. The I² statistic was used to investigate the possibility of heterogeneity of articles (I² ≥ 50% indicate heterogeneity). A forest plot was applied to report the results. A funnel plot exploited due to publication bias assessment.

Approximately 22% of the reviewed articles have been done at the national level of Iran. Most studies have examined the utilization of outpatient and inpatient services. Based on the random effects method, the pooled value of UP was obtained at 47.82%, (95% CI: 39.33–56.31). Also, the pooled percentage of utilization was statistically significant (Test of UP = 0, Z = 456.44, p = 0.000).

Policymakers can improve the level of utilization from health services by expanding universal coverage, expanding insurance coverage and removing direct and indirect barriers.

To the best of the authors’ knowledge, this is the first systematic review and meta-analysis on health services utilization in Iran that completely considers the utilization rate in all health services and states the practical solutions to cope with utilization deficiencies and barriers.

Health-care workers (HCWs) are at increased risk of exposure to the COVID-19 virus, which necessitates implementing transmission prevention measures in health-care delivery facilities, particularly hospitals. This study aims to assess COVID-19 risk in a health-care setting and recommend managerial strategies to cope with existing risk procedures.

This cross-sectional study was conducted among HCWs working in a general hospital in Qazvin, northwest of the country. A total of 310 employees working at different clinical and non-clinical occupational levels participated in the study. The WHO COVID-19 risk assessment tool categorised HCWs in high- or low-risk groups exposed to COVID-19 infection.

Findings revealed statistically significant relationships between workplace exposure to the COVID-19 virus and variables, including job type, performing the aerosol-generating procedure, access to personal protective equipment (PPE) and being trained on Infection Prevention and Control (IPC) guidelines (p < 0.05). HCWs older than 36 years were at 8% more risk of COVID-19 virus. Being a medical doctor or delivering health-care services as a nurse were relatively 28% and 32% times more likely to be at high risk of infection than other hospital staff categories. Having inadequate access to PPE and lack of training on IPC guidelines were also key determinants of high-risk infection.

As most cases at risk of COVID-19 infection belonged to frontline health-care staff in older age groups, this study recommend limiting the exposure of vulnerable staff to COVID-19 patients, increasing protective measures for HCWs and providing essential information about infection control procedures.

This study aimed to compare mortality rate, length of stay (LOS) and hospitalization costs at different priority levels for a patient admitted to an intensive care unit (ICU) at a public tertiary hospital in Qazvin, Iran. This study also aimed to predict influencing factors on patients’ mortality, ICU LOS and hospitalization costs in different admission groups.

The authors conducted a retrospective cohort study among patients who mainly suffered from internal diseases admitted to an ICU of a public hospital. This study was conducted among 127 patients admitted to ICU from July to September 2019. The authors categorized patients into four groups based on two crucial hemodynamic and respiratory status criteria. The authors used a logistic regression model to predict the likelihood of mortality in ICU admitted patients during hospitalizations for the four prioritization groups. Furthermore, the authors conducted a multivariate analysis using the “enter” method to identify risk factors for LOS.

Results showed a statistically significant relationship between the priority of being admitted to ICU and hospitalization costs. The authors’ findings revealed that age, LOS and levels of consciousness had a predictability role in determining in-hospital mortality. Besides, age, gender, consciousness level of patients and type of the disease were mentioned as affecting factors of LOS.

This study’s findings emphasize the necessity of categorizing patients according to specific criteria to efficiently use available resources to help health-care authorities reduce the costs and allocate the budget to different health sectors.

This purpose of this study was to investigate the role of nurses’ resilience as an indicator of their mental health on sick leave absenteeism during the COVID-19 pandemic.

This descriptive-analytical study was conducted in 2020 to identify the predictors of absenteeism among 260 nurses working in two training hospitals delivering specialized services in the treatment of COVID-19 patients. Data was collected through the use of standard questionnaires including demographic information, nurses’ resilience, intention for job turnover and absenteeism from the workplace. To predict sick leave absenteeism, regression analyses were implemented.

Study results revealed that the most influencing features for predicting the probability of taking sick leave among nurses were marital status, tenacity, age, work experience and optimism. Logistic regression also depicted that nurses who had less faith in God or less self-control were more likely to take sick leave.

The resilience of nurses working in the COVID-19 pandemic was relatively low, which needs careful consideration to apply for organizational support. Main challenge that most of the health systems face include an inadequate supply of nurses which consequently lead to reduced efficiency, poor quality of care and decreased job performance. Thus, hospital managers need to put appropriate managerial interventions into practice, such as building a pleasant and healthy work environment, to improve nurses’ resilience in response to heavy workloads and stressful conditions.

To the best of the authors’ knowledge, this is the first study to examine such a relationship, thus contributing findings will provide a clear contribution to nursing management and decision-making processes. Resilience is an important factor for nurses who constantly face challenging situations in a multifaceted health-care system.

Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015.

A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item’s importance from the patients’ perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly.

Findings revealed a significant gap between service importance and performance. From the patients’ viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively).

Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction.

The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

As hospitals are the most costly service providers in every healthcare systems, special attention should be given to their performance in terms of resource allocation and consumption. The purpose of this paper is to evaluate technical, allocative and economic efficiency in intensive care units (ICUs) of hospitals affiliated by Yazd University of Medical Sciences (YUMS) in 2015.

This was a descriptive, analytical study conducted in ICUs of seven training hospitals affiliated by YUMS using data envelopment analysis (DEA) in 2015. The number of physicians, nurses, active beds and equipment were regarded as input variables and bed occupancy rate, the number of discharged patients, economic information such as bed price and physicians’ fees were mentioned as output variables of the study. Available data from study variables were retrospectively gathered and analyzed through the Deap 2.1 software using the variable returns to scale methodology.

The study findings revealed the average scores of allocative, economic, technical, managerial and scale efficiency to be relatively 0.956, 0.866, 0.883, 0.89 and 0.913. Regarding to latter three types of efficiency, five hospitals had desirable performance.

Given that additional costs due to an extra number of manpower or unnecessary capital resources impose economic pressure on hospitals also the fact that reduction of surplus production plays a major role in reducing such expenditures in hospitals, it is suggested that departments with low efficiency reduce their input surpluses to achieve the optimal level of performance.

The authors applied a DEA approach to measure allocative, economic, technical, managerial and scale efficiency of under-study hospitals. This is a helpful linear programming method which acts as a powerful and understandable approach for comparative performance assessment in healthcare settings and a guidance for healthcare managers to improve their departments’ performance.

Today, healthcare organizations focus mainly on development and implementation of patient safety strategic plan to improve quality and ensure safety of provided services. The purpose of this paper is to recommend potential strategies for successful implementation of patient safety program in Iranian hospitals based on a strengths, weaknesses, opportunities, threats (SWOT) analysis.

In this qualitative study, key informant interviews and documentation review were done to identify strength and weakness points of Iranian hospitals in addition to opportunities and threats facing them in successful implementation of a patient safety program. Accordingly, the research team formulated main patient safety strategies and consequently prioritized them based on Quantitative Strategic Planning Matrix (QSPM) matrix.

The study recommended some of the potential patient safety strategies including provision of education for employees, promoting a safety culture in hospitals, managerial support and accountability, creating a safe and high-quality delivery environment, developing national legislations for hospital staff to comply with patient safety standards and developing a continuous monitoring system for quality improvement and patient safety activities to ensure the achievement of predetermined goals.

Developing a comprehensive and integrated strategic plan for patient safety based on accurate information about the health system’s weaknesses, strengths, opportunities and threats and trying to implement the plan in accordance with patient safety principles can help hospitals achieve great success.

Ministry of Health and Medical Education (MOHME) conducted a national study to recommend potential strategies for successful implementation of patient safety in Iranian hospitals based on a SWOT analysis and QSPM matrix.

Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran.

This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services – their frequency and severity – were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation.

Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures.

Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function.

Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.