Suchergebnisse

Background: Since the early 1990s, Iran has initiated structural and decentralization reforms in the hospital system. This policy led to the formation of a Board of Trustees (BOTs) for the governing of public educational hospitals and making important modifications in hospitals' financing. This study was conducted to identify the barriers in implementing this policy. Methods: All the Iranian Medical Sciences Universities and hospitals involved in the policy implementation were included in this qualitative study. The data were analyzed by using content analysis. Results: In total, 403 problems were divided into 9 classes including problems related to implementing regulation, financial problems in policy implementation, problems related to faculty members, ambiguity in executive regulation, problems related to the BOTs, authority level, hospital structure, the quality and quantity of hospital human resources, and fee for services. Conclusion: It appears that "implementing regulation" and "financial problems" embrace over 50 of the barriers. Apparently, the new approach to hospitals' autonomy has not achieved the desired goals. Considering the contextual factor, the evidence and identification of the clear role of various stakeholders should be essential determinants. Partial implementation of this policy without paying attention to the other aspects would end in failure. The results showed insufficient budget to be the most influential factor that posed a dilemma in implementing the BOTs' policy. However, BOTs in Iranian health system need to strive toward a higher level of performance that will improve effectiveness and efficiency now more than ever. © 2018 John Wiley & Sons, Ltd.

Background: Since the early 1990s, Iran has initiated structural and decentralization reforms in the hospital system. This policy led to the formation of a Board of Trustees (BOTs) for the governing of public educational hospitals and making important modifications in hospitals' financing. This study was conducted to identify the barriers in implementing this policy. Methods: All the Iranian Medical Sciences Universities and hospitals involved in the policy implementation were included in this qualitative study. The data were analyzed by using content analysis. Results: In total, 403 problems were divided into 9 classes including problems related to implementing regulation, financial problems in policy implementation, problems related to faculty members, ambiguity in executive regulation, problems related to the BOTs, authority level, hospital structure, the quality and quantity of hospital human resources, and fee for services. Conclusion: It appears that "implementing regulation" and "financial problems" embrace over 50 of the barriers. Apparently, the new approach to hospitals' autonomy has not achieved the desired goals. Considering the contextual factor, the evidence and identification of the clear role of various stakeholders should be essential determinants. Partial implementation of this policy without paying attention to the other aspects would end in failure. The results showed insufficient budget to be the most influential factor that posed a dilemma in implementing the BOTs' policy. However, BOTs in Iranian health system need to strive toward a higher level of performance that will improve effectiveness and efficiency now more than ever. © 2018 John Wiley & Sons, Ltd.

Background: In 1995, teaching and public hospitals that are affiliated with the ministry of health and medical education (MOHME) in Iran were granted financial self-sufficiency to practice contract-based relations with insurance organizations. The so-called "hospital autonomy" policy involved giving authority to the insurance organizations to purchase health services. The policy aimed at improving hospitals' performance, hoping to reduce government's costs. However, the policy was never implemented as intended. This was because most participating hospitals gave up to implement autonomous financing and took other financing pathways. This paper analyses the reasons for the gap between the intended policy and its execution. The lessons learned from this analysis can inform, we envisage, the implementation of similar initiatives in other settings. Methods: We conducted semi-structured interviews with 28 national and 13 regional health policy experts. We also gathered a comprehensive and purposeful set of related documents and analyzed their content. The qualitative data were analyzed by thematic inductive-deductive approach. Results: We found a number of prerequisites and requirements that were not prepared prior to the implementing hospital autonomy policy and categorized them into policy content (sources of funds for the policy), implementation context (organization of insurance organizations, medical tariffs, hospitals' organization, feasibility of policy implementation, actors and stakeholders' support), and implementation approach (implementation method, blanket approach to the implementation and timing of implementation). These characteristics resulted in unsuitable platform for policy implementation and eventually led to policy failure. Conclusions: Autonomy of teaching hospitals and their exclusive financing through insurance organizations did not achieve the desired goals of purchaser-provider split in Iran. Unless contextual preparations are in place, hospital autonomy will not succeed and problematic financial relations between service providers and patients in autonomous hospitals may not be ceased as a result. © 2016 Doshmangir et al.

Background: In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals� financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees� policy did not achieve its perceived objectives. Methods: We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran�s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results: Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals� organization and capacity and actors� interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion: The implementation of the board of trustees� policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization policies in the past and their outcomes were overlooked, while the context was not prepared appropriately and key stakeholders, particularly the government, did not support the decentralization of Iran�s health system. © 2015 by Kerman University of Medical Sciences.

Introduction: Policy formulation and adoption often happen in a black box. Implementation challenges affect and modify the nature of a policy. We analyzed hospitals' autonomy policy in Iran that was intended to reduce hospitals' financial burden on government and improve their efficiency. Methods: We followed a retrospective case-study methodology, involving inductive and deductive analyses of parliamentary proceedings, policy documents, gray literature, published papers and interview transcripts. We analyzed data to develop a policy map that included important dates and events leading to the policy process milestones. Results: We identified four time-periods with distinctive features: 'moving toward the policy' (1989-1994), 'disorganized implementation' (1995 -1997), 'continuing challenges and indecisiveness in hospitals financing' (1998-2003), and 'other structural and financial policies in public hospitals' (2004 to date). We found that stakeholders required different and conflicting objectives, which certainly resulted in an unsatisfactory implementation process. The policy led to long-lasting and often negative changes in the hospital sector and the entire Iranian health system. Conclusion: Hospital autonomy appeared to be an ill-advised policy to remedy the inefficiency problems in low socioeconomic areas of the country. The assumption that hospital autonomy reforms would necessarily result in a better health system, may be a false assumption as their success relies on many contextual, structural and policy implementation factors. © 2015, Academy of Medical Sciences of I.R. Iran. All rights reserved.

© 2016 IEEE. Superconducting magnetic energy storage (SMES) systems with different superconducting materials are attracting great attentions and funding from the governments around the world because they are promising large-scale energy storage devices for future smart grid. Due to the high cost of SMES, its manufacturing quality and operation reliability have to be investigated in the design optimization stage. This paper presents a robust design optimization method to solve this issue based on a benchmark problem, TEAM problem 22. The proposed method is based on a technique called design for Six Sigma. Meanwhile, a three-level optimization framework is employed to reduce the computation cost of a finite-element analysis due to high-dimensional design space and Monte-Carlo analysis. As shown, the manufacturing reliability and quality of the investigated SMES after robust optimization have been increased greatly.

Background: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals. Objective: The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies. Method: This review�s methodology was inspired by Arksey and O�Malley�s methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020. Results: Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study�s objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature. Conclusions: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results. © 2021, The Author(s).

Chemical cleaning is vital for the optimal operation of membrane systems. Membrane chemical cleaning protocols are often developed in the laboratory flow cells (e.g., Membrane Fouling Simulator (MFS)) using synthetic feed water (nutrient excess) and short experimental time of typically days. However, full-scale Reverse Osmosis (RO) membranes are usually fed with nutrient limited feed water (due to extensive pre-treatment) and operated for a long-time of typically years. These operational differences lead to significant differences in the efficiency of chemical Cleaning-In-Place (CIP) carried out on laboratory-scale and on full-scale RO systems. Therefore, we investigated the suitability of lab-scale CIP results for full-scale applications. A lab-scale flow cell (i.e., MFSs) and two full-scale RO modules were analysed to compare CIP efficiency in terms of water flux recovery and biofouling properties (biomass content, Extracellular Polymeric Substances (EPS) composition and EPS adherence) under typical lab-scale and full-scale conditions. We observed a significant difference between the CIP efficiency in lab-scale (~50%) and full-scale (9–20%) RO membranes. Typical biomass analysis such as Total Organic Carbon (TOC) and Adenosine triphosphate (ATP) measurements did not indicate any correlation to the observed trend in the CIP efficiency in the lab-scale and full-scale RO membranes. However, the biofilms formed in the lab-scale contains different EPS than the biofilms in the full-scale RO modules. The biofilms in the lab-scale MFS have polysaccharide-rich EPS (Protein/Polysaccharide ratio = 0.5) as opposed to biofilm developed in full-scale modules which contain protein-rich EPS (Protein/Polysaccharide ratio = 2.2). Moreover, EPS analysis indicates the EPS extracted from full-scale biofilms have a higher affinity and rigidity to the membrane surface compared to EPS from lab-scale biofilm. Thus, we propose that CIP protocols should be optimized in long-term experiments using the realistic feed water. ; This study was funded by European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No. 676070. The authors gratefully acknowledge Özgür Gölbasi and David Moed (Evides Industriewater B.V. The Netherlands) and Celestin Claeys (De Watergroep N.V. Belgium) for kindly providing membrane modules and related supports. The authors acknowledge Elien Wallaert (Ghent University) for her great help in proving SEM images. This communication reflects only the authors' view and the Research Executive Agency of the EU is not responsible for any use that may be made of the information it contains.

The economic impact of fouling in spiral wound membranes is not yet well explored. There has been an established assumption that the cost of fouling in membrane processes is significant, but this hypothesis has not been thoroughly evaluated. We conducted an economic analysis on seven full-scale installations, four nanofiltration (NF) and three reverse osmosis (RO), to estimate the cost of fouling in industrial plants. The cost of fouling was calculated in detail, including costs of increase in feed channel pressure drop, water permeability reduction, early membrane replacement, and extensive cleaning-in-place (CIP). The estimated cost of fouling was expressed as a fraction of operational expenses (OPEX) for each plant and the major cost factors in fouling and CIP costs were identified. The selected NF plants were fed with anoxic ground water, while the feed water to RO plants was either surface water or municipal wastewater effluent. All the NF plants produce drinking water, while the RO plants produce demineralized water for industrial applications. We found that the cost of fouling in the RO plants was around 24% of OPEX, while the fouling related costs in NF cases was only around 11% due to the low biofouling potential of the anoxic ground water. The major factor in the cost of fouling is the early membrane replacement cost, followed by additional energy and with only a minor contribution from the cleaning costs. The down-time cost (caused by the interruption of water production during a CIP event) can be the major CIP cost factor for the plants with frequent cleaning events, while the cost of chemicals dominates in the plants with non-frequent CIP. In case of manual cleaning-in-place, the cost of fouling is increased by around 2% for the RO plants with frequent CIP. The manual execution of CIP cleaning is an attention point to reconsider, as the reviewed plants hold an automated CIP cleaning, providing membrane productivity advantages. ; This study was funded by European Union's Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No. 676070. The authors gratefully acknowledge Martin Pot (Evides Industriewater B.V. The Netherlands) and Sandie Chauveau (Global Water & Energy Group, Belgium) for the fruitful discussion during concept development phase of this study. This communication reflects only the authors' view and the Research Executive Agency of the EU is not responsible for any use that may be made of the information it contains.