Razi Journal of Medical Sciences

fa نگاهی نو به مشکلات و چالش‌های دانشگاه علوم پزشکی ایران؛ گام اول در مسیر ارتقای عملکرد Reevaluation of Problems and Challenges in Iran University of Medical Sciences, the First Step to an Effective Performance Improvement اپیدمیولوژی Epidemiology پژوهشي Research زمینه و هدف: دانشگاههای علوم پزشکی کشور به‌عنوان مراکزی برای تفکر و نوآوری متولی تأمین، حفظ و ارتقای سلامت جمعیت تحت پوشش خود و سایر نقاط کشور هستند. مدیران دانشگاه با شناسایی مشکلات و چالش‌ها و با تکیه بر ابزارهای توسعه خلاقیت و حل‌مساله و حرکت به سمت دانشگاه‌های نسل سوم می‌تواند اهداف دانشگاه را محقق کنند. روش کار: این مطالعه یک پژوهش کاربردی است که به ‌روش کیفی در سه مرحله به احصاء و دسته‌بندی چالش‌های عملکردی مراکز و واحدهای تحت پوشش دانشگاه علوم پزشکی ایران پرداخته است. جامعه مورد بررسی در این پژوهش را خبرگان، مدیران و کارشناسان مراکز مختلف دانشگاه تشکیل دادند. تحلیل داده‌ها به روش تحلیل محتوایی انجام شد. یافته‌ها: مجموع 215 مساله جمع‌آوری شده در 3 محور کلی مدیریت مبتنی بر شواهد، وجود بروکراسی سنگین و فرهنگ سازمانی تقسیم‌بندی شد. پرتکرارترین مشکلات در حوزه مدیریت مبتنی بر شواهد ذکر شد و نقص در شایسته‌سالاری سرفصلی بود که در هر سه محور مورد توجه قرار گرفته‌ بود. فقدان برنامه پایش و ارزشیابی مؤثر، نبود چارچوب مدون برای استفاده از نتایج پایش و ارزشیابی موجود، کمی‌گرایی، نبود سیستم تنبیهی و تشویقی کارآمد، ایرادات قانونی، مدیریتی، تشکیلاتی و فرایندی، مشکلات آموزش، ارتباطات، انگیزش، عملکرد و نگرش نیروی انسانی و ضعف در تعلق سازمانی پرسنل از سایر موارد مهم مورد اشاره بود. نتیجه‌گیری: به نظر می‌رسد که مهم‌ترین مشکلات دانشگاه از منظر کارکنان به صورت مجموعه به هم مرتبطی از محدودیت‌های بوروکراتیک، تصمیم‌گیری‌های فاقد پشتوانه و تاثیرات سوء و متقابل این دو و مشکلات مربوط به  فرهنگ سازمانی نمود می‌یابد و هر نوع تغییری برای رفع این مشکلات باید با در نظر گرفتن اثرات احتمالی آن بر سایر عوامل ذکر شده انجام شود.   Background & Aims: In Iran’s health system, with integration of medical education and ministry of health, medical universities have a variety of responsibilities apart from delivering medical education to university students. Medical universities are playing an essential role in management of the health system. They are in charge of providing the necessary prevention and treatment services in provincial levels, as well as management and oversight of the health services needed by the population. Meanwhile, medical universities are expected to maintain and improve population health through scientific and innovative methods. Although the indicators highlight the success of these universities in many of their tasks, sometimes they fail to fulfil the expected targets. Identifying problems and challenges that hinder universities’ performance and supporting them with innovative problem solving methods can help managers in achieving university goals. Therefore, recognizing and analyzing the university challenges are essential steps that should be taken for the strengthening the university system and empower them to respond more successfully to the existing and future needs and to assure that the university continues its pathway toward growth and development and keeps up the track of achieving its goals. Methods: This study is an applied research project, which has been designed to identify and categorize the challenges that affect the performance of different sectors of Iran University of Medical Sciences. The participants of this qualitative study were experts, managers, directors and officers of different sectors of the university, including faculties, deputies, offices, hospitals and health centers. In the first step, an open-ended questionnaire was developed and evaluated to extract challenges and problems faced by different units in the university. Then, this open-ended questionnaire was distributed and the challenges and problems of different academic and non-academic units of the university were collected through questioning the managers and staff of all units and subunits about the most important challenges they face. For each challenge they mentioned, title of the challenge, description, and the rational of their importance and priority was provided. The process continued until no new themes emerged. At the end of this step, a list of existing challenges and problems along with their description and rational for selection were available. In the next step, the collected concepts were analyzed in order to investigate the limiting role of these challenges on the performance of different units in the university. After organizing the answers and reviewing the suggested items, similar and overlapping items were merged or removed.  Also, challenges that targeted a limited number of units or those targeting people (instead of problems or processes) were removed. In the following step, reviewing and coding was performed and themes were extracted by two independent researchers. Finally, the themes were summarized based on the opinions of different experts and by achieving consensus. At the end of this step, affecting factors were identified, categorized and presented. In the last step, three rounds of focus group discussions were held to evaluate the accuracy of the obtained data. In all steps of the study, in order to benefit from the views of a wide range of experts and managers and officers with different experiences, purposive sampling was performed. The data collection continued until data reached saturation. Content analysis was undertaken to provide a complete understanding of the collected data. For maintaining the ethical considerations, the names of the study units and any reference to specific people and occasions were removed from the reports and texts. Results: we achieved a response rate of 90 percent through multiple reminders and follow ups we sent to unit managers. Based on the responses from units, 215 problems were identified from 38 participating units. The identified problems were categorized into three main themes. Most of the mentioned problems could be categorized under the general theme of lack of evidence-based management. In fact, issues related to lack of evidence-based management was mentioned by almost every participant. This theme includes issues such as Lack of effective monitoring and evaluation systems, and poor frameworks and process flows for applying evaluation results; excessive focus on quantitative approaches for evaluating performance of teams and individuals, and lack of efficient and fair rewarding and punishing systems. The second emerged theme was inefficient bureaucracy, where issues such as legal, managerial, structural and process problems are addresses. Organizational culture was the third extracted theme and defective staff education, communication and motivation, poor workforce performance and attitudes to organization; and insufficient professional commitment were among the most frequently indicated problems. Lack of meritocracy was an issue mentioned across all three themes by participants and was considered as an important determining topic linking all three themes. This topic highlighted lack of predefined approaches for selecting staff at different levels and unclear process of succession in different organizational levels and units. Conclusion: According to the university workforce, the main problems and challenges that hinder university performance are rooted in an environment of interrelated factors which can be categorized mainly in absence of evidence-based management, inefficient bureaucratic structure, undefined and underdeveloped decision-making process at different levels of the organization, and some aspects of the organizational culture that may adversely affect the processes of the organization. Based on these results, it can be concluded that the university’s existing performance management system, is generally hindering the evidence based management, which in turn, results in shaping of an overall ineffective approach to the decision making processes and a rather static organizational status. Moreover, such cultural environment can consequently cause a attitude of resistance versus different efforts toward evidence based management. Finally, it can be concluded that if a sustainable and effective change is intended to occur in the management of the university, the probable concurrent effects of the designed interventions an all three hindering factors should be considered with high caution. This consideration is especially important because it is believed that implementing an evidence based decision making system in an organization requires detailed evaluation of organizational culture and characteristics; and failing to provide these information properly can result in a serious obstacles in success of the interventions.   بروکراسی, عملکرد, فرهنگ سازمانی, مدیریت مبتنی بر شواهد Performance, Improvement, Organizational Culture 1 9 http://rjms.iums.ac.ir/browse.php?a_code=A-10-2684-4&slc_lang=fa&sid=1 Samira Alihosseini سمیرا علی حسینی 3900319475328460072245 3900319475328460072245 No Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات علوم مدیریت و اقتصاد سلامت، پژوهشکده مدیریت سلامت، دانشگاه علوم پزشکی ایران، تهران، ایران Aliakbar Haghdoost علی اکبر حق دوست 3900319475328460072246 3900319475328460072246 No HIV/STI Surveillance Research Center and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran مرکز تحقیقات مراقبت HIV و عفونت‌های آمیزشی، پژوهشکده آینده پژوهی در سلامت، دانشگاه علوم پزشکی کرمان، ایران Leila Ghalichi لیلا قالیچی ghalichi.l@iums.ac.ir 3900319475328460072247 3900319475328460072247 Yes Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran مرکز تحقیقات بهداشت روان، پژوهشکده پیشگیری از آسیب‌های اجتماعی، دانشگاه علوم پزشکی ایران، تهران، ایران Salime Goharinezhad سلیمه گوهری نژاد 3900319475328460072248 3900319475328460072248 No Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات طب پیشگیری و سلامت جمعیت، پژوهشکده پیشگیری از آسیب‌های اجتماعی، دانشگاه علوم پزشکی ایران، تهران، ایران Bita Mehravi بیتا مهروی mehravi.b@iums.ac.ir 3900319475328460072249 3900319475328460072249 No Department of Medical Nanotechnology, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran گروه نانوفناوری پزشکی، دانشکده فناوری‌های نوین پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Omid Barati امید براتی omidbarati40@gmail.com 3900319475328460072250 3900319475328460072250 No School of management and medical information sciences, Shiraz University of Medical Sciences, Shiraz, Iran دانشکده مدیریت و اطلاع رسانی، دانشگاه علوم پزشکی شیراز، شیراز، ایران Babak Eshrati بابک عشرتی eshrati.b@iums.ac.ir 3900319475328460072251 3900319475328460072251 No Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات طب پیشگیری و سلامت جمعیت، پژوهشکده پیشگیری از آسیب‌های اجتماعی، دانشگاه علوم پزشکی ایران، تهران، ایران Tayebeh Najafimoghadam طیبه نجفی مقدم drnajafimoghadam@gmail.com 3900319475328460072252 3900319475328460072252 No Non-communication disease group, Health deputy, Iran University of Medical Sciences, Tehran, Iran گروه بیماری‌های غیرواگیر، معاونت بهداشتی دانشگاه علوم پزشکی ایران، تهران، ایران Ali Kabir علی کبیر aikabir@yahoo.com 3900319475328460072253 3900319475328460072253 No Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات جراحی‌های کم تهاجمی، دانشگاه علوم پزشکی ایران، تهران، ایران Fereshteh Azedi فرشته عاضدی azeditehrani.f@tak.iums.ac.ir 3900319475328460072254 3900319475328460072254 No Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات سلولی و مولکولی، دانشگاه علوم پزشکی ایران، تهران، ایران Morteza Naserbakht مرتضی ناصربخت 3900319475328460072255 3900319475328460072255 No مرکز تحقیقات بهداشت روان، پژوهشکده پیشگیری از آسیب‌های اجتماعی، دانشگاه علوم پزشکی ایران، تهران، ایران Jalil Koohpayezadeh جلیل کوهپایه زاده 3900319475328460072256 3900319475328460072256 No Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran مرکز تحقیقات طب پیشگیری و سلامت جمعیت، پژوهشکده پیشگیری از آسیب‌های اجتماعی دانشگاه علوم پزشکی ایران، تهران، ایران