Objective: Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method. Methods: A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework. Results: Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism. Conclusion: This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

Background: There is growing interest in examining the factors affecting the reporting of errors by nurses. However, little research has been conducted into the effects of perceived patient safety culture and leader coaching of nurses on the intention to report errors. Methods: This cross-sectional study was conducted amongst 256 nurses in the emergency departments of 18 public and private hospitals in Tabriz, northwest Iran. Participants completed the Hospital Survey on Patient Safety Culture (HSOPSC), Coaching Behavior Scale and Intention to Report Errors’ questionnaires and the data was analyzed using multiple linear regression analysis. Results: Overall, 43% of nurses had an intention to report errors; 50% of respondents reported that their nursing managers demonstrated high levels of coaching. With regard to patient safety culture, areas of strength and weakness were “teamwork within units” (PRR = 66.8%) and “non-punitive response errors” (PRR = 19.7%). Regression analysis findings highlighted a significant association between an intention to report errors and patient safety culture (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.05), leader coaching behavior (B = 0.2, CI 95%: 0.1 to 0.3, P < 0.01) and nurses’ educational status (B = 0.8, 95% CI: − 0.1 to 1.6, P < 0.05). Conclusions: Further research is needed to assess how interventions addressing patient safety culture and leader coaching behaviours might increase the intention to report errors.

Delivering interventions is the main task of health systems whose accurate measurement is an essential input into tracking performance. Recently, the concept of effective coverage was introduced by World Health Organization to incorporate into health system performance assessment. The aim of present scoping review was mapping the key elements and steps of effective coverage assessment in practical efforts including kinds of interventions, criteria for selecting them and the need, use and quality estimation approaches and strategies of each intervention. We conducted a scoping review of health system/program assessments which assessed effective coverage till May 2017. Seven databases were systematically searched with no time and language restriction through applying combined keyword of “effective coverage”. Eighteen studies contributed findings on monitoring effective coverage of health interventions and they all were included in the review. Only 4 contributed findings on health system and the others were related to specific intervention(s) assessment. The interventions monitored by effective coverage were mainly in child health, prenatal and antenatal care and delivery, and chronic conditions areas. Potential impact on the burden of disease, leading causes of mortality and morbidity, and high occurrence and prevalence rate were among the main intervention selection criteria. Availability of data was the critical prerequisite, especially, in all of the studies applied ex post approach in estimating effective coverage. Estimation based on a norm, self- reporting from surveys and biomarkers were the main strategies and methods of need, utilization and quality measurement, respectively. More studies are needed to contribute to the ongoing improvement in the development of effective coverage concept and increasing practical efforts, especially through defining prospective approaches and strategies into estimation of composite measures based on the effective coverage framework. Also, further attention needs to be paid to quality measures of effective coverage in a manner that better conceptualizes and measures the connection between coverage rates and interventions’ effectiveness. At the administrative system level, more innovation is needed to develop data systems in order to enhance capacity of routine health service information.

To investigate the distribution and trends associated with brucellosis incidence rates in Iran from 2011 to 2014. The reported incidence rates of brucellosis for the years 2011-2014 were collected and entered into GIS 10.1. The Cochran-Armitage test for linear trends, choropleth maps, hot-spot analysis, and high-low clustering analysis were used to investigate patterns of the disease over the study period and by season, and to identify high-risk areas and any clustering of the disease. The significance level was set at p<0.05. A total of 68493 cases of brucellosis were reported during the study period, giving an average brucellosis incidence rate for this period of 38.67/100000. In 2011, the highest rate of brucellosis was observed in Koohrang County of Chaharmahal-Bakhtiari Province, with 317/100 000. In the subsequent years, 2012-2014, Charuymaq County of East-Azerbaijan Province had incidence rates of 384, 534, and 583/100000, respectively. However, the incidence rate of the disease did not follow a linear trend (p<0.001). The maximum and minimum incidence rates of the disease occurred in mid-summer and mid-winter, respectively. The results of the hot-spot analysis showed that the distribution of the disease was highest in the mountainous areas of Iran, particularly along the Zagros mountain range and in most cities near the Zagros Mountains (p<0.01). In addition, the cluster analysis showed a clustering pattern in these high incidence areas (p<0.01). There were significant differences in the geographic distribution of brucellosis, with the incidence rates being highest in most of the cities in the west and north-west of the country. The incidence of this disease also increased during the summer. It is important to take these patterns into account when allocating resources to combat this disease and to ensure that health programs and other interventions focus on the areas of greatest need.

Around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment's and services. In order to respond these challenges and reduction of health system's transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby's index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.

Aim: To investigate barriers to patient engagement in the delivery of safe hospital care.Design: Qualitative exploratory study.Methods: A qualitative study with 35 Iranian health professionals was conducted from February to April 2019 using semi‐structured interviews to elicit their opinions. MAXQDA 11 software was used for data management, and the data were analysed using framework analysis.Results: Barriers, which potentially have negative impact on patient engagement in the delivery of safer care, were categorized into four themes. The first category included patient‐related barriers such as low levels of health literacy, ineffective education, patient unwillingness and cultural barriers. The second category included staff‐related barriers such as the existence of negative attitudes towards engaging patients in matters relating to patient safety, ineffective communication, high workload and the reluctance on the part of physicians to engage with patients. Barriers created by limited resources and inadequate training provided by universities and in the workplace formed the third category and community‐related barriers such as the inadequate dissemination of information via the mass media and a lack of community‐based services formed the fourth category.Conclusion: Results demonstrate the multilayered nature of the significant barriers to the engagement of patients in the delivery of safe care and reflect the need for a collaborative approach between the recipients of care, researchers, care providers and policy makers if these are to be overcome.