بازطراحی مدل کارآمد برون‌سپاری مراکز جامع سلامت حاشیه شهر مبتنی بر نظریه داده بنیاد، مطالعه موردی یک کلان شهر

نوع مقاله : مقاله پژوهشی

نویسندگان
گروه مدیریت خدمات بهداشتی درمانی،واحد تهران جنوب،دانشگاه آزاد سلامی،تهران،ایران
چکیده
مقدمه: اجرای رویکرد برون سپاری خدمات سلامت حاشیه شهر با چالش ها و فرصتهایی مواجه بوده نیازمند بررسی نظام مند است. این مطالعه درکلان شهر مشهد و به منظور ارایه الگویی برای اجرای کارآمد مبتنی بر داده های تجربی انجام شد.
روش‌ها:  این مطالعه با رویکرد نظریه داده‌ بنیاد و با استفاده از مصاحبه‌های نیمه‌ساختاریافته با متخصصین حوزه سلامت انجام شد. داده‌ها از طریق کدگذاری باز، محوری و انتخابی در نرم افزار مکس کیودا 20تحلیل گردید. درکدگذاری انتخابی، عنصر مرکزی نظریه استخراج شد. این مقوله در تعامل با شرایط علّی ، زمینه‌ای ، مداخله‌گر ، راهبرد  و پیامد ، روایت نهایی نظریه را شکل داد.
یافته‌ها:  شش طبقه مفهومی از جمله سه طبقه(و هفت زیر طبقه)  چالش شامل محدودیت منابع مالی، ضعف نظام نظارت و پایین بودن سطح اعتماد جامعه و سه طبقه(و شش زیر طبقه)  فرصت شامل دسترسی به ارایه‌دهندگان خصوصی محلی، مشارکت فعال جامعه و حمایت سیاستی، از تحلیل داده ها آشکار گردید.
نتیجه‌گیری:  مقوله‌ی «پرداخت و انگیزه مالی» به‌عنوان محور ارتباطی سایر عوامل ساختاری، زمینه‌ای و مداخله‌گر شناسایی شد. این یافته بیانگر آن است که هرگونه اصلاح در سیاست‌های برون‌سپاری خدمات سلامت باید با تمرکز بر بازطراحی نظام‌های پرداخت، شفاف‌سازی قراردادها و تقویت زیرساخت‌های نظارتی و فناوری صورت گیرد.

کلیدواژه‌ها

موضوعات


عنوان مقاله English

Redesigning an efficient outsourcing model for urban fringe comprehensive health centers of based on Grounded theory :a case study of a metropolis

نویسندگان English

Mohammad Ali Azizi
ُShaghayegh Vahdat
Soad Mahfoozpour
Somayeh Hessam
Department of Health Services management ,ST.C.,Islamic Azad Unversity,Tehran,Iran
چکیده English

Abstract



Background:

Implementation of outsourcing strategies within the health system has been introduced as a managerial approach to enhance efficiency and equity in service delivery at urban fringe comprehensive health centers; however, it faces multiple challenges and opportunities that require systematic investigation. This study was conducted in the metropolitan area of Mashhad with the aim of developing an evidence based, data driven model for effective outsourcing implementation.

Methods:

Employing the Grounded Theory approach, this qualitative research utilized semi structured interviews with health system experts. Data were analyzed through open, axial, and selective coding using MAXQDA 20. During selective coding, the core category was extracted, which interacted with causal, contextual, intervening, strategic, and consequential conditions to formulate the final theoretical narrative.

Results:

Six conceptual categories emerged from the data analysis, including three categories (and seven subcategories) of challenges namely, limited financial resources, weak monitoring systems, and low public trust and three categories (and six subcategories) of opportunities including access to local private providers, active community participation, and policy support.

Conclusion:

The category of “payment and financial incentives” was identified as the central connecting axis among other structural, contextual, and intervening factors. This finding suggests that any reform in health service outsourcing policies should focus on redesigning payment systems, enhancing contract transparency, and strengthening monitoring and technological infrastructures

Keywords: Outsourcing; Health services; Comprehensive health centers; Urban periphery; Grounded theory; Health policy; Service delivery.

کلیدواژه‌ها English

Outsourcing
Health services
Suburban health centers
Grounded theory
Health policy
Service delivery
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