Background
Methods
Study design and setting
Recruitment of participants
Data collection
Data analysis
Results
Demographic characteristics of the participants
Variables | Frequency | Percent |
---|---|---|
Sex | ||
Male | 17 | 81.0% |
Female | 4 | 19.0% |
Education | ||
Medical Doctor (M.D) | 12 | 57.1% |
PhD in health services management | 5 | 23.8% |
PhD in other field | 4 | 19.1% |
Position | ||
Top-level manager | 5 | 23.8% |
Middle-level manager | 4 | 19.0% |
Operational manager | 2 | 9.5% |
Faculty member | 4 | 19.0% |
Expert | 6 | 28.7% |
Challenges of the organizational structure of the health network
Theme | Sub-themes | Frequency |
---|---|---|
Complexity | Administrative and financial duplication in the network headquarters, health center and hospital | 16 |
Multiplicity and excessive expansion of organizational levels and scope of vertical and horizontal monitoring (lack of agility) | 19 | |
High distribution of network subsidiaries geographically | 17 | |
Extensive scope of monitoring | 18 | |
Late understanding of health and hospitals problems by network | 10 | |
Multiplicity and diversity in clients and customers | 12 | |
Lack of coordination and interference in the duties of subordinate units (weakness in coordination) | 20 | |
Multiplicity of programs, processes, increased responsibilities and high volume of activities | 20 | |
Complexity and difference in the nature of services and types of activities (health, treatment, food and medicine, pre-hospital, etc.) | 16 | |
Incongruity between manpower and duties (health, treatment, food and medicine, pre-hospital, etc.) | 11 | |
Multiplicity in responsible and accountable centers (multiple levels of management) (network manager, head of health center, treatment deputy, head of hospital and head of medical emergencies) | 12 | |
Conflict of interest in network policies and conflict between different departments (network headquarters, health and treatment) /lack of integration and internal cohesion | 14 | |
High dynamics in the field of health and the need for a fast response to challenges and problems | 14 | |
Formalization | Uncertainty in the scope of authority and responsibility in practice | 19 |
Excessive administrative bureaucracy | 20 | |
Ignoring guidelines, rules and regulations | 18 | |
lack of belief in the administrative structure and hierarchy | 17 | |
Dismissal and appointment of managers based on individual decisions | 11 | |
person-centered management | 17 | |
Lack of clear organization and structure for deputies (except for health) | 18 | |
Lack of transparency in the division of managerial duties among the network system components | 15 | |
Weaknesses and defect in the control and monitoring system | 19 | |
lack of paying attention to the organizational structure in practice, lack of observing the hierarchy and reducing the scope of responsibility and accountability of operational managers | 19 | |
improper division of work | 12 | |
Changes in service packages and job descriptions | 18 | |
Centralization | Focus of power (financial and administrative and decision-making powers) in the network manager and headquarters | 18 |
Inadequate authority of managers in hospitals and health centers | 19 | |
Relocation of resources (financial, manpower, equipment) by the manager and the network headquarters in different departments (network headquarters, hospital, health center and emergency) | 19 | |
High level of responsibility and high work pressure on the network manager in the county | 18 | |
inefficiency in making decisions due to structural barriers | 14 | |
Lack of application of communication and information system at decision-making levels | 17 | |
Weakness in communication (between network headquarters and hospital / between network headquarters and health center and affiliated units) | 18 | |
Environment | Continuous political, economic, social and environmental changes | 10 |
Change in national divisions | 12 | |
Changes in the appearance of death and disease | 9 | |
Epidemiological transition | 10 | |
Nutritional transition | 10 | |
Demographic transition (demographic change) | 12 | |
Not considering the social determinants of health in the structure of the network system | 15 | |
Ignoring the role and position of the private, public, and charity sectors in the organizational structure | 11 | |
Ignoring the role and position of the people (citizen-oriented and responding to needs of the people) | 9 | |
Imposing the duties of other departments on the network system | 5 | |
Lack of proper organization in coping with environmental threats | 11 | |
Culture | The effect of organizational culture on the structure of network system | 14 |
Ignoring local (regional) culture in the structure of network system | 14 | |
Increasing and changing people expectations | 18 | |
Increasing and changing expectations of employees | 12 | |
non-importance of competence and seniority in organizational promotion and managerial positions | 13 | |
Instability of management in the network, hospital and health center | 16 | |
Resources | Inconsistency between resources and the structure of the network | 16 |
Lack of financial resources and funds to achieve objectives | 15 | |
Lack of manpower | 15 | |
Lack of equipment | 15 | |
Inconsistency between line and headquarters staff | 13 | |
Lack of necessary consistency in the composition and distribution of organizational positions of units | 14 | |
Unfair distribution of resources | 16 |
“The structure of the health network in cities is very wide in terms of organizational levels, geographical distribution and variety of tasks and the structure does not have the necessary agility.” [Interviewee 9]
“There is a parallel operation in administrative and financial affairs in the health network headquarters, the county health center and the county hospital.” [Interviewee 13]
“Unfortunately, network administrators do not pay attention to organizational structure in practice and not paying attention to the hierarchy reduces the limits of responsibility and accountability of operational managers.” [Interviewee 15]
“Management in the health network system is more person-centered and personalized, and after change each manager, a lot of changes are made in the processes.” [Interviewee 20]
“Financial and administrative power and decision-making powers are concentrated at the level of the health network headquarters, and the powers of managers in hospitals and health centers are insufficient.” (Interviewee 6)
“Financial resources, manpower and equipment of different departments (hospital, health center and emergencies) are transferred by the network manager and staff without coordination with the health center and hospital.” (Interviewee 11)
“Environmental changes (political, economic, social and environmental) affect the tasks and responsibilities of the health network.” (Interviewee 9)
“Social determinants of health are not included in the structure of the network system.” (Interviewee 16)
In this regard, one of the participants mentioned “Over the years, the expectations of people and staff have changed a lot, so it is necessary to adapt the structure of its network system to these changes.” (Interviewee 10)
“Competence and seniority system has no place in organizational promotion and management positions in health care networks.” (Interviewee 19)
Interviewee 3 stated that "The health network is facing a lack of resources including financial, human, equipment, physical to achieve its goals and tasks.”
Also, one of the interviewees said that “Distribution of resources in the health sector is not equality.” (Interviewee 14)