The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin's change theory and the model presented in this paper underpins the change management in any organizations.

Background The aim of this study was to present challenges of implementing the accreditation model in university and military hospitals in Iran. Methods In this qualitative study, purposive sampling was used to select hospital managers and implementers of the model working in 3 hospitals affiliated to Kerman University of Medical Sciences and in 3 military hospitals in Kerman, Iran. A total of 39 participants were interviewed, and semi-structured questionnaires and thematic analysis were used for data collection and analysis, respectively. Results In this study, 5 major codes and 17 subcodes were identified: (1) perspectives on accreditation model with 5 subcodes: a difficult and time-consuming model, less attention to the patient, accreditation as a way of money acquisition, not being cost-effective, and accreditation means incorrect documentation; (2) absence of appropriate executive policy, with 3 subcodes: lack of financial funds and personnel, disregarding local conditions in implementation and evaluation, and absence of the principle of unity of command; (3) training problems of the accreditation model, with 2 subcodes: absence of proper training and incoordination of training and evaluation; (4) human resources problems, with 3 subcodes: no profit for nonphysician personnel, heavy workload of the personnel, and physicians’ nonparticipation; (5) evaluation problems, with 4 subcodes: no precise and comprehensive evaluation, inconformity of authorities’ perspectives on evaluation, considerable change in evaluation criteria, and excessive reliance on certificates. Conclusions This study provided useful data on the challenges of implementing hospitals’ accreditation, which can be used by health policymakers to revise and modify accreditation procedures in Iran and other countries with similar conditions. The accreditation model is comprehensive and has been implemented to improve the quality of services and patients’ safety. The basic philosophy of hospital accreditation did not fully comply with the underlying conditions of the hospitals. The hospital staff considered accreditation as the ultimate goal rather than a means for achieving quality of service. The Ministry of Health and Medical Education performed accreditation hastily for all Iranian hospitals, while the hospitals were not prepared and equipped to implement the accreditation model.

IntroductionIn order to improve health, hospital sources such as beds and staffing should be properly allocated and used. The aim of this study is reallocation of Shafa hospital beds in Kerman using a goal-programming model.MethodsThis study was an applied cross-sectional study, which used the goal programming model and software WinQSB to optimize bed allocation. By review of the literature and interviews with experts, the constraints in beds allocation were identified, and using the collected data the desired model was designed.ResultsHospital beds were redistributed based on the constraints of the goal-programming model and objectives. The results showed that there was a shortage of beds in departments such as burns, GICU, HICU, cardiac surgery, emergency, and orthopedics, and excess of beds in the ear, nose, and throat (ENT), ophthalmology, and neurology departments.ConclusionIt is anticipated that the optimal allocation of hospital beds, regarding hospital activity indicators, can lead to greater justice in the provision of services and a better distribution of resources.

Background: The health insurance ecosystem involves all the organizations and institutions which act as ecosystem actors in accordance with the objectives, values and functions of the ecosystem as its elements. Comprehensive understanding of the elements and actors of this ecosystem can be effective in improving its current status and in the future. Thus, the present study aimed to discuss the key elements (objectives, values and functions), as well as the actors of the health insurance ecosystem by a systematic review method. Methods: This systematic review study was conducted in January 2021 using the six-step Walsh and Downe technique in the form of meta-synthesis. The question proposed a search strategy using the SPIDER framework, and the search was done in PubMed, Scopus, Web of Science ,Cochrane and Persian database of Magiran without considering a specific time and place. Content analysis method and MAXQDA 2020 were used to combine the findings. the Mixed Methods Appraisal Tool (MMAT) evaluation checklist version 2018 was used to evaluate quality of studies. Results: 1410 articles were found in major databases, and 10 papers were found by manual searching using the search strategy. In addition, 612 duplicate records were removed from the search results after entering the results in EndNote X7 software. Ultimately, 9 studies reached the stage of quality evaluation and meta-synthesis. The selected studies were reviewed one by one, and their key concepts and themes were identified using content analysis method. Finally, the list of actors and key elements of the health insurance ecosystem was made. Conclusion: Establishing fair participation and financial protection were identified as the most important key elements in the health insurance ecosystem, achieved through governance functions, resource supply, and service delivery in the context of an integrated and transparent structure. Applying governance is the most important role of ecosystem, forming the necessary participation and coordination between the actors in different roles, and regulating the interactions between them through mechanisms such as tariffs and the payment system. The role played by many actors with different roles or different roles by one actor in the ecosystem results in complexity and conflict of interest.