Volume 11, Issue 2 (6-2022)                   JCHR 2022, 11(2): 126-136 | Back to browse issues page


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Bahariniya S, Shafii M, Madadizadeh F, Sharif Yazdi M. Strategies and Challenges for Managing Human Influenza in the Iranian hospitals: A Qualitative Study in Yazd province, Central part of Iran. JCHR 2022; 11 (2) :126-136
URL: http://jhr.ssu.ac.ir/article-1-880-en.html
1- 1. MSc student of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- 2. Department of Health Services Management, Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- 3. Center for healthcare Data modeling, Departments of biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. , f.madadizadeh@ssu.ac.ir
4- Assistant Professor, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Abstract
Introduction:
Influenza virus is one of the deadliest viruses that has threatened the human population over the years. Every year, organizations and hospitals must be prepared to deal with the disease and treat people with the flu and be able to manage the disease in the hospital. The aim of this study was to identify hospital management strategies for human influenza in Yazd province, central part of Iran.

Methods: This study was a qualitative study with inductive conventional approach. A total of 14 main hospitals in Yazd province were surveyed in 2021. The study population included heads and managers of hospitals, nurses, educational and clinical supervisors, metrons, officials of the quality improvement office and the infection Control Committee. Participants were selected using snowball sampling method. Semi structured interviews were used to collect data. The sample size in this study was up to information saturation. Content analysis method was used to analyze the data.
Results: Using the opinions and views of 38 managers and officials of selected hospitals  in Yazd province, data saturation was obtained. The most important tasks of the hospital management in terms of influenza control and management were divided into 5 areas (field measures, support, training, awareness, protection and measures in the field of human resources). The major challenges   regarding the influenza control and management were classified into 3 areas: hospital (health), macro (university, provincial, national and Ministry of  Health guidelines) and community level. Finally, the most important solutions and suggestions were categorized in these 3 key areas.
Conclusion: Based on the categorized challenges and problems, as well as the classification of the most important strategies and suggestions, useful action can be taken to the control and management of influenza, both at the hospital level and in the community, in Iranian hospitals especially in Yazd province.

Keywords: Hospital Management, Influenza, Yazd Province
Introduction
The flu virus is one of the deadliest viruses that has threatened the human population over the years. The prevalence and prevalence of influenza virus is a factor in its survival and one of the most important reasons for the death of this virus (1-3). Influenza has different frequencies and intensities between different groups and even has a higher mortality rate in some groups with underlying diseases. Health professionals usually diagnose the flu based on its symptoms. Rarely, they detect the flu virus by testing blood or nasal or throat fluid samples. The flu is accompanied by fever, cough, chills with chills, bruising and pain, headache and fatigue. These symptoms usually last for 3 to 4 days. Influenza is a distinct viral disease with its own specific symptoms and usually occurs in late autumn and winter (4). Failure to accurately and timely identify the cause of the disease in people with the flu and the use of inappropriate antibiotics can lead to death (5, 6). Every year, as the weather cools, flu outbreaks are reported across the country and in different parts of the world. Influenza is an acute and deadly disease with the potential for widespread epidemics. In order to reduce the social and economic costs of this disease, vaccination against it is very effective in the whole population and endangered populations (7-9).
It seems that increasing the level of public awareness of this disease and placing more emphasis on the power of transmission and contagion, in addition to improving public awareness and perceived severity of this disease, also helps to improve preventive behaviors (8, 10, 11).
According to the statistics published by the Vice Chancellor for Health of Shahid Sadoughi University of Medical Sciences in Yazd, the number of definite positive cases of influenza in 2017 was two and in 1397, it was four, which has increased to 60 in 1398. Also this year, 960 people suspected of having this disease were identified in the province, of which 406 people were hospitalized in the province, and the majority of these people were elderly. The point that is very important is that every year all organizations and hospitals must be prepared to deal with this disease and treat people with the flu and be able to manage this disease in the hospital and therefore the hospital. Do not face problems such as lack of beds, lack of manpower, dangerous outbreaks of influenza in the hospital environment and other problems (12).
In a similar study, Mehdipour et al (2018) investigated the factors related to hospitalization in patients with H1N1 influenza at Afzalipour Hospital in Kerman and concluded that the disease and background factors play a major role in the exacerbation of the disease. Therefore, the health system should take the necessary preventive measures during an epidemic. In this study, it is pointed out the need to pay attention to preventive measures in order to have an effective solution (13).
This study aimed to identify the Strategies and the challenges for managing human Influenza in the Iranian hospitals, especially in Yazd province, central part of Iran.
Methods
This qualitative study was conducted by content analysis method with inductive contractual approach. Lack of sufficient information about hospital management of influenza led to the use of inductive contractual approach in the present study; By referring to the experiences of people, we gradually categorized, summarized information and obtained the main concepts. In the first step, the scattered data were examined, then we obtained the implicit concepts and finally the abstract levels. Achieving abstract levels was the end of the data analysis phase.
A total of 14 main hospitals in Yazd province were surveyed. The selected hospitals of Yazd province were: "Shahid Sadoughi", "Shahid Rahnemoun", "Afshar", "Kargar Martyrs", "Seyed Al-Shohada", "Shahid Beheshti Taft", "Fatemeh Al-Zahra Mehriz", "Imam Jafar Sadegh Meybod", "Ziaei Ardakan", "Valiasr Bafgh", "Ayatollah Khatami Khatam", "Khatam Al-Anbia Abarkooh", "Mortaz" and "Mojibian".
The study population included heads and managers of hospitals, nurses, educational and clinical supervisors, metrons, officials of the Quality Improvement Office and the Infection Control Committee Participants were selected using snowball sampling method. semi-structured interviews were used to collect data. The focus of the interview questions was the position and importance of the hospital management position in controlling the flu and the challenges facing the hospital management.
 These challenges were expressed in 5 basic themes, which are: structure and organization, laws and instructions, resources and facilities, weakness of explanatory and educational courses on influenza to the people, and macro and upstream policies. The sample size   as well as qualitative studies was done until there were no new information (saturation).
Content analysis method was also used to analyze the study data. Among the most important criteria for inclusion in the study were having knowledge and experience in the field of hospital management, good communication skills and having time for interviews. Also, people who did not have the time or inclination to be interviewed and participate in the study were excluded from the study. It should be noted that at the beginning of the interview, the purpose of the research, the interview method and the right of individuals to participate in the study or to refuse it were explained to the participants by the researcher. They were told about the recording of the interviews and the confidentiality of the information, and then their informed consent was obtained.
The research project was approved by the Research Council of Shahid Sadoughi University of Medical Sciences in Yazd and was in the form of a research grant from the university.
Ethics Code
IR.SSU.REC.1399.037
Results
Data saturation was obtained by using the opinions and views of 38 managers and officials of selected hospitals in Yazd province, which was done purposefully and then with the method of snowball.
The interview guide questions in the present study included the interviewees' experiences in important areas such as the tasks of the hospital management, challenges and problems, solutions and suggestions and opinions regarding the national and provincial communication guidelines (possible weaknesses) (Table1).

The most important tasks of the hospital management regarding influenza control and management were divided into 5 areas (field measures, support measures, training and awareness measures, protection measures and measures in the field of human resources) (Table 2).
The most important challenges and problems regarding influenza control and management were classified into 3 areas: hospital (health), macro (university, provincial, national and Ministry of Health guidelines) and community level (Table 3).
The most important strategies and suggestions regarding influenza control and management were classified into 3 areas: hospital (health), macro (university, provincial, national and instructions issued by the Ministry of Health) and community level (Table 4).
Discussion
The influenza virus has about sixteen serotypes, six of which have caused disease in humans (H1, H2, H3, H5, H7 and H9). It is said that one of the three types H1, H2 and H3 has been identified as the etiological cause of the recent influenza epidemic. This virus is transmitted from person to person through respiratory secretions. The power of this virus in changing surface antigens is the most important factor that can cause new epidemics in human societies every year. Therefore, it is known as the sixth cause of death among humans (12).
The aim of this study was to investigate hospital management strategies for influenza in Yazd province. In the present study, the opinions and views of 38 managers and officials of selected hospitals in Yazd province were purposefully extracted and then by snowball method. According to the results, one of the major challenges, both at the macro level, such as the pillars of the Ministry of Health and Medical Education, and at the community and general public level, is the lack of health knowledge and literacy. Lack of awareness, lack of knowledge and lack of health literacy among health professionals, professionals, policymakers and the general public has led to the spread of infectious diseases such as the flu and can lead to irreparable damage. It seems that it is better to take effective measures to increase the health knowledge and literacy of senior managers, health system policy makers and specialists first. Then health knowledge should be injected into the heart of society as a culture. According to the results of Yildirim (2020) study, although vaccine can be an effective drug to fight infectious diseases such as influenza, but effective interventions must be taken to greatly reduce the incidence of the disease. Effective education and prevention can greatly reduce the use of health services and thus reduce costs and contribute to the health economy (14). The results of this study show the need to pay attention to health, prevention and education, which is consistent with the results of the present study.
Another major challenge addressed in this study is the shortage and limitation of vaccine distribution. Lack of vaccine or even late distribution of vaccine can have dangerous and irreversible consequences for both the medical staff and the general public. Relevant authorities should take the necessary measures to prepare and distribute the vaccine fairly before the outbreak of autumn and the outbreak of influenza. In the first place, the necessary measures should be taken for the fair distribution of vaccines and vaccinations of medical staff in hospitals. The Deputy Minister of Health of the Ministry of Health and the Deputy Ministers of Health of the relevant universities must have a well-written and efficient plan for the fair distribution of the vaccine in a timely manner. Therefore, it seems that the main priority in the first place is to vaccinate the treatment staff before the onset of the cold season. Late distribution may not lead to potential effects or reduce problems. A similar study was conducted by Lai in 2020 and placed special emphasis on the need to vaccinate medical staff to prevent influenza (15), the results of which are in line with the results of the present study.
The next issue is the vaccination of high-risk groups at the community level. Obviously, the whole community can’t be fully vaccinated. Therefore, precise mechanisms must be developed to vaccinate high-risk and sensitive groups in society (16). A study in 2019 by Costantino found that distrust, fear of adverse reactions, and not being considered a high-risk group for influenza were the main reasons for not getting the flu vaccine. Counts (17). Although health and prevention are a key element, in the next phase of influenza vaccination is a key factor in preventing economic losses such as absenteeism and indirect costs. It seems that health system policymakers should develop comprehensive and detailed guidelines for vaccinating high-risk groups in society and instill confidence in the vaccine in the spirit of society.
Another major challenge and issue that Yazd province is grappling with is the influx of immigrants and non-natives (especially from the south of the country). Due to the fact that Yazd province has committed, compassionate and experienced doctors, many people in other cities tend to receive services from Yazd hospitals and doctors. It is also necessary to mention that Yazd province has international expertise in many fields and has become the center of medical tourism in the country. Yazd province is a tourist-friendly province and it is obvious that tourists lead to the spread of more and more diseases in Yazd city. However, preventing them from entering the city of Yazd also causes many problems. Preventing patients and tourists from entering the charter calls into question patient rights and prevents better and more patient access. Therefore, it is necessary for senior managers and policy makers of the health system to use useful monitoring mechanisms to prevent the spread of flu and conflict in Yazd despite the entry of patients from other cities to Yazd province and the lack of economic damage to public hospitals. One of the measures that can be done is screening patients before entering Yazd province.
Other major challenges include poor documentation and experience recording, as
well as a lack of evidence-based knowledge management structure
(18). With a knowledge management database, remote treatment staff will be able to operate (protect themselves from illness) and thereby experience a great patient care experience (19). A physician can also share and disseminate new knowledge gained while working in the field. The physician can also access the decision-making process and the scenarios drawn, so that he or she is aware of the type of actions and how to deal with specific cases when they occur. The World Health Organization maintains up-to-date knowledge and shares key findings among governments, health organizations, and the public as well as awareness of symptoms, treatment, and measures to prevent further outbreaks. Despite the ability to share digital knowledge, the general public, as well as health care professionals and government agencies, can obtain the information they need through these databases and, after analysis and review, take the necessary steps. Sharing knowledge about the flu focuses on prevention; Today's world is in dire need of better knowledge management, as a tool to create an alert and response system for the spread of diseases such as the flu. Knowledge management saves lives with the ability to share the most accurate and up-to-date global knowledge about health information (3).

Lack of standard isolated isolation rooms and lack of proper ventilation systems are among the most important challenges and problems of the support department of hospitals in Yazd province (20, 21). It seems that these issues should be carefully considered and followed at the beginning of the construction of a hospital. If all the necessary standards are observed at the beginning of the construction of a hospital, further problems will be avoided and additional costs will not be borne by the hospitals. The Ministry of Health, Treatment and Medical Education, as the main trustee of public health, should issue strict and standard instructions to build highly efficient respiratory isolation rooms and ventilation systems, and to allocate suitable spaces in hospitals for this purpose (22).
It seems that paying attention to the hospital field (health), macro field (university, provincial and national), community level and the field of communication instructions and implementation of the proposed solutions can significantly reduce the challenges and problems. And control and manage the flu well and reduce the damage and subsequent problems.
One of the important operational limitations of the present study was the prevalence of Covid-19 disease. Due to the conflict between hospitals and senior managers, there was a delay in conducting the present study and conducting interviews. Also, due to the acute conditions of the hospitals, a number of interviews were conducted in absentia (telephone and cyberspace). Lack of similar previous studies is another limitation in the discussion of the present study.
Conclusion
Based on the challenges and problems categorized in the present study, as well as the classification of the most important strategies and suggestions, useful measures can be taken to   the control and management of influenza, both at the hospital   and in the community level.
It should be noted that the basic principle and important point is to pay attention to healthcare education, providing guidelines for prevention and treatment. All relevant university, provincial and national institutions should pay special attention to health and prevention in order to reduce the huge costs in the field of treatment and thus not to impose a heavy financial burden on patients. Paying attention to the field of hospital (health), macro (university, provincial and national), community level and the field of communication instructions and implementation of the proposed solutions can significantly reduce the challenges and problems.
Conflicts of interest
All authors declare to have no conflict of interest.
Author contribution
The authors all were involved in the whole article but specifically, S.B. Was involved with interviewing and Discussion part, F.M., and M.S. were involved with coding and theme analysis and writing the Results section. M.S.Y. was involved with literature review, references, and writing the introduction part of the article.
Acknowledgment
We would like to thank all our participants who kindly gave their worthy time even though they were under great pressure. Also, this research was approved as a research project with code 7108 by the Research Council of Shahid Sadoughi University of Medical Sciences, Yazd.

 
Review: Research | Subject: Health care management
Received: 2022/03/4 | Accepted: 2022/06/20 | Published: 2022/07/5

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