In under two years, all general managers in hospitals in Iran have been trained in management and leadership skills and are improving quality of care as a result.
Access to quality health services is at the heart of achieving UHC, and improving hospital performance is an important entry point.
Patients experience improved quality of health care, hospitals are more efficient, and patients have greater satsifaction with services.
The Ministry of Health and Medical Education worked closely with WHO to deliver the nationwide training. Iran's experience has been so successful that the programme is now being replicated in Iraq and Afghanistan.
Following the training programme, we have greater focus on hospital productivity and quality improvement, illustrated by several projects that hospital managers have implemented themselves as a result of having participated in the programme.
The training programme significantly improved my knowledge and skills and changed my attitude to be more confident and proactive. I’m better equipped to lead other management team members and challenge ‘business as usual’ so that we can improve performance.
The training programme has increased my capacity to use data to support dialogue with physicians. I have learned to introduce indicators in several departments which facilitates the solving of problems.
By implementing this programme, we witnessed improvements in the quality of services, increased efficiency of public hospitals in the field of financial and human resources, and satisfaction of people and service providers.
Progress to date is exciting. In less than two years, all general managers in hospitals in Iran have been trained in management and leadership skills. As a result, the quality of care in hospitals is already improving. The tailored course entailed 28 days of training in 7 modules over a period of 8 months.
The experience in Iran has been so successful that the programme is being replicated in Iraq and Afghanistan, with 25 trainers from each country initially participating. Modules are now being contextualized for each nation. There are also plans to extend this to Oman and Jordan in 2019.
In Iran, the combination of clear national vision and commitment from the MOHME and a strong supporting role from WHO is now transforming practice in public hospitals.
"The training programme was created as a national programme with strong commitment from the MOHME and dedicated resources, building on national policies with a focus on supporting and implementing national priorities,” said Dr Hossein Salarianzadeh, Management Development and Administrative Revolution Center, MOHME.
WHO is collaborating widely with the Ministry of Health and Medical Education of the Islamic Republic of Iran towards achieving UHC as a common objective. In this endeavor improving quality of care and performance of hospitals is one of the critical areas in which WHO as the leading international partner on health and wellbeing is involved.
"Capacity building of public sector hospital on management and leadership will ultimately strengthen the quality of health care services for all Iranians across the country,” said Shadrokh Sirous, National Professional officer, WHO Country Office Iran.
Tailored training leads to results
The MOHME has been working closely with WHO to deliver this nationwide training for all hospital managers. A range of national and international experts developed the programme over time, and it was then tailored to the Iranian context based on feedback from hospital managers themselves. The approach emphasized peer learning and the sharing of experiences so that modules were entirely appropriate for the context.
How did the work evolve?
In 2015, WHO EMRO conducted a regional training programme on hospital management. It included modules on the role of hospitals in the health system, leadership, strategic thinking and governance, financial management, human resource management, quality improvement, hospital information management, supply chain management and emergency and disaster management.
Five Iranian colleagues took part and were keen to establish something similar in Iran. The MOHME got involved to drive the process and decided to adapt it to the unique context of Iran. The effort in Iran started with a comprehensive situation analysis of the hospital sector to assess the required competencies and training needs
A two-day consultation was held with national and international experts from the MOHME and WHO staff from all three levels: HQ, regional and country office.
International facilitators and national trainers collaborated to develop the core content of the modules and 100 national trainers (academics and hospital managers) were carefully selected to attend a Training of Trainers programme.
Adapting to Iran's context
The training modules were then adapted to fit the Iranian context by a national team, and each module required about ten trainers for nationwide coverage.
A pilot phase initially trained 30 hospital managers and then training was rolled out to all hospital managers in Iran. In total, about 700 hospital managers were trained through 2 rounds of training in 10 hubs across the country.
"It was a structured process to develop the training programne, with contributions from international experts yet customized to national needs,” said Dr Eric de Roodenbeke, international course facilitator, International Hospital Federation
"We gained a new perspective from the international trainers and an understanding of adult learning echnique through ‘learning by doing’ and continued to adapt modules based on feedback from participants,” said Dr Mehdi Jafari, Head of National Health Managers Development Institute (HMDI) and national trainer.
"One of the main objectives of the course is to empower managers to manage all resources properly. The course is important in relation to the professional competence of managers, in their selection and appointment,” said Dr. Seyed Ali Sadro Sadat, ex-Deputy of management and resources development-MOHME
A team of trainers including academics and hospital staff was essential to establish a mix of theoretical and practical points of view. As the training emphasized peer learning and adaptation to the local context, there was a strong sense of ownership over the process.
Involving all key stakeholders allowed them to share their experiences and understanding, and have a precise knowledge of what this programme should look like. This really helped with the speed of the process. The nature of the programme also allowed hospital managers to network and share their experiences
"The training programme helped to establish a ‘direct channel’ between the hospital managers and the MOHME that was lauded by hospital managers and facilitated better coordination, integration, group formation and guidance,” said Dr Ali Maher, Ex Technical and Planning deputy of curative affairs, MOHME.
Thanks to the strong administrative and logistics support provided by the MOHME, the roll-out of the training programme nationwide went very smoothly. Strong collaboration between WHO’s three levels also supported the process effectively.
"While the County Office and Regional Office very closely supported the MOH at all stages, HQ provided more punctual support and helped align with international perspectives on hospitals of the future, within the Framework of Integrated and People Centered Health Services (IPCHS) that was approved by WHA in 2016,” said Dr Ann-Lise Guisset, WHO HQ Services Organization and Clinical Interventions unit.
Looking to the future
"By implementing this programme, we witnessed improvements in the quality of services, increased efficiency of public hospitals in the field of financial and human resources, and satisfaction of people and service providers,” said Dr Mohammad Aghajani, Chancellor of Shahid Beheshti University of medical sciences and ex- Deputy of Curative Affairs-MOHME.
This success had an impact. Shortly after the course took place, MOHME established the Health Managers Development Institute - a national centre of excellence in health management - to train all managers in the health sector. Currently, it is working to train all hospital directors using the same methodology of training of trainers and roll-out nationwide.
The MOHME is also aware that it needs to ensure the skills gained through the training programme are sustained and reinforced. By establishing communities of practice and peer groups and facilitating the creation of a professional association for hospital managers, much can be achieved
"The training of hospital managers, using an adult learning approach, is a step forward in the professionalization of hospital management,” said Dr Hamid Ravaghi, Regional Advisor, Hospital are and Management Unit, WHO EMRO.