There has been too much of a one-way flow drift down a river of evidence. Researchers from rich countries have produced the primary evidence which they proceed to summarise within reviews. These summaries have directed care worldwide. However, things are changing and the river of evidence can flow in the other direction. The care of women with eclampsia has been changed or refined throughout the world because of a large low and middle income country trial. The global care of people with heart disease has been greatly modified by studies originating in China. The care of people who are acutely aggressive because of psychosis has to be reconsidered in the light of the evidence coming from Brazil and India. Healthcare is an issue everywhere and evaluation of care is not the premise of any one culture—the evidence—river must run both ways

This paper aims to provide a description of the need for Culturally and Linguistically Appropriate Services (CLAS) for Limited English Proficient (LEP) patients, an identification of how the lack of CLAS for LEP patients can compromise patient safety and healthcare quality, and discuss barriers to the provision of CLAS.

Background A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model. Methods The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement. Results The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation. Conclusion A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence.

Reduction in maternal mortality requires an in-depth knowledge of the causes of death. This study was conducted to explore the circumstances and events leading to maternal mortality through a holistic approach. Using narrative text analysis, all documents related to maternal deaths occurred from 2007 to 2011 in Kerman province/Iran were reviewed thoroughly by an expert panel. A 93-item chart abstraction instrument was developed according to the expert panel and literature. The instrument consisted of demographic and pregnancy related variables, underlying and contributing causes of death, and type of delays regarding public health aspects, medical and system performance issues. A total of 64 maternal deaths were examined. One third of deaths occurred in women less than 18 or higher than 35 years. Nearly 95% of them lived in a low or mid socioeconomic status. In half of the cases, inappropriate or nonuse of contraceptives was seen. Delay in the provision of any adequate treatment after arrival at the health facility was seen in 59% of cases. The most common medical causes of death were preeclampsia/eclampsia (15.6%), postpartum hemorrhage (12.5%) and deep phlebothrombosis (10.9%), respectively. Negligence was accounted for 95% of maternal deaths. To overcome the root causes of maternal death, more emphasis should be devoted to system failures and patient safety rather than the underlying causes of death and medical issues solely.

Background Today, despite the efforts of the medical community and healthcare staff along with the advancements in medical technology, patients’ dissatisfaction and complaints have been increased. The present study aimed at making a survey on the patients’ complaints in a large training hospital affiliated to Mashhad University of Medical Sciences (MUMS). Methods This descriptive, cross-sectional study was conducted on written and verbal complaints of patients and their relatives in a tertiary (specialty and sub-specialty) training hospital. All the recorded patients’ complaints, from March to December 2012, were reviewed. Data were categorized and analyzed using descriptive statistics by Microsoft Excel 2007. Results A total of 233 complaints were reviewed, of which 46.35%, 31.34% and 22.31%, respectively, were verbal, written and made on the phone. The main reasons for complaints were accessibility to medical staff (21.46%), communication failures (20.17%) and dissatisfaction with the provided care (14.59%). Thirty one (13.31%) cases were solved at first place, 194 (83.26%) referred to the complaints from the committee and 3.43% referred to the legal authorities. The average response time was about six to seven days. Conclusion The findings of the study suggest that sufficient availability of medical staff, improvement in communication skills and paying attention to the patients’ needs and expectations may reduce complaints from public health facilities.

Background Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. Methods This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. Results The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. Conclusion 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 Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran’s southern provinces. Methods All deaths (29916) which happened during 2004–2011 in Bushehr province were assessed. Nolte and McKee’s avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age-standardized death rate. Results Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. Conclusion Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas.

Background Avoidable mortality as an indicator for assessing the health system performance has caught the attention of researchers for a long time. In this study we aimed to compare the health system performance using this indicator in rural and urban areas of one of Iran’s southern provinces. Methods All deaths (29916) which happened during 2004–2011 in Bushehr province were assessed. Nolte and McKee’s avoidable deaths model was used to distinguish avoidable and unavoidable conditions. Accordingly, all deaths were classified into four categories including three avoidable death categories and one unavoidable death category. STATA software was used to conduct Poisson Regression Test and age-standardized death rate. Results Findings showed that avoidable mortality rates declined in both urban and rural areas at 3.33% per year, but decline rates were influenced by Ischemic Heart Disease (IHD) and preventable death categories to treatable death category. Annual decline rate for IHD category in rural and urban areas was nearly the same as 8%, but in preventable death category, rural areas experienced more decreases than urban ones (7% vs 5% respectively). However, decline rate in treatable mortality neither in urban and nor in rural areas was statistically significant. Conclusion Despite the annual decline in the rate of avoidable deaths, policy making initiatives especially screening and inter-sectoral measures targeting cause of deaths such as colon and breast cancers, hypertension, lung cancer and traffic accidents, can still further decrease avoidable deaths in both areas.

Background Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. Methods We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. Results According to the findings of this research, fiscal decentralization in the health sector had a negative impact on U5M. On the other hand, fiscal decentralization in provincial revenues had a positive impact on U5M. In addition, U5M had a negative association with the density of physicians, hospital beds, and provincial GDP per capita, but a positive relationship with Gini coefficient and unemployment. Conclusion The findings of our study indicated that fiscal decentralization should be emphasized in the health sector. The results suggest the need for caution in the implementation of fiscal decentralization in provincial revenues.

Background Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities.

The instrumental use of social networks has become a central tenet of international health policy and advocacy since the Millennium project. In asking, ‘How to facilitate social contagion?’, Karl Blanchet of the London School of Hygiene and Tropical Medicine therefore reflects not only on the recent success, but also hints to growing challenges; the tactics of partnerships, alliances and platforms no longer seem to be delivering at the same rate and maybe reversing. A better understanding of how social networks work may therefore be needed to strengthen a tactical instrument that has been used to remarkable recent effect. But in focusing on the unbounded rhetoric and narrative options of Global Health, the danger will surely be on missing the fundamental factors constraining network growth. Future growth will depend on understanding these constraints, and Global Health may do well to think of social networks not only instrumentally, but also analytically in terms of the strategic contexts and environments in which such instruments are deployed.

The recent report by Barnhill and King about obesity prevention policy raises important issues for discussion and analysis. In response, this article raises four points for further consideration. First, a distinction between equality and justice needs to be made and consistently maintained. Second, different theories of justice highlight one additional important source of disagreement about the ethical propriety of the proposed obesity prevention policies. Third, another point of contention arises with respect to different understandings of the principle of respect for autonomy due to its often-mistaken equation with simple, unfettered freedom. Finally, based on a more robust definition of autonomy, the key issues in obesity prevention policies can be suitably re-framed in terms of whether they advance just social conditions that enable people to realize human capabilities to the fullest extent possible.

In this commentary, we argue that financial incentives are only one of many key components that employers should consider when designing and implementing a workplace wellness program. Strategies such as social encouragement and providing token rewards may also be effective in improving awareness and engagement. Should employers choose to utilize financial incentives, they should tailor them to the goals for the program as well as the targeted behaviors and health outcomes.

I would like to thank Sridhar Ventakapuram, Daniel Goldberg, and Lachlan Forrow for thoughtful responses to my article (1–4). All endorse my main point, that conditioning the very aid that patients need in order to become healthier on their success in becoming healthier is (usually) wrong. They may think me, however, too friendly to an approach that gives patients “carrots” or “sticks” depending on how healthy their choices are. Ventakapuram writes, “What comes out of the article most clearly is that Eyal is fine with the carrots and sticks approach to health policy, he just wants to help clarify what should and should not be the carrots and sticks”.

Food taxes increase prices of food or food ingredients in order to stimulate consumers to change their eating behaviour and finally to level up population health. Their aim is to tackle the high rates of obesity and other lifestyle diseases. As Bonnet argues, often food taxes are set up out of an economic perspective (1). To change consumer behaviour is one thing, to level up people’s health is a complex matter. Evidently, to evaluate the most accurate measures, governments require rigorous consideration (2). People have to go along a process, through different stages and challenges (3–6).