To determine the future changes affecting the hospitals, 33 people were interviewed in the first phase. The characteristics of the participants in this phase are presented in table number one (table 1).
Table 1. Characteristics of participants in phase one
Organization
|
Role/task
|
Number
|
Ministry of Health and Medical Education
(MOHME)
|
Specialists of Research and Technology Vice-Chancellor
Specialists of the Vice-Chancellor of Education
Specialists of the Vice-Chancellor of Treatment
Specialists of the Deputy Food and Drug Administration
Specialists of the vice president of development and management and planning
|
7
|
health insurance
(HI)
|
Specialists of the Social Security Health Insurance Organization
Specialists of Iran Health Insurance Organization
|
5
|
Health care Provider
HP
|
General practitioner
specialist
Nurse
|
5
|
Hospital Management
HM
|
Hospital managers
Hospital supervisors
Officials of quality improvement units
|
7
|
Researchers and faculty members
RFM
|
Researchers in the field of health economics, health service management, health technology assessment, and futures studies in health
|
9
|
By content analyzing the interviews in phase one, 144 elements of change were identified. Some of them are mentioned as follows.
Participants stated that hospitals would become smaller but more specialized in the future. "...hospitals will only focus on patients for whom the other health system providers will not have the necessary facilities and expertise, and patients with complex conditions will be referred to them from other levels, and simpler cases will also be at other levels. To be treated..." (MoH).
Hospitals will have an active, patient-oriented, and user-friendly social role." Providing services will not be limited to hospitals. Hospital teams in the community will actively promote the lifestyle and treatment of patients in their homes..” (HP). "Due to factors such as the growth of technology and information; The quality and safety of services will increase, the preferences of patients will be taken into account in the design of spaces, processes, and services of hospitals..." (HM).
There will be an increase in the patient’s and health force’s mobility. "Due to megatrends such as globalization or trends of increasing immigration and urbanization, we will see patients and health workers with different cultures from different cities and countries every day..." (RFM).
A change in the characteristics of the health workforce will occur. "With the arrival of the millennial generation, we will see rapid and large changes in the expectations of employees from work environments. The retirement age will increase to compensate for the lack of workforce and skills" ( MoH).
National and international cooperation and interactions of hospitals with each other and related stakeholders will increase. "...health tourism will flourish..., national and international standards and institutions supervising the activities of hospitals will increase, and hospitals will form a network with each other and use each other's resources and experiences" (RFM). "As the role of hospitals in improving the health of communities increases, they will need to cooperate with different stakeholders because they can not achieve this goal lonely" (HM).
Changes in developed countries will happen faster than in developing countries. Also, the rate of change has increased compared to the past." In my opinion, due to trends such as globalization and international communication, several changes are common between developed and developing countries, such as technologies; the only difference is that usually, These changes in those [developed] countries have either already happened or their speed and intensity are more significant than in developing countries..., another point that comes to my mind is the speed of changes. We constantly change in the workforce. Or we had the expectations of the patients, but the only thing that has happened now is that due to the growth of technologies such as the media and the Internet, their speed has now increased..." (RFM). Another point that can be extracted from this interview is that some changes will facilitate and accelerate other changes. For example, developing health monitoring technologies will enable the development of home care services for patients.
In the future, we will see changes in the composition and pattern of diseases. "Clearly, due to the increase in life expectancy and the population aging, it can be predicted that the burden of chronic diseases will increase, even in my opinion, the state of multiple diseases and physical and mental diseases will increase together..." (RFM). "Climate changes, drought or global warming and even water and food insecurity that we are witnessing now, can potentially change the patterns of chronic and infectious diseases" (RFM). "The experience of Covid-19 also showed that the threats of emerging and re-emerging infectious diseases can always exist, so future hospitals should not neglect these issues" (MoH).
Environmental scanning units will be activated in future hospitals. "Hospital administrators will be aware of the importance of political, social, and economic changes in the hospital environment and will monitor them. In my opinion, future hospitals will establish active environmental monitoring units" (HM).
The role of the private sector and attention to financial efficiency will increase due to the lack of resources and the increase in technological costs. "Hospitals will increase partnerships with private sectors and non-governmental organizations to attract more resources..., strategic purchasing will be done more carefully" (HI).
The growth of technology will move forward faster and affect all sectors of the healthcare system. "In my opinion, using cryptocurrencies and technologies such as blockchain will increase hospitals' financial and information transfers. It would help if you considered that with the growth of big data and the increase in its use, blockchain could be used to maintain this information in the health system" (HI).
"In the past years, we consider a significant growth in health technologies, wearable health sensors that help patients control health parameters are one of them. I hope hospital information systems will use this information in the future" (HP). "The development of information analysis methods such as cloud computing can greatly help health systems analyze big data" (RFM).
A change in norms will happen. "Associations supporting patients' rights will become more and more active. Due to the growth of social networks, patients will be able to form a network with each other and express their expectations loudly" (RFM). The problems of life and the rush and stress that people have now will cause them mental issues; in my opinion, attention to spiritual health will also increase (HP).
In the second phase, 12 experts were selected among the participants of the first phase. Table two shows the participants' characteristics in the panel of experts (table number 2).
Table 2. Details of participants in the expert panel
Organization
|
Role/Tas
|
Number
|
Ministry of Health and Medical Education(MOHME)
|
Vice President of Development and Management and Planning
|
1
|
health insurance
(HI)
|
expert of Iran Health Insurance Organization
|
2
|
Health care Provider
HP
|
General practitioner
|
1
|
Hospital Management
HM
|
Hospital managers
|
2
|
Researchers and faculty members
RFM
|
Health services management, health economics, health technology assessment, and futures studies in health
|
7
|
To prepare the mind map framework, the experts categorized the future changes into ten main categories as follows:
- Structure and role
- Management of knowledge and research
- Service delivery
- Health forces
- Political and legal issues
- Economic
- Population and disease
- Technological issues
- Values and Philosophy
- Environmental issues
And in the next step, the concepts' cognitive map was drawn with experts' participation and insights (Figure 1).