Table 2 Challenges of the county health care network
Theme | Sub-themes | Frequency |
|---|---|---|
Complexity | Administrative and financial duplication in the network headquarters, health center and hospital | 16 |
Multiplicity and excessive expansion of organizational levels and scope of vertical and horizontal monitoring (lack of agility) | 19 | |
High distribution of network subsidiaries geographically | 17 | |
Extensive scope of monitoring | 18 | |
Late understanding of health and hospitals problems by network | 10 | |
Multiplicity and diversity in clients and customers | 12 | |
Lack of coordination and interference in the duties of subordinate units (weakness in coordination) | 20 | |
Multiplicity of programs, processes, increased responsibilities and high volume of activities | 20 | |
Complexity and difference in the nature of services and types of activities (health, treatment, food and medicine, pre-hospital, etc.) | 16 | |
Incongruity between manpower and duties (health, treatment, food and medicine, pre-hospital, etc.) | 11 | |
Multiplicity in responsible and accountable centers (multiple levels of management) (network manager, head of health center, treatment deputy, head of hospital and head of medical emergencies) | 12 | |
Conflict of interest in network policies and conflict between different departments (network headquarters, health and treatment) /lack of integration and internal cohesion | 14 | |
High dynamics in the field of health and the need for a fast response to challenges and problems | 14 | |
Formalization | Uncertainty in the scope of authority and responsibility in practice | 19 |
Excessive administrative bureaucracy | 20 | |
Ignoring guidelines, rules and regulations | 18 | |
lack of belief in the administrative structure and hierarchy | 17 | |
Dismissal and appointment of managers based on individual decisions | 11 | |
person-centered management | 17 | |
Lack of clear organization and structure for deputies (except for health) | 18 | |
Lack of transparency in the division of managerial duties among the network system components | 15 | |
Weaknesses and defect in the control and monitoring system | 19 | |
lack of paying attention to the organizational structure in practice, lack of observing the hierarchy and reducing the scope of responsibility and accountability of operational managers | 19 | |
improper division of work | 12 | |
Changes in service packages and job descriptions | 18 | |
Centralization | Focus of power (financial and administrative and decision-making powers) in the network manager and headquarters | 18 |
Inadequate authority of managers in hospitals and health centers | 19 | |
Relocation of resources (financial, manpower, equipment) by the manager and the network headquarters in different departments (network headquarters, hospital, health center and emergency) | 19 | |
High level of responsibility and high work pressure on the network manager in the county | 18 | |
inefficiency in making decisions due to structural barriers | 14 | |
Lack of application of communication and information system at decision-making levels | 17 | |
Weakness in communication (between network headquarters and hospital / between network headquarters and health center and affiliated units) | 18 | |
Environment | Continuous political, economic, social and environmental changes | 10 |
Change in national divisions | 12 | |
Changes in the appearance of death and disease | 9 | |
Epidemiological transition | 10 | |
Nutritional transition | 10 | |
Demographic transition (demographic change) | 12 | |
Not considering the social determinants of health in the structure of the network system | 15 | |
Ignoring the role and position of the private, public, and charity sectors in the organizational structure | 11 | |
Ignoring the role and position of the people (citizen-oriented and responding to needs of the people) | 9 | |
Imposing the duties of other departments on the network system | 5 | |
Lack of proper organization in coping with environmental threats | 11 | |
Culture | The effect of organizational culture on the structure of network system | 14 |
Ignoring local (regional) culture in the structure of network system | 14 | |
Increasing and changing people expectations | 18 | |
Increasing and changing expectations of employees | 12 | |
non-importance of competence and seniority in organizational promotion and managerial positions | 13 | |
Instability of management in the network, hospital and health center | 16 | |
Resources | Inconsistency between resources and the structure of the network | 16 |
Lack of financial resources and funds to achieve objectives | 15 | |
Lack of manpower | 15 | |
Lack of equipment | 15 | |
Inconsistency between line and headquarters staff | 13 | |
Lack of necessary consistency in the composition and distribution of organizational positions of units | 14 | |
Unfair distribution of resources | 16 |