Introduction

Manpower is the main asset of any organization demonstrating continuation of life. In fact, the productivity and efficiency of any organization depend on the organizational behavior and manpower performance in that organization, so it would be possible to take steps to achieve the goals of that organization (1).   Motivated manpower is the most important factor in productivity, and employees’ motivation is also enhanced by increased levels of employee’s morale and job satisfaction (2).  In Iran, over the past 4 decades, medical education has undergone many transformations, one of the most important of which is the integration of medical education into healthcare service in 1985 (3). In addition, one of the recent changes in this area is the implementation of the health system transformation plan in early 2014. The project was implemented in the following seven service packages: reducing payment of patients’ being hospitalized, supporting physicians staying at deprived areas, attendance of specialist physicians in public hospitals over 64 beds, improving the quality of hoteling in public hospitals, improving the quality of business services of visiting in public hospitals, normal delivery promotion program, and financial protection program (4).  Studies have indicated that the health system transformation plan has succeeded in achieving its primary and most important goal which is reducing the level of payments from the patients’ pockets (4). However, some other studies have shown that health care personnel do not have satisfaction with the implementation of the health system reform plan in Iran (5). Providing high-quality and effective educational and services in the health area has always been the most important aspect of every country and is always taken into consideration in macro planning. The most important guarantee for the success of the health system transformation plan is to pay attention to health service providers, including physicians and faculty members. Investigating their satisfaction can help designers and executives to better understand its strengths and weaknesses, so they can seek to improve it. Therefore, this study was conducted to evaluate the satisfaction of clinical faculty members of Ahvaz Jundishapur University of Medical Sciences with the implementation of the health system reform plan in the academic year of 2018-2019.

Methods

Ahvaz Jundishapur University of Medical Sciences in southwestern Iran is one of the type 1 universities of the Ministry of Health and Medical Education having 660 faculty members at the present time (formal, contracted, committed, and conscripted). Almost half of faculty members are working at medical school in the university, two-thirds of them are working at clinical school, and one-third of them are faculty members. The present study was a descriptive cross-sectional study conducted in the academic year of 2018-2019. The research population included all clinical faculty members working at Ahvaz Jundishapur University of Medical Sciences. A total of clinical faculty members working in all teaching hospitals of Ahvaz Jundishapur University of Medical Sciences with at least one year of employment history. The Specialty level of education and assistant professor degree were selected randomly. After stating the objectives of the research and taking their oral consent to the samples studied, they were ensured that the obtained information would be protected and that individuals could be excluded at any time if they did not wish to cooperate. The inclusion criteria were the clinical faculty members willing to participate in the research and having passed at least one year of their work. Withdrawing from the study and being a clinical faculty member under one year of work experience were considered the exclusion criteria. Questionnaires were distributed among clinical faculty members in 5 teaching hospitals of the university in their different shifts in workplace. Finally, 90 completed questionnaires were collected among all the questionnaires distributed after excluding incomplete questionnaires. Data collection tools including a demographic questionnaire and a researcher-made questionnaire were prepared based on previous studies and interviews through Delphi method with 16 of clinical faculty members who had the highest involvement in the health system reform plan (by convenience judgmental Sampling method). Individuals' personal information (according to Table 1) included age, gender, educational level, type of employment, employment history, academic rank and place of employment, and type of service (full-time or geographically full time). The researcher-made questionnaire included 13 major questions about the most frequently considered items by clinical faculty members. The questionnaire consisted of 13 four-option questions (strongly disagree = 0, disagree = 1, somewhat = 2, agree = 3, and strongly agree = 4), scored on a 5-point Likert scale.  The minimum score was zero and the maximum score was 4 and higher scores indicated higher satisfaction of faculty members with the health system reform plan. The face and content validity of the questionnaire was assessed and approved by experts and its reliability was assessed and confirmed by Cronbach alpha coefficient of 81%.  In order to observe the ethical principles, unanimous questionnaires samples were provided for faculty members and the confidentiality of the information was ensured them and the questionnaires were collected after their completion. Descriptive statistics (mean, standard deviation, and percentage) and inferential statistics were used for data analysis in SPSS 22 software.

Results

As shown in Table 1, a total of 90 respondents were included in the study. According to the table, 72 (80%) were male and 18 (20%) were female. Other demographic characteristics of the samples are summarized in this table.

Table 1. Individual characteristics of research sample

As shown in Table 2, 0% of clinical faculty members of Ahvaz Jundishapur University of Medical Sciences agree (strongly agree and agree) and 73.3% disagree (disagree and strongly disagree) with the health system reform plan. The mean score of general satisfaction of clinical faculty members of Ahvaz Jundishapur University of Medical Sciences was 56% (0.56 2.17). The highest satisfaction was related to work hours and work shifts after implementation of health system reform plan (16.7%) compared to the past, and the highest dissatisfaction was related to the way of payment of salaries and benefits (93.4%).

Table 2. Evaluation of clinical faculty members' satisfaction with health system reform plan

As shown in Table 3, variables of age (P = 0.019) and employment type (P = 0.027) of clinical faculty members had a significant effect on their satisfaction with the implementation of the health system reform plan. However, the effect of gender, educational status, employment history, academic rank, hospital of work place and having or not having a personal clinic (full time or geographically full time) for clinical faculty members had no impact on their satisfaction with the implementation of the health system reform plan and it was not significant (P >0.05).

Table 3. Evaluation of the effect of demographic variables of clinical faculty members on their satisfaction with implementation of health system reform plan

 Discussion

Our research is valuable because until now there were not many studies concerning the evaluation of the clinical faculty members’ satisfaction with the implementation of the health system reform plan in Iran. This study was conducted at one of Iran's largest medical universities. Based on the results of this study, the satisfaction of clinical faculty members with the implementation of the health system reform plan in Ahvaz Jundishapur University of Medical Sciences was at a relatively undesirable level. The highest dissatisfaction was related to the way of payment of salaries and benefits, while the highest satisfaction was related to work hours and work shifts after implementation of the health system reform plan compared to the past. In addition, variables of age and type of employment of clinical faculty members had a significant effect on their satisfaction with the implementation of the health system reform plan. However, the effect of other variables was not significant. Studies have shown that Iran's medical education system and health services need to be reformed (5, 6). The Health Reform Program began in Turkey in 2002, and it started in Thailand in 2003; however, it started as the Iranian Transformation Plan in Iran in 2014. In these three countries, service recipients were satisfied; however, the providers of health services were less satisfied (7, 8). Based on the results of this study, the satisfaction of clinical faculty members with the implementation of the health system reform plan in Ahvaz Jundishapur University of Medical Sciences was at a relatively undesirable level. Their highest dissatisfaction was related to the way of their payment and benefits after implementing the health system reform plan. A study conducted by Heydarzadeh et al at Rafsanjan University of Medical Sciences in the center of Iran also showed that most physicians were dissatisfied with the implementation of the health system reform plan and the highest dissatisfaction was related to the way of payment of salaries and benefits (9). The study conducted by Gholami et al also showed that the highest dissatisfaction in the staff of teaching hospitals of Qazvin University of Medical Sciences in Iran was the way of payment of salaries and benefits after the implementation of the health system reform plan (2). Moreover, Bastani et al showed that only 56 percent of physicians in a teaching hospital in Shiraz University of Medical Sciences in the center of Iran were satisfied with the health system reform plan (10). Their results are in line with those of our study.  Numerous similar studies have also been conducted among nurses indicating their dissatisfaction with the implementation of this plan (11-14). Shariati et al conducted a study to evaluate nurses' satisfaction with the implementation of health system transformation plan in teaching hospitals of Ahvaz in southwestern Iran.  The results of this study showed that 83.1% were dissatisfied, 16.4% had moderate satisfaction and 0.5% was completely satisfied.  In this study, most nurses were dissatisfied with the implementation of the health system reform plan (11). Bahman Ziyari et al also conducted a study to evaluate the level of nurses' satisfaction with the implementation of the health system transformation plan in Shiraz teaching hospitals in the center of Iran. The research conducted by Ghorbani Nia et al also showed that many nurses in Pasteur Hospital in Bam city in 2015 were not satisfied with the implementation of the health system reform plan (13). The study conducted by Nakhee et al also showed that many nurses working in hospitals affiliated with Birjand University of Medical Sciences in northeastern Iran were not satisfied with the implementation of this plan (14). In a review study conducted by Gilavand in 2017, it was found that most nurses working in Iran's medical universities were dissatisfied with the implementation of this plan (5). This study also showed that the age of clinical faculty members had a significant effect on their satisfaction with health plan implementation. The results of the research conducted by Nakhee also showed that satisfaction of the nurses aged over 40 years was more than that of other age groups (14). Moreover, in the study conducted by Bastani, there was a significant and inverse correlation between age and their satisfaction with health plan implementation (10).

Despite its advantages, the health system reform plan has some disadvantages leading to dissatisfaction of interest groups, so it needs periodic monitoring and evaluation. Uncertainty in level of health services on one hand and the limited resources of this area, on the other hand, have always created challenges and disruptions in the Iranian health care system. These challenges have led to physicians' dissatisfaction. They need to cope with the large volume of clients and tolerate delays in payment of their wages. Therefore, in the financial dimension, increasing the dissatisfaction of medical staff following the injustice of payments and the lack of sustainable resources to continue the project can be considered as the main challenges of this plan. Hence, given the importance of continuing the health system reform plan and the necessity of reviewing its executive processes with the pathological approach and developing effective interventions to reform the implementation strategies and executive plans, strategic counseling of health system transformation plan has been determined by Minister of Health and Medical Education in 2017 to resolve some design challenges. However, it is necessary to pay more attention to the dimensions in which there is the highest dissatisfaction in future planning which aims to periodically monitor this plan and resolve potential problems.

The limitation of the present study is this study was conducted only at one of Iran's largest medical universities and authors are not sure to extend the results of this study to all medical universities in Iran.

Ethical considerations 

Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.

Acknowledgment

The researchers appreciate all the clinical faculty members of Ahvaz Jundishapur University of Medical Sciences for their cooperation in this research.

Financial Support

This research was derived from the research project approved by Deputy of Research and Technology of Ahvaz Jundishapur University of Medical Sciences with number SDH-9706 and Ethics Code of IR.AJUMS.REC.1397.370.

Conflicts of interest

The authors declare that they have no competing interests.