Qom University of Medical Sciences Journal

There are many definitions for bureaucracy;however, there is a consensus on the definitions related to the structural features such as organizational hierarchy, clear division of work, concentration of power, authority, and regulations governing individuals. Bureaucracy is the most effective form of organization that can be used for the public sector which has been given positive and negative attributes. Bureauphobia is the fear of bureaucracy that is unrealistic and exaggerated. In this attitude, the clients are satisfied with the services received, but they do not trust the service provider. Bureauphobia in the public sector questions the direct effect of the desired services on the clients’ trust and presents a new topic. Citizens’ perceptions of the government’s performance are very different from the evaluations made by experts. Some experts such as Frederickson, Goodsell and Berman identified a negative attitude towards government employees that is not necessarily related to the performance of the public sector. They pointed to observing behaviors among citizens who had negative evaluations of the government in providing services. Recently, similar phenomena have been observed in the US, Japan, Belgium, Spain and Norway. It is a negative image of government employees, which continue even after experiencing and positively encountering them, which is called Bureauphobia.
In Iran, the administrative and bureaucratic system has always been criticized. Some critiques have been from top officials and managers of the country and some from the public. In recent years, with the increase in diseases, hospital costs, hospital equipment and facilities, and expectations of patients, decision makers and managers in the health sector have faced new and serious challenges. Patients now expect more than ever from doctors, nurses, medical centers, treatment method, and rights, and show sensitivity in choosing medical services more than before. Improvement in the governmental hospitals can satisfy patients, improve the health of the society, and increase trust in the public sector. Some studies on satisfaction and trust in hospitals in Iran have shown lack of trust but satisfaction with medical services, indicating the existence of bureauphobia in Iranian public hospitals. Therefore, the current study aims to survey the bureauphobia attitude in public hospitals of Qom Province in Iran.

Methods
The study population consists of all people referred to public hospitals in Qom province. These hospitals were Shahid Beheshti Hospital, Amir al-Momenin Hospital, Kamkar Arabnia Hospital, Nekuei Hedayati Forqani Hospital, Shohada Hospital, Izadi Hospital, and Masoumeh Children Hospital. The samples were selected using a convenience sampling method. Considering that the number of patients referred to the hospitals was variable, to ensure the accuracy of the results, the hospitals were considered with an unlimited population; hence, 1000 questionnaires were distributed. A researcher-made questionnaire was used to collected data which had 2 questions: “Are you satisfied with the services provided in public hospitals?” and “Do you trust in public hospitals?”. The demographic characteristics such as age, gender, educational level, citizenship, and employment in the public sector were also included in the questionnaire. The content validity of the questionnaire was confirmed by the opinion of a panel of experts. Cronbach’s alpha coefficient was used to evaluate the reliability (internal consistency) of the questionnaire after distributing them among 30 participants, which was obtained 0.84. Logistic regression analysis was used to investigate demographic factors affecting bureauphobia. In the regression model, bureauphobia was considered as a dependent variable while age, gender, education, citizenship, and employment in the public sector were independent variables.
Results
It was found that 24% of participants had bureauphobia. Age and gender were directly and significantly related to bureauphobia. Employment in the public sector and citizenship had negative significant relationship with bureauphobia. There was no significant relationship between educational level and bureauphobia. The increase of age increased bureauphobia.
Discussion
Bureauphobia was more prevalent among males than females. Public sector employees had lower bureauphobia than the public hospital staff. People from other countries (Afghanistan, Iraq, and Pakistan) referred to public hospitals in Qom had lower bureauphobia than the public hospital staff. This study showed that people with a bureauphobia had a pessimistic view, and satisfaction with the services received from public hospitals in Qom could not lead to trust in them.

Ethical Considerations
Compliance with ethical guidelines
All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions
All authors equally contributed to preparing this article..
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors consider it necessary to appreciate and thank all Managers and staff of Qom University of Medical Sciences who have cooperated in this research.