Hospital

A pilot study: Development of a local model to hospital disaster risk assessment

Ali Ardalan

Background: vulnerable events could damage structural, non structural and functional components of hospitals that might lead to community crisis, accordingly. Risk assessment is the first step to develop of a hospital disaster plan. In this study, a primary phase of developing a local tool for Iran's hospital disaster risk assessment entitled "Hospital Safety Index (HSI)" was conducted by World Health Organization originally.
Materials and Methods: First, the original index was translated into Farsi in five forms and 145 items. Then a group of four experts from the fields of medicine and engineering assessed the items one-by-one for their relevance and applicability. Revised edition tested three times at Shariati hospital in Tehran. An expert panel also evaluated the feature and content validity of the index. They also weighted the items as well.
Results: Test-retest of the index by two independent research groups found 93% of agreement. Furthermore, 244 points were revised or added to the original edition. The most important changes included: Combining instruction parts with related items for increasing educational properties, completing the list of hazards, developing a plan to analysis, and to present a quantitative and graphic of the model and finally to prepare an educational package as well.
Conclusion: Persian version of HSI, in response to needs of Iranian's health system, represents a rapid no-expensive tool for screening disaster risks at hospitals based on an international template that was tested in several countries. Based on this study, the Farsi index would be evaluated in more hospitals around the country. The assessment results will provide Iranian's health system with evidence-based information for more effective allocated resources and interventions evaluating.

Relation of emotional intelligence and Self-Efficacy beliefs of nurses who worked in the emergency department with patients' satisfaction from the treatment process

Iraj Shakerinia

Background: There is a worthy position in a suitable reaction with patients' emotional intelligence, self - efficacy. The nurses who have more emotional intelligence and self-efficacy are able to draw patients and accompanier's, and help to cooperate and abiding the remedy and also will promote their satisfactory of remedy process.

Materials and Methods: In a study with cross- sectional approach to examine the relationship among emotional intelligence, nurse's self-efficacy believes with the patient's satisfactory of remedy process , The researcher chose 45 nurses who work at the private and non-private emergency at Rasht hospitals and gave them the emotional intelligence and self-efficacy questionnaires and asked them to complete them. To measure the patient's satisfactory of remedy process questionnaires. Then they analyzed the data with Pierson correlation and regression analysis.

Conclusion: The findings showed that there is a significant correlation among emotional intelligence and nurses self-efficacy and patients satisfactory (P (001/0>.

A survey in causes and rates of under reimbursement bills imposed on admitted patient's under social security insurance in medical teaching hospitals in Yazd province in 2008

Fatemeh Keshmiri

Background: The hospitals are the most significant providers of health care services. According to more health funds spending by hospitals, economic management in hospitals is necessary. Determining the causes and rates of insurance under reimbursement bills was the objective of this study.

Materials and Methods: This research is a descriptive cross-sectional survey was done in 2008. The samples of study were the al records' patients who undertaken of social security insurance system in the teaching hospitals of Shahid Sadoughi University of Medical Science. The data complied in SPSS 16 software and then analyzed.

Results: In this study, 9.8% cases of all hospitalization bills were deducted. The highest rates of under reimbursement bills was in Afshar hospital (12.7%), followed by burn hospital (12.5% ), Shahid Sadoughi hospital (10%), and Shahid Rahnemoon hospital (8.2%). The highest rates of under reimbursement bills imposed to the surgeon fees (28.4%), treatment fees (15.06%), and medicine (14.3%) costs. However assistant surgeon fees had no under reimbursement. The most important causes of under reimbursement were defects in the insurance records of patients and noncompliance with insurance organization regulations.

Conclusion: Training of human resources and optimized use of hospital information systems could be helpful to hospitals for reducing insurance reimbursement to ultimately improve hospitals to financial statements.

Evaluation of relation between styles of conflict management and creativity of staff in teaching hospitals of Kerman city in 2008

Azadeh Taghavi Rad

Background: The world is changing continually and organizations as the subsystems of the world should be adapted with these changes by helping to develope of creativity and innovation.This study to evaluate the relationships between conflict management styles and creativity of staff in training hospitals in Kerman province.

Materials & Methods:This is a cross-sectional study from aspect of descriptive -analytical. For gathering data, the standard questionnaires of conflict management for managers and creativity for staff applied. The participants in the study were all disciplinary managers from selected hospitals in one group and all disciplinary staff of selected hospitals in another group.Data analysis used in SPSS software.

Results:The results showed that there is a significant and opposite assosiation between enforcing styles and negotiating styles between managers (P<0/05, r= -0/187) and creativity of staff (P<0/05 , r= -0/155) . Meanwhile, there is a significant relation between marital status and educated staff and their creativity. This research reveales that avoiding styles applied among men is less than women.

Conclusion: To develop creativity of staff and managers should decrease using of enforcing and negotiating styles to solve the conflicts in hospitals.

The Assessing of Inappropriate Admissions and Hospitalization based on Appropriate Evaluation Protocol in Alinasab hospital in Tabriz- 2009

A Khalafi

Background: Assessing applied resources in a hospital as a health system will lead to identify organizational problems in this section and subsequently the necessary actions to resolve them. The aim of this study was to determine measurement of inappropriate admission and hospitalization (ISP: Inappropriateness Patient Stay) and associated reasons.

Materials & Methods: One widely used tools to assess appropriate use of hospital recourse is Appropriateness Evaluation Protocol which include objective criteria related to clinical services provided to the patient. Survey of admission and hospitalization in a cross-sectional and prospective study for 246 patients in the Alinasab hospital affiliated insurance organization carried out in Tabriz.

Results: The total of 7 percent of admissions and 6.2 percent of hospitalized were diagnosed inappropriate manner. There was no significant association between inappropriate admissions and other variables. There was significant relationships between Inappropriate bed days with insurance (P=0/041) and duration of hospital stay (P=0/041). However, there were no association between sex, disease diagnosis and hospital days per week with Inappropriate bed days.

Conclusion: The reasons of inappropriate admission and hospitalization in Iran are similar to other countries. Upgrading strategies to referral system performance, creating standard protocols to evaluate criteria for medical personnel and increasing outpatient diagnostic institutions could be reduce inappropriate admissions and stay of patients.

The survey of satisfaction rate and the effective factors on the aged peoples satisfaction regarding to the given services in the hospitals Tehran university of medical sciences

M Varmaghani

Background: The elderly population in Iran is increasing . The aim of this study is the survey of satisfaction rate and the effective factors on the elderly - aged peoples satisfaction regarding to the given services in the hospitals affiliated to the Tehran university of medical sciences.

Materials & Methods: This research is a descriptive - analytical study with applied results. It shows the problems cross - section ally.The research society involves the whole elderly - aged people whit 65 years old and more than that used the bedridden services of the hospitals affiliated to the Tehran university of medical sciences. The sample involves 360 elderly. For collecting the data, a questionnaire with three parts was used. The validity of questionnaire by the content measurement and the reliability of questionnaire by test re test (r = 0.84) were achieved. And also we used SPSS software for data analysis.

Results: : Results showed that 25/6%patients from management type, 41/9%from facilities ,17/2% from behavior personality and 30/3% from public services are dissatisfaction. A total of 12 variable were analyzed, and the results showed that: The education level, age, sex, type of refer, dealing with the bed shortage and occupations have the meaningful relation with their satisfaction rate. The one - variable - analyzers in the logistic regration model showed that among the whole meaningful variables, the education level has the strongest relation with satisfaction. With increasing the education level, the satisfaction rate have been decreased.

Conclusion: Due to results satisfaction rate among participant of this study is good and accepted. Using of results is effective step in increase productivity services and further evaluation needed to be done for functional styles patient elderly satisfaction.

Capabilities assessing of teaching hospitals in Iran University of medical sciences in attracting medical tourists according to JCI patient-oriented standards

R Khodayari

Background: Medical tourism is an increasing industry that patients travel to abroad for receiving health care services. The countries which are successful in this industry have global accrediting quality. This research is aimed to access capabilities of selected hospitals in Iran University of Medical Sciences in attracting medical tourists according to JCI patient-oriented standards.

Materials & Methods: This research is a descriptive, cross-sectional study that carried out in Hasheminejad, Rajaie and Motahhari hospitals. To collect data patient-oriented checklist of JCI standard used. Data analyzed by using descriptive statistic techniques.

Results: The results showed the high rates of consideration is related to medication management and standards used (84/5%), and anesthesia and surgical care standards (80%) that both of them are related to Hasheminejad hospital and also patient and family rights standards (47/5%) are low rates of considerations that are related to Motahhari hospital. Generally, the mean rates of consideration in Hasheminejad (71/8%) are more than Rajaie hospital (67%) and these hospitals are more than Motahhari hospital (62/3%).

Conclusion: Generally, the selected hospitals had rather readiness and possible and appropriate capabilities in attracting medical tourists. Some standards (access to care and continuity of care, patient and family education, assessment of patients, anesthesia and surgical care) were appropriate and some of them were insufficient (patient and family rights, care of patients and patient and family education). According to identify strengths and weaknesses of the hospitals in medical tourism, they could use SWOT analytical model to increase their capabilities.

The Role of Tehran's Hospitals Capability in Development of Medical Tourism

Amir Ashkan Nasiripour

Background: Medical tourism is an opportunity for hospitals to fuel growth by tapping the potential of the international patient marketing. Some countries have specifically considered the need of the 21st century that man to fully benefit from the topic of "medical tourism" to use the available opportunities in their countries. The aim of this study was to develop of medical tourism through capability of the Tehran's hospitals.

Materials & Methods: This research is a practical in the aim used of correlations as in method. In this regards 4 hospitals in Tehran city which were active in the medical tourism area with a high number of foreign patients collected. The participants were 63 doctors and nurses worked in these hospitals. The Questionnaire was researcher made including 6 Likert scale points (5 = very much, 4=much, 3=mid, 2=little, 1 = very little and 0 = none) as the data collection tool. Validity was confirmed by using the expert opinion professional and the reliability was approved by obtaining a Cronbach alpha of 0.859. SPSS software was used for statistical analysis and Spearman's correlation coefficient was used to measure the associations between variables.

Results: The results showed that medical equipments had the best status with the mean score of 3.9 and information applying and communication techniques recorded the lowest scores with the mean of 1.7. The correlation between average revenue of foreign patients and medical equipment status followed by costs of services was 1 score with a positive significant correlation (P = 0.000).

Conclusion: Using the advance of medical equipments with high international technology and standards make a clear statement in the field of medical services fees, and making the competitive costs is the great benefit to develop medical tourism.

Determining nursing manpower needed in a sample hospital

F Kokabi

Background: Hospital is the most expensive part of a health system. Manpower is the mainly valuable factor in productivity and service delivery. Since personnel costs make up more than 60% of hospital costs, increasing productivity and efficiency of human resources are significant. The most important ways to increase utilization of this valuable resource is to standardize the quantity and composition of the human distribution. This study determined the standardizing of nurses resources in a sample hospital.

Materials & Methods: The descriptive and cross-sectional study applied in 2008. Data of study collected by questionnaires and library studies by using descriptive statistics were analyzed. Sample of study is the private general hospital with 85 active beds, including gynecology, surgery, men and children, women, surgery, neonatal intensive care wards. Data collection tools were tables containing the number and composition of nurses and hospital performance indicators. After gathering data, it compared with the standards and recommendations were conducted. Using standard of job hours of nursing care required for each group of patients and protocols of Ministry of Health and Medical Education.

Findings: The numbers of nursing staff in the hospital were 96 people, including 38 nurses, 16 assistance nurses and 42 aid nurses. The optimum numbers based on average annual bed occupancy in different sectors were: 94 nurses, including 60 nurses, 34 assistance nurses and aid nurses.

Conclusion: A sample hospital uses healthcare workers as an aid nurses to assist in a wide range of patients' care. With regard to development of medical sciences and become more specialized nursing care industry and major changes in techniques and equipments, to move on from traditional invasive surgical procedures to non-invasive medical practices and the incidence of further complex cases, it will be effected to replace them with educated nurses to care of patients.

Prioritizing factors effecting on human resources productivity: Viewing of middle class managers in Isfahan University of Medical Sciences-2009

E Farahabadi

Background: Since, multidisciplinary & Combination of different factors that affecting on productivity of human resources are different in organizations due to variation in indoor and outdoor features, so the aim of this study was to prioritize the factors effecting on human resources productivity by viewing of middle level managers to make the basis of human resources management decisions to manpower planning and maintenance for reducing costs due to staff quitting.

Materials & Methods: This cross-sectional & descriptive study was carried out in 2009 .Middle class managers in Isfahan University of Medical Sciences examined as a statistical population. Data collected used by researcher constructed questionnaire that validation was confirmed through interviews with faculty members and experts. Cronbach alpha was calculated for reliability (0/935). Data analyzed by SPSS statistical software the maximum means score was 5 and the minimum was 1.

Results: Management style with a mean score of 4.41 was the most important factors in human resource's productivity. Factors related to individuals with a mean score of 4.3, culture with a mean score of 4.1, organizational structure with a mean score of 4.06, compensation systems with a mean score of 4, courses of training with a mean score of 3.85 and environmental factors that related to physical space with a mean of 3.769 compared to other options had less consequence.

Conclusions: Reforming employment systems and organizational structures, job enrichment, needs of educational planning, devolution to the middle levels managers and decision supervised measuring in the volume and balance with each other and further fields. Health incentive programs with job skills and staff development can be affected to increase productivity of human resources and promoting health system.