Hospital

Service Quality of maternity care from the perspective of pregnant women in Tabriz Health Centers and Health Posts – 2010-2011

K Gholipour

Objective: This study was aimed to assess Service Quality (SQ) of maternity care from the perception of pregnant women. Methods and materials: A cross-sectional study was conducted using a sample of 185 pregnant women at the 9th month of pregnancy were selected randomly from 40 health posts and urban health centers in Tabriz, Iran. Service Quality was calculated using: SQ = 10 – (Importance × Performance) based on importance and performance of non-health aspects from the customer’ perspective. Data collection used a researcher-developed questionnaire whose validity and reliability was reviewed and confirmed. Data analyzed using SPSS-17 software. Independent sample T-test and ANOVA were used to investigate relationship between service quality dimensions and categorical variables. Results: From the customers’ perspective the average service quality score was 7.59 of 10. Service quality aspects of “confidentiality” achieved scores at the level of good quality (≥9) and “support group” (3.48) reached low service quality scores. Also, result indicate housewife assess SQ better than worker (p=0.047) and mother who's have planned pregnancy has had greater SQ score (p=0.022). Although, in the linear regression analysis, job status and planned pregnancy were significantly and independently related to SQ score. Conclusion: Findings revealed a significant room for quality improvement in most aspects of provided care, particularly support group and safety from the perception of people who received maternity care.

Organizational Commitment and Intention to Leave among Hospitals’ Employees in Tehran Hospitals

f Akbari

Background: This study is aimed to compare organizational commitment and intention to leave among employees in Teheran`s hospitals. Materials and Methods: In this survey 3 hospitals with different ownership`s type were examined included: A public hospital, a hospital owned by Social Security Organization, and a private hospital. The data were collected by distributing 450, questionnaires among 450 employees, which were randomly chosen. Results: Among all studied subjects few employees allocated high score of organizational commitment to themselves .This average rate is nearly 20%. Committed employees were impressively low in the Social Security hospitals compared to others. Comparing intention to leave indicate revealed the Public hospital`s employees have lowest scores among all subjects. There is a statistical significant correlation between commitment`s components and intention to leave. Conclusion: Generally the majority of employees have average and low organizational commitment. Employees with high level of commitment and high level of intention to leave make a small proportion of all hospital employees. Social security hospitals must be taken into consideration due to the levels of commitment and intention to leave.

Sources of conflict between physicians and nurses

A Pourreza

Background: In the hospital setting, the potential for conflict is considerably high, because of the frequent and complicated interactions among nurses, physicians and other medical team staff and also the variety of their roles. With regards to the destructive conflict between physician and nurse which can negatively impact on the quality of health care delivery, this study aimed to investigate sources of conflict between physicians and nurses. Materials & Methods: The study population involved a total of physicians and nursing cadre employed in 4 hospitals affiliated to Ardebil University of Medical Sciences. 260 subjects were selected by both census and Simple random sampling methods. Data collection process was accomplished through questionnaire that its reliability and validity were confirmed. Data analysis was done using the Descriptive statistics and Mann-Whitney, Kruskal-Wallis tests. Results: Inequality in the social status between physicians and nurses from the perspective of patients and their attendants and also inequality in distribution of immaterial benefits between two forementioned groups (mean=3.23) were the most leading factors in arising conflict. The Social economic system (p<0.001), the health system (p=0.013), the hospital system (p<0.001) and interpersonal relations (p<0.001) variables had a significant relationship with the organizational position. Conclusion: creating appropriate social and cultural contexts in order to promote the social status of nursing profession as well as improving the organization and its management could be effective to prevent or at least mitigate conflict between physicians and nurses.

Department of Industrial Engineering, Faculty of Engineering, Tarbiat Modares University, Tehran, Iran.

R Baradaran Kazemzadeh

Background and purpose: Hospital is the largest and most important executive unit of healthcare system therefore, full consideration of how to assess its quality is of particular importance. A question is always raised as how to evaluate the quality of the services. The current study seeks to provide a fuzzy model for assessing the service quality in this healthcare sector. Material and method: The present cross-sectional study was conducted in two hospitals in Zahedan 2012.Via reviewing the related literature, the dimensions and components of service quality assessment were identified. The SERVQUAL questionnaire for hierarchical analyses was designed and the fuzzy AHP (Analytical Hierarchy Process) model was presented. SPSS v 10.0 and Fuzzy TOPSIS Solver 2013 software were used to analyze data. Results: The findings indicated that the most important dimension for estimating the quality of healthcare services was empathy. Responsiveness, assurance, and tangible assets were the last important factors. The hospitals were compared using fuzzy AHP. According to the calculations, the ranking of the hospitals based on their performance was as follows: Imam Ali hospital with 31% compared to Social Security hospital with 29% had a better performance in service quality. Conclusion: The results revealed that hospitals needed to focus more on empathy, expertise and reliability than providing high quality and satisfactory services. By considering their weaknesses, each of these hospitals can enhance service quality and consequently, provide a better service for patients.

Direct and Indirect Costs of Household Health Expenditure

A Assari arani

Background: Today, the lack of financial protection against the health costs is recognized as a major flaw in the health systems. It seems that the first step towards solving this problem is exact identification of household health expenditure`s components which will result in better selection of prevention policies and appropriate procedures to solve the problem. Materials and Methods: This study is a qualitative research conducted in two stages. The first stage consisted of interview with a sample formed by households from eight provinces of the country to identify the different components of household health expenditure. After that, a panel of experts categorized the identified components to direct and indirect costs. Results: In The first stage, 93 kinds of households’ health expenditure were identified. In the next stage, 61 cases of these were categorized as direct costs and the other 32 cases were categorized as indirect costs. Conclusion: The exact identification of the components of health expenditure of households and dividing them into two categories of direct and indirect costs can be useful for a more accurate calculation of the household health expenditure in future studies.

Predicting the Relationship between Learning Environmental Dimensions and Training Transfer in Tehran Milad Hospital and Model Offering

ZH Dadgarpanah

Background: Increaseing efficiency and effectiveness is the ultimate goal of staff training. Determining and being aware of staff training`s results efficiency is the necessity of learning transfer process and environmental identification which can complete the training cycle and leads to more effective plans and training activities. This study is aimed to predict the relationship between the aspects of learning environment and transmission of learning in Milad Hospital from clinical staff`s viewpoints. Materials & Methods: In this study, 306 people from different hospital's wards were selected by random sampling. The data were collected using Bartram et al learning questionnaire and researcher-made questionnaire of training transmission.The data were analyzed using Pearson correlation test and regression analysis. Results: There is a significant relationship between learning environment and learning transmission with correlation coefficient of 0.604 and coefficient of determination of. 0.604 with positive direction. About 0.60% of training transfer can be clarified by learning environment. Conclusion: Identifying the elements of learning environment is essential to enhance learning transfer to workplace. Learning transfer can lead to the development of organizational learning and sharing skills in order to optimize quality of services provided for clients and patients.

Predicting A Pattern of Patient Arrival at Emergency Department by Using Data Mining Technique and Neural Network Model

N Bigdeli

Background: Emergency department (ED) is the first place for providing diagnostic and therapeutic services to emergency patients. Due to importance of speed and accuracy in providing services the proper allocation of resources, the department must consider this matter in a particular way. Planning Emergency resources implements regardless of patient overcrowding which occurs at different times. In conclusion the emergency department may faces lack of resources and it results in delay of providing services, a whole mess in functions and decreasing in quality of services. This study is aimed to overcome these problems by suggesting a model for predicting the number of arrival patients at ED. Materials and Methods: The number of arrival patients is predicted based on the data colleted by counting arrival patients and using the data mining technique and neural network model (Multi-layer Perceptron). Results: The number of arrival patients during whole days of a week and 24 hours a day were calculated by sorting out 1, 2 and 3 priorities . The highest number of arrival patients counted was for Saturdays and the lowest for Fridays. Holidays and non-holidays` number of arrival patients differ . The number of arrival patients on formal holidays was similar to Fridays. The highest number of arrivals was between 9 am and 11 and also between 20 pm and 23 pm and the lowest arrivals was between 2 am and 7 am. Conclusion: prediction the number of ED arrival patients can be used for estimating required sources and distributing them appropriately and improving quality of services.

Assessing Hamadan`s Nurses Perceptions of Patient Safety Culture`s Dimensions

B Moeini

Background: Health care providers`culture about the patient safety means accepting and considering patient safety as the first priority and organizational core value or health center`s staffs beliefs, perceptions and trends of on patient safetywhich is reflected in their behavior. This study is aimed to assess nurses perceptions of patient safety culture`s dimensions which is working in hamadan`s hospital. Materials & Methods:The method of this study is descriptive- analytical type and statistical society includes 215 nurses of 3 hospitals of Hamadan which had been selected by random sampling. Stanford patient safety culture questionnaire was used to assess dimensions of patient safety culture.The data were analyzed by SPSS 15 software and descriptive tests. Results: The result indicated that all dimensions of patient safety culture through nurses` perception are weak . Among these dimensions, the " Unit Leadership for Safety " with 25.21 percentage and "Learning and Feedback " with 41.82 percentage were the lowest and highest positive rating in all three hospitals respictively . Conclusion: According to weak rate of all patient safety culture`s dimensions in studied hospitals, performing training programs by head nurses is suggested in order to improve cultural concepts such as establishing “supportive mechanisms for patients families” and "culture of discussion of errors among nurses" .

Waste Management in Selected Hospitals of Teheran University of Medical Sciences: Staff Awareness and Hospital Performance -2012

J Saeid Pour

Background: Hospital waste is one of the environmental problems .Ignoring the proper management of these wastes can lead to outbreak of diseases and epidemics which threat the public health and rise high costs as a result. This study is aimed to assess the level of staff awareness and hospital performance concerning waste management in selected hospitals of Tehran University of Medical Sciences in 2010. Materials & Methods: This is a descriptive-analytical study. The data were collected by distributing a multipartite Likert scale questionnaire among 351 individuals which had been used to measure hospital awareness and performance. The collected data were analyzed by SPSS software. Among Descriptive tests Chi-Square test was used to determine the correlation of qualitative variables and Pearson correlation coefficient was used for quantitative variables. The significance level was considered at 0.05. Results: Significant differences had been seen among different professions` level of awareness .There were no significant difference among different hospitals ` average awareness level although there were significant statistical differences among each hospital`s performance level (p ≤ 0.001). Conclusion: Due to relatively poor status of hospital`s waste management and hospital staff `s performance , better planning for proper management and wastes `excretion is needed to achieve sustainable development, public health protection and the environmental preservation. Staff Training and their performance monitoring and improving is one of the most important factors of hospital waste management plan success.

Assessing Performance of Kerman Province`s Hospitals Using Pabon Lasso Diagram between 2008 and 2010

T Barfeh Shahrbabak

Background: A method of performance assessment is required to improve Productivity and reduce hospital costs . Pabon Lasso diagram is known as a tool for performance assessment. The current study is aimed to assess and compare Kerman province`s hospitals performance by using Pabon Lasso diagram. Materials & Methods: This descriptive and cross-sectional study was conducted retrospectively between 2008 and 2010. All hospitals of Kerman province in three groups of public, social security and private were selected by census method (N=23). The data were gathered from statistics unit and entered into SPSS 18.0. Three indicators include bed occupancy rate, bed turnover and average of length of stay were calculated and then hospitals` performance were analyzed by Pabon Lasso diagram. Results: In first two years, seven and eight hospitals out of twenty-three and in third year nine hospitals out of twenty-two located in third zone of the model (desired productivity) respectively. Among all hospitals, regarding number and ownership type, social security hospitals had better performance in 2008. Additionally Public hospitals had better performance than others in 2009 and 2010,. Conclusion: Public hospitals had better performance.Although studied hospitals` performance experienced growing trend, only one third of the them had desired performance. It can be caused by changing the provided services type from inpatient to outpatient services.It seems that Considering type of ownership and assessing past trend of 3 studied indicators concurrently is necessary for Planning for development of a broader range of inpatient services and diversified medical services based on province`s need.