Hospital

Improving Emergency Department Performance Using Simulation

khodakaram Salimifard

Background: Emergency department performance can be evaluated in quantitative and qualitative criteria. Some quantitative criteria are considered such as length of stay, patient waiting time, the percentage of patients that treat in a specific time and etc. In this paper the performance of emergency department was evaluated in terms of these criteria. Then four scenarios by using simulations was proposed. Materials & Methods: patient flow was modeled by discrete event simulation (DES) and the simulation was done by Arena software. Data was gathered randomly and patient waiting time, length of stay and the percentage of patients by noticing 6-hour boarding limit for EDs were performance criteria. Result: The result show 70% of patients were hospitalized in ED over 6 hours and it is an important bottleneck. The fourth scenario is that best of the scenarios, that improve in waiting times for hospital admission (85%), total waiting time before hospitalization (63%) and the percentage of the beds utilization (15%). Conclusion: the findings of this paper show that the fourth scenario has greatest improve in the process. In this scenario, to reduce waiting times for patients admitted to the emergency department as well as to reduce the high percentage of occupied beds, 3 beds and 1 nurse were added.

Survey of Medical Errors in Shiraz Public Hospitals: 2013

ramin ravangard

Background: Nowadays, Medical error as a major challenge has been attention of health authorities and community. The main purpose of this study was survey of medical errors in Shiraz public hospitals. Materials & Methods: This study was a survey which conducted as analytical in 2013. Study population was Shiraz public hospitals which 10 hospitals were examined. Standard checklist was used for collecting data of medical error documentations. Data entered in SPSS software version 21 and used of descriptive, spearman and chi-square test for data analysis. Results: the number of medical errors in hospitals during the one year was 4379 recorded and the most of error was related to larger hospitals. Nurses committed wrong more than other groups and systemic error had the highest frequency. There was a significant relationship between trespassing, time and type of error, (P=0.000). Moreover, there was a significant relationship between type of error with wards and hospitals). P=0.000, P=0.011 respectively) Conclusion: The number of errors occurring in hospitals is symptoms of poor performance, therefore to prevent and reduce the medical errors and costs, managers should pay more attention to hospital performance and treatment guidelines are revised. Moreover, the hospital staff, especially nurses should pay more attention to their activities.

Safety Attitude in Operating Room’s Staff’s in selected hospitals of Tehran University of Medical Sciences in 2013

Mehdi Asghari

Background and Objective: The operating room is one of the main units in hospital, where the most important phase of patient treatment is performed. This study aimed to investigate the safety attitude among the staff of operating room in selected hospitals of Tehran University of Medical Sciences.

Methods: In this descriptive - analytical study, 230 staff of operating room of hospitals affiliated to Tehran University of medical sciences were selected by Random cluster sampling. Research tool was a safety attitude questionnaire (Cronbach’s alpha 0.854) that classified in 3 categories: demographic questions (11questions), quality of communications (14questions) and safety attitude questions (58 questions). All data collected were analyzed using SPSS18. T-test, Spearman correlation, analysis of variance (ANOVA) and Chi-square have been used for data analyzing.

Results: The results indicated that 90.9% of staffs had moderate safety attitude and the average of the safety attitude score was 188.52(± 22.4). As the results showed, there was a positive and significant relationship between the safety attitude score and age, total work experience and work experience at hospital (p 046/0=, r =±0.141). There were significant differences between: average of the safety attitude score among men and women (P=0.047) average of the safety attitude score among staffs who have been trained and untrained safety (P=0.004).

Conclusion: The safety attitude score among the staff. It is therefore necessary to implement the effective interventions to improve safety attitude among operating room staff in understudy hospitals.

Keywords: Safety attitude, Operating Room, Hospital, Staff

Relationship between Strategy and Organizational Structure: A Comparative Study between Public and Private Hospitals of Tehran 2012

Rahim Khodayari Zarnaq

Background: Strategy is one of the important factors affecting the organizational structure. Taking the relationship between these two mentioned factors into consideration is essential. This study surveys the relationship between organizational structure and strategies of public and private hospitals in Tehran.

Materials & Methods: This study is a descriptive and analytical study of 20 selected public and private hospitals conducted in Tehran in the year 2012. The statistical population included supreme hospitals managers .We did a complete count because the sample size was small(60 managers). Research instrument was Miles and Snow strategy and Robbins's organizational structure questionnaire. A panel of experts were used for validity of questionnaires while the estimation of their reliability was calculated by Cronbach`s Alpha which was 0.75. The data analysis was conducted with descriptive statistics and Spearman correlation test.

Results: Among the structural dimensions, “centralization” was between was 85% and 75%, “formality” was 92% and 88% and “complexity” was 81% and 100% public and private hospitals respectively. Dominant strategy for both groups of hospitals was analytic. Correlation coefficient between strategy and organizational structure in public hospitals was -0.2 and in private hospitals was +0.3 which showed that relationship was not significant.

Conclusion: There was not a significant relationship between dimensions of organizational structure and the dominant strategy (analytical strategy) in public and private hospitals. If these hospitals tend to follow analytical strategies, they should reduce their complexity. Moreover, centralization could be towards analytical strategies if there is a strict control on current activities and little on new ones.

Barriers and Facilitators of Care/ Treatment Monitoring in Hamedan University of Medical Sciences

Negar Aghighi

Background: Monitoring and/or control are the management main duties. This duty is so important which some of authorities believed that efficient management depends on Effective Control System (ECS).This study aimed at identifyingbarriersandfacilitators of performance monitoring and providing some strategies for effective health care monitoring.

Materials and Method: This study was a qualitative one which data was collected bySemi-structured questionnaire filled by interview in2011-2012 and analyzed usingframeworkanalysis. Study population consisted of 25 experts and directors of care/treatment performance monitoring.

Results:Based on study results, nineconceptswere extracted as following:specialized nature of treatment performance monitoring, health assessors’ education, work experience in line units, prerequisites for new treatment performance monitoring, personal characteristics of care monitoring expert, managerial support of assessors, culture of monitoring process acceptability, facilitators and barriers of monitoring. Based on these concepts, 28 codes were identified.

Conclusion: Experienced assessors’ assessment, based on their specialty professionals’accurate and applied systematic education and management support are main items which will be result in more effective care/treatment performance monitoring.

Determining the Relationship between organizational justice and organizational commitment among employees of Shariati and Vali Asr hospital (as) in the year 1390

Abollghasem pourreza

Background: Organizations need dedicated human resource to achieve their goals. Doing justice to personnel result in increasing job satisfaction and organizational commitment. This study is aimed to determine the relationship between organizational justice and organizational commitment among Shariati and vali Asr (as) hospital staff in the year 1390.

Materials and Methods: This survey has been done using a cross-sectional descriptive analytical method. 140 of personnel of Shariati and vali asr hospital were involved in the survey. Nyhvf and Moorman (1993) and Meyer (1990) questionnaire were used. The former was used for measuring dimensions of organizational justice and the latter was used for determining the level of organizational commitment. The data were analyzed descriptively inferentially using SPSS version 18.

Result: The mean and standard deviation of organizational justice were 2/84 and 0/72 respectively and the mean and standard deviation of organizational commitment were 2/89 and 0/66 respectively. The results showed a direct significant relationship between organizational justice and organizational commitment .The value of correlation coefficient indicates a direct relationship between variables.

Conclusions: According to the results of study, organizational Justice and organizational commitment were in average level among samples. These variables merit further consideration as their direct and significant relationship and also their crucial role in increasing efficiency of organizations especially hospitals. Managers would have to give increasing organizational justice serious consideration

The Relationship between Clinical Governance and Hospital Performance: Evidence of Ardabil

hassan khalili

In many countries, different methods and tools for improving the quality of health cares have been used. Among these methods, the NHS clinical governance provided by the NHS British government as a strategy to enhance the quality of clinical cares was introduced in 1998. Clinical governance both responsibilities for maintain the current level of cares and improving the quality of future care are emphasized. Materials & Methods: The aim of this study was to investigate the relationship between clinical governance and organizational performance of hospitals in Ardabil. The research is an applied one questionnaire is used to collecting data. The population comprises patients, doctors employees and hospitals managers of Ardabil 180 were selected as the sample. To investigate the hypothesis test, correlation and regression analysis were used. Results: According to data, there is a significant relationship between organizational performance and clinical governance. On the other hand, the results of F test showed meaningful level for the components of %99, so we can use linear regression. Furthermore, the coefficient of all the components of clinical governance has a positive and significant effect on performance. Among the components of clinical governance, clinical audit component has %163 of the minimum amount, and staff management component 908 percent has the most effect on hospital performance. Conclusion: According to the results, are considered essential patient’s engagement in treatment, the use of information and patients' family’s experiences to provide more services to patients, credit allocation for staff training and staff expertise in the field of employees training.

Segmentation of Medical Tourism Market Using Cluster Analysis Medical tourism and cluster analysis

Leyla Torkzade

Background: Industry growing and work load of financial turnovers are one of the medical tourism’s reason. Because of additional capacity building in health domain especially in medical levels, medical tourism can be solved some problems similar to extra capacityby means of an essential strategy. The aim of this study was to Segment external clients based on their benefits expectations about health services in four hospitals in Iran.

Materials andMethods:In current study, library reviewing and health care experts’ viewpoints were used in order to determine the characteristics of healthcare services.After determining the variables, factor analysis was performed to brief variables.Then, cluster analysis was performed on extracted factors using K MEANS algorithm and characteristics of each cluster was determined.

Results: Four factors were extracted by factor analysis .Then, Cluster analysis was done on the factors andPatients were divided into four sections whilethe first section respect with health care services efficacy, the second and fourthparts tend to get care with respect and the third parthave a tendency to have individual ability

of hospitals.

Conclusion: Individuals obtained the most important percent to care providing with respects among four extracted clusters. Thus, hospitals should have the most focus on communication quality regarding their marketing efforts with their clients.

The importance of Recruitment of qualified manpower and Its role in promoting efficiency: A case study

Abbas Jahangiri

Background : All managers want to improve their organization 's efficiency . The purpose of this paper In addition to the asses the efficiency of Hospital during the time, is trying to answer to this question that, is the recruitment of new personnel able to increase hospital efficiency?

Materials & Methods : In this sectional study, the relative efficiency of Imam Khomeini Hospital in Arak during the thirty-one months Since April 2011 to November 2013 (16 months before and 15 months after the recruitment) by input-oriented DEA method with five inputs and five outputs and with considering each month as a decision making unit, was calculated by DEAP 2.1 software. Then, the efficiency scores during the two stages, once for sixteen months, and once for a total of thirty one month separately by Mann - Kendall test via Minitab 16 software was analyzed and the most important event in the hospital during the study period, was asked from hospital authorities.

Results: Most inputs and outputs of hospital have increased. The efficiency of the last eight months was equal to one . In addition, the efficiency of eleventh month was lower. The value of z_s for first sixteen months and for a total of thirty-one months -0.55769 and 2.05318, respectively calculated .

Conclusion: Trend analysis of the efficiency Scores showed that simultaneously with the recruitment of new personnel without reports of other influential factors, Hospital efficiency has significantly improved.

The Survey of relationship between organizational intelligence with Performance indicators of selected hospitals in Mashhad University of Medical Sciences-2012

mahboubeh asadi

Background & objectives: one of new and unique tools for survival of organizations among their competitors having comprehensive knowledge of all the environmental factors affecting the organization, means organizational intelligence, that with its measurement Strengths and weaknesses of the organization are identified and can affect the performance of organization and in this way, they help to organization in the measurement and evaluating progress in achieving its goals. Materials and Methods: This descriptive analytical study was performed in 12 general hospitals affiliated to Mashhad University of Medical Sciences in 2012. Study samples were 375 employees who were selected through stratified sampling method. The study Tool of data accumulation was Albrecht organizational intelligence standard questionnaire and checklist of hospital performance indicators that was determined by the Ministry of Health. To determine score organizational intelligence was used the five-point Likert scale. Data were analyzed by SPSS v.16 using Statistical tests and Pearson correlation coefficient (P=0/05). Results: we found that there was a significant positive relationship between hospitals’ organizational intelligence and all the performance indicators of the exception of “Bed occupancy ratio”, “Ratio of surgeries to operation beds” (P<0.05), and organizational intelligence had the highest correlation with indicators of Bed Turnover Interval (r = 0.739) and the average length of patient stay (0.691) Conclusion: it seems that attention and planning to strengthen and increase organizational intelligence can be effective in improving the performance of hospitals.

Evaluation of fungal and bacterial aerosols in the different wards of Malayer city’s hospitals in 2011-2012

Mahmoud Taghavi

Background and objective: Bioaerosols are airborne particles which can cause a wide range of health effects including hospital and occupational infections, acute toxic effects, allergies and cancer. Hence, the aim of this study was the qualitative and quantitative evaluation of bioaerosol in different wards of Malayer city’s hospitals.

Material and methods: Sampling was conducted from twelve wards in two hospitals. Both bacterial and fungal sample were taken based on method of ACGIH bioaerosol committee. The samples were transported to blood agar and sabouraud medium then cultivated immediately. The type and number of colonies were determined in the laboratory then, the bioaerosol concentration was calculated in terms of cfu/m3.

Results: Overall, the maximum concentration of bacterial (21.27 cfu/m3) and fungal (66.49 cfu/m3) colonies were found in pediatric and CCU wards, respectively. The minimum concentration of both bacterial (8.74 cfu/m3) and fungal (2.18 cfu/m3) colonies were found in autoclaving ward. Staphylococ negative coagulase(33.76%), Micrococ species(16.23%) and Bacillus species(15.58%) were found to be the most common organisms and, Penicillium spp. (50.9%), Cladosporium spp. (27.02%) and Aspergillus spp. (8.1%) were the most common fungal genus.

Conclusion: Except of a few cases, total concentration of bioaerosols was lower than the guideline concentration (30 cfu/m3) in the all wards. High concentrations of bioaerosols in some wards can be explained by some reasons such as wear and tear of buildings, improper ventilation, incomplete disinfection of wards and, the high number of patients and visitors.

A Survey on the Relationship between Leadership Style and Strategy of Conflict Management among Top Managers of Urmia Hospitals: 2013

Farshad Faghisolouk

Background: Hospital as core of health and care system requires an effective leadership style and suitable strategy for organizational differences and conflict’ solving. Main goal of this study is to survey of relationship between leadership style and strategy of conflict management among chief executive officers of Urmia hospitals. Materials and Methods: This analytical-descriptive cross-sectional study was implemented in Urmia hospitals in 2013. Study population of the research includes thirty top managers in ten hospitals of Urmia. Data gathered through three questionnaires (personal and job characteristic leadership style with method of Fiedler LPC and conflict management). Data analyzed through SPSS software, mainly by Chi 2, Kruskal–Wallis and Spearman's Rho tests. Results: Results showed that Leadership style had significant statistical relationship with average of managers work experience (p=0.040). Also age and strategy of control had significant statistical relationship (p=0.01). Leadership styles and strategies of conflict management weren’t significantly with other descriptive variables such as (position, level of education, marriage situation, work experience, managerial studies and second job). Leadership styles and strategy of conflict management weren’t significant relationship, finally. Conclusion: Since that the determination of leadership style and methods of dealing with conflict management in hospitals is important, it is recommended that ever done comprehensive research on the effects of other factors such as organizational culture, social culture, character on leadership style and conflict management.

The relationship between Emotional Intelligence and Organizational Commitment among Southern Khorasa`s Hospitals Administrative Staff

Mohammad Akbari Booreng

Background:An organization`s effectiveness and efficiency is strongly dependent on its staff`s commitment. Therefore, identification of organizational commitment and its related variables seems necessary. This study is aimed to examine the relationship between emotional intelligence and organizational commitment.

Materials & Methods: This is a descriptive correlation survey. Our study statistical population included all administrative staff of in southern Khorasan province` hospitals. 110 samples were chosen by a stratified random sampling. The data were collected by standard questionnaires of emotional intelligence and organizational commitment and analyzed by using descriptive and inferential statistics.

Results: The results showed that organizational commitment is in the moderate level among administrative staff. There is a statistically significant relationship between emotional intelligence and organizational commitment. There is a statistically significant relationship between emotional intelligence and commitment subcomponents(normative and emotional commitment). By performing multiple regression analysis ,the outcome showed among the all emotional intelligence subcomponent ,solely “self-awareness” can predict organizational , emotional and normative commitment .

Conclusion: Improving individual's emotional intelligence should be taken into consideration due to the strong bond between emotional intelligence and organizational commitment.