Hospital

Assessing the Public and Private Hospital Performance Based on Considering Resilience Engineering Indices: An Integrated Simulation and Decision Making Approach

fariborz jolai

Background: Health care systems especially hospitals often encounter several risks which has weaken efficiency and hospitals performance entirely. Resilience engineering (RE) enables to remain high risk systems stable faced to sudden changes or minimizes negative effects of changes.

Materials and Methods: This study considered a new hybrid framework concept regarding the non-value added waiting time and resilience engineering indices as efficiency indices to evaluate private and public hospitals performance. With the intention of evaluating the hospitals performance, a hybrid framework including simulation and MADM methods utilized. Output-oriented Data Envelopment Analysis (DEA) approach used as MADM method.

Results: The results revealed that RE factors play a significant role in hospitals performance's promotion; also the private hospitals had better performance compared to the public ones.

Conclusions: Study results indicated that teamwork efficiency index compare to other efficiency indices had more effect on hospitals performance. Health system managers should be considered improved performance and efficiency policies and focus more on other RE indices parallel team work index.

Cost – effectiveness Analysis of Dialysis and Kidney Transplant using DALY in Afzalipour Hospital of Kerman

Reza Goudarzi

Background: Chronic renal failure disease is considered as a health problem . Because of their high prevalence and economic burden on the society, health system managers consider to the disease as a public health concern. This study aimed at comparing the cost-effectiveness of long-term dialysis treatments and kidney transplant using DALY index.

Materials and Methods:This cross-sectional study was designed to compare the cost-effectiveness of two methods such as long-term hemodialysis and kidney transplant using Disability Adjusted Life Years (DALY) in Afzalipour Hospital of Kerman in 2012. The decision tree model and TreeAge software were used for data analysis. In this research, costs and effects were studied from the patient perspective.

Results: The cost of a kidney transplant was 165 million Rials, effectiveness of a kidney transplant was 4.40 DALY, chronic dialysis cost was 1.283 billion Rials and its effectiveness was 6.52 DALY. Cost-effectiveness ratio for dialysis was 196 million Rials per DALY and this ratio is 37 million Rials per DALY for a kidney transplant respectively. According to the findings, kidney transplant is more cost effective than dialysis.

Conclusion: This study suggests kidney transplant over dialysis due to its better quality of life and more life expectancy. The results can help out the government to decide about the more resource allocation to kidney transplant programs. The method in this research can be applied to measure the cost-effectiveness of other organs transplantation.

Comparison of Responsiveness Rate among Private and Social Security Hospitals in Tehran City

Background: Three aspects of health, responsiveness rate and equitable financing introduced as the main goals of health systems. In this study, responsiveness rate was assessed among private and social security hospitals in 2013.

Materials and Methods: The descriptive-analytical study conducted as a cross-sectional one among 10 hospitals in Tehran city (20 percent of total social security and private, 8:2 respectively) in 2013. Study population consisted of all inpatients and outpatients referee to eight private and two social security hospitals and 333 subjects selected to data gathering randomly. The valid and reliable World Health Survey questionnaire was utilized. Data was analyzed by SPSS₁₇ using descriptive statistic, Mann–Whitney and Kruskal–Wallis tests.

Results: In points of view among inpatient and outpatient, the mean score of responsiveness rate were 4.1±0.71 and 3.7±0.60 respectively. These amounts estimated 4.4±0.46 and 3.2±0.82 for inpatient and 3.8±0.58 and 3.5±0.63 for outpatient in private and social security hospitals respectively. Also, the mean score of responsibility rate assessed 4.4 in private hospital which was higher than social security ones (3.2); and this difference was statistically significant (P<0.001).

Conclusion: Responsiveness rate dimensions were evaluated moderate to high among assessed hospitals. These results were enhanced in private hospitals rather than social security ones. It is recommended that hospital managers should pay more attention to client and mechanisms to improve responsiveness rate and providing more services quality.

The Impact of Quality Management on Employees’ Job Satisfaction in Respiratory Intensive Care Unit at Labbafinejad Hospital

Background: Quality management as an organizational strategy helps enhance hospital efficiency, effectiveness and productivity. This study aimed to examine the impact of quality management on employees’ job satisfaction at Respiratory Intensive Care unit, Labafijejad Hospital.

Materials and Methods: A participatory action research was used for the intervention in 2013. A quality improvement team was established and operational processes were improved using a quality management model. The quality improvement team identified and standardized working processes, identified quality goals for the processes and improved them until achieved quality goals. Employees’ job satisfaction data was collected before and after the intervention.

Results: The quality management model implementation improved employees’ job satisfaction at the Respiratory Intensive Care unit. Employees’ job satisfaction was increased from 56.6 percent in 2013 to 68.3 percent in 2014. Integrating employees’ needs in quality improvement activities helps sustain the benefits of quality management. As a result, employees’ moral and satisfaction increase.

Conclusions: Implementing an appropriate quality management model appropriately in a supportive environment helps enhance employees’ job satisfaction and morale. Managers' and employees' commitment and involvement in quality improvement activities are required for successful quality management implementation.

Assessing the length of stay and influential factors among general Intensive Care Units in hospitals affiliated to Tehran University of Medical Sciences

farnaz khatami

Background: This study investigated the Length of Stay (LOS) in the Intensive Care Unit (ICU) and its influential factors as a step toward revising hospital policies, more appropriate resources usage and improving health system performance.

Materials and Methods: this cross-sectional study was conducted on 246 patients, among nine general ICUs of Tehran University of Medical Sciences. Variables such as age, type of disease, existing nosocomial infection and APACHE II (Acute Physiology and Chronic Health Evaluation) score were studied. SPSS software utilized for statistical analysis using Mann Witney U and regression.

Results: The mean and median of LOS was 8.6±19.2 and 2 (1-7) days, respectively. Mortality rate was 19.9% (N=49). The mean age was 52.7±22.07 yrs which LOS enhanced with increasing age (r=0.35, p<0.001). The mean of APACHE II score was 14.2±6 and it raised with increasing patients LOS (r=0.19, p=0.01). Average length of stay in patients with surgical diagnosis was 6.71 days less than others. Among effecting factors, nosocomial infection (p<0.001), need for mechanical ventilation in the first 24 hours of hospitalization (p<0.001) and a past medical history (p=0.012) which prolonged LOS significantly.

Conclusions: In this study, type of disease, hospital infection and age were the most important affecting factors on the length of stay. Thus, implementing effective interventions in order to maintain patients' health and safety is recommended. Since, half of the patients were hospitalized less than two days, providing protocols are necessary to make better use of ICU resources for patients who really need.

Technical Quality of Patients with Type 2 Diabetes

yeganeh partovi

Background: Type 2 diabetes is a chronic disease which has incremental prevalence regarding to unhealthy lifestyle. Based on the significant gap between received and standard care in patients with type 2 diabetes, this condition occurred high costs to health system. In order to eliminate this gap, this study aimed at measuring the technical quality of perceived care among patients with type 2 diabetes.

Materials and method: A cross-sectional study was carried out among 180 people with two type of diabetes in diabetes clinic using convenience sampling method. A three part questionnaire includes demographic information, disease statue and the technical quality questions was that the validity and reliability of it was approved. The data were analyzed using SPSS13software.

Results: Total technical quality score was 2.9 which was lower than bench mark 5. The main indices related to diabetic control (HbA_1c, blood pressure, LDL) were acceptable regarding Iranian diabetic guideline and they were controlled well.

Conclusion: According to notable gap between existing standards and perceived care in type 2 diabetic patients, there is a good opportunity to promote quality of services.

Hospital Emergency Response of Iran's Hospitals against Disasters: A Case Study in Karaj

Background: Emergency response of hospitals to deal with disasters is essential to success in providing qualified emergency services. The aim of current study was to evaluate emergency response of hospitals in Karaj against disasters.

Materials and Methods: This study was a cross sectional one which performed among 13 Karaj hospitals in 2013. To collect data, emergency response Checklist WHO (2011) was utilized with 90 questions prepared in 9 domains (Command and control, Communication, Safety and security, Triage, Surge capacity, Continuity of essential services, Human resources, Logistics and supply management and Post-disaster recovery). Data analysis carried out using SPSS version 20 with descriptive tests.

Results: mean score of emergency response was 44.17%. The most and the worst dimensions were hospital triage 70.30% and accident reconstruction after the emergency 24.84% respectively.

Conclusions: Based on WHO checklist, only 44.17% of studied hospitals were able to respond disaster events. Planning and providing a systematic framework to deal with disasters is a necessity, and the major role of hospitals should not be ignored in providing services considering its priority in plans and budgets in disasters conditions.

Relation Analysis between Internal Environment and Organizational Success Dimensions in Hospital

Background: Today's Hospitals operate in an inconstant and competitive environment. To have a successful presence in this environment, there is a need to recognize their own strengths and weakness points which can design appropriate strategies towards. The purpose of this study was to assess the internal environment of a hospital based on Weisbord model and analyze its relation with organizational success dimensions.

Materials and Methods: This study was a cross – sectional and applied one. The study instrument consisted of three sections including demographic information, Weisbord Model questionnaire and dimensions of organizational success assessment.124 out of 150 staff of Oil Industry hospital in Gachsaran participated in the study. In order to data analysis, descriptive statistics and Pearson correlation coefficient test were utilized.

Results: The studied hospital had a relative strength at the scoping (3.63) and leadership dimensions score (3.65) and also a relative weakness at the score of rewards (4.64) and communication dimensions (4.11). In terms of organizational success dimensions, speed (3.28) and flexibility (3.83) had better status than innovation (4.12) and cohesion (4.05). There was a positive and significant correlation between all organizational success dimensions and internal environment. In general, hospital success had the strongest relation with communication dimension(r=0.521).

Conclusion: Hospitals are able to take action through accurate recognition of weakness and strengths points and attempting appropriate modification to achieve organizational success in competitive fields. Then, they take steps towards optimization by improving programs.

Assessing the Services Costing Based on Activity Based Costing Method in Hematology Ward of Imam Reza Hospital in the First Semester of 2014

Mahmoud Zamandi

Background: First of all, in method of Activity Based Costing (ABC), activities identify and then direct and overhead costs associated with each activity calculate based on allocation methods. This study aimed at estimating cost of Hematology ward based on method of Activity Based Costing in Imam Reza hospital of Tehran city in 2014.

Materials and Methods: This study was an applied and cross-sectional one. Specific and overhead data cost of Hematology ward collected using activity-based costing method in Imam Reza hospital in the first semester of 2014. In order to allocate the costs of Hematology ward services, first, allocation bases were determined and then direct allocation method utilized to estimate the costs.

Results: The study findings indicated that costs of each CBC Test, Malaria slide, Cell Count of Biological Fluids and Reticulocyte count were 72673, 64678, 48509 and 48508 Rials respectively. Among the cost centers, the highest costs belonged to buildings depreciation (overhead) (714117127 Rials), Hematology personneles (4182223581 Rials (and materials and supplies costs (110635349 Rials), respectively.

Conclusions: Based on study results, estimated costs differed from tariffs and only Cell Count of Biological Fluids tariff is greater than the estimated cost, the rest of the tests had fewer tariffs than estimated cost which cause laboratory financial loss. At first, in order to control or increase productivity, it is essential to focus on building depreciation costs (e.g. increasing the number of tests) and then should be plan properly to increase manpower productivity of materials and supplies. All tariffs were estimated higher than the estimated cost without building depreciation cost.

Assessing the Barriers of Strategic Plan Implementation from Hospital Managers' Perspective in Kerman City

mostafa shahabi nejad

Background: Strategic plan in hospitals will not be run spontaneously and managers encountered with some barriers in order to have a successful strategic planning implementation. This study aimed at recognizing the barriers of strategic plan implementation from hospital managers' perspective.

Materials and Methods: This cross-sectional study was performed in all Kerman hospitals in 2014. Fifty three individuals including chairmen, internal administrators, quality improvement managers, matrons and strategic plan executers participated by census sampling method. Data was collected using a questionnaire including demographic information and human, processes, structures and institutions factors affecting the strategies implementation. Data analysis was performed by SPSS software version21.

Results: Study results revealed that the barriers to strategic plan implementation were structural factors (27.71±6.68), process agents (19.54±10.06), human factors (19.09±5.37) and institutional factors (15.73±4.52) respectively. There was no significant association between management background and barriers of strategic plan implementation in hospitals (P < 0.05).

Conclusions: In order to achieve desired results, chairmen and hospitals managers should be entirely conscious about barriers /failure factors of strategic decisions concerning foresight and appropriate managing or approaches change during strategic management process implementation.

Nursing Care Quality and its Association with Process Management in Beheshti Hospital of Kashan in 2014 Shahid

Background: The present study performed with the purpose of nursing care quality assessment and its association with process management in Shahid Beheshti hospital of Kashan in 2014.

Materials and Methods: In this applied, cross sectional and correlation study with the purpose of assessing the nursing care quality, 200 hospitalized patients who had more than 48 hours length time selected randomly conducting modified four parts SERVQUAL questionnaire in likert scale. In order to evaluate hospital performance based on process management model (EFQM) Excellence model questionnaire was utilized. Data analyzed using SPSS software version 16 by descriptive statistics and multivariate regression tests at a significance level of less than 0.05.

Results: Data extracted from 200 completed questionnaires analyzed. Respondents included 104 women and 96 men. The mean duration of hospitalization was 6.9 ±12.9 hours and the mean age of patients was 37 ± 12.02 years. Total nursing quality services were more than average and it assessed good (3.8 ± 0.92).Scores of Shahid Beheshi hospital were 215.66 and 217.64 in empowerment and results EFQM dimensions respectively. Multivariate regression coefficient was assessed 0.57.

Conclusions: Based on study results, it is necessary to make use of new management system and professional training to nurses in order to improve nursing quality services in hospitals.

Distribution and Adequacy of Human Resources of Hospitals in Iran (A Review Study)

hojat

Background: providing human resources is one of the most important factors to achieve the organization goals. Human resources are the most valuable aspect in production and service delivery. Staff shortages and excesses can be effective in reducing quality of services.This study aimed at assessing the hospitals' human resources condition from 2001 to 2014.

Materials and Methods: This review article extracted required information from ISI, Pubmed, Scopus, Wiley, Proquest, Emerald, Magiran, SID ,Iranmedex, Google, Google scholar and other related database considering keywords Human resource, Human resource management, Staff, Workforce, Hospital ,Iran, staff nursing, medical, physician personnel with Persian equation. Searched Articles Search Based on article objectives analyzed step to step with arrangement with study title, abstract and full text.

Results: Findings revealed that the majority of hospitals faced to lack and inappropriate distribution of human resources especially in medicine and nursing but there was no shortage in logistic, financial, paramedics and allied professional human resources.

Conclusions: Correct and appropriate human resources management, planning due to compensated inadequate human resources and raising them to a standard level can enhance the efficiency and effectiveness of hospital activities.

Predicting of intellectual and social capitals in knowledge organizational management of: A case study of Imam Ali Hospital in Kermanshah

Ayoub Pazhouhan

Background: Today, intellectual and social capitals as intangible and knowledge-based assets are one of the main factors of organizations’ success. On the other hand, knowledge management is a process which helps organizations engenders wealth from knowledge, intellectual and social capitals. This study aimed to determine the role of intellectual and social capitals in predicting knowledge management.

Materials and Methods: The present research is a descriptive-analytical study carried out in the spring 2015. The target population consisted of all staff of Imam Ali hospital in which selected 155 employees using the quota non-random sampling. The data were collected using three standard questionnaires of Bontis’ intellectual capital (42 items) including human, structural, and relational dimensions, Nahapiet and Goshal’s social capital (17 items) including structural, relational, and cognitive dimensions, and Lawson’ knowledge management (24 items). The data were analyzed using Pearson correlation, employing IBM SPSS version 22 software and structural equation technique of AMOS.

Result: 71% of study participants had bachelor's degree and 40% aged less than 30 years old. The results indicated that the dimensions of social and intellectual capitals were significantly and positively correlated with knowledge management. The results of path analysis revealed the intellectual and social capitals predicted knowledge management with the positive changes 0.79 and 0.89 respectively. As a final point, the structural dimension of intellectual capital and the relational dimension of social capital had the highest direct impact on knowledge management.

Conclusions: Given the important role of intellectual and social capitals in the application of strategies of knowledge management, hospital officials are able to facilitate hospitals increase added value and improve performance and excellence in presenting clinical services by investing more in knowledge-based assets.