Hospital

Existing Challenges in Clinical Governance Establishment Evaluation Based on National Assessors' Aspect (A Qualitative Study)

Mohammad Arab

Background: Clinical Governance (CG) is a framework which obligates heath care system to responsiveness regarding maintaining and improving health care services' quality. Purpose of this study was to exists challenges in Clinical Governance establishment evaluation based on national assessors' aspect.

Materials and Methods: This qualitative study was conducted with national assessors' participation of Clinical Governance plan in 2014.Data collection was carried out using face to face interviews with assessors and analyzed based on content analysis.

Results: Three main themes were categorized including problems related to clinical governance standards, Existing challenges in assessment process and recommendations to improve quality assessment process.

From the assessors' aspects, the main existing challenges were lack of knowledge and adequate skills in some assessors towards CG, lack of sufficient accordance among assessors team, resistance of some universities and health care systems, lack of existing comprehensive guidelines with the purpose of responsiveness in related ambiguity in assessment and direction process among assessors.

Conclusion: Reinforcement of quality improvement culture in hospitals and increasing susceptibility in plan continuation, correct assessors election and ensuring about knowledge in responsibilities, updating assessors' training and putting to use equal indices in improving clinical governance assessment can be a considerable assist to improve assessment process and resolve related problems.

Assessing the Teamwork among Surgical Teams of Hospitals Affiliated to Social Security Organizations in Tehran City

seyed abolfazl zakerian

Background:In the healthcare system, teamwork is important to improve the quality of services and provide safe and effective cares. Operation room, as a high-risk environment, requires high levels of teamwork employees to secure performance. This study aimed at assessing the teamwork among surgical teams of hospitals affiliated to Social Security Organizations in Tehran City.

Materials and Methods: In this cross-sectional study "Observational Teamwork Assessment for Surgery" checklist was used to evaluate teamwork skill in surgical teams. Sixty surgical teams from two hospitals were assessed. In order to data analysis, descriptive statistics was used to calculate mean and standard deviation of age, work experience and teamwork scores in surgical, nursing and anesthesia sub teams. Two-Way ANOVA test was used to study relationship between scores of three surgical phases, sub teams and behaviors domains.

Results: Mean and standard deviation of age and work experience of participants were 42.81±8.57 and 10.62±6.18 years, respectively. Mean score of teamwork was 3.60±0.51 (out of 6) that showed higher than average team performance level. Among three sub teams, nursing achieved the highest score (3.78±0.44). There was a significant difference between nursing sub team and others (p<0.05).

Conclusion: Although mean score of teamwork was in higher than average level in studied teams, but discrepancies between three sub teams were high and worrisome. Use of educational solutions utilization can be effective to improve teamwork and increase quality of behaviors in operation room.

Comparison of Patient-Centered Situation in Selected Hospitals Affiliated to Tehran University of Medical Sciences from the Viewpoint of Nurses and Patients

Pejman Hamouzadeh

Background: One of the main pillars of quality in health services is patient-centered that brings the best outcomes for patients. This study was aimed at comparing the patient-centered situation in selected hospitals affiliated to Tehran University of Medical Sciences (TUMS) from the viewpoint of nurses and patients in 2014.

Materials and Methods: This descriptive cross-sectional study was done among 220 nurses (n=103) and hospitalized patients (n=117) in selected hospitals of TUMS. The data gathering instrument was a researcher-made questionnaire which measured seven dimensions of the patient-centered. The validty was confirmed by the opinions of experts and its reliability was 0.96 by Cronbach's alpha. Data analyzes were performed by SPSS software and using one-way ANOVAtest.

Results: Mean score of patient-centered in the studied hospitals from the nurses and patients viewpoint was 2.79 (±0.50) and 2.87 (±0.58), respectively. From the viewpointof nurses and patients, the highest and the lowest mean score were related to the confidentiality and dignity dimension and the patient choice dimension, respectively. Based on ANOVA analysis, there was a significant difference between the mean scores of nurses and patients in quality of amenity and social support dimension (p<0.05).

Conclusion: Patient choice, quality of amenity and prompt attention were identified as priorities for action to improve patient-centered situation in studied hospitals. It is recommended that hospital authorities should be place in a matter of priority the dimensions of the patient-centered which are in poor condition in order to increase the level of patient satisfaction and loyalty.

Assessing the Causes of Medication Errors from the Nurses' Viewpoints of Hospitals at Abadan City in 2013

abdorrahman mosahneh

Introduction: Medication process to patients is one of the most important tasks of nurses and doing in correct way can play a significant role in patient safety. This issue is the most significant part of quality care which consisted of patient safety as the impotant element. Medication errors are the main threatening factors of patients' safety. This study aimed at assessing the causes of medication errors from the nurses' viewpoints

Materials and Methods: This study was a descriptive-sectional-analytical one which was done in 2013. The study population consisted of 232 nursing staff of Abadan hospitals(Imam khomeini,Taleghani,Shahidbeheshti ,17shahrivar) which were covered by Ahvaz University of Medical Sciences,Oil Company and Social Security Organization ,respectively. Study instrument was a two part questionnaire including demographic - occupational information and causes of medication errors in 28 items in four fields (nurse, ward, nursing management and pharmaceutical causes).Content validity of questionnaire provided by review of related papers and experts'openion and required correction was performed.reliability of questionnaire was estimated 0.91 using Cronbach's alpha method.

Results: the most important causes of medication errors included shortage of nurses in propration to patient(%44),compression of work in ward(%36.2),fatigue due to over work(%35.8),illegible physician oder(%24.5),anxiety and stress due to work(%25),noise in ward(%22.4),nurse dissatisfaction of salary(%29.7) and similarity in medicine shape(%14.7) respectively.

Conclusion: Management causes such as nursing shortage, organizational factors such as compression of work in ward and some factors like nurses' fatigue had the most effect on occurance of medication errors among nurses. Thus, organizational processes reform and hospital organization to improve service quality and patient safety in order to resolve nurses' problems.

Assessing the Causes of Dedicated Revenues' Fractions in Health Care Centers and Strategies to Reduce Them (A Qualitative Study)

Saeideh Alidoost

Background: Lack of financial resources or their poor organization is one of the service delivery challenges and Fraction of dedicated revenues is significant problem in health centers in financial resources management. Hence, this study conducted to investigate causes of dedicated revenue's fraction and strategies to reduce them.

Materials and Methods: This qualitative study was carried out based on phenomenology approach in East Azerbaijan Province in 2014. Data collection methods were Focus Group Discussion (FGD) and semi-structure interview guide based which continued to saturation. their participants were selected using purposeful sampling method. Data were analyzed using content analysis method.

Results: Based on participants' experiences, six themes were extracted for causes of fraction and strategies to reduce them. These themes included causes and strategies related to fractions per capita, insurance fractions, fractions related to sending documents, registration fractions, clients' deductions and fractions related to incomplete deposit of cash incomes. In general, eighteen causes and twenty three strategies were identified in dedicated revenues fractions.

Conclusion: The causes of fractions were related to all stages of changing service process to revenue and insurance obligations in health care centers and strategies and identified interventions emphasize on mentioned fields.

The Potential of Medical Tourist's attraction in Hospitals (A Case Study of a Military Hospitals in Tehran)

Zahra Moshkani

Background: Many hospitals of Iran make use of their therapeutic capacities in order to attract medical tourists and increase revenue and efficiency of their affiliated hospitals. This issue has major benefits for hospital and tourists. This study assessed the potential of medical tourists' attraction in a military hospital in Tehran.

Materials and Methods: This was a descriptive- analytical one which used secondary data to analyze. Data gained from quality improvement and finance offices, recipients of service and health information management units from the first of 2014 to the first semester of 2015. Strategic plan document were used to analyze the opportunities and strengths points.

Results: The mean of studied hospital performance indicators like bed occupancy rate, length of stay, Bed turnover, rate of admissions to bed, mortality and bedsores rates, nosocomial infections, medication error, patients' rights and patient satisfaction were 4.68 , 3.3, 5.1 , 6.6 , 5.2, 1, 69, 9.74 , 70 percent respectively. The strengths points of the studied hospital were diverse expertise, updated equipment and minimum waiting time.

Conclusion: Because of skilled man power, physical resources and especially modern equipment, the hospital does not need huge investment in medical tourists' attraction. This issue will increase admission, productivity and satisfaction of clients and staff.

Analysis of the Spatial Distribution of Hospitals and its Optimum Locating of Saqqez City in 2014

Sharare Saidpour

Background: The issue of access to urban services is one of the important one that affects different aspects of urban affairs. In some cases, lack of proper access to some land, people's health is exposed to risk, for example Health care services especially in hospitals that impose requirements in a timely and appropriate access to it for all members of society. This study aimed at analyzing the distribution of hospitals and locates new hospitals regards to the lack in Saqqez city.

Materials and Methods: This study was a cross sectional and descriptive one. In order to classify and analyze data, the models of AHP and network analysis have been used. Also, ARC / GIS software and Expert choice has been used to map layers.

Results: According to assessed studies about the distribution of available hospitals and determination of their standard performance, 62.93 percent of the city area has not access to the hospitals.

Conclusion: This study results showed that hospitals in terms of compatibility with other land uses and access is inappropriate in the city. Thus, optimal areas for construction of new hospitals in five final maps from very good to very poor were classified and proposed using combining different layers of effective land uses.

Assessing the Patients' Hospitalization and Discharge Processes Based on Kaizen approach and Multiple-Criteria Decision Making (MCDM) in a Hospital

Kambiz Shahroodi

Background: Enhancing the need for health care services and its related costs, lead hospitals to improve and organize their processes. The aim of current study was to assess the Patients' Hospitalization and Discharge Processes Based on Kaizen approach and Multiple-Criteria Decision Making (MCDM) in an internal ward of one Hospital.

Materials and Methods: In this descriptive analytical study, ten managers completed the hospitalization and discharge questionnaires and answered three open questions according to Kaizen principles. Then, satisfaction score was measured for 100 patients using a reliable questionnaire (α=0.93). At third phase, after evaluating the proposed solutions using Analytic Hierarchy Process (AHP), the managers prioritized them based on cost, time and effectiveness considering indicators.

Results: Study findings revealed that mean scores of activity in hospitalization and discharge processes were 88.52 and 90.33 (out of 100) respectively, which showed high conformity with Kaizen approach. Also, mean scores of hospitalization and discharge satisfaction which indicated desirable satisfaction were 76.75 and 78.6 (out of 100), respectively. Based on managers' view points, results of MCDM and AHP methods indicated that effectiveness was the most important indicator and time as well as cost gained next priorities for solutions implementation.

Conclusion: This study showed that although, hospitalization and discharge processes were relatively desirable in the internal ward in mentioned hospitals, it is still a necessary to seek the best solutions in terms of effectiveness, time and cost for patients' satisfaction.

The Role of Demographic Variables on Medical Tourists' Viewpoints about Service Quality of Hospitals

Maryam Gholami

Background: The subjects' demographic characteristics are factors influencing their viewpoints about healthcare quality and have a positive association with the clients’ satisfaction. This study aimed at investigating the role of demographic variables on medical tourists' viewpoints about service quality of hospitals in Shiraz.

Materials and Methods: This descriptive-analytical and cross-sectional study was conducted on 200 foreign patients who referred to Shiraz hospitals during the first six months of 2013. Data collection tool was a questionnaire consisting of two parts. In the first part, medical tourists' information was collected and in the second part, their expectations and perceptions of services quality were measured using adapted SERVQUAL scale. The validity was checked out by experts and reliability confirmed by Cronbach’s Alpha test for expectations and perceptions separately (90% and 89%). Finally, data analyzed through SPSS v.16 software using independent t-test and ANOVA.

Result: According to the results, the mean score of the quality gap was estimated -0.26 for people over the age of 50 years, as it was lower than other groups. Also, the lowest total values of this quantity were related to the individuals with low level of literacy and those who stayed less than 7 days for treatment which were estimated -0.32 and -0.36 respectively. In addition, based on statistically significant dimensions, married tourists, people from Oman and those who had received eye surgery had lower gap mean score than the other patients as their total values were estimated -0.42, -0.21 and -0.22, respectively.

Conclusion: In order to develop the medical tourism industry, the demographic characteristics of the subjects should be considered in policy making and service design which can be result in majority satisfaction.

Application of Data Envelopment Analysis Technique in Iranian hospitals (A Systematic Review)

Abbas Jahangiri

Background: Data Envelopment Analysis (DEA) is a mathematical model that evaluates the relative efficiency of Decision Making Units (DMUs) with multiple input and output. The purpose of this paper was systematic study of applying this technique in Iranian hospitals.

Materials and Methods: In this systematic review which was conducted in September 2015 and February2016, attempted to search the research which conducted in Iranian hospitals regardless of the time of publication using searching keywords in six scientific databases and with the help of Google search engine. A total of 6,613 researches found. Then, 6,566 researches removed from the study because of the irrelevant, repetitive and Inaccessibility to the full text. Then, attempted to statistical analysis of 47 remaining researches via Excel 2010 software.

Results: 93.6 percent of the researches were published in 2009 onwards. The most research and least research have been conducted in three and eleven provinces respectively. The diversity of output indexes have been more than diversity of input indexes. In 81 percent of researches; input oriented model was used and in 74.5 percent of researches variable returns to scale is assumed. In most studies, referred to Iran's inefficient hospitals because of existence of excess resources.

Conclusions: In last seven years, the interest of Iranian researchers has increased about DEA application in hospitals especially in Tehran, Yazd and Khoozestan provinces. Scientific and rational use of resources is a proposal to the relevant authorities.

Geriatric Specialists Prediction Based on Dynamic System Approach for the Iranian Elderly

seyyed jamaledin tabibi

Background: Demographic prediction indicates that Iran population move towards an aged society until 2025, Hence, the need for medical care will be increased. The study aimed at predicting geriatric specialists based on dynamic system approach for the Iranian elderly.

Materials and Methods: After an exploratory study, data gathering and building similar structured in order to determine geriatrics number prediction by considering the important factors. Causal loop diagram to show relationship between variables, stock-flow diagrams for quantitative analysis of system dynamic behavior was conducted and model equations in Vensim software version 5 used.

Results: After simulation, intake students' simulated model revealed increased trend then a sharp decline and finally the pattern had fixed trend from 2009 to 2012. Pattern of physician who was still in study and also graduated physician was in growing trend. Employed physician had growing trend and then it fixed, and retired physician had fixed trend at first and then had an incremental trend. Finally, the various behavior of workforce assessed in three level.

Conclusion: According to increasing growth of the elderly population until 2025, we will encounter with shortage more than 2500 geriatrics which can be compensate by 50% graduated admissions of the major annually.