Hospital

Assessing issues and problems in relatioship between basic insurance organizations and university hospitals: a qualitative research

A Rashidian

Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals.
Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data.
Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.

The Causes of not Reporting Medication Errors from the Viewpoints of Nursing in Baharlo Hospital in 2010

Abolghasem pourreza

Background: Reporting of medication errors leads to saving Patients &apossafety and also is counted as a valuable information source for further prevention of mistake in future. The aim of this study was to determine the reasons for refusing to report medication errors from the viewpoints of nurses.

Material and Methods:In this descriptive study, 140 of 200 nurses who were employees of Baharlo hospital of Tehran participated in the study (response rate = 70%). Data were collected through a questionnaire. Test- retest analysis conducted for measuring reliability of the questionnaire and content and face validity of the instrument confirmed by key statisticians and methodologists. . SPSS software and descriptive statistics were used for analyzing the collected data.

Results:Our findings indicate that the reasons of not reporting medication errors were Management factors (3.68 ± 1.12), Fear of reporting outcomes (3.09 ± 1.68) and Process related to reporting (2.73± 1.26). Management factors domain was the major cause of refuse of reporting medication errors.

Conclusion:Since medication errors seem to be unavoidable, suppression, decreasing medication error depends on using a systematic approach with emphasis on management and nursing care.

Safety and diagnostic performance of dual-source CT scan in comparison with single source CT scan and conventional angiography in coronary heart diseases

A akbari Sari

Background: The aim of this study is to explore the safety and diagnostic performance of dual-source CT scan in comparison with single source CT scan and conventional angiography in patients with coronary heart diseases.
Materials and methods: A systematic review was performed using CRD standard methods. The Cochrane Library, MEDLINE, EMBASE، Google Scholar and TRIP were searched up to April 2009. The references of the marked studies and gray literature were also searched.

Results: 17 articles were included. 9 articles reported the safety and 12 articles reported the diagnostic performance of DSCT. Generally DSCT was a non-invasive and safe procedure. Using DSCT the exposure of patient to X-ray was less than 64-slice single source CT (SSCT) and more than conventional angiography. For the DSCT the mean sensitivity was 90.4%, mean specificity was 82%, mean PPV was 83% and mean NPV was 96%. For the SSCT the mean sensitivity was 90.4%, mean specificity was 82%, mean PPV was 83% and mean NPV was 96%. The mean sensitivity, specificity, PPV and NPV of DSCT were slightly higher than SSCT.

Conclusion: DSCT is a noninvasive and relatively safe technology. The diagnostic performance of DSCT is higher than SSCT, but its performance is not so much high to be able to substitute the conventional invasive angiography which is still the gold standard test.

Survey of quality ergonomic of Iran's hospital information system and comparison with three other software from users' point of view

Leila Shahmoradi

Introduction: Evaluations of a system of information, without analyzing its users understand is impossible. User satisfaction is as key factor of success information system. It is essential to consider information system context (user, task, equipment and environment), user type and user experience in quality ergonomic computerized information systems. Therefore in this study HIS quality ergonomic of Iran compared with other software.

Methods: A comparative study in 1389 was conducted. In order to compare the evaluation results of hospital information system with other software, applications were selected that already were evaluated using isometric questionnaire. These software are a) IS-H * med (software evaluated by Hamburg and colleagues in 2004), b) SAP-HR (software evaluated by Gruber 2000) and c) Microsoft word for Windows (software evaluated by Gediga and colleagues in 1999). Users view analyzed through descriptive statistical and one sample t-test. Data analyzed through SPSS and Excel.

Results: HIS than IS-H * med of is significantly more usable. HIS than SAP-HR in terms of the IsoMetric Scales such as "suitable for task," "suitable for learning", "Error tolerance" and "learning ability" is significantly more usable. HIS vs. Microsoft's word is significantly less usable.

Conclusion: The results of this study showed that hospital information system in Iran than the other software studied is average level in terms of ergonomic software quality. It is recommended regarding user expectations when designing and developing of information systems.

Reasons for patients' readmission in Tehran University of Medical Sciences Hospitals

mohammad Arab

Background: Most hospitals face with incremental demands, low facilities and readmission of patients as well as dissatisfaction of the clients in regarding to the quality and access of services. Investigating the reasons for readmission and solutions for decreasing the rate of these kinds of admissions can decrease hospital expenditures and improve the efficiency of hospital recourses. By offering high quality standard services and establishing appropriate procedures we can satisfy patients' needs and relieve their pains and discomfort. In this study we are going to evaluate the reasons for patients' readmission in Tehran University of Medical Sciences hospitals

Materials and Method: This is a descriptive and cross- sectional study consisting of 9 hospitals. The samples were consisted of patients who readmitted in hospitals affiliated to Tehran University of Medical Sciences. The required information has been registered in a questionnaire by means of computer, admission forms and index cards. The medical records of 250 patients were collected and analyzed by t test, Fisher Exact Test and Chi Square test.

Result: 17.8% of understudy patients were admitted two times and 80.7% were admitted more than two times in the hospital. Most of these 80.7% of patients were over 60 years old. It was seen a significant relation between patients' age and readmission also occurring infection. In categorizing diseases according to the reason of patients' readmission (23.1% in the second period and 20.2% in the third period) encountered diseases related to body blood system while readmitting in the hospital. The average cost of patients bedridden admitted for the second and third times because of the same reason was 3241532 and 1576593 tomans. There was a significant relationship between readmission and length of stay in both periods. Pursuit of treatment in 101 cases with average cost of 1802757 tomans in second time and 84 cases with average cost of 1205283 tomans in the third period was among the highest costs of readmission causes. Also the highest length of stay was related to surgery unit (9.98 days). The highest average of patients' costs related to surgery unit was 3543854 and 3911168 tomans for second and third periods.

Conclusion: Most of readmissions are among 60 years old patients and the most important reasons for the second and third readmissions are as a result of treatment follow up, adverse effect and illness complication which can be for the reason of incomplete treatment, non compliance of clinical protocols and lacking standard instruments. Results show that readmissions can increase patients' length of stay and additional burden of costs for patients, hospitals and insurance institutes. Therefore we can prevent these unnecessary costs and increase patients' satisfaction by complying clinical protocols, standardizing hospital procedures and instruments, personnel training and using new methods of diagnosis and treatment. The reform in Health care policies and focusing on the health care quality on the side of the administrators also paying more attention to home visits and home care are recommended to this case.

The Relationship between Leadership Styles and Conflict Management Strategies Used by Top and Middle Managers of Kerman's Educational Hospitals

sajad delavari

Background: One of the necessities of hospital administrations is that the top and middle managers should be familiar with leadership styles and conflict management strategies completely and select a right managerial method. Through this, they can actively play a significant role in improving effectiveness and efficiency of hospital performance. The main objective of this research is surveying the relationship between Fidler's LPC score (as a sign for leadership style) and conflict management strategies (avoidance oriented, solution oriented, control oriented).

Materials and Methods: For surveying leadership styles Fiddler's Least Preferred Coworker questionnaire and for surveying conflict management strategies, another questionnaire was used. The reliability of these two was 0.90 and 0.88 respectively. The survey population was consisted of the high and middle managers of Kerman's educational hospitals (81), and a sample 67 individuals was selected for survey.

Results: The result showed that respondents mostly use communication oriented style and employed conflict management strategies are avoidance, solution and control respectively. Also it was observed that there is a positive and significant relation between LPC score and avoidance and solution strategies (r= 0.512 and 0.298 respectively). But there is a negative and significant relation between LPC score and control oriented strategy (r= -0.474).

Conclusion: According to the findings it is suggested that, the reasons of using avoidance strategy should be surveyed and try to encourage people to state their inconsistent ideas and converse freely. This could help organization to improve its performance. But communication oriented style is suitable and its maintenance should be taken into consideration.

Relationship of quality of working life in Kashan teching and non-teaching hospitals with knowledge management according to the top and middle manager's point of view

monika motaghi

Background: The purpose of the present study was to compare quality of working life in Kashan teaching and non-teaching hospitals and to determine its relationship with knowledge mamangment.

Materials and Methods:the study was descriptive in nature.The statistical population comprised of middle and senior managers at Kashan teaching and non-teaching hospitals.The data were collected using a valid Likert style questionaire (Very little to very much).Data analysis was carried out using SPSS.

Results : Worke space gained the highest score among another parameters (3.64 in teaching hospitals and 3.47 in non-teaching hospitals.Material facilities scored the lowest in teaching hospitals (2.7). Job designe also attained the lowest score in non-teaching hospitals (2.81).

Democracy showed the strongest correlation with knowledge management in teaching hospitals (r=0.83). There was a strong correlation between education and knowledge management in non-teaching hospitals (r=0.69).

There was a strong correlation between quality of working life and knowledge managment both in teaching and non-teaching hospitals (r=0.92 and r=0.83), respectively.

Conclusion : Based on the fidinges of the study, paying special attention to participation in decision-making and education could play a crucial role in improving work life quality.

The impact of effective factors on organizational citizenship behavior in Shiraz University of Medical Sciences`(SUMS) staff in 2010

Peyvand Bastani

Background: Organizational Citizenship Behavior indicates an individual cautious behavior that although is not known by formal organizational reward system directly, can have a positive and effective role on the organizational performance and lead to functional improvement. In this study the relationship between Organizational Citizenship Behavior and its determinant factors has been surveyed.

Materials & Method: This is a cross- sectional study that was done on an accidental sample of 130 staff working in Shiraz University of Medical Sciences (SUMS). The required data was gathered by using a questionnaire and descriptive statistics and person regression test were applied in significant level of 0.05.

Results: Results showed that there were statistically positive significant differences between OCB and organizational culture, personality and internal control focus (p<0.001) in contrast with the reversed and significant differences between OCB and job stress (p<0.001).In addition there were statistically positive significant differences between various dimensions of OCB with each other (p<0.001). furthermore , between courtesy and organizational culture, control focus and personality, citizenship behavior and organizational culture, sacrifice with culture and personality and between conscience and culture, the statistically positive significant differences were observed in spite of the statistically negative significant differences between courtesy, citizenship behavior, conscience with job stress and also between conscience and personality(p<0.05).

Conclusion: reducing job stress , existing organizational justice and the group oriented organizational culture and also staff` characteristics the same as personality , control focus, etc can have an effective role on the incidence rate of Organizational Citizenship Behavior shown by staff in Shiraz University of Medical Sciences . So attention to each of these dimensions and key factors and attempts for amplifying and supporting them by managers can develop these behaviors and lead to functional improvement in the organizations.

Women health worker's views about the screening and management program for domestic violence: a qualitative research

Abbas Rahimi foroushani

Background: Health care providers have important role in identification and management of domestic violence against women. The purpose of this study was to explore views and ideas of the women health worker about the screening and management programs related to domestic violence against women, their benefits and barriers and introducing the appropriate interventions for removing the barriers.

Materials and methods: This qualitative study was held through six focus group discussions and three in-depth interviews by the participation of fifty-six women who had provided reproductive health care of South Tehran, Rey and Eslamshahr Health Networks. The health care providers' views about domestic violence screening and management were extracted, categorized and analyzed.

Results: The majority of health care providers were aware of the importance of identifying and management of domestic violence cases in health care facilities. Respondents felt that they have responsibility to screen for domestic violence. Major barriers to domestic violence screening and management included perceived lack of time and place, insufficient knowledge and skills related to domestic violence screening and management, insufficient personnel and referral services.

Conclusion: : Improvement of identifying and management of domestic violence in health care settings by removing the barriers to screening and improvement of referral and supportive services, can lead to decreasing in domestic violence against women cases.

Modeling and scheduling intelligent method's application in increasing hospitals' efficiency

neda Darvish

Background: Achieved results from this research shows that despite in health system in country efficiencies such as work force efficiency(doctors and nurses) is not incomputable and percentage of bed occupation and regulating shift work program prepare manually and with paper, this issue results in time consuming of managers and wasting costs and errors in carried out computations. Therefore with technology improvement and automation system there is possibility of making such automatic data is provided. Using of intelligent system consider essentially for preparing optimal program. Studying of Data showed that the present situation of planning and determination of efficiency in Iran Hospitals is not desirable. In this research, Markov methods and Petri net and genetic algorithm as modeling method and developments of model and intelligent optimization for solving problems, reducing costs and planning for work force was used successfully and there is the possibility to generalize it with changes and reforms in programming. In Achieved results of studies show that, the present research is a suitable base for expanding researches in future in field of system designs in a way that can be used in different wards and can provide more facilities to approach the real world

Material & Methods: the present study is applied and descriptive-analysis one which had been as the software design and data collection tool was the checklist of Booali Hospital's patients' files which its admissibility confirmed by the related experts and studied after observation, chronoscope and also time of manpower servicing to several patients and study of the nurse and doctors working scheduling with use of intelligent system's designing. Data analysis and planning is carried out with the method of Petri net and Markov and genetic algorithm with use of Matlab and Hpsim software

Results:42 % improvement in expense decreasing and 87% time saving in servicing time to patients can be seen from comparing prepared program and designed system.

Conclusion: Research various models can be used as a suitable tool for scheduling and determination staffs optimized number needed in several parts of a hospital which has a vital role. In case that the designed system in the current project is limited to the achieved and collected data from educational center of Booali attached to Tehran Islamic Azad university, it is need to make changes in programming based on data for generalizing it and optimized utilization in other hospitals. So it is recommended to make the prepared program close to the real world for make these systems utilizable in other hospitals and increasing restrictions.