Hospital

Computation Cost Price of clinical laboratories services in valiasr hospitals in Tehran in 1387 by using of ABC model

A.A Nasiripoor

Background: The most basic financial information and data which are needed for a laboratory manager is the costs allocated to the cost unit and the cost of services. The cost prime can increase the managers function in practical beget and strategies plan and this article based on function , is don to calculate the cost prim of clinical laboratories services in VALI A SR Hospital in Tehran by using of ABC model . Material & Methods: the study is a practical research done by descriptive-analytic method in a periodical and retrospective form during Forward to Esfand of 1378. Thirty tests were chosen according to the fluency chart. Data collecting tools, information sheets, interviews and direct observations were collected and analyzed and the cost price of laboratory services calculated by the help of MY ABCM software. Results: In VALI A SR Hospital's laboratory, Findings demonstrate that, maximum and minimum costs are related to human recourses cost (44%) and energy cost (.5%) also about activities, most activities is related to expertise activates(97% of total ). these result show THE importance of human recourses especially expert human recourse in prime cost. the maximum prime cost is related to urine analysis(11%) and the minimum prime cost is related to sodium an of biochemistry's group(21%). it means more frequency of services lead to reduce of services prime cost. Finally the average of calculated prime cost was different to hygiene ministry tariff (about 63%).this difference is result of unrealistic tariffs vs. prime cost of services.
Conclusion: According to volume test operational and other conveniences in the Valia'asr hospital's laboratory, this laboratory encounter to missing budget. We can reduce the service's prime cost by improvement of performance management especially in human recourse filed and consume recourses in best way by standardization of consumption.

A Survey Of Effective Factors in improvement Of Staff performance based on ACHIEVE Model in the view of managers (senior, administrative and nursing) in teaching hospitals in Isfahan

M Yaghoubi

Background: If a managers try for further income or productivity so they must attentive their staff incentive. One of the most issue in the management process is that managers can distinguish strength of staff but they can't determine their weakness . ACHIEVE model present seven factors ( ability, clarify, help, incentive , evaluation, validity , environment ) that effective to staff performance . and this model help manager to determine cause of performance problem. And create change strategy for solving those problem .
Material & Methods: It is descriptive , survey and inferential study , the population is university hospital managers in Esfahan university. data is gathered through achieve questionnaire that supported by member of management faculty.The reliability is supported based on α koren bakh . for analysis of data use spss soft ware .
Results: Finding show that : Average number of ability factor is (87/5+12/2) , clarify factor (82/3+14/8), help factor (82/6+15/7) , incentive factor ( 81/4+ 15/4), evaluation factor (77/2+15/6) , validity factor (82/7+ 17/3),and environment factor is (85/2+12/8). and base on Pierson test (p<0/05) all of the factor are effective on staff performance.
Conclusion: Today the important problem in health care organization is staff effectiveness . in fact , performance improvement is the most step for organization improvement.

Estimating the number of needed personnel in admission department of Children's Medical Center affiliated with Tehran University of medical sciences using work and time Measurement

M Yousefi

Background: The admission department as a first point of patients contact with hospital needed special attention. This study has tried to estimate number of needed personnel with work measurement of general functions of admission department.

Material & Methods: This study was a descriptive-analytical and practical research. This study tried to measure real and expected time and determined difficulty degree and skills needed for each task of admission department, then determined total work units and needed personnel in admission department of Children's Medical Center affiliated with Tehran University of medical sciences in 2009.

Results: Total work units in admission department were approximately 10780 units for one month. Counting at least 987 units for every person per month, the number of human resources needed for this unit was 11, while current number of human resources in this department is nine.

Conclusion: Finding of this study show that Children's Medical Center involves with inadequate human resources and multiple pressure due to insufficiency in mentioned department, and tries to promote the technology using in this department and increase the personnel and reset the payment system based on work load

The rate and causes of surgery cancellation: Identifying areas for improvement.

N Markazi Moghaddam

Background: Operating room efficiency is a major determinant of hospital cost. Maximizing throughput, while maintaining quality, is therefore paramount to maintenance of financial viability. Cancellation of surgery may increase a hospital's cost and affect the efficiency of operating room and waste of resources. This study was conducted to determine the rate and causes of canceled surgeries, and identifies areas for improvement in a teaching hospital in Tehran.

Material & Methods: We carried out a descriptive study of the reasons for canceling scheduled operations. Data were collected during 9 consecutive months. The reasons for cancellation were identified by theatre staff. We grouped all the reasons into 13 reasons. Other necessary information like operated surgery was obtained from IT department. Descriptive statistics (frequency, percentage, 95% confidence interval) were used to analyses of data. Statistical analyses were performed using SPSS and Excel Microsoft office.

Results: in this study, 18.2% of the 3381 scheduled operation were canceled on the day of surgery, 32.1% of them because of vascular surgery, followed by orthopedics (18.7%), general surgery (15.5%) and nose and throat surgery (13.7%). The common reasons for cancellation were lack of theatre time, clinical change in the patient's condition, lack of paraclinic tests and consultant's report on patient flow problems, blood preservation, drug and necessary equipment for surgery.

Conclusion: This study demonstrated that most cancellations of scheduled operation are due to hospital deficiencies and medical team reasons that most of them are preventable. Several changes like better infrastructural facilities, enhanced interdepartmental communication are suggested to try and reduce the cancellation rate.

The Relationship Between Services Quality and patient 's loyalty in Tehran Public and Private Hospitals:2009

S shahri

Background: the competitive of existing area in servicing organizations which are showing the desired services, the importance and satisfy customers and making content about their needs more than before.

Material & Methods: The present study descriptive survey of practical purpose and its method correlation study has been done. Statistical Society of this research is all referred patients to outpatient clinics in private and governmental hospitals at Tehran province(N=260). The data collecting tools have included two questionnaires, so for measuring of services quality was used from servqual standard questionnaire and part of parasoraman, zitamel and berry(1996) standard questionnaire about customer's behavioral tendencies for measuring of loyalty.

Results: T-test was used for comparing the average in private and governmental section at all the five dimentions and pierson correlation coefficient was used for determining the relation between one by one the five dimentions of services quality with patient 's loyalty and also used regression test. 36% of variance in patients' loyalty is due to components of service quality. A change of one unit in tangible factors, ensuring, and empathy results in 0.263, 0.285, and 0.116 change in patient 's loyalty, respectively. Regression model cannot make any prediction for other components because the significance levels of components are greater than 0.05.

Conclusion: whereas in this research there is meaningful relation between services quality and patient's loyaltyit seems that in such organizations the strategic application which cause the improving of qualitywill redound the increasing of patient'sloyalty and finally it will cause more profitability for hospitals.

Study of pre and post anxiety of coronary artery bypass graft surgery inpatients in hospitals affiliated With Tehran University of Medical Sciences

A pourreza

Background: Multiple environmental factors have roles in producing anxiety. Individualized differences and environmental conditions can affect the anxiety level. So, hospital environment and especially cardiac surgery ward have a great importance because they can save the patient's life.

Material & Methods: The present study is a descriptive- analytical one which has been conducted upon studying the level of anxiety pre and post coronary artery bypass graft surgery in the hospitals of Tehran University of Medical Sciences and preparing an educational program for such patients, was the other goal of the study.

Study population consists of 150 patients under examination that at the time of the study have been voluntaries to coronary artery bypass graft surgery. The sample was studied 24 hours before and weeks after surgery. The sample was selected randomly and data collected through a questionnaire with two separate parts. For the purpose of data analysis, SPSS software was employed.

Results: The result of the study shows that the level of anxiety before coronary artery bypass graft have been more than the level of anxiety after the operation. The difference between of the levels of anxiety have had significant relations with some of independent variables of the study such as sex, age, number of children and marital status, but there were not significant relations between occupation, educational level, non cardiac disease background, background of MI, non cardiac surgery background, the period of suffering from coronary disease background of hospitalization.

Conclusion: It seems that the men's ability to return to pre-operation socio-economic condition reduces their post operation anxiety. When people become older, they will be more fearful regarding the future's events but people older than 46 years old will obtain more life expectancy after surgery due to more extended familial relationship.

Married people experience less anxiety due to post operation, familial responsibilities and relief of cardiac symptoms. It can be concluded that anxiety reduction in these patients can result from cultural, socio-economic and demographic variables. Believes as cultural factors in the life have a great role in appearance and the level of anxiety.

Using The SERVQUAL model in perfomance Measurment of national program of Iranian Hospitals Evaluation

E Jaafari pooyan

Background: Various studies have highlighted the importance of accreditation as a ubiquitous performance measurement system of hospitals. However, the effectiveness of this mechanism has not been addressed, as much it deserves, in developing countries. Therefore, current study intends to investigate the performance of the system using the SERVQUAL model.
Material and Methods: This research is an applied and cross-sectional survey. Decision-making Board of Hamedan Hospitals (N= 200) constitutes the target group. A self-administered questionnaire including both structured and open-ended questions has been used for data collection. Analysis of the quantitative and qualitative data was conducted using SPSS and Thematic Content Analysis (TCA), respectively.
Results: Only 39 percent of the target group had high awareness of current accreditation programme. The highest rate of gap, 55.8%, between the group's perceptions and expectations from accreditation system, belonged to the indicator of staff's satisfaction and the lowest rate, 17.3%, to structures and establishments.
Conclusion: The low score of the target group's perceptions towards the accreditation programme could be a sign of the low degree of their satisfaction, which might result in their poor cooperation. More and effective attention to hospital managers' views, recommendations and reactions might be an appropriate preventive solution.

Key Success Factors in E-Learning and Preparation exact departments in Medical Education

H Emami

Background: As in many countries, Medical Education (ME) is offered in three levels including Undergraduate ME, Graduate ME, and Continuing ME. Information theology development has provided a suitable chance for ME. E-learning in ME is growing more and more. The present study seeks to determine the key success factors (KSF) in E-learning in medical fields.
Material and Methods: KSF has been scrutinized in the literature following of which, and due to similarity, a classification with seven groupings was established including institutional factor, technology, interested parties, information knowledge, methods and approaches educational resources, and environmental factors. Through a questionnaire, the data were gathered from the information technology (IT) directors in all medical universities throughout the country. The data collected were subjected to factorial analysis. Data from heads of educational groups were obtained through focus group discussion. Cronbach reliability coefficient was calculated for questionnaire used. Factorial analysis was used to identify meaningful KSF. T-Test, and one-way variance analysis as well as Pearson's correlation were used. The analysis was conducted with SPSS software.
Results: The preparedness factors were analyzed through group discussions with the heads of the academic departments under the study. By factorial analyses, five factors were found. Fisher Exeact Test was used to compare the obtained ratios in 5% curve whose results showed that among the three factors including legal and technical environment, specialized hardware and software, and high speed internet, performance interest and potentials showed a significant difference (p=0.002). A p=0.011 was found for the authorities' interest and financial and non-financial rewards. No other significant differences were found anywhere else.
Conclusion: Appropriate strategies to coordinate and aligned with the conditions that must be taken, including some of them can be cited : Document Perspective drawn by the Ministry of Health, Content production (medical, etc.) to the appropriate shape, Develop technical and communications infrastructure, First e-learning development in the field of basic science And then as a complementary training in Clinical Science, Develop and build information literacy skills among teachers and students And encourage them in this area, Platforms and create the appropriate structures and interactions necessary, Despite the virtual library, Drawing rules for the protection of creators and owners of content rights education, Culture correct and appropriate, Private sector participation in developing e-learning and ..so on

Survey on Nursing Service Quality by SERVQUAL at Tehran Social Security Organization Hospitals

M Mohammadnia

Background: However nurses are responsible for patients quality care legally and ethically, in other side, patients have rights to receive appropriate and quality care. The aim of this descriptive study was to explore SERVQUAL dimensions (Reliability, Responsiveness, Assurance and Empathy) of Nursing Service Quality (NSQ) at Tehran Social Security Organization (SSO) Hospitals.
Material and Methods: This study was carried out as an applied, descriptive and cross- sectional study during the summer and autumn of 2009 in Tehran SSO hospitals. Study tool was prepared on the basis of the standard and modified questionnaire of SERVQUAL based on Parasuraman, Zeithaml and Berry questionnaire (1988) for NSQ and consisted of 4 dimensions which were Reliability, Assurance, Empathy, and Responsiveness. The population for this study included of all inpatients of selected Tehran SSO hospitals who were selected by random sampling (N=200). For accounting Means, Standard Deviations and percents SPSS (ver. 16) have been used.
Result:The total percentage of NSQ was upper middle (66), prescriptively Reliability (74), Assurance (69) and Empathy (64) were the most ones and Responsiveness (58) was the lowest.
Conclusion: The results of this study showed that NSQ was in desired degree from patients` perspective in selected hospitals. The health care managers should have been attention to nursing as an important workforce of a hospital for raising the service quality of their organizations .Nurses are main role in quality care improvement and patients satisfaction. So, actions regarding to improve their performance are useful and necessary. Due to lowest score of Responsiveness among nursing staff, we suggest training courses for improving organizational culture on responding and effective communication to achieve high quality performance of all nursing group staff.

Improving Summative Evaluation of Clerkship for Health Services Management Students in Tabriz Faculty of Health and Nutrition, Using OSFE

JS Tabrizi

Background: Education and evaluation should be designed to educate and evaluate students in the real field or similar to their future work place. This study aimed to improve summative evaluation in internship.
Material & Methods: A quantitative (61 students) and qualitative (15 students) study with health services management students conducted in Tabriz Faculty of Health and Nutrition. OSFE was developed as a summative evaluation method based on students' experiences about final evaluation of clerkship, which ascertained using two FGDs. In the OSFE method students attended in the several stations to do particular skills individually. In each station students' skill has been assessed by a trained examiner using standard checklists. At the end of exam, students' opinion about new method has been asked through qualitative and quantitative methods. Qualitative data analyzed by hand and SPSS software was used to analyze quantitative data.
Results: Findings from FGDs (after OSFE) showed that the majority of students were satisfied about OSFE and they believed that it is a good method to assess students' skills and competencies. Quantitative study also demonstrated that 74% of students believed that OSFE is a good method to evaluate their capabilities and 70% verified that they have been attended in an orientation session about OSFE. Moreover, 58% considered OSFE as an equitable method.
Conclusion: It can be suggested that OSFE could be used as a valuable summative evaluation method for non-medical students' clerkship and practical courses.

Review of corruption in the health Sector: theory, methods and interventions

Hossein Joodaki

As health care delivery systems develop, and their cost - as a percentage of total society expenditure - increases, policy-makers are more and more concerned about how to control these spiraling costs. An important section of policy makers' efforts to reduce costs is concentrated on preventing wastage in the health system. While a significant part of the resource wastage is due to inefficiencies in health system delivery, corruption and health care fraud and abuse are also to blame. The nature and the rate of corruption in the health care differ from one country to another. Still all countries encounter this problem and invest in interventions to combat corruption. Here we provide the readers with translated version of a very useful and readable paper by Vian. The paper reviews and summarizes the theories, methods, and interventions to combating corruption in health care.