Hospital

Developing a national accreditation model via Delphi Technique

F Gharibi

Background: Accreditation is one of the evaluation systems which have numerous effects on the key indicators in health care system. To develop a suitable accreditation model, a best way could be the benchmark of the powerful and successful accreditation models in all over the world. By considering likely differences in the various countries health systems, this study aims to survey the compatibility of the best accreditation models and standards in Islamic Republic of Iran's health care system.
Materials & Methods: In this study, the expert's perspectives have been ascertained about standards of selected references accreditation models based on standards "importance" and "feasibility" using two rounds Delphi Technique. The experts selected among scientific and academic experts in the areas of accreditation and health services management. They were asked to fill up the Delphi questionnaire and send back it to the researchers in the designated time. Each standard scored in Likert scale from 1 to 9. Standards with mean score of ≤ 3 were rejected, standards with mean score between 4 and 6 send to the second round and standards with mean score ≥ 7 included in the national model.
Results: In the first round, 20 out of 27 questionnaires have been obtained from experts. After data analyses all the standards have been accepted except 31 with mean score between 4 and 6. Remained 31 standards with achieved mean scores in first round, send back to the study experts through the second round. In the second round, 17 out of 20 questionnaires collected and finally 18 standards were rejected.
Conclusion: According to the variety of standards, comprehensive categories and richness of necessary details of standards, the resulted model in this study could be a rich and suitable model for Islamic Republic of Iran. Therefore, using this model could empower evaluation system and improve the quality of health care system.

Validation of Farsi version of hospital survey on patient Safety culture questionnaire, using confirmatory factor analysis method

M Arab

Background: Patient safety is one of the most important components of health care quality. Given that assessing the current culture of patient safety is the first step in improving patient safety, we decided to translate and validate one of the most used patient safety culture assessment tool (HSOPS questionnaire) for the first time in Iran, and in this way take a step toward improving patient safety in our hospitals.
Materials & Methods: This cross sectional study was done among four general hospitals of Tehran University of Medical Sciences (TUMS), which were selected purposefully. Questionnaires randomly distributed among 420 members of the study population, and were collected after completion. Results were analyzed using Confirmatory Factor Analysis (CFA), internal Consistency and correlation.
Results: The value of Fitness function (FF) was 14.25 and according to that, the value of Goodness of Fit Index (GFI) was 0.96. Almost in all of the dimensions, the internal consistency of items in the translated Persian questionnaire was lower than the original one and ranged between 0.57 to 0.8.
Conclusion: Regarding to the findings of this study the Persian translation of the HSOPS questionnaire is a valid tool for the assessment of patient safety culture in Iran's hospitals.

Relationship between official performance measurement scores and Relative efficiency in general hospitals

Alireza Ilbeigi

Background: The aim of this research was to measure and compare relative efficiency of general hospitals under supervision of Mashhad University of Medical Sciences (MUMS). The study also seek to investigate the likely relationship between the official evaluating scores reported by MUMS with findings of this study.
Materials & Methods: Data Envelopment Analysis (DEA) is utilized to determine relative efficiency of individual decision making units (DMUs). From state-run general hospitals in this study, 17 were selected based on the criteria suggested by the model. To distinguish efficient hospitals from inefficient ones, revised input-based BCC model was used incorporating ‘number of physicians' and ‘number of nurses' as inputs. Outputs were set as ‘the rate of inpatient days to staffed beds', ‘outpatient visits' and ‘number of surgeries' reported both at emergency and wards.
Results: The findings based on both CRS and VRS simulations indicate that the mean of technical efficiency was 0.823, mean managerial efficiency was 0.931 and subsequently mean scale efficiency was 0.881. It was further noticed that, there was no significant relationship between the performance appraisal outcomes from DEA model, and scores allocated to each hospital through official evaluation system.
Conclusion: Current official appraisal system based on pre-defined checklists may not be a reliable mean for evaluating and ranking efficiency of general hospitals.

Relationship between job burnout and mental health of nurses working in province of Qom

Mehdi Asghari

Background: Job Burnout is one of the important factors to reduce productivity, making mental and physical adverse effects on jobs related to human services and losing efficient manpower by considering the important role of nurses in the health care systems. This study has been done to survey the association between mental health and job burnout syndrome among nurses' staff in training hospitals in Qom province.

Materials & Methods: This is an analytic-descriptive study which has been performed among 200 nurses personnel in the training hospitals of Qom province with applying proboblity multistage statistical method.Three quetionnaires including demographic data,general health and Maslach,s Burnout questionnaire (Inventory) were used to data gathering by which validity and reliability were certified in the previous studies. Data analyzed by SPSS18. Descriptive statistics such as frequency, percentage, inferential statistics (Chi-square test and correlation coefficient of spearman and pearson) and also man-whitney test applied.
Results: Average score of job burnout was 60.8. Respecting general health, 53% of nurses was in danger. Average score of emotional fatique,the personalization and personal accomplishment was 27.2,12.17 and 21.7,respectively. 50 percent of nurses had physical dysfunction,44.5% suffered from anxiety and sleep disorders, 32.5 and 44.5% had social dysfunction and depression, respectively. There was a significant correlation between burnout syndrome and general health. Based on the spearman correlation test, there was a significant correlation between emotional fatique and physical disorders, anxiety and sleep disorders and social dysfunction.
Conclusion: Regarding srtessful nature of nursing job and high prevalence of disorders in general and mental health of nurses incomparision to others and also high prevalence of burnout among nurses in Qom province,it is nesecary to decrease these sort of problems through applying arrangements such as enhancing motivation, increasing work stability, increasing job satisfaction, clearance in how individuals respond to take actions and tasks division among personnels to reduce workload.

Study of patients'safety culture in Selected Training hospitals affiliated whith Tehran university of medical sciences

Farbod Ebadi fard azar

Background: Patients' safety is a critical component of health care quality. As health care organizations continually strive to improve, there is important growing recognize of establishing a culture of patients' safety. To establish a safety culture in a healthcare organization, the first step is measuring the current culture. The aim of the study was to measure physicians, nurses and Para clinical personnel perceptions in patient safety culture in Tehran's selected hospitals, and to compare findings with U.S. hospitals.
Materials & Methods: Physicians, nurses, and Para clinical personnel who worked in training hospitals affiliated with Tehran university of medical sciences were asked to complete a self-administrated patients' safety culture survey (n = 145). Data collection was carried by using the Persian version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Cronbach's alpha and chi-square tests were employed in statistical analyses.
Results: Among the dimensions of patients' safety culture with the highest percentage of positive responses the teamwork within units (67%) was higher, whereas that with the lowest percentage of positive responses was non-punitive response to error (51%). Except to Handoffs and transitions dimension the entire dimension scores were lower than the benchmark scores. The study revealed that more than half of the participants were not reported the errors.
Conclusion: Improving patients' safety culture should be a priority among hospital administrators. Meanwhile, Healthcare staff should be encouraged to report errors without fear of punishment action.

Technical efficiency analyses in hospitals of Tabriz University of Medical Sciences

Alireza Dadashi

Background: The hospital is one of the main organizations which offering health care and medical services in a high level allocated sources in the health sectors. Therefore, considering to efficiency costs is great importance. This study aims in considering the efficiency of the hospitals of Medical University in Tabriz, Iran, by using Data Exhaustive Analysis Method.
Materials & Methods: The study inspected and analyzed the technical efficiency and also effective factors on it in selected hospitals by using Data Exhaustive Analysis Method during the 3 period years (1384-1387). In order to conduct this study, the comprehensive Input-oriented Form of Data Exhaustive Analysis Method assuming in the variable return compared with the scale. The variables of the inputs in this study included number of physicians, non-physician staff, and active bed and annual costs of the hospital. The variables of the outputs included the coefficient of the occupied beds, number of admitted patients, and surgeries. To data analyzing, SPSS and data envelopment analysis software were used. It is worth mention that the data in this study were accumulated by using the forms devised by the authors and standardized questionnaire via referring and going to the hospitals.
Results: The findings of data exhaustive analysis method showed that there was %5(TE=0/953) possible capacity augment in the technical efficiency. The findings also suggest that there is a potential frugality in consuming the inputs in order to produce a constant amount of the output. Meanwhile, there is a potential augment of the output by using a constant amount of the input, as well. The findings also represent the effect of the demographic factors and functional factors on the efficiency of the hospitals.
Conclusion: It is suggested that to leave out the surplus staff, decrease the surplus costs of the hospital through replacing the energy consumption and a proper management of energy and other surplus inputs, hire sophisticated managers and applying the graduated field of management in health care and medical services and also hire the managers with high quality degrees, create the data envelopment analysis of enhancing efficiency should be one of the useful way to provide qualified medical services in our society as a comprehensive programming. Based on the findings of the data Exhaustive analysis method, improving the efficiency of the hospitals, health care system and medical section are essential as well.

Study of payment methods to Doctors in the referral system in selected countries and suggestions for Iranian social security organization- Direct medical service provision

Masoud Ferdosi

Background: Payment method is one of the most important control knobs in the health system. All organizations that mobilize funds for health sector must be decided: who should be paid? Why this money should be paid to them? And how much should be paid? So the main purpose of this study is to identify different methods of paying to the doctors in referral system of selected countries, and ultimately providing some suggestions for Iranian social security organizations- direct medical service provision.
Materials & Methods: This was a comparative study designed in 2008. First we studied theoretical issues and analyzed them within the framework of the current situation. Then we conducted a comparative study to find some solutions for it. Then we validated selected suggestions using by Delphi technique.
Results: Most selected countries use a combination of methods to pay to the physicians. Usually for employed physicians in insurance organizations, salary makes a large part of doctor`s income. In countries where GPs play the role of gatekeeper, the per capita payment method has a special room. In American Health Maintenance Organizations (HMOs), based on employment or contractual relationship, they pay physicians by one of three methods: "Per Capita", "Salary Monthly" or "Prepayment". In addition to Salaries (if any employment relationship), specialists usually receive some fees for their Services widely.
Conclusion: Bonus payment in exchange for quality indicators is considered as a recently developed payment method for both GPs and specialists, but due to wide infrastructures, it needs accurate designing and plenty of arrangements.

An introduction to hospital sites selection and design

Mehdi Eshlaghi

Background: The hospital is an important element in the new public health. The health in the populations requires access to the medical and hospital services as well as preventive care and a healthy environment. This study attempts to review the important factors to be considered in the hospital sites selected and design in the urban, regional and country levels. Finally, suggestions have exhibited to the hospital sites selected and design for its optimum and efficiency. It's also suggests proposals for appropriate site selected and design of hospitals for optimum efficiency.
Materials & Methods: This is a review article which documentary method and Internet search have been employed.
Results: What principles do you use to decide on the location and layout of a new or expanded site selection? What information do you need to consider before selecting a site location? How do you maximize inherently safer design with minimal impact on the cost and schedule? How do you manage sitting issues when limited space is available? How do you address security concerns in a new site? These questions are considered cases in paper to attempt to answer it.
Conclusion: To determine the feasibility of the project, the first consideration in the survey is to study the character, needs and possibilities of the community which the hospital is going to serve. The hospital facilities in the region should be studied in terms of:
• Population of the region
• Quality and number of hospitals
• Patient and disease pattern
• Cost of investigation and treatment
• Physical and Environmental characteristics of the site
This study considers the specific problems of creating a well distributed network of hospitals that deliver its services to the target population in minimal time, pollution and cost. The study has showed that if these criteria considered, it would assessed the extent to which authorities of hospital planning and administration have utilized in the planning.