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M Arab, S Fazayeli, M Mohamadpour, V Pirmoazen, M Yousefi,
Volume 8, Issue 3 (7 2010)
Abstract
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
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Volume 8, Issue 5 (21 2009)
Abstract
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Volume 10, Issue 3 (23 2011)
Abstract
Seyed A Alavi , A Ahmadabadi , M Molaei Qelichi , V Pato , K Borhani ,
Volume 12, Issue 2 (9-2013)
Abstract
Background: In Iran, the rapid growth of urbanization is in a way that it fits into the appropriate location for urban spaces are not switching. The main consequence of this is failure of service delivery and service system to citizens. One of the most important public services that hospitals provide most of the citizens' health. The purpose of this study, “Optimal locating of hospitals in region 7 in Tehran city”.
Material and methods: This research is descriptive - analytical study has been done. For collecting information and data is used field studies and According to information obtained, To review the study area in terms of access to communication road, green space, away from industrial centers, military, and the fault, as well as for weighting the criteria, is used the AHP model. Then, using a decision model of TOPSIS in GIS software, valuation of criteria has been studied and appropriate maps is prepared, finally map that represents the best location for the construction of hospitals in this area is extracted.
Results: with combination and overlaying of data layers, the final map was obtained and determined that the northeastern section (Cross Resalat Street and cabli), central (martyr Motahari streets and Miremad) and southeast (Bakhshi fard and part of Damavand street) in district 7 are have priority and more points to construct hospitals.
Conclusion : System of Multi Criteria Decision Making (MCDM) with GIS can be used as effective tool in site selection of hospitals. Being located of hospitals, near to green spaces and comunication road and its distance from the industrial and military areas as well as the fault, capability of this model in this study is prove.
M Mayel Afshar , A Pourreza , M Memarpour ,
Volume 12, Issue 2 (9-2013)
Abstract
Background: One of the behaviors taken into consideration in organizations such as hospitals is organizational citizenship behavior. Recent studies have shown that organization employees show interest in organizational citizenship behavior and this subject may be influenced by demographic specifications.This study aims to determine the relationship between organizational citizenship behavior and demographic specification (gender, age, marital status, educational qualifications, salary&wage ,ethnicity,employment type, work type, organizational post, place of employment and work experience) among selected hospitals employees of selected hospitals of Tehran and Shahid Beheshti Medical Sciencesis Universities. Materials and Methods: This research has been implemented in six selected Hospitals of Tehran and Shahid Beheshti Medical Sciencesis Universities and data was collected by distributing a questionnaire among 429 employees of these hospitals using a two-stages random sampling method.The research methodology has been cross-sectional- descriptive using field study. In order to accept or reject the research hypothesis kruskal-wallis and mann-whitneyU tests have been used. Results: Results showed that, the most studied demographic characteristics have an effect on organizational citizenship behavior of the staff of selected hospitals employees in Tehran and Shahid Beheshti Universities of Medical Sciences. Conclusion: Findings of this research indicated that men have shown more organizational citizenship behavior compared to women, Married people have shown higher organizational citizenship behavior compared to single and divorced people and people in the age class of 50 to 54 years have been the highest organizational citizenship behavior average. In addition to, people with master degree, have been the highest organizational citizenship behavior. Also our findings show that Ethnicity does not have effect on the incidence of organizational citizenship behavior.
R Baradaran Kazemzadeh , M Sepehri , F Firouzi Jahantigh ,
Volume 12, Issue 4 (3-2014)
Abstract
Background and purpose: Hospital is the largest and most important executive unit of healthcare system therefore, full consideration of how to assess its quality is of particular importance. A question is always raised as how to evaluate the quality of the services. The current study seeks to provide a fuzzy model for assessing the service quality in this healthcare sector.
Material and method: The present cross-sectional study was conducted in two hospitals in Zahedan 2012.Via reviewing the related literature, the dimensions and components of service quality assessment were identified. The SERVQUAL questionnaire for hierarchical analyses was designed and the fuzzy AHP (Analytical Hierarchy Process) model was presented. SPSS v 10.0 and Fuzzy TOPSIS Solver 2013 software were used to analyze data.
Results: The findings indicated that the most important dimension for estimating the quality of healthcare services was empathy. Responsiveness, assurance, and tangible assets were the last important factors. The hospitals were compared using fuzzy AHP. According to the calculations, the ranking of the hospitals based on their performance was as follows: Imam Ali hospital with 31% compared to Social Security hospital with 29% had a better performance in service quality.
Conclusion: The results revealed that hospitals needed to focus more on empathy, expertise and reliability than providing high quality and satisfactory services. By considering their weaknesses, each of these hospitals can enhance service quality and consequently, provide a better service for patients.
M Yousefi , A Assari Arani , B Sahabi , A Kazemnejad ,
Volume 12, Issue 4 (3-2014)
Abstract
Background: Today, the lack of financial protection against the health costs is recognized as a major flaw in the health systems. It seems that the first step towards solving this problem is exact identification of household health expenditure`s components which will result in better selection of prevention policies and appropriate procedures to solve the problem.
Materials and Methods: This study is a qualitative research conducted in two stages. The first stage consisted of interview with a sample formed by households from eight provinces of the country to identify the different components of household health expenditure. After that, a panel of experts categorized the identified components to direct and indirect costs.
Results: In The first stage, 93 kinds of households’ health expenditure were identified. In the next stage, 61 cases of these were categorized as direct costs and the other 32 cases were categorized as indirect costs.
Conclusion: The exact identification of the components of health expenditure of households and dividing them into two categories of direct and indirect costs can be useful for a more accurate calculation of the household health expenditure in future studies.
Sh Nosratnejad , A Purreza , M Moieni , H Heydari ,
Volume 13, Issue 2 (8-2014)
Abstract
Background: Nowadays Social health insurance does not cover all health expenditures because of increasing cost of diagnosis and treatment services which results in private insurer entry to health market. This study is aimed to determine key indicators which have important effect on the demand for private health. This identification of indicators leads to better planning for prospering private health insurance.
Material & Method: This is a a descriptive and analytical study. The data were collected by questionnaires which has been filled by a sample of 950 households .The samples had been chosen by three-stage cluster sampling. The model had been estimated by econometric methods based on models of Probit and extreme value distribution..
Result: The result indicated that having basic health insurance, doing exercise each day routinely, having regular medical checks, being landlord and being retired raised the probability of demand for private health insurance. On the other hand, demanding private health insurance is less common among older adults and people who use to wear seat belts.
Conclusion: Identification of important factors which influence the demand for private health insurance would assist policy makers to provide essential structures for expanding private health insurance coverage.
Master Science Mohsen Afsahi, Dr. Mohammad Mehdi Sepehri, Master Ehsan Ameri,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Deciding on the number of hospital beds is one of the most serious challenges managers face. More hospital beds result in higher running cost although less hospital beds might cause disorder in patients flow. Minimizing total cost besides maximizing the patients flow in a hospital network, considering the practical limitations is the main objective of this survey.
Materials & Methods: This study had main steps to investigate following: identifying current limitations of changing capacity of each ward, by conducting interview with hospital managers and other personnel of Modares hospital, analyzing cardiac patient flow analysis, simulating current flow, determining practical scenarios and choosing the best among them by mathematical modeling could minimize total cost and maximize patient flow.
Results: 31 practical scenarios have been determined and analyzed by surveying limitations among all existing scenarios. Finally, eight best scenarios had been selected. Results showed that decreasing the number of beds in CCU and increasing the number of beds in Post-CCU can improve patients flow, considering cost limitations.
Conclusion: A recommended approach in this study can be a general guide for capacity planning with taking practical limitations into consideration. This survey could be useful for the managers who are against the benefits of post CCU by comparing the patient flow with and without this ward.
Neda Asadi, Zahra Royani,
Volume 14, Issue 2 (8-2015)
Abstract
Background: Depression is a common disorder with incremental trend among patients with hemodialysis. This study conducted in order to determine correlation between social support and depression among patients undergoing hemodialysis of Kerman city.
Materials and Methods: This study was a cross-sectional one. 182 hemodialysis patients referred to health centers of Kerman were selected by census sampling method. data was collected Using questionnaires including demographic information, Beck's Depression Questionnaire (BDI) and Social Support Questionnaire (ESSI: Enriched Social Support Instrument) and analyzed by SPSS software version 17 utilizing descriptive statistics (mean and standard deviation) and Pearson Correlation Coefficient test.
Results: 68.1% of the subjects had some degree of depression. Also, 83% of participants reported good social support. Furthermore, Assessing the relation between depression and social support revealed an inverse relationship between depression and social support (P =0.005), increasing social support occurred decreasing depression as well.
Conclusion: Study results indicated high prevalence of depression among the patients. It seems special attention in should be paid to psychological issues in hemodialysis wards. Nurses can prevent depression incidence by recognizing high risk individuals in term of perceiving social support among these patients.
Masoumeh Saeedian, Mohammadmehdi Sepehri, Hassan Aghajani, Toktam Khatibi,
Volume 14, Issue 3 (9-2015)
Abstract
Background: Myocardial Infarction (MI) is the most common cause of death in developed and developing countries. Based on World Health Organization prediction, MI will be the leading cause of death in the world up to 2020. The main goal of acute myocardial infarction therapy is reperfusion which is performed by two treatment approaches, although these two methods use for unique complication treatment but they are different in treatment cost and quality; Since the costs of health care is growing, this study aimed at identifying affected differentiated costs among patients with acute MI with the purpose of providing a framework to compare two treatment methods.
Materials and Methods: In presented model in current study, with the purpose of select affecting cost attributes utilized hybrid of Genetic algorithm and decision tree approach as a new method and compare its result using random method.
Results: Study result presented classifies error reduction up to 0.2 compare with random method error. Then, based on selected attributes, presented a framework comparing two treatment methods. Also, in the majority of direct cost and total cost, Primary Angioplasty was cost effective more than Thrombolytic Therapy, but in indirect cost, we achieved some results dissimilar to physicians' expected results such as kidney failure.
Conclusion: Suggested approach in this research can be a guidance to physicians and insurances institutes in acute myocardial infarction treatment policies.
Dr Bakhtiar Ostadi, Ms Asrin Navidi,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Since, energy consumption per square meter in hospitals is much higher than other types of service institutions; in this study, some actions performed toward optimizing energy consumption improvement projects based on the definition and prioritization in hospital.
Materials and Methods: The necessity of optimizing energy consumption in hospitals were described according to some scales including the average consumption and cost of water, electricity and gas for bed days and active bed, and these indices calculated in the case. Then, improvement actions were identified using energy audit, interviews with hospital experts and conducted studies in hospitals. Next, projects with high importance were extracted regarding to impact on energy consumption indices, expert opinion, aggregation, feasibility, and limitations such as prerequisite, synchronicity and post-requisite. Finally, specific criteria were identified in three dimensions, i.e., factors affecting the level of energy consumption, trying to execute project and risk and the projects were prioritized using questionnaire and FAHP.
Results: The study results revealed that energy consumption was higher than the world standards in the studied hospital; this confirmed the necessity of optimizing energy consumption and using energy management systems. The results of prioritization also showed the first four priorities.
Conclusion: It seems necessary to save energy consumption through improvement projects implementation in the hospitals. Regarding the number and resources limitation, hospitals can choose to implement some low risk and payback period projects based on existing priority and budget annually.
Zohreh Kaheh, Dr Ali Husseinzadeh Kashan,
Volume 15, Issue 4 (1-2017)
Abstract
Background: medical centers location is one of the most important problems, which should be considered in different dimensions to improve the services. In this paper, we consider the hierarchical maximum covering problem for bi-level healthcare systems including Clinics and hospitals, by taking the service rates into account. In this problem, the initial objective is minimizing the uncovered demand nodes, and secondary objective is the minimizing the lost demand rate as a measure of potentially patients’ retention in coverage radius.
Methods: In this paper, the serving system in the Tehran heart center hospital is considered for queue analyses. The proposed method is a mathematical optimization model called probabilistic two-stage programming model. To evaluate this model, a number of numerical problems are solved through GAMS software.
Results: according to the results, we have found that the best condition for locating the medical centers is that the clinic are located adjacent to a hospital. Decision making about the location problem by considering the service rate in each healthcare centers, increases the reliability to the result of the optimization model.
Conclusion: The proposed model is able to help the decision makers to attain an optimized decision for locating the medical centers in deprived areas, inspired by the medical centers in areas with similar population. Therefore, if the clinics and hospitals are located by considering the hierarchical mode and their service rates, the patients’ welfare will be enhanced.
Mahdieh Tavakoli, Mohssen Ghanavatinejad, Fatemeh Jalalifar, Dr Elham Yavari,
Volume 17, Issue 4 (2-2019)
Abstract
Background: The admission unit is the main entrance of the hospital and the first patient communication with the hospital is through this unit. The waiting time of patients, which is one of the main consequent of this unit, is not only one of the important factors affecting the satisfaction of the patients, but also is one of indicators of the quality of service of the hospital. This study aimed to provide scenarios at reducing patients’ waiting times.
Materials and Methods: This research in terms of methods and goals was a descriptive and an applied one, respectively. This study performed on 110 patients who had been admitted to the Mohb-e-Mehr hospital during 70 days and were uniformly trained on all days of the week. Information was also obtained using observation and data recording in prepared forms. The simulation model was designed and implemented with the Arena 14 software.
Results: Based on research findings, the para-clinical unit and the waiting room for hospitalization were two main bottlenecks in the studied system. In order to solve the problem, for each of the above units, a scenario designed and simulated. The implementation of these tests revealed that the proposed scenarios in comparison with the existing conditions had better results in reducing the waiting time and also increasing the number of admitted patients.
Conclusion: Improvement of the therapeutic processes will occur through the recognition of the hospital services system and analysis of the bottlenecks and its weakness points. According to the results, an increase in the number of para-clinical unit staff and hospital beds improves the hospital admission function. The implementation of mentioned scenarios reduces waiting time for patients by about 78% and reduces the waiting time for emptying the bed by about 50%.
Iman Dehghan, Dr Bakhtiar Ostadi, Dr Saeid Hosseini,
Volume 17, Issue 4 (2-2019)
Abstract
Background: The operating rooms in each health center are one of the most sensitive units in the center, whereas scheduling and scheduling operations are in particular importance and their optimization has a significant effect on the optimization of the whole complex. The scheduling of heart surgery in addition to the limitations of manpower, time, and facilities includes the limitation of the patient's surgical deadline, which is the purpose of the surgical scheduling given this parameter.
Materials and Methods: In this quantitative study, an algorithm containing 3 + 1 function was proposed. This algorithm also addresses uncertainty while monitoring the limitations of available resources and the maximum delay for surgery. In this study, patients categorize to emergency and non-emergency patients which only the scheduling of non-emergency patients is considered. In this study 343 patient was studied.
Results: Based on a six-month period information reviewing from Shahid Rajaie Cardiovascular Center in Tehran, a 11% improvement has been made in respecting the maximum delay for the patient's referral process. The optimization rate is often related to the difference in patient selection based on their deadline for surgery, which in the present algorithm has been a major contributor to the denial of service patients. Another advantage of the proposed algorithm is the dynamic process of the algorithm and appropriate response to the changes.
Conclusion: The longer the length of the queue, the lower the chance of accepting non-emergency patients with the shorter maximum delays.
Dr Bakhtiar Ostadi, Reza Mokhtarian Daloie, Dr Mohamad Mahdi Sepehri,
Volume 17, Issue 4 (2-2019)
Abstract
Background: Today, hospitals have faced many requests for quality services, while their costs are increasingly growing as well. These facts; Therefore, necessitate much more attention from hospital mangers in order to reduce healthcare costs. Moreover, the urgent need for a precise costing approach is more evident. Activity-based costing provides useful information on the activities required to achieve services with desirable quality. However, given that the basic information for ABC system is provided under conditions of certainty, the possibility of using this approach in terms of uncertainty would be greatly decreased. This study aims to propose a new framework called FL-ABC.
Materials and Methods: Since, costing processes environment happen under conditions of uncertainty in the hospital, fuzzy logic in the ABC model was used in order to make more accurate estimates of hospital costs and increase the reliability of the results.
Results: This proposed model was used in a hospital lab unit and the results were compared with the standard ABC system. The results showed that the maximum difference in the prescribed costs was 77708951.89 and 67508112.57 IRR in serology and parasitology tests, respectively, mostly due to uncertainty in the assigned costs to each activity.
Conclusion: The FL-ABC system, in terms of taking into account the uncertainty in the parameters of cost, provides more accurate estimates of the cost of activities under conditions of uncertainty which estimates the costs of health care services more accurately.
Mohssen Ghanavatinejad, Mahdieh Tavakoli, Dr Mohamadmehdi Sepehri,
Volume 18, Issue 3 (10-2019)
Abstract
Background: with increasing demand for treatment, patients are monitored with help of Internet of Things(IOT). Patient's monitoring devices and technologies include heart rate measurement, blood pressure measurement, blood glucose and other vital signs. The purpose of study is to provide a model of clustering patient physical monitoring gadgets and apps in Healthcare Internet of Things (HIOT) environment using data mining techniques, so based on the needs and characteristics of the user, the more appropriate results of choosing technologies acquired.
Materials and methods: This study is a review and functional since its result. The data includes 6 unique features of 60 selected technologies including function, price, connectivity route, power supply, location and type of use that has been extracted from R&D and advertising sites of technologies and also relevant articles. data analysis method is clustering technique and K-medoids algorithm. to identify the most effective features, random forest algorithm has been used.
Results: the proposed clustering model takes into account 6 as inputs and clusters gadgets and apps in accordance with selected characteristics as the model outputs. clustering problem data is clustered in 4 categories. Silhouette index is 0.45, which indicates the validity of the model. The type of application and then the price had the greatest impact on clustering.
Conclusion: By this model, patients or users can find the most appropriate technology based on the type of disease and other effective features, such as price. So with accurate physical and momentary monitoring, disease progression decrease and prevention of disease will improve.
Nader Markazi Moghadam, Sanaz Zargar, Zaniar Ghaderi, Ehsan Tofighi,
Volume 19, Issue 1 (4-2020)
Abstract
Background: Hospitals play a key role in ensuring community health. Among the hospital departments, the surgery room accounts for a significant portion of the cost and revenue of the hospital. Surgery timing is important to increase the efficiency of operating rooms. The purpose of this study was to optimize surgical hall scheduling based on discrete event simulation model.
Materials & Methods: This cross-sectional study was performed in the summer of 2018 in the operation room of one of the hospitals in Tehran. As people entered the operation room, their information about the cause and condition that caused the surgery, the type of surgery (elective or emergency) the time of being in the operation was recorded by details. Data analysis was performed SPSS software and simulation of therapeutic system was performed Arena software.
Results: By analyzing the input data of 625 patients during three months, more than 60% of patients were men and less than 40% were women. The first entry into the surgery room for the selected patients was at 7:10 am and the last was at 5:00 pm. Of the eight scenarios presented, two arrival rate correction scenarios (noon arrival distribution) and a combined scenario (noon queue correction and patient adding) resulted in the greatest reduction in waiting time.
Conclusion: The results of this study showed that changing the distribution of patients 'arrival to hours with less input time can decrease patients' waiting time and increase the efficiency of surgery room.
Bahare Rahmani Manshadi, Bakhtiar Ostadi, Amirhosein Jalali,
Volume 20, Issue 2 (9-2021)
Abstract
Background: The waiting list is a list of selected patients in the surgical queue. If demand exceeds capacity, the waiting list grows rapidly, which may lead to unacceptable waiting for patients, especially those in need of acute medical care. Patients waiting for heart surgery are placed on the waiting list for surgery, and sometimes the waiting time is longer than patients expect. Reducing the waiting time for medical services, including heart surgery, is one of the challenges of the health system. In this regard, the present study was performed by identifying an effective solution to reduce the queue length of patients undergoing cardiac surgery.
Materials and Methods: In this article, the process of scheduling open heart surgery at Shahid Rajaei Hospital was reviewed and improved with a discrete event simulation approach in Arena simulation software. After designing the process, the existing bottlenecks leading to the long waiting time of the patients were identified. The waiting time and the number of patients visited were determined as the objective function and the patient flow was improved by presenting improvement scenarios and selecting the best scenario.
Results: Simulation results on 66 selected patients in 7 months from October 2020 to May 27, 2021 show that Scenario number 10 has the most improvement in performance criteria but is not applicable in practice. Therefore, due to system limitations, Scenario 2 was selected as the best scenario. Implementing Scenario 2 could reduce the waiting time by 40 percent and increase the number of patients visited by 21 percent.
Conclusion: Patient prioritization methods allow patients with higher needs to receive more services than those with lower urgent needs, although they also have longer waiting times for patients with lower urgent needs.
Sara Souri, Mohammad Ghafari, Hossein Shirazi, Seyed Hamid Khodadad Hosseini,
Volume 21, Issue 3 (12-2022)
Abstract
Background: Brand citizenship behavior is one of the new concepts in branding with emphasis on the role of employees. This study aims to provide a model for development of brand citizenship behavior in a way that is compatible with the local environment of medical tourism in Iran.
Materials & Methods: The present qualitative research is based on the systematic database method. The required data were collected through semi-structured interviews with 16 experts in medical tourism and academic experts using judgmental, snowball, and accessible sampling methods, following the saturation rule. Data analysis was done using the Strauss and Corbin model and in three stages of open, central and selective coding.
Results: Brand citizenship behavior is created as a result of causal conditions, including factors related to employees, organizations, and tourists, and through human resource support strategies and comprehensive marketing and branding planning with the influence of intervening factors, including organizational structure, management performance, characteristics of the treatment industry, Environmental factors, career history and personal quality of life are implemented in the framework of the social capital of the organization, organizational justice, quality of work life, competitive atmosphere of the work environment and social responsibility of the organization and lead to consequences related to tourists, organizations, employees and extra-organizations.
Conclusion: The model obtained from this research shows the influence of several factors in the formation of brand citizenship behavior of medical staff, which, if paid attention to by managers, will lead to the satisfaction and attraction of tourists and gain a competitive advantage.
