Journal of

---

Background: Quality management as an organizational strategy helps enhance hospital efficiency, effectiveness and productivity. This study aimed to examine the impact of quality management on employees’ job satisfaction at Respiratory Intensive Care unit, Labafijejad Hospital.

Materials and Methods: A participatory action research was used for the intervention in 2013. A quality improvement team was established and operational processes were improved using a quality management model. The quality improvement team identified and standardized working processes, identified quality goals for the processes and improved them until achieved quality goals. Employees’ job satisfaction data was collected before and after the intervention.

Results: The quality management model implementation improved employees’ job satisfaction at the Respiratory Intensive Care unit. Employees’ job satisfaction was increased from 56.6 percent in 2013 to 68.3 percent in 2014. Integrating employees’ needs in quality improvement activities helps sustain the benefits of quality management. As a result, employees’ moral and satisfaction increase.

Conclusions: Implementing an appropriate quality management model appropriately in a supportive environment helps enhance employees’ job satisfaction and morale. Managers' and employees' commitment and involvement in quality improvement activities are required for successful quality management implementation.

---

Background: Type 2 diabetes is a chronic disease which has incremental prevalence regarding to unhealthy lifestyle. Based on the significant gap between received and standard care in patients with type 2 diabetes, this condition occurred high costs to health system. In order to eliminate this gap, this study aimed at measuring the technical quality of perceived care among patients with type 2 diabetes.

Materials and method: A cross-sectional study was carried out among 180 people with two type of diabetes in diabetes clinic using convenience sampling method. A three part questionnaire includes demographic information, disease statue and the technical quality questions was that the validity and reliability of it was approved.  The data were analyzed using SPSS13software.

Results: Total technical quality score was 2.9 which was lower than bench mark 5. The main indices related to diabetic control (HbA_1c, blood pressure, LDL) were acceptable regarding Iranian diabetic guideline and they were controlled well.

Conclusion: According to notable gap between existing standards and perceived care in type 2 diabetic patients, there is a good opportunity to promote quality of services.

---

Background: Informative hospital website is a suitable system to exchange information between patients, hospital and health professionals and attracting consumers in hospitals. This study aimed at determining quality indicators of hospitals' websites.

Materials and Methods: A literature review study was performed by searching in different databases  such as ProQuest, Ovid, Science direct, Scopus, Google scholar, PMC, PubMed  and Persian Electronic Databases  like  Iranmedex ،Magiran ، SID, Iran doc)  using Quality and Hospital website keywords. Full text of articles including English and Persian were reviewed from 2001 to 2014. Selection criteria were articles' subject which were about quality websites hospital and some articles which found from other health-related Websites (85 articles). According to the requirements and selection criteria 45 article were utilized.

Results: In this review, some indicators notified such as Alexa rank, Google page rank, website type, technical content of website, information and hospital facilities, medical and admission service, online interactive services, research scientific activities, accessibility, speed of website, comprehensive plan of website, protect users' personal data, website language, user satisfaction, website map, possibility to navigating in hospital website, email of website and impartiality.

Conclusion: Today, regarding to the importance of hospital websites' quality and addressing to biotourism, it is recommended that hospital websites become so efficient, accessible, useful, credible and accessible in order to further clients satisfaction.

---

Background: Medication administration is an important part of care process. Correct medication administration and its accordance with standards are essential concerning the significant effects on patients’ health. Hence, this study was designed and carried out to determine Medication administration process using “clinical audit”.

Materials and Methods: This study was a cross-sectional one which carried out with “clinical audit” in a hospital of Tabriz city in 2014. This audit conducted in six steps as followed: 1) selecting topic of clinical audit, 2) determining the criteria and standards, 3) assessment of current status, 4) comparing current situation with standards( Standards of Ministry of Health, Medication safety handbook, medication administration curriculum and NHS guideline in medication management), 5) designing and implementing intervention and 6) re-audit. In order to organize process evaluation, a valid instrument used via observation and checklist.

Results: Results of this audit study revealed that 11 out of 25 assessed steps had very low accordance with standards (less than 15%) and the average accordance of total process was 47 percent before intervention. However, the average of standard adherence rate increased to 78 percent after intervention implementation.

Conclusions: The results indicated the effectiveness of educational intervention programs in using kardex instead of medication card on improving medication administration process generally. In spite of the occurred improvement, it is necessary to have an ongoing assessment and intervention in order to quality improvement. 

---

Background: Medical centers and hospitals need to expand internet, Application Service Providing (ASP) to convert it to a long-lasting choice to compete. Hence, the present study carried out with the aim of determining the relationship between quality of service providing software systems and customer satisfaction in selected hospitals of Tehran University of Medical Sciences with similar hospital information systems.

Materials and Methods: This study was a descriptive-analytical and correlation one. The study population consisted of revenue and clearance employees' unit in selected hospitals. Study method was census using Kim et al questionnaire. Descriptive statistics such as frequency, percentage and average; and inferential statistics like Kolmogorov-Smirnove Test and Pearson correlation coefficient utilized in order to data analysis.

Results: There was a significant positive correlation between quality of Application System Provider variables and users satisfaction in order of severity in system quality (r = 0.734, P = 0.01), service quality(r=0.721, P = 0.01) and information quality(r=0.521, P = 0.01). As, system quality had the most impact on users' satisfaction.

Conclusion: There was a significant relationship between the quality of Application Service Providing (ASP) with the users' satisfaction in selected hospitals of Tehran University of medical sciences. Although, all variables had positive and significant relationship with user satisfaction, their average was less than moderate limit. So, the health managers are advised to consider these issues in management methods.

---

  Abstract

  Background and Aim: Especially in the case of Hospital services, quality assesment is an complicated and vague issue. For achieving this goal Multiple Criteria Decision Making methods help us. These studies aims to knowledge and prioritize quality indicators and rank selected inpatient wards in an elected hospital of Tehran university of medical science by using Analytical Hierarchy Process and TOPSIS methods.

  Materials and Methods: This is a descriptive-analytical and cross-sectional research. At the first, with an overview of the research literature and expert opinion, indicators of quality assessment were selected. Then we did prioritization of these indicators with using of expert opinion and AHP method. In the final stage, selected inpatient wards the Hospital were ranked in terms of quality of service using TOPSIS by a sample consist of 300 of inpatients.

  Results: Eight main domains (Responsiveness, Safety and risk management, Tangibles, attention to patient, Health communications, Competency and professionalism, accessibility, Credit and assurance) were selected for quality assessment. Among these indicators, competency had the highest priority and attention to patient had the lowest priority. Also the department of Heart had the highest quality of service and the department of Neurology had the lowest quality.

  Conclusion: According to crucial role of the service quality on patients’ satisfaction, the use of appropriate indicators for quality of services, prioritizing them and also proper assessment of the quality of hospital services can play a major role in health policies.

---

Introduction: High quality health care service leads us towards a healthy society. Present paper aimed to use the service quality concept in health care sector based on service quality approach (SERVQUAL) in public hospitals. Methods: In present research a hybrid approach based on Analytic Network Process (ANP) and Fuzzy TOPSIS was used where the former was used for prioritization of healthcare service quality measures and the latter was used to operationalize the hospitals. Questionnaires and ANP and Fuzzy TOPSIS were used for data collection and analysis. Five public hospitals in Rash were evaluated. The time period of the study including data collection was 2014-2015. Results: The service quality criteria comprised of 6 main criteria and 19 sub-criteria in present study. Among five hospitals studied in present research, Rasoul Akram hospital obtained the first rank and other hospitals obtained the other ranks. All criteria and sub-criteria used in present study obtained some rank indicating their importance in the research context. Conclusions: With conducting present research, various criteria and sub-criteria related to service quality (SERVQAL) and their importance were identified and this may contribute to improved performance of health care services

---

Background: The growing importance of hospitals in physical and mental health improvement has led to focus on improving service quality; and hospitals have considered it as a major competitive advantage. This study aimed at investigating the role of improving services quality on hospital brand preference in healthcare industry.

Materials and Methods: This applied study was a descriptive one. A sample of 394 patients selected using stratified and convenient sampling from hospitals of Shiraz city. Data gathering using questionnaire; in order to data analysis, LISREL_8.80 and SPSS₁₉ were utilized using confirmatory factor analysis and structural equation modeling techniques. Data analysis was used to confirm the relationships between variables.

Results: Study results indicated that there was a significant positive effect of service quality on patient satisfaction, patient loyalty and brand equity of hospital. Patient satisfaction had positive effect on patient loyalty to the hospital and the loyalty had significant effect on hospital’s brand equity. Finally, the effect of hospital brand equity was confirmed on hospital brand preference.

Conclusion: According to the study results, it can be suggested that hospitals management take some measures for service quality improvement which can be enhanced hospital brand preference among other hospitals, both spreading justly public health in all layers of society as well as increasing profitability.

Keywords: Service quality, Brand Preference, Hospital

---

Background: The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.

Materials and Methods: A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department.  Related data were collected before and after the intervention to determine the effect of quality management system on deductions.

Results: The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.

Conclusion: Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively

---

Background: Because of the current population policies adopted in Iran followed by increasing the number of births, this study aimed to investigate the current situation of safe delivery and proposed a model based on clinical governance.

Materials and Methods: This study is a combinatorial-exploratory research (Mixed Method) conducted in four hospitals in Qazvin and Semnan provinces including two stages in 2014.  The first stage was the assessment of current situation; clarifying safe delivery, reviewing literatures, providing two checklists, assessment of current situation based on assessment of continuous quality improvement and assurance of the quality and the second stage was presenting the model including codification of safe delivery model in seven axes of clinical governance, the approval of the model on the panel using nominal group technique.

Results: In quality assurance, hospital (4) and hospital (2) obtained the maximum score (1431) and minimum score (1237) respectively. All hospitals in continuous quality assessment, admission in the intensive care unit (P < 0.001), mothers with severe consequence of pregnancy (P = 0.004) and 16 cases out of 27 errors had significant statistical difference.

Conclusions: In order to improve the quality of Maternity ward, hospitals' accreditation also should be based on the principles of clinical governance. In addition to evaluations based on quality assurance and annual accreditation, assessment using continuous quality improvement methods based on clinical governance is essential. The proposed model includes seven axes of clinical governance.

---

Background: The quality of services is a comparison of the customer´s perspective (expectations) with what it has received. If the expectations are more than perceptions, the quality of received services is not sufficient based on customer´s view which resulted in his/her dissatisfaction. The present study performed with the purpose of determining the quality of provided and excepted services to outpatients among hospitals affiliated to Tehran University of Medical Sciences.

Material and Methods: The present study is a descriptive- analytics and cross sectional one which has been done in 2015. The study population included all outpatients attending hospital clinics affiliated to Tehran University of Medical Sciences.The sample size was calculated 225 participants based on formula. In order to data gathering in quality of provided and expected services, a 22-items standard questionnaire of Servqual was utilized. Data analysis performed by SPSS using paired t-test, Mann-Whitney and Kruskal-Wallis tests.

Results: The study findings represented that there was a negative gap in the quality of services provided. The highest gap was related to accountability (-0.97) and the lowest gap related to tangibles factors (-0.69) .Moreover, regarding to  relationship between demographic variables with perceived service quality, there were significant relationship between  insurance type with reliability and empathy dimensions and supplementary insurance with tangibles factors and reliability.

Conclusion: Negative gap (higher expectations than perception) in all aspects of quality improvement is required in all dimensions. Especially, it is necessary to adopt some strategies in the accountability dimension. Reforming management processes, reducing waiting times and increasing employees' motivation in order to achieve appropriate accountability are in this kind of strategies.

---

Background: Today, in order to reduce costs along with the realization of superior qualities, assignment of all or part of the responsibility for performing a specific organizational task outside the organization is a great importance. Therefore, this study aimed to assess the role of corporate culture on the quality of working relationships in outsourcing activities at Tehran University of Medical Sciences.
 
Materials and Methods: This research was a correlational study. The study population consisted of all the staff of the outsourced units of Tehran University of Medical Sciences. Staff who were in contact with outsourced units included 600 individuals. To collect data, a questionnaire based on Zoghbi et al study (2014) was utilized. Two hundred fourteen analyzable questionnaires were collected using multistage cluster sampling method.
 
Results: Structural simulation results with LISREL software revealed that corporate culture had a positive impact on the quality of working relationships during outsourcing of activities. Hierarchical culture was associated with adverse impacts on disruptions in customer service and orientation. Ethnic culture had a positive effect on both components. The market culture had a positive impact on obstruction and had a negative effect on customer oriented. Temporary culture had no significant impact on both of components.
 
Conclusion: given that the quality of working relationships between staffs of outsourced units and organizational staffs is of utmost significance for organizational productivity; the interest of managers affiliated to Tehran University of Medical Sciences regarding corporate culture, and also, strengthening hierarchical and ethnical culture is noteworthy to improve customer orientation and reducing disruptions in customer services.
 

---

Background: Hospital accreditation is assumed as an effective control mechanism for health systems to improve quality and efficiency. Current study thus, seeks to look into the relationship between hospitals’ accreditation and efficiency
Materials and Methods: In order to measure efficiency, hospital inputs and outputs included the ratio of physician and nurse to bed, mortality and nosocomial infection rate and quality of inpatientservices were used. A sample of 554 hospitalized patients selected using stratified random sampling
method. Data gathering instruments were researcher-developed questionnaire and checklists. DEAP and SPSS software deployed to assess correlation between accreditation rank and technical efficiency
Results: Average hospitals’ technical efficiency score was 0.94 indicating an improvement capacityof %5.1 for hospitals efficiency. The mean quality score was 4.13 out of 5( in the range of 3.9-4.3)There was no correlation between hospitals accreditation rank and their technical efficiency
Conclusion: According to the results, it seems efficiency should be also considered in accreditationmetrics. In addition, for measuring efficiency, performance based inputs and specifically outputs tohave reliable results should be chosen

---

Background: One of the main important factors which affects nurses' job performance and potentially influences their capability in accomplishing their tasks and responsibilities is job burnout (JB). This study aimed to investigate the moderating role of JB on the relationship between QWL and job performance among nurses' employees in emergency departments of five training hospitals affiliated to Qazvin University of Medical Sciences in 2017.
 
Materials and Methods: This descriptive, cross-sectional study was conducted among 178 nurses' employees in emergency departments of five teaching hospitals affiliated to Qazvin University of Medical Sciences in 2017. In order to assess main variables of present study, three standard questionnaires consisted of Walton QWL, Maslach and Jackson job burnout and Paterson job performance were used. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression analysis were used to analyze data. The level of significance was set less than 0.05.
 
Results: Study results revealed that most of the nursing staff had a low level of QWL, experienced a considerable JB with a moderate to high level of performance. Furthermore, QWL predicted 21% of variances regarding to job performance (R²=0.21, p=0.04). The moderated multiple regression results supported the hypothesis that JB had a significant effect on the relationship between QWL and nurses' job performance (β≠0, p=0.02).
 
Conclusion: Considering the importance of QWL and efforts to develop an appropriate condition to promote different aspects of QWL would play an important role in nurses' productivity and accomplishment of their performance goals.
 

---

Background: Visual disorders in old age is one of the most important factors in decreasing quality of life of older people. This study aimed to access the vision-related quality of life of older people in Tehran and to examine some of the underlying factors.
Materials and Methods: This was a population-based cross-sectional study among 566 older people aged 60 years and over, living in Tehran. A multistage cluster randomized sampling method was used to select study population, data was gathered using interviewing them at their home. NEI-25 VFQ (Visual-Functioning Questionnaire) was used to measure the vision-related quality of life of the participants. Multi-level linear regression analysis was used to data analysis.

Results: The average score of the vision-related quality of life was 80 out of 100. Among 12 dimensions of Visual-Functioning Questionnaire, the dimensions of color vision (CV), vision specificsocial functioning (VSSF) and peripheral vision with the scores of 96.8, 96.7 and 95 gained the highest and the dimensions of driving and vision specific dependency (VSD) with the scores of 42.6 and 50.3 had the lowest scores, respectively. Significant associations were observed between being a women, older, and having a lower education with poorer vision-related quality of life. 

Conclusion: This study results provides an evidence for policymakers in prioritizing visual health services based on more impaired visual function and also at risk older people.
 

---

Background: The present research aimed to assess the readiness of selected hospitals of Tehran University of Medical Sciences to implement quality improvement programs and clinical audits from the viewpoint of managers.
Materials and Methods: A descriptive-analytic study was conducted in May 2017 in four selected hospitals of Tehran University of Medical Sciences. The study population of this study was 20 managers of selected hospitals who were selected by census sampling method and entered the study. The data gathering tool was a two-part questionnaire whose validity and reliability were confirmed. In this study, we used SPSS software version 23 and statistical tests to analyze the data.
Results: The effectiveness and readiness of hospitals to implement a clinical audit program was equal to 60% in the field of data and information, cardiology and feedback; 55% in resources, design and implementation, clinical audit management, and evidence and standards; 50% in illness and education; and 45% in manpower. Also, with increasing frequency of clinical audits, hospital readiness for quality improvement processes increases.
Conclusion: Due to the effectiveness and low readiness of hospitals in implementing a clinical audit program, especially in the field of human resources (45%), it is necessary that managers and planners of clinical audit programs in hospitals have a precise knowledge of these factors in order to control the organizational environment and help improve the effectiveness of audit programs.
 

---

Background: Nosocomial Infections (Nis) Are Regarded As The Most Common Complications Of Health Cares. These Infections Affect Patient’s Safety in Developing and Developed Countries. The Aim Of This Study Was To Epidemiology and Determine the Causes of Nosocomial Infectioin Teaching Hospital of Tehran In A Teaching Hospital In Tehran.
Materials and Methods: This Cross-Sectional, Descriptive And Analytical Study Was Designed In 2019 At A Teaching Hospital Affiliated With Iran University Of Medical Sciences. The Nosocomial Infection Registry Data between 2017 and 2018 Was Used. The SPSS24.0 Software Package Was Used To Analyze Data Into Descriptive (Frequency, Percentage, Mean and Standard Deviation( And Analytical) ANOVA) Statistics.
Result: The Most Frequent Type of Infections Were Urinary Tract (39.76%), Ventilator Associated Events (20.92%), Bloodstream (20.71%), Respectively. Skin and Soft Tissue Infections (0.7%) Had The Lowest Prevalence. The Highest Incidence Of Nosocomial Infection Was In The ICU With 200 Patients And The Lowest Incidence Was In The ENT With 23.1 Patients And The Overall Incidence Of Nosocomial Infections Was 84.9 Patients Per 10,000 Patient-Days.

---

Background: The purpose of this study was to investigate the quality of life of employees working in a psychiatric hospital.
 
Materials & Methods: The present study is a descriptive cross-sectional study conducted in Roozbeh Hospital in 2018. The sample size was calculated using Cochran's formula and 112 questionnaires were analyzed. Quality of life was assessed using the 36-item Short Form questionnaire (SF-36). Data analysis was conducted using SPSS software, descriptive statistics, Kruskal-Wallis, Chi-Square and Cramer's post-test.
 
Results: The findings revealed that the overall score of quality of life was 68.8. The highest mean of quality of life score was related to Physical functioning function (84.2) and energy fatigue had the least score (58.7). Also, the results of the study showed that there was a significant relationship between education groups and quality of life in terms of physical functioning (P-value=0.007); work experience and quality of life in social functioning dimensions (P-value<0.02); between having hospital patient communication and caregivers' communication with the quality of life in energy fatigue and pain dimensions (0.005, 0.05> P-Value); in Roozbeh Psychiatric Hospital staff.
 
Conclusion: According to the research findings, the quality of life of Roozbeh Psychiatric Hospital staff is moderate and educational and therapeutic interventions are recommended to improve the quality of life of the staff.

---

Background: Assessing and improving the quality of services in hospitals because deal with the health of humans is very important. The purpose of this study is to identify and weigh quality criteria and ranking of four hospitals in Mashhad.
 
Materials & Methods: The present study is of type  Applied Studies  that is a cross-sectional study conducted in the winter of 1396. In this study, by literature review, dimensions of service quality in the hospital was identified. Then, a paired comparison questionnaire (including 8 people) was used to conduct the survey. Then coefficients of importance of each dimension were calculated through the process of hierarchical analysis in a fuzzy environment. Decision-making matrix questionnaire was completed by a 400-person sample of patient companions in four hospitals.Then, hospitals were ranked using GRA-TOPSIS method. The validity of questionnaires were confirmed by the expert group.
 
Results:Using FAHP, knowledge and skills of medicine obtained the most important coefficient. Also, using GRA-TOPSIS, third hospital received the fourth place in the provision of services. Also in the third hospital the quality of access requires the greatest improvement.
 
Conclusion: In addition to ranking hospitals based on quality of service criteria, the GRA-TOPSIS method is able to identify each hospital's weaknesses in each criterion. As a result, the priorities for improving the quality of service in each hospital were identified, and the hospital manager could work to improve performance on the criteria that he or she achieved with lower performance than other hospitals.

---

Background: equality in access of health care services is one of the most important goals of Health system .In this study, we provided a description of the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017.
Materials & Methods: This descriptive-analytical study was conducted in 2017 to describe the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Data were gathered through Ministry of Health and Statistical Center of Iran. Gini Coefficient, Concentration Curve ,Multiple Regression and Geographic Maps used by Microsoft R Version 3-6-0 for data analysis.
Results: The highest and lowest ratio of Otorhinolaryngology Head & neck surgery specialists per population in the year 2017 was reported in Tehran (2.31 per 100,000 populations) and Hormozgan (0.39 per 100,000 populations).
Conclusion: There was a considerable disparity between different regions of the country in terms of access to Otorhinolaryngology specialists.