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Dr Mohammad Arab, Farhad Habibi Nodeh, Dr Abbas Rahimi Foroushani, Dr Ali Akbari Sari,
Volume 13, Issue 4 (3-2015)
Abstract

Background: Hospital waste need a very sensitive and cautious attention due to holding hazardous, toxic, and pathogenic factors such as infectious, pharmaceutical, pathological, chemical and radioactive left-overs. Thus, this study aimed to evaluate the observance of safety measures by workers responsible for collecting hospital wastes in the public hospitals affiliated to Tehran University of medical sciences. Methods and Materials: This cross-sectional and descriptive-analytic study was conducted in 1391. Data were collected through using a questionnaire. According to the frequency distribution, total score for participants was divided into three weak (<26), average (26-30), and high (>30) categories. Data were analyzed by the SPSS 18 software using T-Test, one-way ANOVA and regression analysis. Findings: Based on the results, 33.3% of hospitals received suitable, 55.5% received average and the remaining (11.2%) received a weak score regarding safety measures. Moreover, there was a statistically significant correlation between cleaning staff’s characteristics (education, age, work experiences and their training) with their safety status score. Conclusion: Implementing current national principles and standards and conquering shortages, proper planning, using young workers alongside with experienced ones, more training courses and respecting and paying enough attention to cleaning staff would help to improve the safety of collecting hospital wastes.
Farbod Ebadifard Azar, Mohammad Arab, Morteza Badloo, Ehsan Rezaei,
Volume 13, Issue 4 (3-2015)
Abstract

Background: New manegerial approachfor hospital administration as one of the health system reforms with several goals including increased staff motivation were enforced. However, motivation and job satisfaction are two very important factors for survival of organisation. The purpose of this study was to investigate the relation between paying the fee for service, motivation and job satisfaction using the expectancy theory of Victor Vroom. Method: The descriptive-analytic research conducted in a public hospital of Tehran city in 2013. The sample size was estimated 209 caseswhich selected by using Stratified sampling method.Information Through a three-part questionnaire containing personal informationwith 6 questions, expectations standard questionnaire with 25 questionsand job satisfaction standard questionnaire with 13 questions were collected. SPSS18 software was used for data analysis. ResultsIn all occupational groups other than physicians, direct significant relationship was observed between the Fee for service and job motivation. In all occupational groups except paraclinic, directly significant relationship between motivation and job satisfaction was observed. Among all occupational groups only in the Administration– Finance Group Direct significant relationship was observed between the Fee for service and job satisfaction. Conclusion: In this study, hospital staff had Above-average job satisfaction and job motivation lower than average. improving skills through training opportunities, Codification of appropriate Politics and Policies of reward–function and situating favorable bonus from view of the employee (According to motivational differences) are Examples of strategies to improve motivation
Ali Jannati, Neda Kabiri, Mohammad Asghari Jafarabadi, Behrooz Pourasghari, Babak Bayaz,
Volume 14, Issue 1 (6-2015)
Abstract

Background: Pay-for-performance (P4P) is a payment model which tries to pay for the measured aspects of performance and encourage health care providers by providing financial incentives in order to achieve pre-defined goals. This research was done to assess the impact of P4P on efficiency of medical laboratory of Imam Reza hoapital in Tabriz in 2013.

Materials & Methods: This interventional research was a before-and-after study. In order to recognize any changes, efficiency indexes of laboratory were measured and compared whole the year. The data were collected manually assessing the related documents. For comparing efficiency before and after intervention, descriptive statistics were used.

Results: Findings showed that costs didn’t differ significantly after the intervention, but revenue was a little increased slightly (14364 to 16874). Laboratory errors were also increased after the intervention. (0 to 17 cases).

Conclusion: Regarding the results of survey , it seems that we can conclude that this bonus payment system can be used in all levels in which care is provided such as primary health care centers, drug stores, diagnostic centers and hospitals through setting pre-defined goals and considering negative point for any staff who makes an error. 


Mohammad Arab, Elham Movahed Kor, Mahmood Mahmoodi,
Volume 14, Issue 1 (6-2015)
Abstract

Introduction: Major consideration on hospital emergency services had been taken into account in recent years. This study is aimed to analyze contributory factors of clients' satisfaction in services provided in emergency unit of selected hospitals affiliated with Tehran and Shahid Beheshti University of  Medical Sciences.

Materials and Methods: This is a descriptive-analytical and cross-sectional study. 768 clients of emergency departments of selected hospitals had been chosen during last year as  samples . 3 general and 3 specialized hospitals had been chosen randomly among total hospitals affiliated with mentioned two universities . A questionnaire consisted of  54 questions in 2 sections had been used for data collection . Reliability and validity were confirmed by professors and 50-sample pilot study respectively. The alpha-cronbach was calculated at 0.87.Responsible rate had been determined at 97.66 % . The data had been analyzed by independent sample t-test, simple linear regression and linear multi-regression.

Results: The demographic characteristics of attendants were as follows: 57.3% women, 56.8%  over  45 years old , 63.1%  social insurance coverage, 92.7% urban residents , 56%  married, 58.7%  low education ( below high school level) and 68.4%  complementary insurance coverage. Clients had to pay more  for services provided by Shahid Beheshti University. Moreover, majority of the clients paid  their  expenditures by out-of-pocket and insurance. Clients were more satisfied with admission unit ,  gaurds, physicians, nursing cadre and environment provided by hospitals of Tehran university. On the other hand , in terms of management , clients were more satisfied with management approach provided by hospitals of Shahid Beheshti university . Totally , women , elderly people , urban residents , individuals who visited physicians out of referral system and also ones who came during physician presence felt more satisfaction .Generally , patients were more satisfied with services delivered by hospital affiliated  with Tehran university .   

Conclusion: Evaluating viewpoints of patients about quality of services result in promoting current trends of providing services.


Mohammad Arab, Mostafa Hoseini, Mohammad Panahi, Ziba Khalili,
Volume 14, Issue 2 (8-2015)
Abstract

Background: Nurses are the largest group of health care providers and emergency department is known as a high risk ward in terms of occupational injuries. The aim of current study is to make out nursing occupational hazards in the emergency department among teaching hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods: The study carried outed on 250 emergency department’s nursing staff of hospitals affiliated to Tehran University of Medical Sciences. A valid and reliable questionnare used for data gathering by Simple random sampling method. Data analysed using descriptive snd inferential statistics.

Results: The level of mean and SD of occupational injuries (2.87 ± 0.55) was assessed moderate. Among occupational hazzards, Psychosocial and institutional (3.58 ± 0.47) and Ergonomic (3.57 ± 0.71) ones were the most prevalent occupational hazards respectively and chemical hazards were the least important source of occupational injury. There was a statistical significant association of occupational injuries and variables such as hospital, years in practice, educational level, type of employment and training courses in occupational hazards (P<0.05).

Conclusion: Nurses exposes a range of risk factors in different domains regarding occupational injuries. With the purpose of eliminating the risk factors, it needs to run various strategies in different domains. Applying ergonomic approaches, developing appropriate educational programs, providing adequate training in this area, etc., can result in reduceing occupational injuries and increasing their productivity.


Farnaz Attar Jannesar Nobari, Taraneh Yousefinezhadi, Faranak Behzadi Goodari, Mohammad Arab,
Volume 14, Issue 2 (8-2015)
Abstract

Background: The goal of clinical risk management is to improve the quality of health care organization’s services and to ensure patients' safety. Thus, this study has identified and evaluated the potential failures by Failure Mode and Effects Analysis (FMEA) approach to eliminate errors occurrence of an Intensive Care Unit (ICU) in a hospital in Tehran city.

Materials and Methods: This study is a descriptive one in which data were gathered qualitatively by direct observation, document review, and Focus Group Discussion (FGD) with the process owners in an Intensive Care Units (ICUs) of a Tehran non-governmental hospital in 2014. According to FMEA method, quantitative data analysis was carried out based on failures’ Risk Priority Number (RPN).

Results: By FMEA, 378 potential failure modes in 180 ICU tasks were identified and evaluated. Then, with 90% confidence, 18 failure modes with RPN≥100 are identified and analyzed as non-acceptable risks totally.

Conclusion: Identifying 18 failures as non accepted risk from identified 378s, and identifying causes, analyzing and then suggesting correction actions reveals the FMEA high capability to identify, evaluate, prioritize and analyze potential failure modes in a such complex and critical hospital ward(ICU).


Abdolvahed Khodamoradi, Arash Rashidian, Siamak Aghlmand, Mohmad Arab,
Volume 14, Issue 3 (9-2015)
Abstract

Background: Informal payments are paid to individuals /health care providing organizations offering as cash or non-cash and are formed out of formal payment channels. This study aim at identifying the types of informal payments, causes, effects and policies to deal with them.

 Materials and Methods: This study was a review  one and relative  published articles identified by searching valid database ( Medlib, SID, Pub Med, Science Direct and Google Scholar)using keywords with their equal in Persian (informal payment and unofficial payment) and 128 articles were extracted. The articles refined step by step. In conclusion, 20 articles were selected according to study aims.

Results: The study findings consist of five main sections including the definition and form of informal payments, the existent causes of informal payments, effects of informal payments, statistics of informal payments in Iran and the world and policies to dealing with this important issue.

Conclusion: Due to the high prevalence of informal payments and severe negative effects on justice and respectable governance, policy-makers should focus on this issue and reduce its effects. Although, strategies to control informal payments are limited but strategies including regulation payment and medical tariffs, regulating power abuse, providing incentives and increasing responsibility of healthcare professionals, and changes in public perception are proposed.


Mohammad Arab, Yeganeh Hayati, Elham Movahed Kor, Mostafa Hosseini,
Volume 15, Issue 1 (6-2016)
Abstract

Background: Nowadays, managers should develop working conditions which attracts new nurses, retains current nurses and prevents their absenteeism. This study at aim at determining Effective Factor Analysis on Health Related Absence among Nurses of Clinical Wards in General Hospitals Affiliated to Tehran University of Medical Sciences

Materials and Methods: four hundred nurses of clinical wards selected as sample size to participate in this descriptive-analytical; cross-sectional study from general hospitals of Tehran University of Medical Sciences. The instrument was a questionnaire in 100 items and two sections including demographic characteristics (13 items) and effective factors of sickness absence (organizational-directorial factors in 49 questions, physical factors in 16 questions and mental factors in 22 questions). The validity of questionnaire confirmed by experts and reliability was calculated 0.79.Absenssism criterion was based on Rajbhandary and Basu' definition (2010); total numbers of days that they didn't present at ward/hospital due to sickness. Data gathered retrospectively from nurses' records. Data analyzed by SPSS using descriptive statistics tests, simple and multiple linear regressions.

Results: The mean age of participants was 44.97±5.910 and 73.8 of them were women. Explaining power of predicting factors was very well (F=71.121, P<0.01). Variables such as Marital Status (β=0.150, P<0.001), ward's type (β=-0.553, P<0.001), physical factors (β=0.101, P=0.001) and mental factors (β=0.226, P<0.001) explained 42% of the absence variance.

Conclusion: considering some aspects such as physical and mental factors and also health issues of nursing staff  based on wards' type  can be result in  absenteeism reduction. 


Raziye Beyranvand, Farbod Ebadi Fard Azar, Sara Emamgholipour, Mohammad Arab,
Volume 15, Issue 2 (6-2016)
Abstract

Background: Todays, hospitals are facing with shortage of resources and increasing costs challenges, So, cost information and cost calculation of hospital delivered services can be effective in efficient resources allocation and tariff rates reforming and budget. This study aimed at calculating the cost of services and  physiotherapy department's income of Sina hospital and comparing with approved tariffs in 2013-2014.

Materials and Methods: This study was a cross sectional and retrospective one. The cost price of 13 physiotherapy services calculated using Activity Based Costing method for physiotherapy unit of Sina hospital of Tehran in 2013-2014. Data collection tool included some forms related to services costs of physiotherapy and related activity centers. Also, in order to estimate cost proportion of other wards in physiotherapy unit, the proportional allocation bases was determined, then direct allocation method was utilized.

Results: The most costs of 13 provided services were less than tariffs in 2013. Generally, the costs pertain of physiotherapy services computed 794286777 Rials which workforce costs (48.4 percent) was the most proportion and then energy buildings depreciation and equipment costs. This issue is due to equipment dependency in physiotherapy unit services.

Conclusions: study results revealed there was difference between real cost of services and approved tariffs, therefore, in order to more accurate pricing, exact calculation methods such as Activity Based Costing recommended. Considering high personnel and capital costs pay special attention to these resources, appropriate use, identifying and omitting wasted costs can be effective in increasing efficiency and saving costs.


Fatemeh Arabi Basharic , Mohammad Reza Mobinizadeh, Alireza Olyaeemanesh, Morteza Arab Zozani ,
Volume 15, Issue 2 (6-2016)
Abstract

Background: Intravascular imaging is a tool to detect coronary artery atherosclerosis which plays the major role in vessel stenosis degree determination and plaque pathology as a supplement of invasive angiography. This study aimed at comparing Intravascular imaging with invasive angiography.

Materials and Methods: For retrieving second type studies, PubMed, Cochrane Library and Centre for Review and Dissemination (CRD) were searched up to September 2013.  Searching was carried out by two persons using angiography and intravascular imaging keywords. Studies which compared intravascular ultrasound technology with invasive angiography were analyzed.

Results: Based on studies which reported the rate of target lesion revascularization (TLR) after one year of follow-up, there was a statistically significant difference between intravascular ultrasound and invasive angiography alone. It seems that TLR rate was lower with intravascular ultrasound (P = 0.02).In terms of cost effectiveness, approximately 54, 000 USD spend per each QALY using IVUS method.

Conclusion: Although, intravascular ultrasound could be able to detect coronary arteries damages and help out physician in selecting the most appropriate treatment, but due to the high cost of an intravascular ultrasound catheter, the invasive angiography is choice of physicians and patients in coronary intervention. 


Alireza Arab, Armin Monirabbasi, Bagher Dastyar,
Volume 15, Issue 2 (6-2016)
Abstract

Background: Partnership between public and private section is the cooperation between institutions in these sectors which perform to attain common goals and eliminate the limitations. This study aimed at investigating the important criteria for attraction of private section in health sector.

Material and Methods: Based on studies and sample surveys, governments have essential role for codification of health policies and special programs in any country. In recent years, the costs of delivered health services increased exponentially and governments are looking for alternative mechanisms for cost reduction; meanwhile, the increased capacity in social programs is accompanied with considerable investments in infrastructures. This article investigated the utilization of different models by previous literature assessment in public- private partnership field and determined key and substantial criteria for these projects' success /failure. Although, the experience of their implementation is still very limited in our country and there is no accurate assessment based on case studies.

Results: Based on study results, some criteria like possibility of returning part of participation costs in tendering for tender, goals and responsibility's clarity, fair and correct mutual risk attocation , lower public costs through less incumbency, private section motivation, clear mechanism monitoring ,conflict resolution and supporting policies from private investment have essential role for successful public- private partnership which special attention should  be drawn.

Conclusion: Governments can have a suitable partnership with private sector in order to prevent increasing costs in rebuilding, maintenance and operation of public facilities like hospitals, considering budget limitations in public sector, providing innovation through opportunism in private section and more efficient risk management.


Dr. Mahammad Arab, Pejman Hamouzadeh, Mani Yousefvand, Faroogh Namani, Mahsa Abdi,
Volume 15, Issue 3 (8-2016)
Abstract

Background: One of the main pillars of quality in health services is patient-centered that brings the best outcomes for patients. This study was aimed at comparing the patient-centered situation in selected hospitals affiliated to Tehran University of Medical Sciences (TUMS) from the viewpoint of nurses and patients in 2014.

Materials and Methods: This descriptive cross-sectional study was done among 220 nurses (n=103) and hospitalized patients (n=117) in selected hospitals of TUMS. The data gathering instrument was a researcher-made questionnaire which measured seven dimensions of the patient-centered. The validty was confirmed by the opinions of experts and its reliability was 0.96 by Cronbach's alpha. Data analyzes were performed by SPSS software and using one-way ANOVAtest.

Results: Mean score of patient-centered in the studied hospitals from the nurses and patients viewpoint was 2.79 (±0.50) and 2.87 (±0.58), respectively. From the viewpointof nurses and patients, the highest and the lowest mean score were related to the confidentiality and dignity dimension and the patient choice dimension, respectively. Based on ANOVA analysis, there was a significant difference between the mean scores of nurses and patients in quality of amenity and social support dimension (p<0.05).

Conclusion: Patient choice, quality of amenity and prompt attention were identified as priorities for action to improve patient-centered situation in studied hospitals. It is recommended that hospital authorities should be place in a matter of priority the dimensions of the patient-centered which are in poor condition in order to increase the level of patient satisfaction and loyalty.


Hamid Ravaghi, Sima Rafiei, Maryam Mohseni, Peigham Heidarpour, Mohammad Arab,
Volume 15, Issue 3 (8-2016)
Abstract

Background: Clinical Governance (CG) is a framework which obligates heath care system to responsiveness regarding maintaining and improving health care services' quality. Purpose of this study was to exists challenges in Clinical Governance establishment evaluation based on national assessors' aspect.

Materials and Methods: This qualitative study was conducted with national assessors' participation of Clinical Governance plan in 2014.Data collection was carried out using face to face interviews with assessors  and analyzed  based on content analysis.

Results: Three main themes were categorized including problems related to clinical governance standards, Existing challenges in assessment process and recommendations to improve quality assessment process.

From the assessors' aspects, the main existing challenges were lack of knowledge and adequate skills in some assessors towards CG, lack of sufficient accordance among assessors team, resistance of some universities and health care systems, lack of existing comprehensive guidelines with the purpose of responsiveness in related ambiguity in assessment and direction process among assessors.

Conclusion: Reinforcement of quality improvement culture in hospitals and increasing susceptibility in plan continuation, correct assessors election and ensuring about knowledge in responsibilities, updating assessors' training and putting to use equal indices in improving clinical governance assessment can be a considerable assist to improve assessment process and resolve related problems. 


Milad Shafiee, Mohammad Hossein Ghafoori, Fatemeh Aboee, Sara Forootan, Mohammad Arab,
Volume 15, Issue 4 (1-2017)
Abstract

  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.


Alimohammad Mosadeghrad, Mohammad Arab, Arezo Mojbafan,
Volume 15, Issue 4 (1-2017)
Abstract

Introduction: In the hospital’s environment, conflict is unavoidable due to differences in gender, educations, and Career goals, frequent and complex interactions between their personnels. Both of two extremely level of conflict (minimum & maximum) are preventing desired performance. Appropriate level of conflict should avoid recession, encourage creativity and reduce stress. The present research aims to determine the amount of conflict in Tehran University of Medical Science’s hospitals. (TUMS).

Method: This study is descriptive - analytic. The study population consists of 706 managers (senior, intermediate, basic) from 14 hospitals affiliated with TUMS. Data was collected by a self-made questionnaire and was analyzed with SPSS software.

Results: The level of conflict in Tehran University of Medical Science’s hospitals was average. 84% of total conflict was caused by organizational factors. There were a significant association between conflict and level of management, educations, work experience, type of unit, bed numbers, the number of employee under supervision, conflict management training course

Conclusion: Hospital managers should change their organizational cultures and revise some structural variables such as goals, procedures…  In order to maintain the optimal level of conflict.

Keywords: Conflict, a mount of Conflict, Managers, Hospital.


Dr Mohammad Arab, Seyed Masood Mousavi, Dr Aidin Arian Khesal, Dr Ali Akbarisari,
Volume 16, Issue 1 (4-2017)
Abstract

Background: in order to quality improvement, accreditation standards implemented with focus on the clinical and non clinical services. A nationwide intervention such as hospital accreditation can affect on measures related to the provision of high quality services. Indeed, such devices can be considered as effective tools in macroeconomic health sector policymaking. The main objective of current study was to investigate the effect of accreditation system on the key performance indicators of hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods: The study was a semi-experimental and descriptive-analytical one which conducted longitudinal using an Interrupted Time Series Analysis approach. Data related to the key performance indicators including average long of stay, Caesarean percent, turnover rate, patient satisfaction percent, bed occupancy rate, self-ordered discharge from emergency room and net death rate) was accumulated through multiple visits to the hospitals during 2012-2014. STATA software was used for data analysis.

Results: The study results revealed that based on implementation of accreditation model, the average stay of patients in the hospitals cesarean section rate and turn-over intervals decreased, while the percentage of patient satisfaction and bed occupancy average increased. Moreover, self-ordered discharge from emergency room and average of net death rate indicator showed no change.

Conclusion In general, it can be concluded that the health system partially has achieved a part of their objectives means key performance indicators promotion as a result of hospital accreditation implementation in hospitals affiliated to Tehran University of Medical Sciences. In order to assess more accurate investigation and understanding the nature of the system effectiveness, analysis of different aspects of hospitals performance indicators and the nature of their changes in longer period seems to be helpful.


Mahnaz Afshari , Dr. Alimohammad Mosadeghrad , Dr. Mohammad Arab ,
Volume 16, Issue 1 (4-2017)
Abstract

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


Yeganeh Hayati , Dr Elham Movahed , Dr Mohammad Arab ,
Volume 16, Issue 1 (4-2017)
Abstract

Background: Hospital managers inevitably have a major impact on their employees' health and because professional cohesion acheives in the shadow of psychological balance; possessing mental health is important among hospital staff. Therefore, current study aimed to determine the status of managers' leadership style and its relationship with mental health staff of hospitals affiliated to Tehran University of Medical Sciences in 2014.

Materials and Methods: This study was a cross-sectional and descriptive-analytical one and sample size consisted of 91 executives, intermediate managers and 320 employees of hospitals affiliated to Tehran University of Medical Sciences. Fiedler leadership style instrument and general health questionnaire were used. Collected data was analyzed by SPSS software version 22 using descriptive and inferential statistics tests.

Results: Responsive rate was85% (272/320). Most of managers adopted task-oriented leadership style. There was a statistically significant relationship between leadership style and mental health, physical problems, anxiety, social function and depression among staff (P<0.05).

Conclusion: Managers can be effective on mental health staff using relationship-oriented leadership style adoption and it seems necessary to train managers in adopting appropriate leadership models and styles in order to prevent and reduce mental health disorders among employees in different situations.


Elham Haghshenas, Dr Mohammad Arab, Dr Abass Rahimi, Dr Elham Movahed,
Volume 16, Issue 2 (7-2017)
Abstract

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.


Yeganeh Hayati , Dr Hojjat Rahmani , Dr Mohammad Arab,
Volume 16, Issue 3 (11-2017)
Abstract

Background: Health of hospital staff has a determinant role in increased productivity and since the main mission of hospitals is community health promotion, in order to achieve this important issue, monitoring, maintaining and improving general health is essential; this study developed to assess general health of staff affiliated to Tehran University of Medical Sciences and identify its related factors.
Materials and Methods: This Cross-Sectional, Descriptive-analytical study was conducted among 320 staff members of the Tehran University of Medical Sciences who selected using random sampling. In order to data collection, the General Health questionnaire was used. Collected data were analyzed using SPSS software through t-test and ANOVA tests.
Results: Study findings revealed that 47.5% of participants had psychological disorders suspiciously; prevalence of physical symptoms, anxiety, social dysfunction and depression were 53.9%, 49.3%, 79.5% and 14.6% respectively. There was a significant relation between general health and demographic features such as gender, marital status, major, job department, housing situation and type of employment (p<0.05).  Also, the personal characteristics of managers influenced on the general health staff.
Conclusion: General Health of staff in hospitals Tehran University of Medical Sciences in comparison with similar studies at inside and abroad is not in good condition, therefore, it is recommended that policy makers and managers concerned the programs and solutions towards priorities in order to promote health personnel.



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