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H Ebrahimipour, S Heidari, L Doshmangir, H Esmailzade,
Volume 8, Issue 2 (23 2009)
Abstract
Background: Priority Setting is necessary. There are different ways of priority Setting. How they are used depend on the situation of the country.
Material and Methods: This research is literature review. Google Scholar, Medline, Iranmedex, SID, Irandoc data base are used to gathering data.
Results: According to this study, there are various standard ways to priority setting such as Essential national health research ( ENHR), combined method, The commission on health research for Development (COHRED), Five-Step Process of the Ad Hoc Committee on Health Research. These methods have their own characteristics. These methods vary from one country to another . However the final impact is the same.
Conclusion: The result shows that it is useful to know about priority setting and strength and weakness of them. Combined method is the best way because it has the strength of other methods and corrects weakness of them.
A Tol, A Pourreza,
Volume 8, Issue 3 (7 2010)
Abstract
Background: Multiple environmental factors have roles in producing anxiety. Individualized differences and environmental conditions can affect the anxiety level. So, hospital environment and especially cardiac surgery ward have a great importance because they can save the patient's life.
Material & Methods: The present study is a descriptive- analytical one which has been conducted upon studying the level of anxiety pre and post coronary artery bypass graft surgery in the hospitals of Tehran University of Medical Sciences and preparing an educational program for such patients, was the other goal of the study.
Study population consists of 150 patients under examination that at the time of the study have been voluntaries to coronary artery bypass graft surgery. The sample was studied 24 hours before and weeks after surgery. The sample was selected randomly and data collected through a questionnaire with two separate parts. For the purpose of data analysis, SPSS software was employed.
Results: The result of the study shows that the level of anxiety before coronary artery bypass graft have been more than the level of anxiety after the operation. The difference between of the levels of anxiety have had significant relations with some of independent variables of the study such as sex, age, number of children and marital status, but there were not significant relations between occupation, educational level, non cardiac disease background, background of MI, non cardiac surgery background, the period of suffering from coronary disease background of hospitalization.
Conclusion: It seems that the men's ability to return to pre-operation socio-economic condition reduces their post operation anxiety. When people become older, they will be more fearful regarding the future's events but people older than 46 years old will obtain more life expectancy after surgery due to more extended familial relationship.
Married people experience less anxiety due to post operation, familial responsibilities and relief of cardiac symptoms. It can be concluded that anxiety reduction in these patients can result from cultural, socio-economic and demographic variables. Believes as cultural factors in the life have a great role in appearance and the level of anxiety.
Hossein Joodaki, Arash Rashidian,
Volume 8, Issue 3 (7 2010)
Abstract
As health care delivery systems develop, and their cost - as a percentage of total society expenditure - increases, policy-makers are more and more concerned about how to control these spiraling costs. An important section of policy makers' efforts to reduce costs is concentrated on preventing wastage in the health system. While a significant part of the resource wastage is due to inefficiencies in health system delivery, corruption and health care fraud and abuse are also to blame. The nature and the rate of corruption in the health care differ from one country to another. Still all countries encounter this problem and invest in interventions to combat corruption. Here we provide the readers with translated version of a very useful and readable paper by Vian. The paper reviews and summarizes the theories, methods, and interventions to combating corruption in health care.
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
Azra Ramezankhani, N Markazi Moghaddam, A Haji Fathali, H Jafari, M Heidari Mnfared, M Mohammadnia,
Volume 8, Issue 3 (7 2010)
Abstract
Background: Operating room efficiency is a major determinant of hospital cost. Maximizing throughput, while maintaining quality, is therefore paramount to maintenance of financial viability. Cancellation of surgery may increase a hospital's cost and affect the efficiency of operating room and waste of resources. This study was conducted to determine the rate and causes of canceled surgeries, and identifies areas for improvement in a teaching hospital in Tehran.
Material & Methods: We carried out a descriptive study of the reasons for canceling scheduled operations. Data were collected during 9 consecutive months. The reasons for cancellation were identified by theatre staff. We grouped all the reasons into 13 reasons. Other necessary information like operated surgery was obtained from IT department. Descriptive statistics (frequency, percentage, 95% confidence interval) were used to analyses of data. Statistical analyses were performed using SPSS and Excel Microsoft office.
Results: in this study, 18.2% of the 3381 scheduled operation were canceled on the day of surgery, 32.1% of them because of vascular surgery, followed by orthopedics (18.7%), general surgery (15.5%) and nose and throat surgery (13.7%). The common reasons for cancellation were lack of theatre time, clinical change in the patient's condition, lack of paraclinic tests and consultant's report on patient flow problems, blood preservation, drug and necessary equipment for surgery.
Conclusion: This study demonstrated that most cancellations of scheduled operation are due to hospital deficiencies and medical team reasons that most of them are preventable. Several changes like better infrastructural facilities, enhanced interdepartmental communication are suggested to try and reduce the cancellation rate.
F Akbari Haghighi, E Jaafari Pooyan,
Volume 8, Issue 3 (7 2010)
Abstract
Background: Various studies have highlighted the importance of accreditation as a ubiquitous performance measurement system of hospitals. However, the effectiveness of this mechanism has not been addressed, as much it deserves, in developing countries. Therefore, current study intends to investigate the performance of the system using the SERVQUAL model.
Material and Methods: This research is an applied and cross-sectional survey. Decision-making Board of Hamedan Hospitals (N= 200) constitutes the target group. A self-administered questionnaire including both structured and open-ended questions has been used for data collection. Analysis of the quantitative and qualitative data was conducted using SPSS and Thematic Content Analysis (TCA), respectively.
Results: Only 39 percent of the target group had high awareness of current accreditation programme.
The highest rate of gap, 55.8%, between the group's perceptions and expectations from accreditation system, belonged to the indicator of staff's satisfaction and the lowest rate, 17.3%, to structures and establishments.
Conclusion: The low score of the target group's perceptions towards the accreditation programme could be a sign of the low degree of their satisfaction, which might result in their poor cooperation. More and effective attention to hospital managers' views, recommendations and reactions might be an appropriate preventive solution.
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Volume 8, Issue 5 (21 2009)
Abstract
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Volume 8, Issue 5 (21 2009)
Abstract
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Volume 8, Issue 5 (21 2009)
Abstract
M Mokhtari Payam, A Akbari Sari, Mr Aye, M Mobinizadeh, S Manavi,
Volume 9, Issue 1 (9 2010)
Abstract
Background: The aim of this study is to explore the safety and diagnostic performance of dual-source CT scan in comparison with single source CT scan and conventional angiography in patients with coronary heart diseases.
Materials and methods: A systematic review was performed using CRD standard methods. The Cochrane Library, MEDLINE, EMBASE، Google Scholar and TRIP were searched up to April 2009. The references of the marked studies and gray literature were also searched.
Results: 17 articles were included. 9 articles reported the safety and 12 articles reported the diagnostic performance of DSCT. Generally DSCT was a non-invasive and safe procedure. Using DSCT the exposure of patient to X-ray was less than 64-slice single source CT (SSCT) and more than conventional angiography. For the DSCT the mean sensitivity was 90.4%, mean specificity was 82%, mean PPV was 83% and mean NPV was 96%. For the SSCT the mean sensitivity was 90.4%, mean specificity was 82%, mean PPV was 83% and mean NPV was 96%. The mean sensitivity, specificity, PPV and NPV of DSCT were slightly higher than SSCT.
Conclusion: DSCT is a noninvasive and relatively safe technology. The diagnostic performance of DSCT is higher than SSCT, but its performance is not so much high to be able to substitute the conventional invasive angiography which is still the gold standard test.
Azar Tol, Abolghasem Pourreza, Golamreza Sharifirad, Bahram Mohebbi, Zahra Gazi,
Volume 9, Issue 1 (9 2010)
Abstract
Background: Reporting of medication errors leads to saving Patients &apossafety and also is counted as a valuable information source for further prevention of mistake in future. The aim of this study was to determine the reasons for refusing to report medication errors from the viewpoints of nurses.
Material and Methods:In this descriptive study, 140 of 200 nurses who were employees of Baharlo hospital of Tehran participated in the study (response rate = 70%). Data were collected through a questionnaire. Test- retest analysis conducted for measuring reliability of the questionnaire and content and face validity of the instrument confirmed by key statisticians and methodologists. . SPSS software and descriptive statistics were used for analyzing the collected data.
Results:Our findings indicate that the reasons of not reporting medication errors were Management factors (3.68 ± 1.12), Fear of reporting outcomes (3.09 ± 1.68) and Process related to reporting (2.73± 1.26). Management factors domain was the major cause of refuse of reporting medication errors.
Conclusion:Since medication errors seem to be unavoidable, suppression, decreasing medication error depends on using a systematic approach with emphasis on management and nursing care.
Reza Safdari, Hussein Dargahi, Leila Shahmoradi,
Volume 9, Issue 1 (9 2010)
Abstract
Introduction: Evaluations of a system of information, without analyzing its users understand is impossible. User satisfaction is as key factor of success information system. It is essential to consider information system context (user, task, equipment and environment), user type and user experience in quality ergonomic computerized information systems. Therefore in this study HIS quality ergonomic of Iran compared with other software.
Methods: A comparative study in 1389 was conducted. In order to compare the evaluation results of hospital information system with other software, applications were selected that already were evaluated using isometric questionnaire. These software are a) IS-H * med (software evaluated by Hamburg and colleagues in 2004), b) SAP-HR (software evaluated by Gruber 2000) and c) Microsoft word for Windows (software evaluated by Gediga and colleagues in 1999). Users view analyzed through descriptive statistical and one sample t-test. Data analyzed through SPSS and Excel.
Results: HIS than IS-H * med of is significantly more usable. HIS than SAP-HR in terms of the IsoMetric Scales such as "suitable for task," "suitable for learning", "Error tolerance" and "learning ability" is significantly more usable. HIS vs. Microsoft's word is significantly less usable.
Conclusion: The results of this study showed that hospital information system in Iran than the other software studied is average level in terms of ergonomic software quality. It is recommended regarding user expectations when designing and developing of information systems.
Mohammad Arab, Zahra Eskandari, Abbas Rahimi, Abolghasem Pourreza, Hussein Dargahi,
Volume 9, Issue 1 (9 2010)
Abstract
Background: Most hospitals face with incremental demands, low facilities and readmission of patients as well as dissatisfaction of the clients in regarding to the quality and access of services. Investigating the reasons for readmission and solutions for decreasing the rate of these kinds of admissions can decrease hospital expenditures and improve the efficiency of hospital recourses. By offering high quality standard services and establishing appropriate procedures we can satisfy patients' needs and relieve their pains and discomfort. In this study we are going to evaluate the reasons for patients' readmission in Tehran University of Medical Sciences hospitals
Materials and Method: This is a descriptive and cross- sectional study consisting of 9 hospitals. The samples were consisted of patients who readmitted in hospitals affiliated to Tehran University of Medical Sciences. The required information has been registered in a questionnaire by means of computer, admission forms and index cards. The medical records of 250 patients were collected and analyzed by t test, Fisher Exact Test and Chi Square test.
Result: 17.8% of understudy patients were admitted two times and 80.7% were admitted more than two times in the hospital. Most of these 80.7% of patients were over 60 years old. It was seen a significant relation between patients' age and readmission also occurring infection. In categorizing diseases according to the reason of patients' readmission (23.1% in the second period and 20.2% in the third period) encountered diseases related to body blood system while readmitting in the hospital. The average cost of patients bedridden admitted for the second and third times because of the same reason was 3241532 and 1576593 tomans. There was a significant relationship between readmission and length of stay in both periods. Pursuit of treatment in 101 cases with average cost of 1802757 tomans in second time and 84 cases with average cost of 1205283 tomans in the third period was among the highest costs of readmission causes. Also the highest length of stay was related to surgery unit (9.98 days). The highest average of patients' costs related to surgery unit was 3543854 and 3911168 tomans for second and third periods.
Conclusion: Most of readmissions are among 60 years old patients and the most important reasons for the second and third readmissions are as a result of treatment follow up, adverse effect and illness complication which can be for the reason of incomplete treatment, non compliance of clinical protocols and lacking standard instruments. Results show that readmissions can increase patients' length of stay and additional burden of costs for patients, hospitals and insurance institutes. Therefore we can prevent these unnecessary costs and increase patients' satisfaction by complying clinical protocols, standardizing hospital procedures and instruments, personnel training and using new methods of diagnosis and treatment. The reform in Health care policies and focusing on the health care quality on the side of the administrators also paying more attention to home visits and home care are recommended to this case.
Bahram Delgoshyii, Leyla Riahi, Monika Motaghi,
Volume 9, Issue 1 (9 2010)
Abstract
Background: The purpose of the present study was to compare quality of working life in Kashan teaching and non-teaching hospitals and to determine its relationship with knowledge mamangment.
Materials and Methods:the study was descriptive in nature.The statistical population comprised of middle and senior managers at Kashan teaching and non-teaching hospitals.The data were collected using a valid Likert style questionaire (Very little to very much).Data analysis was carried out using SPSS.
Results : Worke space gained the highest score among another parameters (3.64 in teaching hospitals and 3.47 in non-teaching hospitals.Material facilities scored the lowest in teaching hospitals (2.7). Job designe also attained the lowest score in non-teaching hospitals (2.81).
Democracy showed the strongest correlation with knowledge management in teaching hospitals (r=0.83). There was a strong correlation between education and knowledge management in non-teaching hospitals (r=0.69).
There was a strong correlation between quality of working life and knowledge managment both in teaching and non-teaching hospitals (r=0.92 and r=0.83), respectively.
Conclusion : Based on the fidinges of the study, paying special attention to participation in decision-making and education could play a crucial role in improving work life quality.
N Nasiriad, A Rashidian, H Joodaki , F Akbari Haghighi, M Arab,
Volume 9, Issue 1 (9 2010)
Abstract
Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals.
Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data.
Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.
Yalda Soleiman Ekhtiari, Fereshtah Majlessi, Mohsen Shams, Abbas Rahimi Foroushani,
Volume 9, Issue 1 (9 2010)
Abstract
Background: Health care providers have important role in identification and management of domestic violence against women. The purpose of this study was to explore views and ideas of the women health worker about the screening and management programs related to domestic violence against women, their benefits and barriers and introducing the appropriate interventions for removing the barriers.
Materials and methods: This qualitative study was held through six focus group discussions and three in-depth interviews by the participation of fifty-six women who had provided reproductive health care of South Tehran, Rey and Eslamshahr Health Networks. The health care providers' views about domestic violence screening and management were extracted, categorized and analyzed.
Results: The majority of health care providers were aware of the importance of identifying and management of domestic violence cases in health care facilities. Respondents felt that they have responsibility to screen for domestic violence. Major barriers to domestic violence screening and management included perceived lack of time and place, insufficient knowledge and skills related to domestic violence screening and management, insufficient personnel and referral services.
Conclusion: : Improvement of identifying and management of domestic violence in health care settings by removing the barriers to screening and improvement of referral and supportive services, can lead to decreasing in domestic violence against women cases.
J Fekari, A Ghiasi, M Ezzati, M Pakdaman, A Khalafi,
Volume 9, Issue 3 (7 2011)
Abstract
Background: Assessing applied resources in a hospital as a health system will lead to identify organizational problems in this section and subsequently the necessary actions to resolve them. The aim of this study was to determine measurement of inappropriate admission and hospitalization (ISP: Inappropriateness Patient Stay) and associated reasons.
Materials & Methods: One widely used tools to assess appropriate use of hospital recourse is Appropriateness Evaluation Protocol which include objective criteria related to clinical services provided to the patient. Survey of admission and hospitalization in a cross-sectional and prospective study for 246 patients in the Alinasab hospital affiliated insurance organization carried out in Tabriz.
Results: The total of 7 percent of admissions and 6.2 percent of hospitalized were diagnosed inappropriate manner. There was no significant association between inappropriate admissions and other variables. There was significant relationships between Inappropriate bed days with insurance (P=0/041) and duration of hospital stay (P=0/041). However, there were no association between sex, disease diagnosis and hospital days per week with Inappropriate bed days.
Conclusion: The reasons of inappropriate admission and hospitalization in Iran are similar to other countries. Upgrading strategies to referral system performance, creating standard protocols to evaluate criteria for medical personnel and increasing outpatient diagnostic institutions could be reduce inappropriate admissions and stay of patients.
Mahmoud Nekuei Moghaddam, Azadeh Taghavi Rad, Saeedeh Hakimipour, Milad Shafiei, Gholamreza Goudarzi,
Volume 9, Issue 3 (7 2011)
Abstract
Background: The world is changing continually and organizations as the subsystems of the world should be adapted with these changes by helping to develope of creativity and innovation.This study to evaluate the relationships between conflict management styles and creativity of staff in training hospitals in Kerman province.
Materials & Methods:This is a cross-sectional study from aspect of descriptive -analytical. For gathering data, the standard questionnaires of conflict management for managers and creativity for staff applied. The participants in the study were all disciplinary managers from selected hospitals in one group and all disciplinary staff of selected hospitals in another group.Data analysis used in SPSS software.
Results:The results showed that there is a significant and opposite assosiation between enforcing styles and negotiating styles between managers (P<0/05, r= -0/187) and creativity of staff (P<0/05 , r= -0/155) . Meanwhile, there is a significant relation between marital status and educated staff and their creativity. This research reveales that avoiding styles applied among men is less than women.
Conclusion: To develop creativity of staff and managers should decrease using of enforcing and negotiating styles to solve the conflicts in hospitals.
Ali Ardalan, Arezu Najafi, Anita Sabzghabaie, Vahid Zonoobi, Saeed Ardalan, Hamidreza Khankeh, Gholamreza Masoumi , Mohsen Abbasi, Amir Nejati, Mehdi Zahabi,
Volume 9, Issue 3 (7 2011)
Abstract
Background: vulnerable events could damage structural, non structural and functional components of hospitals that might lead to community crisis, accordingly. Risk assessment is the first step to develop of a hospital disaster plan. In this study, a primary phase of developing a local tool for Iran's hospital disaster risk assessment entitled "Hospital Safety Index (HSI)" was conducted by World Health Organization originally.
Materials and Methods: First, the original index was translated into Farsi in five forms and 145 items. Then a group of four experts from the fields of medicine and engineering assessed the items one-by-one for their relevance and applicability. Revised edition tested three times at Shariati hospital in Tehran. An expert panel also evaluated the feature and content validity of the index. They also weighted the items as well.
Results: Test-retest of the index by two independent research groups found 93% of agreement. Furthermore, 244 points were revised or added to the original edition. The most important changes included: Combining instruction parts with related items for increasing educational properties, completing the list of hazards, developing a plan to analysis, and to present a quantitative and graphic of the model and finally to prepare an educational package as well.
Conclusion: Persian version of HSI, in response to needs of Iranian's health system, represents a rapid no-expensive tool for screening disaster risks at hospitals based on an international template that was tested in several countries. Based on this study, the Farsi index would be evaluated in more hospitals around the country. The assessment results will provide Iranian's health system with evidence-based information for more effective allocated resources and interventions evaluating.
Roohollah Askari, Hamid Reza Dehghan, Mohammad Amin Bahrami, Fatemeh Keshmiri,
Volume 9, Issue 3 (7 2011)
Abstract
Background: The hospitals are the most significant providers of health care services. According to more health funds spending by hospitals, economic management in hospitals is necessary. Determining the causes and rates of insurance under reimbursement bills was the objective of this study.
Materials and Methods: This research is a descriptive cross-sectional survey was done in 2008. The samples of study were the al records' patients who undertaken of social security insurance system in the teaching hospitals of Shahid Sadoughi University of Medical Science. The data complied in SPSS 16 software and then analyzed.
Results: In this study, 9.8% cases of all hospitalization bills were deducted. The highest rates of under reimbursement bills was in Afshar hospital (12.7%), followed by burn hospital (12.5% ), Shahid Sadoughi hospital (10%), and Shahid Rahnemoon hospital (8.2%). The highest rates of under reimbursement bills imposed to the surgeon fees (28.4%), treatment fees (15.06%), and medicine (14.3%) costs. However assistant surgeon fees had no under reimbursement. The most important causes of under reimbursement were defects in the insurance records of patients and noncompliance with insurance organization regulations.
Conclusion: Training of human resources and optimized use of hospital information systems could be helpful to hospitals for reducing insurance reimbursement to ultimately improve hospitals to financial statements.
