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Arash Mofarahzat, Ali Akbar Fazaeli, Yadollah Hamidi,
Volume 19, Issue 1 (4-2020)
Abstract
Background and Objective: Tuberculosis is an infectious disease and is the leading cause of death from single-agent infectious diseases. The purpose of this study was to estimate the economic costs of this disease and its effective factors in Hamadan province.
Methods: This descriptive-analytical study was conducted on a cross-sectional (two-year time scale) study in 2014 and 2015. The population of this study is tuberculosis patients in Hamadan province. Data extraction was performed by examining the file of patients with tuberculosis in urban and rural health centers and patients of hospital in Hamadan. Also, using a logistic model and Stata 15, social factors and households that are more likely to be exposed to this disease were studied.
Results: A total of 173 tuberculosis patients were identified, with an estimated cost of treatment of 8307 million IRR. Also, the results of the Logit model showed that people living in the city over 65, low educated, and people with HIV The order of 22, 14, 18, and 6 percent would be greater than the likelihood of exposure to tuberculosis.
Conclusion: The cost of tuberculosis, in addition to allocating a significant amount of health resources in the province, also imposes a high burden on households. The social and economic consequences of these costs lead to many abnormalities such as the exclusion of women with a family or the abandonment of the children of affected people.
Masoud Etemadian, Ali Mohammad Mosadeghrad, Mahmoud Reza Mohaghegh Dolatabadi, Hamed Dehnavi,
Volume 19, Issue 1 (4-2020)
Abstract
Background: Public-private partnership (PPP) in constructing and operating hospitals is a good strategy to provide high quality services to people at lower cost for the government. However, PPP is facing several challenges. The objective of this research was to identify and explore the PPP challenges in building Moheb Yas hospital in Tehran, Iran.
Materials and Methods: A qualitative approach was used for this case study in 2018. In-depth semi-structured interviews were conducted with 24 key stakeholders, managers and employees who were involved in PPP initiative implementation using purposive and snowball sampling methods. Thematic analysis approach was used for data analysis.
Results: Moheb Yas hospital was built in the yard of a public hospital (Co-location PPP) by the private entity. Then, the public hospital was moved into the private hospital. The new hospital was transferred to the government after one year owing to some challenges. These challenges include an inappropriate PPP model, low government capacity and competency in PPP, low trust in private partner, difficulty in funding the project, demolishing the old building, applying for hospital licences, merging two public and private hospitals, and difficulties in equipping the new hospital with human and physical resources.
Conclusion: The PPP was not successful in this case. Although PPP initiatives have benefits for the health system, but, it comes with numerous challenges especially in developing countries owing to disparate goals, incentives, and management practices of public and private sectors. The research findings provide useful insights for policy makers and senior managers in health systems in similar countries about the main barriers of PPP initiatives in the health sectors.
Ali Akbari Sari, Mahboubeh Bayat, Mohammad Arab, Mehdi Yaseri, Seyedeh Fatemeh Hosseini,
Volume 19, Issue 1 (4-2020)
Abstract
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.
Ali Akbarisari, Farhad Habibi, Bahman Khosravi, Pejman Hamouzadeh, Mani Yousefvand,
Volume 19, Issue 1 (4-2020)
Abstract
Background: Performance appraisal and quality evaluation of the services provided will achieve the organizational goals and improve the level of staff capability. In order to evaluate accurately and efficiently, we need to use standard indices, to compare the quality and quantity of work with standards, to know the current conditions and to solve its problems
Methods: This study is an applied study. This was done through a combined method of reviewing the texts and consensus of experts. Initially, the literature review and emergency evaluation indices were extracted, then the duplicate indices were removed and similar indices were merged, then weighted experts and questionnaires were compiled with the indices. Content validity, Cronbach's alpha coefficient and test-retest were used to assess the validity, internal consistency and reproducibility of the questionnaire, respectively. Data were analyzed using Excel and SPSS 20 software.
Finding: Final questionnaire with 105 questions in 8 areas including management and leadership (15); human resources (22); physical space and facilities (18); medicine and medical equipment (6); guidelines and policies (17); patient-centered (10); documentation of patient records (5); quality and time indices in the emergency department (12). The results showed that the final questionnaire was reliable (0.89) and repeatable (ICC = 0.98).
Conclusion: The Hospital Emergency Performance Assessment Questionnaire is a valid and reliable instrument and can be used to evaluate the performance of hospital emergency services.
Ziba Khalili, Mohammad Panahi Tosanloo, Bahman Khosravi, Naser Iravanimanesh, Rezvan Kazemi Dastjerdeei, Loghman Azmoudeh, Ramin Ahmadzadeh, Abolghasem Pourreza,
Volume 19, Issue 1 (4-2020)
Abstract
Background and Aim: Conflict between health workers is an important problem in health care units around the world. The aim of this study was to identify the causes of conflict between nursing staff and other occupational groups in the hospital.
Materials and Methods: This descriptive-analytical study was conducted in 2018. A researcher-made questionnaire was used to collect data. The questionnaire was designed in two parts: demographic variables and causes of conflict between nursing and other occupational groups with a Likert scale of 5 points. 120 nursing staff of Ardabil University of Medical Sciences randomly selected were surveyed. Data were analyzed by SPSS software15 using descriptive and inferential statistical methods.
Results: The highest rate of conflict reported by nurses was related to the conflict with the group of managers (4.17±0.94) and the lowest rate was with administrative, financial and support staff (3.55±1.13). The most important reasons for conflict between nursing staff and different groups were: imposing non-specialist roles (such as completing doctors' documentation); perceived inequality in workload distribution; insufficient understanding of nursing work conditions; unreasonable differences in salaries and other benefits, and unfair distribution of manpower. There was also a statistically significant correlation between the level of conflict with marital status, work experience, age group (p <0.05).
Conclusion: The results of the present study showed the role of some factors causing conflict between nursing staff and other occupational groups. These findings could be a practical guide for hospital managers in making practical decisions and strategies for managing workplace conflicts.
Ali Mohammad Mosadeghrad, Fatemeh Khalaj,
Volume 19, Issue 1 (4-2020)
Abstract
Background and purpose: Electrocautery is a very important tool in surgery. Electrocautery burn is a common side effect of operation surgeries. Quality management is a useful strategy for improving the quality and safety of hospital services. The objective of this study was to examine the impact of quality management on reducing electrocautery burns.
Materials and methods: A participatory action research was conducted in the operating theatre of a hospital in Tehran, Iran, in 2013 and 2014. A quality improvement team was established in the hospital operating theatre. The quality improvement team using an 8-step quality management model, standardized working processes, identified quality goals for the processes and improved them until achieved the quality goals. Data on electrocautery burns was collected before and after the intervention and compared.
Results: Electrocautery burn rate was 0.40% in 2012. A wet patient due to sweating or washing during the surgery, in-appropriate patient position, faulty earth well, faulty anti-static mattress and long usage of electrocautery devices were the main reasons of electrocautery burn injuries. Accordingly an action plan was developed and implemented for preventing and reducing electrocautery burns. Consequently, electrocautery burn rate was reduced to 0.21% and 0.02% in 2013 and 2014. Electrocautery burn was significantly reduced by 95% in two years.
Conclusion: Electrocautery burns can be easily prevented using the quality management strategy. Implementing an appropriate quality management model appropriately in a supportive environment enhances the safety of hospital services.
Elham Ramezan Pour, Hojjat Rahmani, Mehdi Raadabadi, Ghasem Rajabi Vasokolaei, Neda Rashidi,
Volume 19, Issue 2 (8-2020)
Abstract
Introduction: The operating room is one of the most sophisticated workplaces, consisting of a vast array of electrical, gas and radiation equipment that are more susceptible to accident than other hospital departments. Therefore it is important to observe safety tips in this section. The purpose of this study was to evaluate the standard of safety in operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences in 2019.
Method: This study was a descriptive cross-sectional study. The statistical population consisted of all operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences. The tool used was a checklist that was completed by researchers by observation and interviewing on-site. Safety standards have been evaluated in terms of the physical space of the operating room, fire safety, personnel safety, patient safety, infection control. Data were analyzed by SPSS version 21.
Results: The operating rooms of university-affiliated hospitals were 80.10% secure in overall safety. The patient's safety area, with 83.34%, had the shortest distance from the standards and the infection control safety area, with 74.24%, had the highest distance from the standards. The highest and lowest scores were related to the safety standard related to the operating room of hospitals (2) and (1).
Conclusion: According to the findings, the operating rooms of the studied hospitals are generally in desirable compliance with safety standards. However, it is essential to pay attention to problem areas to increase the safety factor for staff and patients in the operating room, so appropriate remedial measures should be taken to ensure complete safety of the operating room for all components.
Mani Yousefvand, Alireza Zali, Sajjad Razavi, Hojjat Rahmani, Saeed Manavi, Noureddin Sharifi, Elham Salehian, Ghasem Rajabi Vasoukolai, Bahman Khosravi,
Volume 19, Issue 3 (11-2020)
Abstract
Background and Aim: The aim of this study was to investigate the income changes resulting from the implementation of this book in the hospitals of the University of Medical Sciences.
Materials & Methods: This cross-sectional study was conducted based on retrospective information related to the first half of 1398 of Shahid Beheshti University of Medical Sciences. Data related to this study were collected from patients' records using hospital information system and hospital intelligent management system of Shahid Beheshti University of Medical Sciences. In order to analyze the data, the average of Rials per service was used for each hospital and type of admission.
Results: The results showed that with the implementation of the book of relative value 2018, the total income of the studied hospitals will increase by 10.67%. In total, the share of total book codes included in the study is 41% of the total, of which 20% is the professional component, 19% is the technical component and 2.4% is anesthesia. After book codes, hoteling with 26% and consumer goods with 14% and medicine with 11% make up the rest.
Conclusion: The approach of the 2018 book is more towards temporary inpatient services and encourages providers not to admit patients to receive services. Also in this book, the proper growth of the technical component of services will occur, which in other words indicates the approach and encouragement of investment in the hospital sector.
Mahmoud Biglar, Hossein Dargahi, Zohreh Ghorbani, Sima Garshasbi,
Volume 19, Issue 3 (11-2020)
Abstract
Background: Employees’ empowerment is the best and efficient organizational strategy for improvement of human resources productivity. Therefore, the present study was aimed to investigate the relationship between empowerment training courses with human resources productivity among Tehran University of Medical Sciences employees.
Materials and Methods: This was a descriptive-analytical and cross-sectional study. The study population included 1452 employees of the university deputies. Research sample was calculated 304 according to Krejcie and Morgan table. The research tool consisted of Hersey's empowerment training courses effectiveness translated by Jafari “et al.” and Hersey-Goldsmith's human resources productivity questionnaires. The content and structural validity including convergent and divergent validity of questionnaires were determined, and their reliability was confirmed by Alpha Cronbach with 0.86 and 0.89 coefficient, respectively. Data were analyzed by SPSS version 23, and descriptive results were presented by absolute and relative frequency and analytical results by inferential statistical techniques and Structural Equation Modeling.
Results: The mean of empowerment training courses effectiveness of employees and human resources productivity was relatively desirable. Also, the relationship between empowerment courses effectiveness and human resources productively of employees was confirmed.
Conclusion: Using different procedures of employees’ empowerment in early period of employment including organizational socialization, on-the-job training courses by workshops, distance learning and in-person training for empowerment of self-esteem, compatibility, and innovation of employees’ for promotion of organizational and individual productivity is recommended.
Hojjat Rahmani, Ghasem Rajabi Vasoukola, Rajabali Daroudi, Mani Yousefvand, Zeinab Fakoorfard,
Volume 19, Issue 4 (12-2020)
Abstract
Background: Considering the importance and position of the health sector in socio-economic development programs, it is necessary to be aware of the current situation and to recognize its issues and problems. Determining costs and the amount of profit or even loss in the health sector helps in managing costs. The purpose of this study was to evaluate the cost of common laboratory services and compare them with the tariffs approved by the Ministry of Health and Medical Education in the selected hospital of Tehran University of Medical Sciences.
Materials and Methods: The present study was a cross-sectional and retrospective study. In this study, activity-based costing technique was used. The study population was the laboratory of the selected hospital of Tehran University of Medical Sciences. Data collection tools were information forms, software, interviews and direct observation. The analysis was performed using Excel 2016 software and finally, the cost price was compared with the approved tariff.
Results: The findings indicated that the highest and lowest costs were related to the cost of manpower and energy carriers, respectively. The highest cost was related to the urine analysis test and the lowest was related to the sodium and potassium tests.
Conclusion: The results of this study showed that the cost of conventional laboratory services in the selected hospital of Tehran University of Medical Sciences and the tariffs approved by the Ministry of Health and Medical Education in 2019 were different.
Leila Hosseini Ghavam Abad, Abbas Vosoogh Moghadam, Rouhollah Zaboli, Mohsen Aarabi,
Volume 19, Issue 4 (12-2020)
Abstract
Background and Aim: Clinical governance is one of the important frameworks for continuous quality improvement and safety in health care systems. Identifying the axes of this approach according to local conditions is one of the important priorities of the health system. The aim of this study was to identify the views of stakeholders on the axes of clinical governance in primary health care based on family physicians in Mazandaran province.
Methods: The present qualitative study was conducted using the conceptual framework analysis method in 2018-2019. The study population were key policy makers of Ministry of Health, Health deputy of the University, the county health network, family physicians association, family physicians, and the parliament research center. Participants were selected using purposeful and snowball sampling methods. Data were collected through semi-structured interviews and were analyzed and coded using MAXQDA 11 software.
Findings: According to the interviewees' views, the research findings were classified into 4 main dimensions: dimensions of clinical governance, requirements and structures, decision-makers and dimensions of quality and safety assessment. 17 sub-themes including community participation, clinical audit, clinical effectiveness, personnel management, training, information use, risk management, guidelines and procedures, promotion of health indicators, equipment and facilities, referral system, financing, policy makers, effectiveness, efficiency, human aspects of services and justice were identified and extracted.
Conclusion: According to the research findings, to facilitate the implementation of clinical governance, solutions such as the existence of appropriate infrastructure, commitment of managers, supportive culture, sufficient knowledge, monitoring and evaluation, appropriate culture building, facilities and equipment and sufficient financial resources are suggested.
Ebrahim Jaafari Pooyan, Hojjat Rahmani, Mohammadamin Mirshekari,
Volume 19, Issue 4 (12-2020)
Abstract
Introduction: Identifying the challenges of Quality Improvement Offices (QIOs) not only helps in planning the quality of hospital services and in trying to provide a suitable solution to solve the problems of these offices but also plays an important role in strengthening the offices and increasing the quality of clinical and non-clinical services of hospitals. This study aimed to investigate the challenges of quality improvement offices in hospitals and provide appropriate solutions.
Methods: The present qualitative research was conducted using semi-structured interviews with 40 managers and hospital boards, matrons, quality improvement experts of hospitals and accreditation offices experts of medical universities in Tehran. Content analysis method was used to analyze the data obtained from the interviews. Then, the collected data were analyzed and classified by MAXQDA10 software.
Results: By analyzing the interviews in the field of challenges and solutions, the extracted codes were classified into four areas of management, standards, evaluation and staff. The most codes were related to management with 5 themes and 21 sub-themes. In addition, most of the solutions were related to the field of management.
Conclusion: The findings of the study showed that most of the challenges and solutions were in the field of management. Focusing on this field could be helpful in improving the quality of offices performance.
Azadeh Sobhkhiz Koozeh Kanan, Zahra Haji Anzahaei, Farideh Ashraf Ganjouei, Mohammadhossein Pourgharib Shahi,
Volume 20, Issue 1 (5-2021)
Abstract
Background
In today's medical information system, various data are stored to be analyzed or retrieved when necessary. Therefore, this study was conducted to determine the needs of stakeholders of athletes' medical information management system based on international standards.
Materials & Methods
The study population included athletes, clinical service providers and managers of sports medicine centers in Iran. In this study, comparison tables of selected countries were used to assess the needs of stakeholders and were quantitative-descriptive. To analyze the data obtained from the questionnaire, the number of answers obtained for each component was determined based on the Likert scale and according to the frequency of answers related to the options, the percentage of each was calculated and the components that were more than 50% were agreed upon.
Results
Findings identified the initial data set, general components of the system and the initial assets of the Athlete Sports Medicine Information System. The results showed that the highest collective agreement about the presence of drug allergies and diabetes in the family's history was in the individual health records of athletes and the lowest agreement was reached on how to join the team. Stakeholder needs, compared to selected countries, included more details, including mental health information, that were not given much attention in the selected countries' datasets.
Conclusion
Based on the findings, it seems that a person's access to sports medicine information is a key point and a person can see and receive their information, problems and related health needs in a patient-centered treatment.
Yusef Eivazi, Yadollah Hamidi, Ali Akbar Fazaeli,
Volume 20, Issue 1 (5-2021)
Abstract
Introduction: Inappropriate admission and inappropriate hospital days are two undesirable indicators in terms of controlling hospital costs. This study was conducted to determine the rate of inappropriate admission and hospital days and related factors in Shohada Hospital in Kermanshah.
Methods: This is descriptive-analytical study.The statistical population included patients admitted of Kermanshah shohada Hospital in 1397. 245 Inpatient records were selected using Cochran's formula and stratified random sampling. Appropriateness evaluation protocol was used to evaluate the inappropriate admission and inappropriate hospital days. The relationship between age, sex, type of admission, type of ward, type of treatment, coverage of cost hospitalization, place of residence, with rate of inappropriate admissions and inappropriate hospital days was assessed using spss16 software.
Results: 5.7% of admissions and 21.4% of hospital days were inappropriate. Inadequate admission was significantly related to gender, type of surgical or medical treatment, type of hospital ward in chi-square test in contingency tables with 95% confidence. Inappropriate hospital days were related to the type of hospitalization ward in kruskal-Wallis test , type of treatment and place of residence in Mann-Whitney test.
Conclusion: By determining the amount of inappropriate admissions and inappropriate hospital days and related factors for policy makers and managers of hospitals and insurance organizations, it is possible to avoid unnecessary costs without reducing the quality of hospital services.
Hiwa Mirzaii, Hojjat Rahmani, Mohammad Arab, Jalal Saeidpour,
Volume 20, Issue 1 (5-2021)
Abstract
Background: Medical tourism has been considered in our country for many years. The arrival of international patients in the country will boost the medical tourism sector; however, the necessary infrastructure must be created for this. The guidelines for the establishment of the International Hospital Unit are one of the legal infrastructures for standardization in this field. Therefore, this study was conducted with the aim of strategic analysis of the establishment of an international patient unit in hospitals of Tehran University of Medical Sciences.
Materials & Methods: This combined study was performed in 2019 in three hospitals of Tehran University of Medical Sciences that had a license to operate this unit. In-depth interviews were conducted in each hospital with experts in this field. The data were then categorized into four categories of strengths, weaknesses, opportunities and threats, and according to the results of the SWOT technique, the necessary strategies were presented.
Results: There are opportunities including low cost of medical services in Iran, low value of Iranian Rial and political and religious ties with countries in the region. Significant threats also included the existence of professional competitors, the widespread activity of brokers, and the large number of trustees for the industry within the country. Finally, appropriate strategies were presented for each hospital.
Conclusion: This market in our country faces many threats and needs policies appropriate to the current situation with an immediate action. The results also showed that two hospitals are in a competitive state and one hospital is in a defensive state.
Ebrahim Jaafari Pooyan, Riaz Alaei Kalajahi, Farhad Habibi, Shiva Toloui Rakhshan,
Volume 20, Issue 1 (5-2021)
Abstract
Kamran Irandoust, Jafar Yahyavi Dizaj, Hiwa Mirzaii, Faroogh Na'emani,
Volume 20, Issue 2 (9-2021)
Abstract
Background & Aims of study: Service delivery is known as the most tangible function of the health system and hospitals are the most obvious manifestation of this function. Also, one of the most important factors in creating catastrophic health expenditures is the use of hospital services; therefore, in the present study, an attempt was made to describe the share of hospital service costs from total household health expenditures.
Materials and Methods: The present descriptive study was performed retrospectively for the period of 2011 to 2015. The study was done using the Household Expenditure and Income Survey (HEIS) which is conducted annually by the Statistical Center of Iran (SCI). Based on the designed model, the share of hospital costs from household health expenditure was determined by year and type of services in urban and rural areas.
Results: On average, 18.5% of households used hospital services and about 28.7% of household health expenditure had been spent on receiving health services from hospitals. The average cost of household hospital medical services was 92.4% in urban areas and 91.4% in rural areas. On average, 51% of the cost of household medical services in hospitals was related to public hospitals, and the highest cost spent by households in public hospitals was allocated to surgery.
Conclusion: The share of hospital services costs and the rate of use of these services among Iranian households are significant, which may lead to poverty and catastrophic health expenditures. Therefore, it is necessary for health decision makers to design and implement evidence-based policies to manage and control this part of health costs.
Farhad Habibi, Moslem Sharifi, Bahman Khosravi,
Volume 20, Issue 2 (9-2021)
Abstract
Seyed Mohammad Hasan Safi, Mohammad Hossein Sadeghian,
Volume 20, Issue 3 (12-2021)
Abstract
Background:The most important and difficult process in any organization is to create change in the organization because today organizations have to react to changes in the environment.The purpose of this study was to investigate the effect of transformational management on quality of work life of the staff of Shohada-ye Tajrish Hospital in Tehran.
Materials & Methods:The is a descriptive-analytic and cross-sectional study that was conducted in Shohada-ye Tajrish Hospital in Tehran in 2020. Data collection tools were Transformational Management Questionnaire(Bass and Olivier)and Quality of Work Life Questionnaire(Walton 1973). Based on Cochran's formula, 234 employees of Shohada-ye Tajrish Hospital in Tehran were selected as study population.The reliability and validity of the measuring tools were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis. Pearson correlation test and structural equation test were used to analyze the data.
Results:The research findings indicated that there was a positive and significant correlation between transformational management with safe and healthy work environment, growth opportunity and security, fair and adequate pay, employee legalism,social affiliation,social cohesion and integration, development of human capabilities and the general atmosphere of working life. In addition, 92% of the variance in quality of work life was explained by the research model.
Conclusion:Considering the impact of transformational management on the development of human capabilities, senior managers should formulate and implement appropriate programs to improve the quality of work life and provide conditions for employees to enjoy their organization and work.
Ebrahim Jaafaripooyan, Batoul Ahmadi, Baheshte Ebrahimi,
Volume 20, Issue 3 (12-2021)
Abstract
Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.
Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.
Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.
Conclusion: The abuse in the health service provision is a high risk for health care managers in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.
