Journal of

Background: Process of discharging patients affects patient’s satisfaction .This is one of the serious challenges that hospital managers face. This study is aimed to determine the average waiting time of patient discharge process and identify influential factors of this process in Imam Reza Hospital in Mashhad in the year of 2014.

Materials & Methods: This is a cross-sectional survey in which waiting time of patients who had discharged from clinical wards of the Imam Reza hospital in Mashhad had been studied. 455 of patients had been selected as samples. The amount of  time spent during discharge in six different departments  such as inside each ward, from each ward to the medical records unit, inside the medical records unit, from medical records unit to  accounting department , during cost calculation and also from  cost accounting to cost payment unit) had been determined by using stop-watch method. The data had been analyzed by descriptive and analytical statistics in significant level of 0.05  using SPSS16.

Results: Results showed that waiting time was 504.26± 362.96 Minutes. Patients spent most and least proportion of their waiting time in ENT and Burns wards during discharge.

Conclusion:   As noticeable number of minutes spent inside wards and cost payment unit by patients, calls for corrective interventions such as changing visit time and predicting schedules for sending medical record to accounting department could  reduce waiting time.

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. 

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.

Background: nutrition department is one of the most important sectors of hospital to improve the patients' health and satisfaction. Lack of standards obsevance causes nosocomial infections and develops health risks. Establishing HACCP standards, many existing shortcomings will be omitted in the hospital nutrition department. This study aimed at assessing the mentioned nutritional standards system in the hospital nutrition department.

Materials and Methods:  This cross - departmental study was conducted at Kermanshah University of Medical Sciences' teaching hospitals in 2013. HACCP questionnaire was used. Data collection performed using observation, interviews and questionnaire filling in from hospitals' nutrition department.5-point likert scale used which rating scale was from 1(lowest) to 5(highest).in order to data entry and analysis SPSS software version 18 utilized using tables, graphs and Kruskal-Wallis test.

Results:  The mean score and percentage of five areas of HACCP standards were 3.58 and 70.23% respectively which were desirable in seven studied hospitals. There was no significant statistical relation between the mean scores of hospitals in the standards.

Conclusion: Although, the situation was assessed desirable, because of the importance of nutrition department, observance of optimum standards and quality improvement can prevent potential infections in food preparation and distribution and result in patients and staff satisfaction.

Background: Patient safety is one of main indicators in quality control of health services. The most prevalent threatening cause of patient safety is medical errors especially medication errors. This study aimed at assessing the rate and type of nurses’ medication errors.

Materials and Methods: This study was a descriptive – analytical one which performed in a non-public hospital in East North Country. The studied hospital has 180 active beds in the fields such as general surgery, obstetrics and gynecology, infants, cardiology, angiography, CCU, ICU, and NICU. Due to limited population, all the nurses in the hospital (97 nurses) were participated in the study. The instrument was a self-designed questionnaire which was composed of two main parts (demographic data and medication errors information). Its reliability and validity was confirmed. Data were analyzed by SPSS software version 15 using t- test and ANOVA.

Results: Among the studied nurses, 76 nurses (78.3%) were female and 21 (21.7%) were male. The mean of age and work experience of participants were 29.3 and 8.7 respectively. The most frequent of medication errors included medication without prescription 136(23.7%), lack of attention to medical complications 134(23.4%), Giving the medication at the wrong time 128(22.4%). The lowest common of medication errors reported as using expired date medication4(0.7%), wrong medication 5(0.9%) and  non administered medication 6(1.1%).

Conclusion: The nursing managers should be consider more attention to reduce medication errors by implementing Training classes, improving nurse's processes and promoting attitudes towards importance of patient safety.

Background:  hospital is one of the most key institutions in the modern health care system and accountability is the most essential organizational functions. Accountability strengthens the main factors to responsibility regarding functions by pushing them up. This study aimed at assessing the situation analysis of  performance accountability in teaching hospitals affiliated to Tehran University of Medical Sciences

Materials and Methods: This descriptive and analytical study performed at 12 teaching hospitals of Tehran University of Medical Sciences in 2013. Data collection performed by performance accountability checklist. Analysis was done by SPSS software version 19 using descriptive and analytical statistics test (Pearson correlation coefficient).

Results: In general, the condition of accountability for hospitals' performance (Mean =1.5 from 2) measured "good"(moderate to high). Strategic planning dimension achieved the highest score (Mean±SD:1.85±0.21) and Stakeholder Participation had the lowest score (Mean±SD: 1.12±0.46). There was a positive significant correlation between all variables (except Motivation) and performance accountability.

Conclusion: Weakness in any part of performance can affect other parts and have negative impact on total hospital performance. Mentioning the current situation of accountability for hospitals' performance and its importance, reinforcing weak dimensions and addressing deficiencies in  performance accountability should be consider as managers' top priority.

Background: Hospitals are best places to provide preventive and health promotion services along with healthcare services. These studies aimed at determine the effect of establishing health promoting hospitals’ standards on hospitals indicators in Fatemieh hospital.

Materials and Methods: This is a comparative study which was conducted in Fatemieh (case) and Khatamolanbia (control) hospitals in 2013. The standards of health promoting hospitals as an independent variable were established in Fatemieh hospital. Data related to indicators of leaving hospital with personal satisfaction, Cardio pulmonary Resuscitation (CPR) and neonatal mortality were collected in both hospitals in second half of 2012 and first half of 2013. SPSS version 16 used for data analysis and Chi-square and Fisher exact tests were utilized. The results were shown by comparative tables.

Results: The neonatal mortality rate before and after the intervention was 7.28 and 14.03 in case hospital, while this rate was 5.26 and 10.83 in control hospital respectively. The percentage of leaving hospital with personal satisfaction before and after interventions was 3.43% and 2.93% respectively in case hospital and success of cardiopulmonary resuscitation in this group was 56.1% and 61.3% correspondingly. There was no significant relation between establishing standards of health promoting hospitals and indicators of leaving hospital with personal satisfaction and neonatal mortality in Fatemieh hospital, while significant relation was obtained between promoting of cardiopulmonary resuscitation indicator and standards of health promoting hospital in mentioned hospital(P=0.001).

Conclusion: Initial results revealed that establishment of health promoting hospitals’ standards had positive effects in Fatemieh hospital and lead to improve a number of indicators. 

Background: Approximately, more than 60 percent of the hospital costs allocate to hospital human resources. The study aimed at determining the number of nurses in the poisoning department of a general hospital in Shiraz.

Methods: This study was an applicable one based on hospital information.  Study population was patients who referred to a hospital poisoning department of Shiraz in 2012.  The medical records were checked up. Monthly stratified data was obtained from the statistics office and patient records (physician's orders and nursing notes) using a monthly systematic data collection randomly. Linear programming techniques using lingo version 8 software were performed to data analysis in order to calculating appropriate number of nurses.

Results: Two nurses in morning, two in evening, three in night and seven in all shifts were at least required nurses in the poisoning department of the general hospital. The number of available nurses was more than estimated number in the department.

Conclusion: The numbers of nurses were over the approximated number in the department in morning and evening shifts.  Besides, the estimated of nurses from quantitative methods such as linear programming were lower than those calculated experimentally by nursing managers. It is recommended to Hospital administrators considering these techniques calculation to achieve appropriate distribution of staff in departments.

Background: Staffs’ Job motivation is one of the most important factors in goals achievement in organization. As a result, considering effective factors of staffs’ motivation is one of the main tasks of organization managers. The aim of current study is to assess the relation between organization climate and job nature with staffs’ job motivation in Isfahan hospitals.

Materials and Methods: this study was a descriptive and correlation one. The study population included all staff of total Hospitals in Isfahan city. The Sample size was estimated to 141based on Cochrane. Three questionnaires including organization climate, Job nature and job motivation were used. Data analysis was performed by SPSS software version16 using Pearson correlation coefficient test, linear regression, one- way ANOVA and LSD tests.

Result: the study result revealed a significant positive correlation relation between organizational climate and job motivation (0.42), and Job nature and job motivation (0.36) (P<0.01). Furthermore, organizational climate (0.18) and Job nature (0.13) are predictors of f job motivation. One-way ANOVA test indicated there were significant statistical differences between job motivation and employment.

Conclusion: With regard to the impact of organizational climate and Job Nature in job motivation, managers should pay more attention to these two valuable factors.

Background: ‌ Based on increasing the privatization in hospitals, conducting researches in various fields of private hospitals and comparison with public hospitals is greatly felt.This study aimed at investigating the relationship between job satisfaction and burnout among employed nurses in selected public and private hospitals in Shiraz city.

Materials and Methods: This was a comparative-correlational study. The study population was composed of employed nurses in public and private hospitals in Shiraz city in 2012. sample size was estimated 320 using Cochran formula. The questionnaire of Spector job satisfaction” and “Maslach burnout” were used for data collection. Study conducted in two private and two public hospitals in Shiraz and data gathered randomly among nurses. In order to analysis descriptive and interfere statistics including mean and standard error, Pearson correlation coefficient, MANOVA and independent t- test.

Results: There was a significant and negative relationship among job satisfaction and three dimensions of job burnout in both public and private sectors (p<0.001). In addition, the results revealed that there was a significant difference among the emotional exhaustion and depersonalization between private and public sectors (p<0.05).  However, there was no significant difference between job satisfaction and reduced productivity performance of these two sectors.

Conclusion: According to the findings, by increase in the nurses' job satisfaction, particularly in the public sector, the adverse effects of burnout can be prevented.

Background: The Pabon Lasso graphical Model is a method to determine hospital efficacy as one of the most important part of health system in developing countries. This study aimed  at assessing the efficacy analysis using Pabon Lasso Model and comparing with national standards of educational hospitals affiliate to Qom University of Medical Sciences.

Materials and Methods: This descriptive study conducted in educational hospitals of Qom University of Medical  Sciences in 2011 - 2013. Data collected by approved forms of Health Ministry and three indicators including bed occupancy percentage, bed turnover rate, and average length of Stay were calculated for each hospital using Pabon Lasso model. One sample t-test conducted to data analysis.

Results: The mean of bed occupancy and bed turnover was 76.9±9.8 and 100.6±35.4 respectively which were significantly higher than national standards. In addition, the average length of Stay was 3±1.1 days that were similar to standard. The Highest efficacy calculated for IZ hospital and lowest efficacy observed in KA and NE hospitals. Moreover, ZA Hospital can achieve excellent efficacy in 2013.

Conclusion: The mean of bed occupancy and bed turnover assessed  very desirable  and higher than national standards. Moreover, only IZ and ZA hospitals had excellent efficacy based on Pabon Lasso model. 

Background: one of the most essential components in patient- physician relationship is the length of visit. Short time visit can affect visit quality and patient- physician relationship. This study aimed at comparing specialists visit length with standards in general hospitals of Qazvin.

Materials and Methods: This cross-sectional study conducted in general hospitals of Qazvin  in 2013. 428 patients were randomly selected to participate who were referred to the outpatient clinics of selected general hospitals. Studied specialties were including Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. In order to data collection, a Checklist including physician and patient related items was used and data analysis performed using SPSS version 19.

Results: The study results revealed the mean score of outpatients' visits length was 4.67±2.43 minutes which had a significant difference from standards (p<0.0001).Higher mean score was relate to  pediatrics (2.55±7.08) and the lower one was internal physicians (1.82±3.93).

Conclusion: In this study, Visit time in developed countries was lower than developing ones. Several factors were identified which affect visit time. Thus, decision makers should use the results to improve outpatients visit quality.

Background: Using vein by Peripheral Catheter is one of the important ways to provid water, electrolytes, medications and nutrients to patients in hospitals and other therapeutic centers. Phlebitis is an important complication of using peripheral cannula. This study performed to determine the incidence of phlebitis related to peripheral cannulae, and its effecting factors.

Materials and Methods: This prospective and analytical study was conducted in adult's medical- surgical units of Shahid Sadoughi Yazd. Two hundred ninety seven cannulae of 297 patients were assessed. Phlebitis was identified by the presence of at least two following symptoms including local pain, redness, swelling, warmth and palpable venous cord.

Results: The mean of patients' age was 40.82±19.48 (12-91 yrs.). The phlebitis incidence rate was 14.1%. Some factors such as smoking (P=0.007), diabetes (P=0.001) had positive and significant association with phlebitis incidence rate. Odd Ratio for smoking and diabetes were 3.107(CI=1.310-7.372, 95%) and 3.736(CI=1.736-8.039, 95%) respectively.

Conclusion: Study findings revealed that overall incidence rate of phlebitis compare with other similar studies was low. Study results indicated high phlebitis incidence in smokers, diabetic patients, and elder patients which can be prevented by considering phlebitis incidence in impatiens.  

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

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

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

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

Background: Three aspects of health, responsiveness rate and equitable financing introduced as the main goals of health systems. In this study, responsiveness rate was assessed among private and social security hospitals in 2013.

Materials and Methods: The descriptive-analytical study conducted as a cross-sectional one among 10 hospitals in Tehran city (20 percent of total social security and private, 8:2 respectively) in 2013. Study population consisted of all inpatients and outpatients referee to eight private and two social security hospitals and 333 subjects selected to data gathering randomly. The valid and reliable World Health Survey questionnaire was utilized. Data was analyzed by SPSS₁₇ using descriptive statistic, Mann–Whitney and Kruskal–Wallis tests.

Results: In points of view among inpatient and outpatient, the mean score of responsiveness rate were 4.1±0.71 and 3.7±0.60 respectively. These amounts estimated 4.4±0.46 and 3.2±0.82 for inpatient and 3.8±0.58 and 3.5±0.63 for outpatient in private and social security hospitals respectively. Also, the mean score of responsibility rate assessed 4.4 in private hospital which was higher than social security ones (3.2); and this difference was statistically significant (P<0.001).

Conclusion: Responsiveness rate dimensions were evaluated moderate to high among assessed hospitals. These results were enhanced in private hospitals rather than social security ones. It is recommended that hospital managers should pay more attention to client and mechanisms to improve responsiveness rate and providing more services quality. 

Background: Today's Hospitals operate in an inconstant and competitive environment. To have a successful presence in this environment, there is a need to recognize their own strengths and weakness points which can design appropriate strategies towards. The purpose of this study was to assess the internal environment of a hospital based on Weisbord model and analyze its relation with organizational success dimensions.

Materials and Methods: This study was a cross – sectional and applied one. The study instrument consisted of three sections including demographic information, Weisbord Model questionnaire and dimensions of organizational success assessment.124 out of 150 staff of Oil Industry hospital in Gachsaran participated in the study. In order to data analysis, descriptive statistics and Pearson correlation coefficient test were utilized.

Results: The studied hospital had a relative strength at the scoping (3.63) and leadership dimensions score (3.65) and also a relative weakness at the score of rewards (4.64) and communication dimensions (4.11). In terms of organizational success dimensions, speed (3.28) and flexibility (3.83) had better status than innovation (4.12) and cohesion (4.05). There was a positive and significant correlation between all organizational success dimensions and internal environment. In general, hospital success had the strongest relation with communication dimension(r=0.521).

Conclusion: Hospitals are able to take action through accurate recognition of weakness and strengths points and attempting appropriate modification to achieve organizational success in competitive fields. Then, they take steps towards optimization by improving programs.

Background: Health care systems especially hospitals often encounter several risks which has weaken efficiency and hospitals performance entirely. Resilience engineering (RE) enables to remain high risk systems stable faced to sudden changes or minimizes negative effects of changes.

Materials and Methods: This study considered a new hybrid framework concept regarding the non-value added waiting time and resilience engineering indices as efficiency indices to evaluate private and public hospitals performance. With the intention of evaluating the hospitals performance, a hybrid framework including simulation and MADM methods utilized. Output-oriented Data Envelopment Analysis (DEA) approach used as MADM method.

Results: The results revealed that RE factors play a significant role in hospitals performance's promotion; also the private hospitals had better performance compared to the public ones.

Conclusions: Study results indicated that teamwork efficiency index compare to other efficiency indices had more effect on hospitals performance. Health system managers should be considered improved performance and efficiency policies and focus more on other RE indices parallel team work index.

Background: The present study performed with the purpose of nursing care quality assessment and its association with process management in Shahid Beheshti hospital of Kashan in 2014.

Materials and Methods: In this applied, cross sectional and correlation study with the purpose of assessing the nursing care quality, 200 hospitalized patients who had more than 48 hours length time selected randomly conducting modified four parts SERVQUAL questionnaire in likert scale. In order to evaluate hospital performance based on process management model (EFQM) Excellence model questionnaire was utilized. Data analyzed using SPSS software version 16 by descriptive statistics and multivariate regression tests at a significance level of less than 0.05.

Results: Data extracted from 200 completed questionnaires analyzed. Respondents included 104 women and 96 men. The mean duration of hospitalization was 6.9 ±12.9 hours and the mean age of patients was 37 ± 12.02 years. Total nursing quality services were more than average and it assessed good (3.8 ± 0.92).Scores of Shahid Beheshi hospital were 215.66 and 217.64 in empowerment and results EFQM dimensions respectively. Multivariate regression coefficient was assessed 0.57.

Conclusions: Based on study results, it is necessary to make use of new management system and professional training to nurses in order to improve nursing quality services in hospitals. 

Background: Strategic plan in hospitals will not be run spontaneously and managers encountered with some barriers in order to have a successful strategic planning implementation. This study aimed at recognizing the barriers of strategic plan implementation from hospital managers' perspective.

Materials and Methods: This cross-sectional study was performed in all Kerman hospitals in 2014. Fifty three individuals including chairmen, internal administrators, quality improvement managers, matrons and strategic plan executers participated by census sampling method. Data was collected using a questionnaire including demographic information and human, processes, structures and institutions factors affecting the strategies implementation. Data analysis was performed by SPSS software version21.

Results:  Study results revealed that the barriers to strategic plan implementation were structural factors (27.71±6.68), process agents (19.54±10.06), human factors (19.09±5.37) and institutional factors (15.73±4.52) respectively. There was no significant association between management background and barriers of strategic plan implementation in hospitals (P < 0.05).

Conclusions: In order to achieve desired results, chairmen and hospitals managers should be entirely conscious about barriers /failure factors of strategic decisions concerning foresight and appropriate managing or approaches change during strategic management process implementation. 

Background: Today, intellectual and social capitals as intangible and knowledge-based assets are one of the main factors of organizations’ success. On the other hand, knowledge management is a process which helps organizations engenders wealth from knowledge, intellectual and social capitals. This study aimed to determine the role of intellectual and social capitals in predicting knowledge management.

Materials and Methods: The present research is a descriptive-analytical study carried out in the spring 2015. The target population consisted of all staff of Imam Ali hospital in which selected 155 employees using the quota non-random sampling. The data were collected using three standard questionnaires of Bontis’ intellectual capital (42 items) including human, structural, and relational dimensions, Nahapiet and Goshal’s social capital (17 items) including structural, relational, and cognitive dimensions, and Lawson’ knowledge management (24 items). The data were analyzed using Pearson correlation, employing IBM SPSS version 22 software and structural equation technique of AMOS.

Result: 71% of study participants had bachelor's degree and 40% aged less than 30 years old. The results indicated that the dimensions of social and intellectual capitals were significantly and positively correlated with knowledge management. The results of path analysis revealed the intellectual and social capitals predicted knowledge management with the positive changes 0.79 and 0.89 respectively. As a final point, the structural dimension of intellectual capital and the relational dimension of social capital had the highest direct impact on knowledge management.

Conclusions: Given the important role of intellectual and social capitals in the application of strategies of knowledge management, hospital officials are able to facilitate hospitals increase added value and improve performance and excellence in presenting clinical services by investing more in knowledge-based assets.