Bahare Rahmani Manshadi, Bakhtiar Ostadi, Amirhosein Jalali,
Volume 20, Issue 2 (9-2021)
Abstract
Background: The waiting list is a list of selected patients in the surgical queue. If demand exceeds capacity, the waiting list grows rapidly, which may lead to unacceptable waiting for patients, especially those in need of acute medical care. Patients waiting for heart surgery are placed on the waiting list for surgery, and sometimes the waiting time is longer than patients expect. Reducing the waiting time for medical services, including heart surgery, is one of the challenges of the health system. In this regard, the present study was performed by identifying an effective solution to reduce the queue length of patients undergoing cardiac surgery.
Materials and Methods: In this article, the process of scheduling open heart surgery at Shahid Rajaei Hospital was reviewed and improved with a discrete event simulation approach in Arena simulation software. After designing the process, the existing bottlenecks leading to the long waiting time of the patients were identified. The waiting time and the number of patients visited were determined as the objective function and the patient flow was improved by presenting improvement scenarios and selecting the best scenario.
Results: Simulation results on 66 selected patients in 7 months from October 2020 to May 27, 2021 show that Scenario number 10 has the most improvement in performance criteria but is not applicable in practice. Therefore, due to system limitations, Scenario 2 was selected as the best scenario. Implementing Scenario 2 could reduce the waiting time by 40 percent and increase the number of patients visited by 21 percent.
Conclusion: Patient prioritization methods allow patients with higher needs to receive more services than those with lower urgent needs, although they also have longer waiting times for patients with lower urgent needs.
Sepideh Safaverdikhan, Asgar Aghaei Hashjin, Aidin Aryankhesal,
Volume 20, Issue 4 (12-2021)
Abstract
Introduction: Root cause analysis is one of the most important tools in disaster management that aims to identify the real causes of an issue and find ways to eliminate them. Surgery is one of the areas in which the possibility of clinical error is significant. Therefore, the study aims to explain the weaknesses and challenges of root cause analysis in surgical events and identify the experience of staff around the technology.
Materials and methods: This qualitative study was conducted through interviews in 2021. Twenty members of the root cause analysis team working in teaching hospitals affiliated to Iran University of Medical Sciences were interviewed. After conducting the interviews, MAXQDA software version 10 was used to analyze the thematic content and extract concepts related to the research objectives.
Results: The majority of participants were female, head nurse, aged 30 to 40, work experience of 11 to 15, and employed in Hasheminejad Hospital. The most important weaknesses identified for root cause analysis included the lack of proper implementation of the root cause analysis process and the lack of participation of individuals, hospitals and universities in this process.
Conclusion: Health managers and policymakers should address the weaknesses of root cause analysis by explaining the necessity of the process, root cause analysis immediately after each clinical event, evaluating the effectiveness of root cause analysis, and providing adequate feedback from the authorities. Upstream therapy, creating a culture of root cause analysis, providing the necessary facilities to perform these analyzes, providing clear instructions to encourage and punish employees.
Seyyed Mohammad Mehdi Baki Hashemi,
Volume 21, Issue 1 (5-2022)
Abstract
Background: thousands of people die or suffer from irreversible damage due to lack of timely and adequate services in medical centers. This research seeks to identify and prioritize factors affecting the demand for patient transfer and provide the most effective measures to facilitate this process.
Materials and Methods: This research is combined in terms of method and inductive research in terms of type of research. The population of study is the senior and middle managers of Guilan University of Medical Sciences who were selected as a sample member using purposive sampling method. The factors affecting patient transfer demand were identified using qualitative data obtained from exploratory studies, then these factors were prioritized using fuzzy Delphi method.
Results: In the first part, a set of factors affecting the demand for patient transfer were identified, and in the second part, the importance and priority of these factors were determined. The results of the research showed fourteen main factors, including disproportionate distribution of specialized human resources, ineffective planning, inefficient management, and inefficiency of human resources.
Conclusion: Inefficient organizational processes and organizational structures along with real needs have been identified as reasons for patient transfer demand,which requires special attention of supervisors and management of organizational development and administrative transformation of universities. It seems that the formation of a special monitoring and planning working group to remove obstacles in a centralized manner at the highest organizational level and a special look at the reports of the care monitoring center as the most effective measure can be used to manage the dispatch process, planning, Monitor and remove obstacles.
Fatemeh Mohammadkhani Ghiasvand, Masoumeh Abbasabadi Arab, Habibollah Taherpour Kalantari, Hossein Alipour,
Volume 21, Issue 2 (9-2022)
Abstract
Background: The occurrence of all kinds of errors and mistakes imposes many costs on the hospital and society. Whistleblowing and error reporting plays an essential role in preventing and reducing errors, but the rate of error reporting in hospitals is low. This research was conducted in order to investigate the effect of selected individual factors on whistleblowing of hospital employees.
Materials: The research was conducted as a descriptive correlational study. 229 nursing and para clinic staff of a hospital in Tehran were selected by random sampling. A standard questionnaire with 69 items from valid questionnaires of selected factors, including organizational commitment, source of control, moral judgment, altruism, individual's attitude towards whistleblowing and intention to whistleblowing was collected and its validity and reliability were confirmed. The method of data analysis was confirmatory factor analysis and SPSS and Amos software were used as well.
Results: The variables of organizational commitment, altruism and individual's attitude towards whistleblowing have an effect on the intention of whistleblowing, and moral judgment and source of control have no effect on the intention of whistleblowing. Also, individual variables such as age, gender, and work experience did not have a significant effect on the intention to blow the whistle.
Conclusion: Strengthening organizational commitment, altruism of employees and the positive attitude of the individual toward whistle-blowing play an important role in improving error reporting. Hospital management methods can strengthen or weaken these factors. Participatory management style, job empowerment, supporting and creating a safe environment for reporting, promoting employees' ethical and professional principles, and learning and sharing medical errors are effective measures in promoting whistle-blowing.
Raziyeh Montazeralfaraj, Sajjad Bahariniya, Sara Jambarsang, Fatemeh Sadat Hashemi,
Volume 21, Issue 4 (1-2023)
Abstract
Introduction and purpose: The main mission of hospitals is to provide quality services for patients. Evaluating the quality of hospital services can lead to the targeted allocation of financial resources to areas that are in worse situation. The aim of the present study was to investigate the quality of services of university hospitals in Yazd province.
Methods: This cross-sectional analytical study was conducted in 2020-2021 in 12 university hospitals of Yazd province. In order to conduct the study, the standard questionnaire of SERVQUAL was used. This questionnaire is made up of two parts, administration and expectations, and each of them contains 28 questions and 6 dimensions. The sampling method was stratified randomly. Data analysis was done in SPSS version 24 software.
Results: 225 patients participated in the study. The majority of patients were over 50 years old (46.7%). The average score of patients' expectations (128.99±8.12) at the high level, the average score of patients' perceptions (107.98±8.62) at the middle level, and the average score of the total quality of hospital services (236.97±12.24) at the high level reported. In both areas of perceptions and expectations, the dimensions of reliability, responsiveness and assurance had a higher mean score and the physical or tangible dimensions, empathy and access had a lower mean score.
Conclusion: The service quality of university hospitals in Yazd province was in a good condition, but the average score of perceptions was lower than the score of expectations. Although there was no deep gap, it is necessary for hospital managers to pay more attention to improving the quality of services.
Behrooz Rahimi, Seyed Mahdi Jalali, Hamed Nazarpour Kashani,
Volume 22, Issue 2 (9-2023)
Abstract
Introduction: Equitable geographical distribution of healthcare system initiatives, aimed at increasing quality and economic efficiency, is a crucial aspect of ensuring access to healthcare services. This study seeks to elucidate the contextual, procedural, and outcome factors of health marketing in Iran, with a focus on enhancing and improving health services.
Methods: This research was conducted using a qualitative approach. The sampling method employed was purposive, resulting in the participation of 51 experts. The study data were analyzed using content analysis.
Findings: The findings of this study have been categorized into conceptual subgroups, including causal conditions, foundational components, strategies, contextual factors, intervening factors, and consequences of implementation.
Conclusion: Adopting an effective health marketing model can create opportunities for service providers to generate sufficient income, thereby motivating them to deliver high-quality services. Attracting ample income, in addition to ensuring service quality for recipients, will also lead to their satisfaction with the healthcare system and contribute to the continuous provision of desirable services.
Hasan Fatahi, Seyyed Mohammad Waziri, Mahyar Souri, Mohammad Hossein Askarian,
Volume 22, Issue 2 (9-2023)
Abstract
Background and purpose: The emergency department of a hospital is akin to its heart, where smooth operations can save many lives. This research aims to reduce patient waiting time in the emergency department using simulation techniques.
Methods: This descriptive-analytical study was conducted cross-sectionally in 2019 at the Qaim Hospital in Mashhad. The study focused on accurately modeling the patient flow process in the emergency department using simulation techniques and Arena software. Key performance indicators such as patient waiting time, number of discharged patients (system output), length of stay, resource efficiency, and improvements in the emergency department were evaluated.
Results: The simulation model's results indicated that the laboratory, specialist doctor examination, and pharmacy departments had the longest waiting times in this department, respectively.
Conclusion: To reduce patient waiting times and improve conditions, the most effective and cost-efficient solution is to add a laboratory technician to the laboratory department during the [15-23] shift at Qaim Hospital in Mashhad, which is projected to decrease patient waiting times by 66 minutes.
Ahmad Kalateh Sadati, Seyed Reza Javadian, Marzieh Sadeghi Hardangi,
Volume 22, Issue 3 (12-2023)
Abstract
Background and Purpose: Discharge planning, as a process for the safe transfer of patients, has always been challenged by the interventions of medical social workers. Identifying these challenges prevents disruptions in effective planning. This research aims to explore the challenges faced by medical social workers in discharge planning.
Materials and Methods: This is a qualitative study conducted in Iran in 2023. Data were collected through semi-structured face-to-face and telephone interviews with 16 social workers working in hospitals and were manually analyzed using thematic analysis.
Results: The findings of this study revealed that hospital social workers encounter structural and professional challenges during discharge planning. As a result, themes such as professional isolation, erosive environment, back-breaking costs, inefficient structures, and professional pressures were identified, with the main theme being unattended discharge.
Conclusion: The results indicate that social workers in hospitals are faced with poor cooperation and participation, a lack of facilities and equipment, and socio-economic barriers at the community level. They encounter professional challenges in adhering to professional principles and values and in maintaining the quality of social work services in discharge planning. Given the importance of post-discharge interventions, organizational, structural, and professional reforms at both the micro and macro levels are recommended.
