Showing 25 results for Clinic
Ali Jannati, Neda Kabiri, Mohammad Asghari Jafarabadi, Behrooz Pourasghari, Babak Bayaz,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Pay-for-performance (P4P) is a payment model which tries to pay for the measured aspects of performance and encourage health care providers by providing financial incentives in order to achieve pre-defined goals. This research was done to assess the impact of P4P on efficiency of medical laboratory of Imam Reza hoapital in Tabriz in 2013.
Materials & Methods: This interventional research was a before-and-after study. In order to recognize any changes, efficiency indexes of laboratory were measured and compared whole the year. The data were collected manually assessing the related documents. For comparing efficiency before and after intervention, descriptive statistics were used.
Results: Findings showed that costs didn’t differ significantly after the intervention, but revenue was a little increased slightly (14364 to 16874). Laboratory errors were also increased after the intervention. (0 to 17 cases).
Conclusion: Regarding the results of survey , it seems that we can conclude that this bonus payment system can be used in all levels in which care is provided such as primary health care centers, drug stores, diagnostic centers and hospitals through setting pre-defined goals and considering negative point for any staff who makes an error.
Jafar Sadegh Tabrizi, Yeganeh Partovi,
Volume 14, Issue 2 (8-2015)
Abstract
Background: consideration of hand hygiene can reduce health care infections effectively. Prevalence of poor hand hygiene consideration will lead to enhance morbidity, mortality and costs. This study aimed at assessing hand hygiene process of nurses by clinical audit method in a selected general hospital in Tabriz.
Materials and Methods: this study was an interventional one using clinical audit method which was conducted during seven months in surgery, internal, child and women units in a selected general hospital in Tabriz in 2013-2014. The study was carried out on nurses in all shifts (morning, evening and night). Study instrument were monitoring performance checklist and hand washing observation. Checklist was developed by WHO and Ministry of Health guideline.
Results: the total number of situation in pre-intervention was 252 which increased to 336 by the interventions implementation. The overall rate of compatibility of hand hygiene process with standards was 59.94% in pre-intervention which promoted to 80.56% after intervention implementation.
Conclusion: This study reveals using clinical audit is a method to improve quality of hand hygiene process.
Maryam Zarghani, Nematollah Shomoosi, Nilofar Mohaghegh, Maryam Haseli, Fatemeh Jahanjooabd, Eman Tahmtan,
Volume 15, Issue 1 (6-2016)
Abstract
Background: Nowadays, it is essential to employ medical and clinical librarians to provide the required information for healthcare professionals and enhance accessibility to evidence based information in hospital libraries. Thus, this study aimed at assessing the medical librarians' employment status in hospital libraries in Tehran city in 2013.
Materials and Methods: This was a descriptive and cross-sectional study. Study population considered from all 152 hospitals in Tehran city. Data collected using a questionnaire and analyzed by SPSS version 18 using descriptive statistics.
Results: only thirteen participants had medical librarianship and information science degree. While 28 persons graduated in librarianship and information science from universities affiliated to Ministry of Science, Research and Technology and others had degree in non relevant fields. The majority of participants (51.3 %) with non-related degree were educated empirically and others had learned librarianship skills with other methods. Most of participants were employed based on hiring official process and friends and relatives recommendation.
Conclusions: There is a real lack of medical librarians in the hospital libraries in Tehran city. Thus, these libraries are not able to perform their professional duties such preparing information and omitting healthcare professionals' needs in hospitals. It is necessary that hospitals’ managers attempt to hire medical librarians' and overcome employment barriers.
Jafar Sadegh Tabrizi, Saeedeh Alidoost, Golshan Asghari,
Volume 15, Issue 1 (6-2016)
Abstract
Background: Medication administration is an important part of care process. Correct medication administration and its accordance with standards are essential concerning the significant effects on patients’ health. Hence, this study was designed and carried out to determine Medication administration process using “clinical audit”.
Materials and Methods: This study was a cross-sectional one which carried out with “clinical audit” in a hospital of Tabriz city in 2014. This audit conducted in six steps as followed: 1) selecting topic of clinical audit, 2) determining the criteria and standards, 3) assessment of current status, 4) comparing current situation with standards( Standards of Ministry of Health, Medication safety handbook, medication administration curriculum and NHS guideline in medication management), 5) designing and implementing intervention and 6) re-audit. In order to organize process evaluation, a valid instrument used via observation and checklist.
Results: Results of this audit study revealed that 11 out of 25 assessed steps had very low accordance with standards (less than 15%) and the average accordance of total process was 47 percent before intervention. However, the average of standard adherence rate increased to 78 percent after intervention implementation.
Conclusions: The results indicated the effectiveness of educational intervention programs in using kardex instead of medication card on improving medication administration process generally. In spite of the occurred improvement, it is necessary to have an ongoing assessment and intervention in order to quality improvement.
Mohammad Arab, Yeganeh Hayati, Elham Movahed Kor, Mostafa Hosseini,
Volume 15, Issue 1 (6-2016)
Abstract
Background: Nowadays, managers should develop working conditions which attracts new nurses, retains current nurses and prevents their absenteeism. This study at aim at determining Effective Factor Analysis on Health Related Absence among Nurses of Clinical Wards in General Hospitals Affiliated to Tehran University of Medical Sciences
Materials and Methods: four hundred nurses of clinical wards selected as sample size to participate in this descriptive-analytical; cross-sectional study from general hospitals of Tehran University of Medical Sciences. The instrument was a questionnaire in 100 items and two sections including demographic characteristics (13 items) and effective factors of sickness absence (organizational-directorial factors in 49 questions, physical factors in 16 questions and mental factors in 22 questions). The validity of questionnaire confirmed by experts and reliability was calculated 0.79.Absenssism criterion was based on Rajbhandary and Basu' definition (2010); total numbers of days that they didn't present at ward/hospital due to sickness. Data gathered retrospectively from nurses' records. Data analyzed by SPSS using descriptive statistics tests, simple and multiple linear regressions.
Results: The mean age of participants was 44.97±5.910 and 73.8 of them were women. Explaining power of predicting factors was very well (F=71.121, P<0.01). Variables such as Marital Status (β=0.150, P<0.001), ward's type (β=-0.553, P<0.001), physical factors (β=0.101, P=0.001) and mental factors (β=0.226, P<0.001) explained 42% of the absence variance.
Conclusion: considering some aspects such as physical and mental factors and also health issues of nursing staff based on wards' type can be result in absenteeism reduction.
Habib Ebrahimpour, Nourmoohammad Yaghubi, Seyd Saied Zahedi,
Volume 15, Issue 2 (6-2016)
Abstract
Background: The organizational learning has been influenced in different theories and model based on theoretical and practical dimensions in organizations development and provides a favorable context for changing and development. Organizational learning capacity can play a main role in clinical governance implemention.
Materials and Methods: This study was a descriptive- analitical and cross-sectional one which performed during the first six months of 2014. Study population included staff of Ardabil Social Security hospital. One hundred and seventy participants selected using simple random sampling. A four dimensional standard questionnaire of Gumejeet et al and a seven dimensional self administrated questionnaire were conducted to examine organizational learning capacity and clinical governance assessment, respectively. Data analysis was carried out using Pierson Correlation Coefficient and Mulivariate regression analysis. Data was analyzed by SPSS18 software.
Results: Study results revealed that there was a positive and significant relation between organizational learning capacity and clinical governance implementation (R= 0.507). This correlation coefficient was 0.644 in management commitment, 0.498 in systematic approach, 0.446 in open climate and 0.261 in knowledge transfer.
Conclusion: According to the main role of organizational learning on implementing clinical governance, providing an essential background to enforce organizational learning capacity in four components especially management commitment and systematic approach to implement efficient clinical governance is recommended.
Hossien Dargahi, Alia Akbar Razghandi, Zeynab , Rajab Nezhad,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Concerning to the importance of team learning and process change, the clinical laboratories employees should be familiar with organizational learning. This study aimed at assessing and determining organizational learning capability among clinical laboratories employees of Tehran University of Medical Sciences hospitals.
Materials and Methods: This study was a descriptive-analytical and cross-sectional one which conducted among 85 employees of clinical laboratories using Cochran formula at five general teaching hospitals of Tehran University of Medical Sciences. The research instrument was Gomez et al. questionnaire consisted of four dimensions such management commitment, systematic approach, open climate and knowledge transfer in 17 questions. Five point Likert scale was used to rank questions. SPSS software 19 version was utilized to data analysis using t- test, Pearson Correlation Coefficient and Welch method.
Results: The average score of organizational learning among employees of studied clinical laboratories was 3.11 which showed relative desirable situation. Also, management commitment as an element of organizational learning had significant difference among the clinical laboratories (p=0.002). There was a significant relationship between employees education level with knowledge transfer and integration capability (p=0.04).
Conclusion: The process of organizational learning capability of the studied clinical laboratories was not desirable. Therefore, in order to complete establishment of organizational learning in clinical laboratories, should pay attention to some elements such establishment of patient safety system, initiation of error registration system and encouraging employees to report the errors
Hamid Ravaghi, Sima Rafiei, Maryam Mohseni, Peigham Heidarpour, Mohammad Arab,
Volume 15, Issue 3 (8-2016)
Abstract
Background: Clinical Governance (CG) is a framework which obligates heath care system to responsiveness regarding maintaining and improving health care services' quality. Purpose of this study was to exists challenges in Clinical Governance establishment evaluation based on national assessors' aspect.
Materials and Methods: This qualitative study was conducted with national assessors' participation of Clinical Governance plan in 2014.Data collection was carried out using face to face interviews with assessors and analyzed based on content analysis.
Results: Three main themes were categorized including problems related to clinical governance standards, Existing challenges in assessment process and recommendations to improve quality assessment process.
From the assessors' aspects, the main existing challenges were lack of knowledge and adequate skills in some assessors towards CG, lack of sufficient accordance among assessors team, resistance of some universities and health care systems, lack of existing comprehensive guidelines with the purpose of responsiveness in related ambiguity in assessment and direction process among assessors.
Conclusion: Reinforcement of quality improvement culture in hospitals and increasing susceptibility in plan continuation, correct assessors election and ensuring about knowledge in responsibilities, updating assessors' training and putting to use equal indices in improving clinical governance assessment can be a considerable assist to improve assessment process and resolve related problems.
Monireh Koohsari , Dr Bahram Mohebbi, Dr Roya Sadeghi, Dr Azar Tol , Dr Abbas Rahimi Forooshani ,
Volume 15, Issue 4 (1-2017)
Abstract
Background: Considering the importance of standard precautions to prevent needle stick injuries and health care staff, this study aimed to determine the effectiveness of educational interventions to improve adherence to standard precautions, health belief model based on professional clinical staff needle stick two hospital "yaftabad" and "Ghiyasi" done.
Materials and Methods: This study was an experimental study of two group. The study population was 90 persons of professional clinical staff Shohada Hospital Yaftabad as the intervention group and 90 patients from the hospital Ghiyasi as compared to randomly selected and three part questionnaire including demographic, structures, health belief model , and practice questions were completed. In analyzing the data, descriptive and inferential statistical methods were used.
Results: At baseline, the two groups regarding demographic variables, health belief model structures and functional do not different between them. After intervention structures perceived severity, perceived susceptibility, perceived barriers, self-efficacy and performance of the experimental group showed statistically significant change (p< 0.05) that the effect of education based on health belief model.
Conclusion: education based on health belief model, you can increase the level of knowledge and capacity building and efficacy in clinical staff needs people to observe standard precautions
Dr. Sima Marzban, Mahshid Moeini Naini, Sayed Hossein Ardehali, Jaber Hekmatyar, Aliamir Savadkouhi,
Volume 16, Issue 1 (4-2017)
Abstract
Background: Injuries related to failures and errors due to clinical interventions in patient hospitalization period in hospital are the main reasons of mortality and mortality in worldwide. This study tries to identify and description ICU care failures and assessing the causes of risks, Severity, Occurrence and identifying risk probability ratio and risk prioritizing using FMEA method.
Materials and Methods: This study was carried out in order to evaluating existing situation using Failure Mode and Effect Analysis and utilizes volere logic to plan the patient safety management system. This study performed in the intensive care unit of Loghman Hakim hospital in Iran.
Results: Study finding revealed sixteen routine failures and its priorities which the five main issues were documented as error in decision phase for patients admission or in-admission (PRN 1000), error in discharge time of patient from ICU (PRN 1000), insufficient infection control (PRN 1000) and error in clinical ordering and prescriptions (PRN 800).
Conclusion: The main requirements of the patient safety management identified as planning standards and clinical guidelines, developing evidence based admission and non admission indicators, enacting infection control rules and education of anticipating standards places, hand washing and disinfecting instrument and equipments.
Mohammad Mehdi Ghaemi, Hamid Moghaddasi, Alireza Kazemi,
Volume 16, Issue 1 (4-2017)
Abstract
Background: Despite the fact that only one-third of chest pains occur due to heart diseases, still physicians have tendency to admit most of these patients to reduce risk of negligence and its consequences.Clinical decision support systems (CDSS) enable physicians to distinguish better cardiac from non-cardiac chest pain. This study reviewed articles which focused on this issue.
Materials and Methods: Google scholar and PubMed database were targeted for search. Out of ninety primary matching articles based on the title, abstract and keywords, 28 full texts were relevant which were included in this study.
Results: Included articles were classified into two categories such as managing hospital resources and increasing the accuracy of diagnosis. Study results in the first categoryshowed decrease in both reception and referral time up to 30% and length of hospital stay up to 26% using CDSS. In the second category, the highest reported accuracy of diagnosis was 97% and the maximum sensitivity and specificity were 100% and 89.43% respectively. Even though, the results of a study revealed that the accuracy of decision support system in diagnosing cardiac chest pain was better than the compared cardiologists.
Conclusion: Considering the role of CDSS in managing hospital resources and improving accuracy of diagnosing cardiac chest pain, it is suggested that emergency wards and cardiac screening centers equipped by these systems.
Dr Afsaneh Keramat, Dr Forozun Olfati, Dr Saeed Asefzadeh, Dr Nasrin Changizi, Dr Masoud Yunesian,
Volume 16, Issue 2 (7-2017)
Abstract
Background: Because of the current population policies adopted in Iran followed by increasing the number of births, this study aimed to investigate the current situation of safe delivery and proposed a model based on clinical governance.
Materials and Methods: This study is a combinatorial-exploratory research (Mixed Method) conducted in four hospitals in Qazvin and Semnan provinces including two stages in 2014. The first stage was the assessment of current situation; clarifying safe delivery, reviewing literatures, providing two checklists, assessment of current situation based on assessment of continuous quality improvement and assurance of the quality and the second stage was presenting the model including codification of safe delivery model in seven axes of clinical governance, the approval of the model on the panel using nominal group technique.
Results: In quality assurance, hospital (4) and hospital (2) obtained the maximum score (1431) and minimum score (1237) respectively. All hospitals in continuous quality assessment, admission in the intensive care unit (P < 0.001), mothers with severe consequence of pregnancy (P = 0.004) and 16 cases out of 27 errors had significant statistical difference.
Conclusions: In order to improve the quality of Maternity ward, hospitals' accreditation also should be based on the principles of clinical governance. In addition to evaluations based on quality assurance and annual accreditation, assessment using continuous quality improvement methods based on clinical governance is essential. The proposed model includes seven axes of clinical governance.
Elham Haghshenas, Dr Mohammad Arab, Dr Abass Rahimi, Dr Elham Movahed,
Volume 16, Issue 2 (7-2017)
Abstract
Background: The quality of services is a comparison of the customer´s perspective (expectations) with what it has received. If the expectations are more than perceptions, the quality of received services is not sufficient based on customer´s view which resulted in his/her dissatisfaction. The present study performed with the purpose of determining the quality of provided and excepted services to outpatients among hospitals affiliated to Tehran University of Medical Sciences.
Material and Methods: The present study is a descriptive- analytics and cross sectional one which has been done in 2015. The study population included all outpatients attending hospital clinics affiliated to Tehran University of Medical Sciences.The sample size was calculated 225 participants based on formula. In order to data gathering in quality of provided and expected services, a 22-items standard questionnaire of Servqual was utilized. Data analysis performed by SPSS using paired t-test, Mann-Whitney and Kruskal-Wallis tests.
Results: The study findings represented that there was a negative gap in the quality of services provided. The highest gap was related to accountability (-0.97) and the lowest gap related to tangibles factors (-0.69) .Moreover, regarding to relationship between demographic variables with perceived service quality, there were significant relationship between insurance type with reliability and empathy dimensions and supplementary insurance with tangibles factors and reliability.
Conclusion: Negative gap (higher expectations than perception) in all aspects of quality improvement is required in all dimensions. Especially, it is necessary to adopt some strategies in the accountability dimension. Reforming management processes, reducing waiting times and increasing employees' motivation in order to achieve appropriate accountability are in this kind of strategies.
Dr Mohamad Hakkak, Seyed Ali Hozni, Neda Shahsiyah, Tahereh Akhlaghi,
Volume 17, Issue 3 (11-2018)
Abstract
Background: Hospitals are the most important and largest institution in each country's health system which health care services are carried out on a large scale. One of the most important processes to improve the quality of health services is accreditation in the country. This study aimed to identify challenges, obstacles and providing solutions in hospital accreditation.
Materials and Methods: This research is a qualitative one which conducted using content analysis approach in the north of the country in 2017. Twenty-five people consisted of two heads of hospitals, three hospital managers, three matrons, four supervisors, ten nurses, three people responsible for accreditation selected as contributors to the study using a targeted sampling approach. After the interview with Maxqda software, coding was performed and necessary analysis was carried out. In order to obtain data validity, two methods of reviewing the participants and reviewing experts were used.
Results: Analyzed data was categorized in the 98 initial codes, 16 concepts and 5 main categories. The main issues included resource challenges, organizational challenges, technical challenges, negative consequences and solutions.
Conclusion: Pathology helps the organization to focus on problems and by collecting and analyzing data and identifying risky spots, managers and planners will find methods to develop and solve the problem. Particularly, the correct implementation of the accreditation process can lead to comprehensive clinical excellence.
Dr Hossein Darghahi, Kamran Irandoust, Seyyed Morteza Mojtabayan,
Volume 18, Issue 2 (8-2019)
Abstract
Background: The present research aimed to assess the readiness of selected hospitals of Tehran University of Medical Sciences to implement quality improvement programs and clinical audits from the viewpoint of managers.
Materials and Methods: A descriptive-analytic study was conducted in May 2017 in four selected hospitals of Tehran University of Medical Sciences. The study population of this study was 20 managers of selected hospitals who were selected by census sampling method and entered the study. The data gathering tool was a two-part questionnaire whose validity and reliability were confirmed. In this study, we used SPSS software version 23 and statistical tests to analyze the data.
Results: The effectiveness and readiness of hospitals to implement a clinical audit program was equal to 60% in the field of data and information, cardiology and feedback; 55% in resources, design and implementation, clinical audit management, and evidence and standards; 50% in illness and education; and 45% in manpower. Also, with increasing frequency of clinical audits, hospital readiness for quality improvement processes increases.
Conclusion: Due to the effectiveness and low readiness of hospitals in implementing a clinical audit program, especially in the field of human resources (45%), it is necessary that managers and planners of clinical audit programs in hospitals have a precise knowledge of these factors in order to control the organizational environment and help improve the effectiveness of audit programs.
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.
Serajaddin Gray, Saeed Bayyenat,
Volume 19, Issue 4 (12-2020)
Abstract
Background: In Iran, the accreditation system is mainly focused on hospitals and has not yet succeeded in providing standards for independent medical centers such as independent clinics. The present study reports the development of an accreditation framework for independent clinics affiliated with the country's armed forces.
Materials & Methods: This is a mixed (qualitative-quantitative) study. Experts' agreement (30 people) on the results of a systematic review (201 items) was obtained using a questionnaire and through holding three expert panels. The necessity of each item was calculated using the method of content validity ratio and the weight of standards and headings based on the average.
Results: The existing 201 items were converted into 75 standards in 13 headings as final standards with the weight of each item.
Conclusion: This framework can be used as a comparison tool between independent medical centers and it is necessary to train evaluators, and prepare legal and organizational requirements in order to implement it.
Serajaddin Gray, Saeed Bayyenat,
Volume 21, Issue 1 (5-2022)
Abstract
Fatemeh Daei Bidgoli, Leila Nazarimanesh, Kamran Hajinabi,
Volume 22, Issue 3 (12-2023)
Abstract
Background and Purpose: Experiential marketing is a type of marketing strategy that attracts and engages customers by creating real-life experiences, allowing them to form lasting positive memories. Creating an excellent customer experience in the healthcare sector is challenging. Therefore, the aim of this study is to investigate the effect of experiential marketing on the intention to revisit social security clinics in Qom province.
Methods: This quantitative and applied research utilized a survey approach for data collection. The statistical population comprised clients of the social security clinics in Qom province. A total of 522 individuals were invited to participate in the study using stratified random sampling. Data analysis was conducted using covariance-oriented structural equation modeling with the help of Amos V24 software.
Results: The effect of experiential marketing (with dimensions of sensory experience, physical experience, emotional experience, cognitive experience, and relational experience) on the intention to return to the clinic was confirmed, with a path coefficient value of +0.540. Additionally, the structural indicators of the model and the validity of the constructs demonstrated a good fit for the model.
Conclusion: Experiential marketing, along with the enhancement of patient-doctor relationships, is crucial. Patient-centered facilities can increase the likelihood of patients returning to clinics by focusing on experiential marketing, providing amenities, and utilizing technologies to improve service delivery.
Mohammad Heydaryan Manesh, Aida Asghary, Ebrahim Jaafaripooyan,
Volume 22, Issue 3 (12-2023)
Abstract
The provision of virtual health care has currently received ample attention from health systems worldwide, due to the recent conditions and events. Many countries are trying to provide their preliminary visits and a relatively wide range of other care virtually, paving the way towards the introduction of virtual clinics. However, in many countries, this concept has not been clearly defined, and the characteristics that are necessary to use the virtual clinics are still unknown. This perspective has sought to explain the concept of virtual clinics and their characteristics with a brief review of related literature.
