Journal of

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: Knowledge management plays an imperative role in the success of organizations. Many factors such as organizational culture affected on knowledge management. Therefore, this study aims at investigating the association between dimensions of organizational culture with knowledge management.

Materials and Methods: A cross-sectional descriptive analytical study was conducted in 2013. Three hundred twenty two employees of three hospitals related to the Zahedan University of Medical Sciences selected through a stratified-randomized sampling. Standard instrument of organizational culture and a self-designed questionnaire of knowledge management were used for data collection. Collected data was analyzed using SPSS version 18 by descriptively and inferential statistics methods.

Results: study results indicated that there was a positive and significant association between organizational culture and knowledge management. Also, results on other objectives pointed out a positive and significant association among dimensions of organizational culture (clan, market, adhocracy) and knowledge management. There was a negative and significant relation between organizational bureaucratic culture and knowledge management.

Conclusion: Organizational culture is one of the most important tools of a successful implementation of knowledge management in organizations. Modifications of organizational culture in health care teaching hospitals of Zahedan University of medical sciences should be set towards establishing knowledge management considering organizational tribe culture and organizational adhocracy culture more than other cultures.

Background: One of the key duties of family physician is to form health records and provided recording services. This study conducted to form health records and aevaluate health records in family physician program in Northern Province of Iran.

Materials and Methods: This cross-sectional study was carried out in second half  2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected using systematic random sampling, and assessed performance recording of all family physicians. A self- designed questionnaire was used which the validity and reliability of were confirmed. Data were analyzed by SPSS₁₈ at the significant level of p<0.05.

Results: Out of the 189 assessed family physicians, the profile of patients referred to the second level and its results were recorded in referral record forms by 43 physicians. Out of 1890 studied families, 1559 families had health record which had filled 892(57%) health record completely. Out of 5869 assessed family members, 4229 patients were examined periodically by their family physician at least once and 1919(46%) results filled entirely. during 559 were reported with health records, among which 892 were filled out completely. There was a significant difference between referral record rates to registered specialist between the Northern Province of Iran (P=0.001).

Conclusion: The quantity and quality of health record formation was not in the expectation level as well and appropriate interventions are needed. 

Background: in recent decades, Medical Tourism Industry has been mentioned by local countries because of its benefits such as high profits, more jobs creation and other benefits. High medical services quality is one of the most important factors developing this industry in health care centers. Therefore, concerning this issue this study assesses the provided medical services quality to the foreign patients by Medical Tourism Centers in Tehran city.

Materials and Methods: This study was an applicable and descriptive in term of purpose and nature repectively. This study conducted to assess provided services quality by Medical Tourism Centers evaluating 154 impatient foreign patients using SERVQUAL approach in ten swlwcted hospitals during March to April in 2014. Graded Integration method and terms of fuzzy set were performed considering complexcity and ambiguity in conceptualizing and weighting dimensions and indices.

Results: there was a negative gap and dissatisfaction in all dimensions and indices among foreign patients in the significant level p<0.05 except physicions and profession medical staff.

Conclusion: Considering the moderate situation of physicians and profession medical staff, modern medical facilities and equipment and appropriate medical costs comparing to services are the main factors of Medical Tourism Industry development, it is possible to enlarge Iran’s bazar portion of Medical Tourism Industry. 

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: In the telemedicine process, using digital techniques in disease diagnosis caused to have felt needs of archiving and storing patient information and high bandwidth in data transfer.

Methods: This study aimed at introducing an efficient way of multi-stage compression of mammographic image data based LM algorithm and artificial neural networks. At First, data derived from mammographic images given to multi-layer neural network has achieved the possibility of forming with minimum damage and  high degree of compaction in the first layer.

Results: The compression process of the mammography images was implemented using images of 128 women aged 46.41±6.55 yrs with BMI 36.78 ±5.5 from three specialized clinics in Sabzevar. The analysis yielded a mean square error (MSE) of 4.24 with the highest difference ratio of 33.46 and compression ratio of 8: 1in the output of the algorithm. The system performance based on the accurate design of the software was acceptable therefore; it demonstrated high efficiency in practice. 

Conclusion: The diagnosis in the discovery stage is highly consistent with the diagnosis in real based on reliability of software output in the compression and release, and considering the fact of mammographic images are not completely degraded during compression; therefore, this system has the capacity to be implemented achieving mammography images in hospitals and justify its application.

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: Nurses are the largest group of health care providers and emergency department is known as a high risk ward in terms of occupational injuries. The aim of current study is to make out nursing occupational hazards in the emergency department among teaching hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods: The study carried outed on 250 emergency department’s nursing staff of hospitals affiliated to Tehran University of Medical Sciences. A valid and reliable questionnare used for data gathering by Simple random sampling method. Data analysed using descriptive snd inferential statistics.

Results: The level of mean and SD of occupational injuries (2.87 ± 0.55) was assessed moderate. Among occupational hazzards, Psychosocial and institutional (3.58 ± 0.47) and Ergonomic (3.57 ± 0.71) ones were the most prevalent occupational hazards respectively and chemical hazards were the least important source of occupational injury. There was a statistical significant association of occupational injuries and variables such as hospital, years in practice, educational level, type of employment and training courses in occupational hazards (P<0.05).

Conclusion: Nurses exposes a range of risk factors in different domains regarding occupational injuries. With the purpose of eliminating the risk factors, it needs to run various strategies in different domains. Applying ergonomic approaches, developing appropriate educational programs, providing adequate training in this area, etc., can result in reduceing occupational injuries and increasing their productivity.

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. 

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: There is close relationship between  quality of life and human health. Since, nurses as the most important health Provider group, they  should have a desirable quality of life. This study aimed  at evaluating the quality of life and related variables among nurses in Zahedan  University of Medical Sciences hospitals.

Materials and Methods: In this descriptive analytic study the Iranian version of SF-36 was utilized to assess nursing quality of life. Data analyzed using  Stata  version 12. logistic regression was used to determine quality of life predictors.

Results: Three hundred women nurses (77.9%) with mean age of 31.6 ± 6/6 years were assessed. The mean of work experience was 7.55± 6.8 years. The most quality of life score was related to Physical domain (39.6 ± 11.8) and social function had the least score(8.2±6.7). Logistic regression analysis revealed marital status, overtime work, working shift Pattern and work experience were quality of life  predictors (P<0.05).

Conclusion: Study results represented  undesirable quality of life among nurses. Low quality of life can affect services quality of nursing. Nursing administrators can  improve nursing quality of life by setting up and adjusting overtime set up and adjust overtime shift based on work experience .

Background: Recently, considerable attention has been paid to medical errors in health care system. Taking into account that nurses spend more time with patients in comparison with other staff, they are more prone to human errors. The present research conducted to investigate nurses' errors in delivery emergency ward in a hospital affiliated to Tehran University of Medical Sciences.

Material and Methods: In the present coss-sectional study,at first, task analysis was conducted  to nursing proffession using Hierarchical Task Analysis (HTA) technique by FGD. In next step, the Human Error Probability (HEP) was determined utilizing SPAR-H method and dependences of performance-shaping factors (PSFs) and action and diagnosis activities were identified. Finally, after determinig dependency level, the final diagnosis HEP was calculated and risk assessment level was carried out  using the risks' probability and intensity tables.

Results: According to the results, four groups of studied tasks, the lowest errors were belonged to "working with serum pumping machine'' subtask with the error level of 0.055 and the highest error probability related to '' transfusion of blood products'' subtask with the error rate of 0.78. Moreover, special responsibilities of the wards had the highest level of undesirable risks.

Conclusion: In the present study, the analysis of identified errors reveals due to high work demand, insufficient time and the need for accurate administrative monitoring and providing required arrangements, the main causes of errors can be attributed to high level of stress and complexity in the tasks of delivery emergency ward. 

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: Patient transfer requires the wide variety of functions such as collaboration, appropriate communication and coordination between hospitals and the Center for Treatment Guidance and Information (CTGI). This study aimed at determining the influencing factors in the coordination of patient transfer and also explaining the situation of the CTGI in patient transfer process coordination.

Materials and Methods: This study was a qualitative study (phenomenology) conducted using three Focus Group Discussions (FGD) and thirty interviews with participants who were involved in the process of patient transfer in a referring hospital, six patient receiver hospitals and CTGI in Tabriz. Purposive sampling was used to select study participants. Data was analyzed using content analysis.

Results: The effective factors of the patient transfer coordination were categorized in four main themes including weakness in the exchange of clinical information, data constraints, legal protections weakness and guidelines implementation and lack of clinical empowerment in managing patient. Eighteen sub-themes were identified which include legal protections weakness and guidelines implementation in center for treatment guidance as sector problems.

Conclusion: There are some problems in coordination of patient transfer process which is relate to non adherence a specific procedure for admission , ineffective interactions and information exchange. In order to achieve uninterrupted medical treatment, the patient transfer coordination should be improved. The center for treatment guidance and information should be obtained its position as a supervising authority.

Background: The emotional intelligence of nurses has several effects on their behavior skills. In this study, the relation between Emotional Intelligence (EI) and Communication Skills (CS) among emergency unit nurses was assessed.

Materials and Methods: In the descriptive analytical study, 253 nurses of fifteen IUMS hospitals were selected using census sampling method. The Golmans instrument for EI assessment and self -administered CS questionnaire filled by study participants. Validity and reliability of the questionnaire confirmed. SPSS software version 18 utilized to analysis using ANOVA, Spearman correlation test and Pearson correlation coefficient.

Results: mean of total EI estimated 78.31 which the highest and lowest score were in self-cognitive dimension (20.83) and self-management dimension (18.19) respectively. The total mean of CS was 70.90. There was a significant statistical correlation between EI and CS (r=0. 775, p<0.001). Moreover, there was a significant statistical correlation between CS and four dimensions of EI.

Conclusion: Based on study results, emotional intelligence and its dimensions had positive effect on communication skills among emergency unit nurses. Hospital managers can reinforce emotional intelligence by providing educational sessions. They should promote communication skills in emergency unit nurses and provide improvement emergency services quality.  

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: This study investigated the Length of Stay (LOS) in the Intensive Care Unit (ICU) and its influential factors as a step toward revising hospital policies, more appropriate resources usage and improving health system performance.

Materials and Methods: this cross-sectional study was conducted on 246 patients, among nine general ICUs of Tehran University of Medical Sciences. Variables such as age, type of disease, existing nosocomial infection and APACHE II (Acute Physiology and Chronic Health Evaluation) score were studied. SPSS software utilized for statistical analysis using Mann Witney U and regression.

Results: The mean and median of LOS was 8.6±19.2 and 2 (1-7) days, respectively. Mortality rate was 19.9% (N=49). The mean age was 52.7±22.07 yrs which LOS enhanced with increasing age (r=0.35, p<0.001). The mean  of APACHE II score was 14.2±6 and it raised  with increasing patients LOS (r=0.19, p=0.01). Average length of stay in patients with surgical diagnosis was 6.71 days less than others. Among effecting factors, nosocomial infection (p<0.001), need for mechanical ventilation in the first 24 hours of hospitalization (p<0.001) and a past medical history (p=0.012) which prolonged LOS significantly.

Conclusions: In this study, type of disease, hospital infection and age were the most important affecting factors on the length of stay. Thus, implementing effective interventions in order to maintain patients' health and safety is recommended. Since, half of the patients were hospitalized less than two days, providing protocols are necessary to make better use of ICU resources for patients who really need.

Background: Type 2 diabetes is a chronic disease which has incremental prevalence regarding to unhealthy lifestyle. Based on the significant gap between received and standard care in patients with type 2 diabetes, this condition occurred high costs to health system. In order to eliminate this gap, this study aimed at measuring the technical quality of perceived care among patients with type 2 diabetes.

Materials and method: A cross-sectional study was carried out among 180 people with two type of diabetes in diabetes clinic using convenience sampling method. A three part questionnaire includes demographic information, disease statue and the technical quality questions was that the validity and reliability of it was approved.  The data were analyzed using SPSS13software.

Results: Total technical quality score was 2.9 which was lower than bench mark 5. The main indices related to diabetic control (HbA_1c, blood pressure, LDL) were acceptable regarding Iranian diabetic guideline and they were controlled well.

Conclusion: According to notable gap between existing standards and perceived care in type 2 diabetic patients, there is a good opportunity to promote quality of services.