Showing 13 results for Improvement
Azra Ramezankhani, N Markazi Moghaddam, A Haji Fathali, H Jafari, M Heidari Mnfared, M Mohammadnia,
Volume 8, Issue 3 (2-2010)
Abstract
Background: Operating room efficiency is a major determinant of hospital cost. Maximizing throughput, while maintaining quality, is therefore paramount to maintenance of financial viability. Cancellation of surgery may increase a hospital's cost and affect the efficiency of operating room and waste of resources. This study was conducted to determine the rate and causes of canceled surgeries, and identifies areas for improvement in a teaching hospital in Tehran.
Material & Methods: We carried out a descriptive study of the reasons for canceling scheduled operations. Data were collected during 9 consecutive months. The reasons for cancellation were identified by theatre staff. We grouped all the reasons into 13 reasons. Other necessary information like operated surgery was obtained from IT department. Descriptive statistics (frequency, percentage, 95% confidence interval) were used to analyses of data. Statistical analyses were performed using SPSS and Excel Microsoft office.
Results: in this study, 18.2% of the 3381 scheduled operation were canceled on the day of surgery, 32.1% of them because of vascular surgery, followed by orthopedics (18.7%), general surgery (15.5%) and nose and throat surgery (13.7%). The common reasons for cancellation were lack of theatre time, clinical change in the patient's condition, lack of paraclinic tests and consultant's report on patient flow problems, blood preservation, drug and necessary equipment for surgery.
Conclusion: This study demonstrated that most cancellations of scheduled operation are due to hospital deficiencies and medical team reasons that most of them are preventable. Several changes like better infrastructural facilities, enhanced interdepartmental communication are suggested to try and reduce the cancellation rate.
M Yaghoubi, S Karimi, A Hasanzadeh, M Javadi, Ha Mandegar, F Abedi,
Volume 8, Issue 3 (2-2010)
Abstract
Background: If a managers try for further income or productivity so they must attentive their staff incentive. One of the most issue in the management process is that managers can distinguish strength of staff but they can't determine their weakness . ACHIEVE model present seven factors ( ability, clarify, help, incentive , evaluation, validity , environment ) that effective to staff performance . and this model help manager to determine cause of performance problem. And create change strategy for solving those problem .
Material & Methods: It is descriptive , survey and inferential study , the population is university hospital managers in Esfahan university. data is gathered through achieve questionnaire that supported by member of management faculty.The reliability is supported based on α koren bakh . for analysis of data use spss soft ware .
Results: Finding show that : Average number of ability factor is (87/5+12/2) , clarify factor (82/3+14/8), help factor (82/6+15/7) , incentive factor ( 81/4+ 15/4), evaluation factor (77/2+15/6) , validity factor (82/7+ 17/3),and environment factor is (85/2+12/8). and base on Pierson test (p<0/05) all of the factor are effective on staff performance.
Conclusion: Today the important problem in health care organization is staff effectiveness . in fact , performance improvement is the most step for organization improvement.
Dr. Khodakaram Salimifard, Leyla Keshtkar, Mohammadsadegh Moradi,
Volume 13, Issue 3 (12-2014)
Abstract
Background: Emergency department performance can be evaluated in quantitative and qualitative criteria. Some quantitative criteria are considered such as length of stay, patient waiting time, the percentage of patients that treat in a specific time and etc. In this paper the performance of emergency department was evaluated in terms of these criteria. Then four scenarios by using simulations was proposed.
Materials & Methods: patient flow was modeled by discrete event simulation (DES) and the simulation was done by Arena software. Data was gathered randomly and patient waiting time, length of stay and the percentage of patients by noticing 6-hour boarding limit for EDs were performance criteria.
Result: The result show 70% of patients were hospitalized in ED over 6 hours and it is an important bottleneck. The fourth scenario is that best of the scenarios, that improve in waiting times for hospital admission (85%), total waiting time before hospitalization (63%) and the percentage of the beds utilization (15%).
Conclusion: the findings of this paper show that the fourth scenario has greatest improve in the process. In this scenario, to reduce waiting times for patients admitted to the emergency department as well as to reduce the high percentage of occupied beds, 3 beds and 1 nurse were added.
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.
Dr Bakhtiar Ostadi, Ms Asrin Navidi,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Since, energy consumption per square meter in hospitals is much higher than other types of service institutions; in this study, some actions performed toward optimizing energy consumption improvement projects based on the definition and prioritization in hospital.
Materials and Methods: The necessity of optimizing energy consumption in hospitals were described according to some scales including the average consumption and cost of water, electricity and gas for bed days and active bed, and these indices calculated in the case. Then, improvement actions were identified using energy audit, interviews with hospital experts and conducted studies in hospitals. Next, projects with high importance were extracted regarding to impact on energy consumption indices, expert opinion, aggregation, feasibility, and limitations such as prerequisite, synchronicity and post-requisite. Finally, specific criteria were identified in three dimensions, i.e., factors affecting the level of energy consumption, trying to execute project and risk and the projects were prioritized using questionnaire and FAHP.
Results: The study results revealed that energy consumption was higher than the world standards in the studied hospital; this confirmed the necessity of optimizing energy consumption and using energy management systems. The results of prioritization also showed the first four priorities.
Conclusion: It seems necessary to save energy consumption through improvement projects implementation in the hospitals. Regarding the number and resources limitation, hospitals can choose to implement some low risk and payback period projects based on existing priority and budget annually.
Mahnaz Afshari , Dr. Alimohammad Mosadeghrad , Dr. Mohammad Arab ,
Volume 16, Issue 1 (4-2017)
Abstract
Background: The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.
Materials and Methods: A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department. Related data were collected before and after the intervention to determine the effect of quality management system on deductions.
Results: The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.
Conclusion: Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively
Mohammadreza Tavakkoli, Dr. Saeed Karimi, Dr. Marzieh Javadi, Dr. Alireza Jabbaria,
Volume 16, Issue 1 (4-2017)
Abstract
Background: In year 1995, new system administration plan of hospitals (fee for service) was notified. This scheme was implemented in hospitals for 20 years. In the early September 2104, new guidelines of performance-based fee for service plan with the aim of deficiencies in the previous plan was reviewed and implemented in hospitals in Isfahan. This study aimed at investigating reform strategies to improve monitoring performance and infrastructure implementation development of the new scheme of fee guidelines in 2014.
Materials and Methods: This study was a qualitative one based of phenomenology. Depth interviews were used to collect data. Eleven individuals assessed including top and middle managers and professors of Isfahan University of Medical Sciences using content analysis method.
Results: In this study, eight main themes and ten sub-themes extracted including appropriate policy making, health management reform in health system, cultural building in monitoring, proper planning, physicians' motivation, infrastructure improvement, improving training, informatics and constructive interactions between senior managers and hospitals' directors.
Conclusion: With the aim of rationalizing the health system, new instructions and fee for service plan should be considered well to tackle weak points. It seems that coping with these weak spots in new fee for service plan, has feasibility to provide more satisfaction among physicians and staff. To achieve main goal of the project which defined as patients and staff satisfaction, using new reform strategies to facilitate plan implementation, continuing observation and stronger mentoring recommended.
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.
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.
Ali Mohammad Mosadeghrad, Fatemeh Khalaj,
Volume 19, Issue 1 (4-2020)
Abstract
Background and purpose: Electrocautery is a very important tool in surgery. Electrocautery burn is a common side effect of operation surgeries. Quality management is a useful strategy for improving the quality and safety of hospital services. The objective of this study was to examine the impact of quality management on reducing electrocautery burns.
Materials and methods: A participatory action research was conducted in the operating theatre of a hospital in Tehran, Iran, in 2013 and 2014. A quality improvement team was established in the hospital operating theatre. The quality improvement team using an 8-step quality management model, standardized working processes, identified quality goals for the processes and improved them until achieved the quality goals. Data on electrocautery burns was collected before and after the intervention and compared.
Results: Electrocautery burn rate was 0.40% in 2012. A wet patient due to sweating or washing during the surgery, in-appropriate patient position, faulty earth well, faulty anti-static mattress and long usage of electrocautery devices were the main reasons of electrocautery burn injuries. Accordingly an action plan was developed and implemented for preventing and reducing electrocautery burns. Consequently, electrocautery burn rate was reduced to 0.21% and 0.02% in 2013 and 2014. Electrocautery burn was significantly reduced by 95% in two years.
Conclusion: Electrocautery burns can be easily prevented using the quality management strategy. Implementing an appropriate quality management model appropriately in a supportive environment enhances the safety of hospital services.
Fatemeh Khazaei, Hasan Mirza Hosseini, Mostafa Nokani,
Volume 19, Issue 2 (8-2020)
Abstract
Introduction: Hemodialysis is one of the effective therapies in patients with chronic renal failure. Along with increasing life expectancy as a benefit of this treatment; this type of service can threaten the quality of life of recipients. Therefore, the present study was conducted to investigate the effectiveness of emotional schema-based therapy on improving the quality of life of dialysis patients.
Materials and Methods: The current semi-experimental, applied study was designed and implemented as pretest-posttest research with a control group. All outpatients treated with dialysis instrument in medical centres affiliated to Tehran University of Medical Sciences in 2009-2010 were the statistical population of the study and the quality of life questionnaire related to kidney patients used for data collection. After the research team performed the treatment protocol in 8 sessions of 90 minutes in the intervention group, the research data were analyzed using SPSS24.
Results: The results of the study showed that the treatment protocol based on emotional schema therapy influence all aspects of quality of life and increase the mean score compared to the pretest. Also, there is a significant difference between the groups, both in the general dimension and specific dimension of dialysis patient's quality of life.
Conclusion: As the study findings show, it can be stated that emotional schema therapy is effective in improving the quality of life of dialysis patients and can be used as a useful intervention to improve the quality of life of patients.
Ebrahim Jaafari Pooyan, Hojjat Rahmani, Mohammadamin Mirshekari,
Volume 19, Issue 4 (12-2020)
Abstract
Introduction: Identifying the challenges of Quality Improvement Offices (QIOs) not only helps in planning the quality of hospital services and in trying to provide a suitable solution to solve the problems of these offices but also plays an important role in strengthening the offices and increasing the quality of clinical and non-clinical services of hospitals. This study aimed to investigate the challenges of quality improvement offices in hospitals and provide appropriate solutions.
Methods: The present qualitative research was conducted using semi-structured interviews with 40 managers and hospital boards, matrons, quality improvement experts of hospitals and accreditation offices experts of medical universities in Tehran. Content analysis method was used to analyze the data obtained from the interviews. Then, the collected data were analyzed and classified by MAXQDA10 software.
Results: By analyzing the interviews in the field of challenges and solutions, the extracted codes were classified into four areas of management, standards, evaluation and staff. The most codes were related to management with 5 themes and 21 sub-themes. In addition, most of the solutions were related to the field of management.
Conclusion: The findings of the study showed that most of the challenges and solutions were in the field of management. Focusing on this field could be helpful in improving the quality of offices performance.
Hassan Niroomand Sadabad, Ali Vafaee Najar, Elahe Houshmand, Jamshid Jamali, Zahra Keyvanloo, Mahdi Dehnavi,
Volume 21, Issue 4 (1-2023)
Abstract
Background and purpose: Considering the important role of doctors in the implementation of accreditation standards and the necessity of their involvement in this process, this study was conducted in order to identify the views of doctors regarding the challenges of participating in accreditation programs in social security hospitals in Mashhad.
Materials and methods: This study is a cross-sectional descriptive-analytical research that was conducted in two hospitals of the Social Security Organization of Mashhad, Iran. in 2022. The participants were 56 full-time working doctors with at least one year of work experience in the hospital. Data analysis was done using SPSS version 26 software.
Findings: Among the challenges of doctors' participation in accreditation programs , the dimensions of the motivational mechanism (3.96±0.63) , provision of suitable resources for the implementation of accreditation (3.83±0.78), physician empowerment programs (3.78±0.73) and the role of the quality improvement office in attracting doctors' participation (3.75±0.74) were more important from the doctors' point of view, and patients' demands (2.90±0.75) and role ambiguity 2.77±0.96), were less important in their opinion.
Conclusion: Managers should consider that employee motivation and resource allocation are necessary for the effective implementation of the accreditation standard. Empowering doctors in the implementation of accreditation standards as well as the participation of quality improvement offices to interact with doctors and attract their participation are very important factors.
