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Hamzeh Amin-Tahmasbi, Maede Ghasemi,
Volume 14, Issue 4 (10-2020)
Volume 14, Issue 4 (10-2020)
Abstract
Background and Aim: The growing healthcare expenses, technological advancements and increasing competition in healthcare services, brings up new challenges for healthcare industry in providing appropriate services to customers. The Lean methodology, which is a managerial approach, provides tools necessary to eliminate waste and increase customer satisfaction through increasing quality of the services and decreasing the wait times and costs. The Scope of this paper is to determine and rank the lean criteria for hospitals.
Materials and Methods: 22 base criteria for a lean organization was selected and reconciled to hospitals from literature review. Then they were evaluated by experts in the field using Likert scale, leading to 18 criteria. The correlation of these criteria was found using ISM methodology, followed by ranking of these criteria. Lastly, the criteria were categorized utilizing MICMAC analysis.
Results: utilizing MICMAC analysis, the "defining the flow of processes & continuous improvement", "utilizing visual surveillance to understand the situation & exploit the problems" were identified as the most important variables.
Conclusion: In order to increase quality of services and customer satisfaction and to reduce operating costs, hospitals are advised to utilize lean methodology. In which case the management should pay more attention to the two more important criteria derived by MICMAC analysis, "Defining the processes in order to find problems" and "Continuous improvement and utilizing visual surveillance in order to find problems".
Materials and Methods: 22 base criteria for a lean organization was selected and reconciled to hospitals from literature review. Then they were evaluated by experts in the field using Likert scale, leading to 18 criteria. The correlation of these criteria was found using ISM methodology, followed by ranking of these criteria. Lastly, the criteria were categorized utilizing MICMAC analysis.
Results: utilizing MICMAC analysis, the "defining the flow of processes & continuous improvement", "utilizing visual surveillance to understand the situation & exploit the problems" were identified as the most important variables.
Conclusion: In order to increase quality of services and customer satisfaction and to reduce operating costs, hospitals are advised to utilize lean methodology. In which case the management should pay more attention to the two more important criteria derived by MICMAC analysis, "Defining the processes in order to find problems" and "Continuous improvement and utilizing visual surveillance in order to find problems".
Azam Lari , Nehzat Goudarzi , Sareh Daneshgar , Mahnaz Taheri Pour,
Volume 14, Issue 4 (10-2020)
Volume 14, Issue 4 (10-2020)
Abstract
Background and Aim: The use of purchasing mechanisms in the field of Medical Equipment and with government law and regulation can serve as a way to move towards smart purchase and increase access to vulnerable groups in order to receive services promote justice. This study conducted to Review of purchase management of Medical Equipment in Hospitals of Tehran University of Medical Sciences.
Materials and Methods: In this applied study conducted in 2018, the study population consisted of 623 individuals and research sample of 431 individuals for each domain that were selected by stratified random sampling. Data were collected using researcher-made questionnaire whose variables were extracted from comparative studies and its validity was measured by content validity Ratio, content validity index and Cronbach's alpha coefficient were obtained. SPSS18 and AMOS software were used to analyze the data by statistical methods of exploratory and confirmatory factor analysis.
Results: According to the results, effective dimensions in purchase management of Medical Equipment in Hospitals of Tehran University of Medical Sciences included Technical, Organizational, Political and Economic dimension with path coefficient of 1.244 1. 151, 0.973 0.845. Values indicate that all study paths are meaningful; in the other words, path coefficients are applicable.
Conclusion: Based on this study, Effective dimensions in purchase management of Medical Equipment consist of four dimensions (Technical, Organizational, Political and Economic) which is a comprehensive and multidimensional concept. Therefore, consideration of all its dimensions and components can best guide the buyer agencies in moving towards efficient purchase.
Materials and Methods: In this applied study conducted in 2018, the study population consisted of 623 individuals and research sample of 431 individuals for each domain that were selected by stratified random sampling. Data were collected using researcher-made questionnaire whose variables were extracted from comparative studies and its validity was measured by content validity Ratio, content validity index and Cronbach's alpha coefficient were obtained. SPSS18 and AMOS software were used to analyze the data by statistical methods of exploratory and confirmatory factor analysis.
Results: According to the results, effective dimensions in purchase management of Medical Equipment in Hospitals of Tehran University of Medical Sciences included Technical, Organizational, Political and Economic dimension with path coefficient of 1.244 1. 151, 0.973 0.845. Values indicate that all study paths are meaningful; in the other words, path coefficients are applicable.
Conclusion: Based on this study, Effective dimensions in purchase management of Medical Equipment consist of four dimensions (Technical, Organizational, Political and Economic) which is a comprehensive and multidimensional concept. Therefore, consideration of all its dimensions and components can best guide the buyer agencies in moving towards efficient purchase.
Ali Mohammad Mosadeghrad, Fatemeh Ghazanfari,
Volume 14, Issue 4 (10-2020)
Volume 14, Issue 4 (10-2020)
Abstract
Background and Aim: Hospital accreditation is “an external evaluation of a hospital’s structures, processes, outputs and outcomes by an independent professional accreditation body using pre-established optimum standards”. Accreditation is a strategy for ensuring the quality and, safety of hospital services. An accreditation program’s efficacy depends on the validity of its governance, methods, standards, and surveyors. The Iranian hospital accreditation program faces some challenges. This study aimed to identify the governance challenges of the Iranian hospital accreditation program and its solutions.
Materials and Methods: This qualitative study was performed using semi-structured interviews in 2019. Using a pluralistic evaluation approach, 151 policy makers, accreditation surveyors, hospital managers and staffs, and academics from the ministry of health, medical universities, hospitals and health insurance companies were purposively recuited and interviewed. Thematic analysis was used fordata analysis.
Results: Overall, 23 governance challenges were identified and were grouped into seven categories, i.e., organizational structure, organizational communication, policy making, planning, financing, stewardship and evalutation. Lack of independence, inappropriate organizational structure, resource shortage, senior managers’ mobility and turnover, weak internal and external communication, a compulsory accreditation program, insufficient knowledge of hospital accreditation, and lack of evaluation of the hospital accreditation were the main challenges. Establishing an accreditation council with four idependent scientific, accreditation, appeal and performance evaluation committes, piloting the accreditation program, proper planning, cascade education and training, allocating a specific budet for hospital accreditation, getting the ISQua accreditation certificate and public announcement of hospitals’ accreditation results were proposed as solutions to these challenges.
Conclusion: The governance of Iran's hospital accreditation program faces serious challenges. Improving the governance of the accreditation program leads to achieving the desired results.
Materials and Methods: This qualitative study was performed using semi-structured interviews in 2019. Using a pluralistic evaluation approach, 151 policy makers, accreditation surveyors, hospital managers and staffs, and academics from the ministry of health, medical universities, hospitals and health insurance companies were purposively recuited and interviewed. Thematic analysis was used fordata analysis.
Results: Overall, 23 governance challenges were identified and were grouped into seven categories, i.e., organizational structure, organizational communication, policy making, planning, financing, stewardship and evalutation. Lack of independence, inappropriate organizational structure, resource shortage, senior managers’ mobility and turnover, weak internal and external communication, a compulsory accreditation program, insufficient knowledge of hospital accreditation, and lack of evaluation of the hospital accreditation were the main challenges. Establishing an accreditation council with four idependent scientific, accreditation, appeal and performance evaluation committes, piloting the accreditation program, proper planning, cascade education and training, allocating a specific budet for hospital accreditation, getting the ISQua accreditation certificate and public announcement of hospitals’ accreditation results were proposed as solutions to these challenges.
Conclusion: The governance of Iran's hospital accreditation program faces serious challenges. Improving the governance of the accreditation program leads to achieving the desired results.
Mohammad Reza Mehregan, Shahrokh Yousefzadeh, Ali Reza Hatam Siahkal Mahalle,
Volume 15, Issue 2 (5-2021)
Volume 15, Issue 2 (5-2021)
Abstract
Background and Aim: The overall goal of the medical department is to develop and manage an efficient and effective supply chain. Intrinsic instability and unpredictability of treatment needs to require a flexible supply chain. Agility reflects the hospital's response to environmental changes, and agile hospitals are able to provide appropriate services to the patients. Hospital supply chain management agility needs to find the main aspects affecting the relationship and communication between them and to analyze the dimensions together. The purpose of this study was interpretive-structural modeling and analysis of dimensions of agile hospital supply chain management.
Materials and Methods: The research design combined descriptive - survey exploratory approach to the future. The population study were doctors, nurses and staff at the University of Medical Sciences. The Delphi technique was used to determine the dimensions of agility and the interpretive-structural modeling approach was used for analysis and modeling. Mick Mac software was used to analyze the dimensions of agility.
Results: The final model of agile hospital supply chain management with 16 dimensions had 8 levels, which was at the highest level of cost reduction and at the lowest level of organizational leadership commitment. The results indicate that leadership commitment is the foundation of supply chain agility in the hospital. Knowledge management variable had low impact and effectiveness and was known as a secondary leverage variable. The results showed that most agile supply chain management aspects of the main causes of complex communication and interaction, and the importance of agility in the hospital of the show.
Conclusion: The analysis and interpretation of functional from the aspect of Impact and Influence of agility dimensions in hospital environment Showed that, Dimensions of strategic planning, human resource development and staff skills training, human resource management and employee satisfaction, process management, process integration and organizational transformation, flexibility, organizational communication development and information management integration, service quality management and continuous improvement, acceptance of new technology and new ideas, speed of service, patient understand and satisfaction, monitor, find best responds demand and market sensitivity in the strategic area are located and They cause model instability and With high impact and high influence, They play an important role in the agility of hospital supply chain management.
Materials and Methods: The research design combined descriptive - survey exploratory approach to the future. The population study were doctors, nurses and staff at the University of Medical Sciences. The Delphi technique was used to determine the dimensions of agility and the interpretive-structural modeling approach was used for analysis and modeling. Mick Mac software was used to analyze the dimensions of agility.
Results: The final model of agile hospital supply chain management with 16 dimensions had 8 levels, which was at the highest level of cost reduction and at the lowest level of organizational leadership commitment. The results indicate that leadership commitment is the foundation of supply chain agility in the hospital. Knowledge management variable had low impact and effectiveness and was known as a secondary leverage variable. The results showed that most agile supply chain management aspects of the main causes of complex communication and interaction, and the importance of agility in the hospital of the show.
Conclusion: The analysis and interpretation of functional from the aspect of Impact and Influence of agility dimensions in hospital environment Showed that, Dimensions of strategic planning, human resource development and staff skills training, human resource management and employee satisfaction, process management, process integration and organizational transformation, flexibility, organizational communication development and information management integration, service quality management and continuous improvement, acceptance of new technology and new ideas, speed of service, patient understand and satisfaction, monitor, find best responds demand and market sensitivity in the strategic area are located and They cause model instability and With high impact and high influence, They play an important role in the agility of hospital supply chain management.
Zahra Aghasizadeh, Ali Reza Pouya, Nasser Motahari Farimani, Ali Vafeaa Najjar,
Volume 16, Issue 1 (3-2022)
Volume 16, Issue 1 (3-2022)
Abstract
Background and Aim: Hospitals are the most important component of the health system and accurate evaluation of their performance is important. So far, much research has been done on the evaluation of hospitals using DEA models, but in these studies, organizations are considered as a black box and system processes and relationships between them are ignored. In this study, the efficiency of hospitals was evaluated using network envelopment analysis and its results were compared with simple envelopment analysis.
Materials and Methods: The method of the present research was ptactical and the nature of the survey was descriptive. The research population was all hospitals and educational centers affiliated to Mashhad University of Medical Sciences with a capacity of more than one hundred beds, which included twelve public hospitals and forty-eight sections. To collect information, methods of observing and studying documents, records and statistics of hospital activities have been used. For validation, by calculating Spearman correlation coefficient, it was found that the proposed model has a significant correlation with the Black Box DEA Model and the validity of the model was confirmed. SOLVER DEA and EXCEL software were used to implement the model.
Results: The results show that by considering the internal departments of the organization as well as the relations between the departments, a more accurate analysis of the efficiency of the hospitals would be done and we will have a better separation in the ranking between the organizations. Also, by using the network DEA model, the overall efficiency, the efficiency of each department and the rank of each department in comparison with similar departments in other hospitals are determined.
Conclusion: The framework presented in this study can be an appropriate criterion for measuring the efficiency of hospitals and their internal sections by determining the overall position of each hospital relative to other hospitals and by determining the efficiency of the section. By determining the efficiency of the internal departments of hospitals, a suitable priority is provided for allocating resources and investing in different departments in the direction of organizational improvement.
Materials and Methods: The method of the present research was ptactical and the nature of the survey was descriptive. The research population was all hospitals and educational centers affiliated to Mashhad University of Medical Sciences with a capacity of more than one hundred beds, which included twelve public hospitals and forty-eight sections. To collect information, methods of observing and studying documents, records and statistics of hospital activities have been used. For validation, by calculating Spearman correlation coefficient, it was found that the proposed model has a significant correlation with the Black Box DEA Model and the validity of the model was confirmed. SOLVER DEA and EXCEL software were used to implement the model.
Results: The results show that by considering the internal departments of the organization as well as the relations between the departments, a more accurate analysis of the efficiency of the hospitals would be done and we will have a better separation in the ranking between the organizations. Also, by using the network DEA model, the overall efficiency, the efficiency of each department and the rank of each department in comparison with similar departments in other hospitals are determined.
Conclusion: The framework presented in this study can be an appropriate criterion for measuring the efficiency of hospitals and their internal sections by determining the overall position of each hospital relative to other hospitals and by determining the efficiency of the section. By determining the efficiency of the internal departments of hospitals, a suitable priority is provided for allocating resources and investing in different departments in the direction of organizational improvement.
Reza Abbasi, Fatemeh Rangraz Jeddi, Shima Anvari, Reza Khajouei,
Volume 16, Issue 3 (8-2022)
Volume 16, Issue 3 (8-2022)
Abstract
Background and Aim: Hospital managers are one of the key decision-makers in the implementation of health information systems. This study aimed to determine the implementation challenges of health information systems based on the hospital managers’ perspective.
Materials and Methods: This descriptive-analytical study was conducted in 2019 on the hospital managers of three provinces (Kerman, Yazd, Sistan and Baluchestan). Data were collected using a self-administrated questionnaire. The face validity of this questionnaire was approved by experts in health informatics and health information management and its reliability was confirmed by Cronbach’s alpha (α=96.7%). Data were analyzed using SPSS. To investigate the relationship between the mean of each challenge with demographic variables, Pearson, Independent T-test, and ANOVA tests were used.
Results: In this study, the factors related to ignoring the hospital manager’s needs in system selection (1.333 out of 2 points), hardware purchase cost, insufficient user training to using the system (1.238), inadequate manpower and health informatics specialists (1.19), software purchase cost, insufficient financial resources (1.142), high cost of system launching, the lack of integration and interoperability among information systems, lack of support from health care professionals (1.047), and lack of management experience in choosing the best system (one out of 2) had the highest scores (out of 2 points). Also, personnel training costs to work with the system (-0.092) and Lack of improvement in work processes (-0.047) obtained the lowest scores. Data analysis showed that managers with clinical backgrounds considered financial and human challenges more important than non-clinical managers (P<0.031).
Conclusion: The hospital managers believed that financial, human, technical, managerial, and organizational factors are the most important challenges in implementing health information systems in Iran’s hospitals respectively. The health policy-makers and planners at large and small levels can address many of the challenges before implementing systems by focusing on identified priorities.
Materials and Methods: This descriptive-analytical study was conducted in 2019 on the hospital managers of three provinces (Kerman, Yazd, Sistan and Baluchestan). Data were collected using a self-administrated questionnaire. The face validity of this questionnaire was approved by experts in health informatics and health information management and its reliability was confirmed by Cronbach’s alpha (α=96.7%). Data were analyzed using SPSS. To investigate the relationship between the mean of each challenge with demographic variables, Pearson, Independent T-test, and ANOVA tests were used.
Results: In this study, the factors related to ignoring the hospital manager’s needs in system selection (1.333 out of 2 points), hardware purchase cost, insufficient user training to using the system (1.238), inadequate manpower and health informatics specialists (1.19), software purchase cost, insufficient financial resources (1.142), high cost of system launching, the lack of integration and interoperability among information systems, lack of support from health care professionals (1.047), and lack of management experience in choosing the best system (one out of 2) had the highest scores (out of 2 points). Also, personnel training costs to work with the system (-0.092) and Lack of improvement in work processes (-0.047) obtained the lowest scores. Data analysis showed that managers with clinical backgrounds considered financial and human challenges more important than non-clinical managers (P<0.031).
Conclusion: The hospital managers believed that financial, human, technical, managerial, and organizational factors are the most important challenges in implementing health information systems in Iran’s hospitals respectively. The health policy-makers and planners at large and small levels can address many of the challenges before implementing systems by focusing on identified priorities.
Hamzeh Amin-Tahmasbi, Kimia Malekzadeh Shafaroudi,
Volume 16, Issue 4 (10-2022)
Volume 16, Issue 4 (10-2022)
Abstract
Background and Aim: Today, treatment is one of the important goals of tourism. Tourism in health and healthcare is growing rapidly in the world. Despite the fact that Guilan province, as one of the most important and touristic provinces of the country, has an annual population of 500,000 foreign tourists and can be the center of health tourism in Iran. Unfortunately, this province has not been able to have a proper share of the revenues of this field and attract foreign patients in parallel with its treatment capacities.
Materials and Method: The aim of this study was to identify the factors affecting the development of health tourism. In this regard, first, literature review was used and opinions of experts in this field, who were employees in five hospitals in Rasht, including Velayat, PourSina, Aria, Pars and Qaem hospitals, were selected using the Snowball sampling method. Twenty-five effective factors were identified and using Delphi method, 14 factors were selected as the final factor. Then by used of the Best and Worst Method (BWM), the importance of each factor was determined. Finally, using DEMATEL method, the effect of this factor on each other was determined.
Results: After conducting two rounds of Delphi, 11 factors that had an average lower than the average of the total opinions of the experts and there was more disagreement about them were eliminated. Then, by implementing the best-worst method, the quality of medical services was determined as the most important factor, and the ease of booking an appointment in advance for admission and the status of the banking system were determined as the least important factors among the final factors. Also, based on the results of the DEMATEL method, the quality of medical services has the greatest effect and the ease of booking an appointment in advance for admission has the least effect on other factors. Finally, the quality of medical services is the most effective and appropriate advertising about health tourism in domestic and foreign chambers of commerce has the least effectiveness.
Conclusion: Health tourism in Iran despite the relative quality and cheap price, has not yet found its place in the market due to the lack of proper advertising is still taking the first steps. Considering the environmental conditions and the existence of tourism aspects of Rasht, carrying out measures such as improving the quality of medical services, appropriate marketing, and improving infrastructures will lead to the development and improvement of health tourism, and as a result, increasing satisfaction and attracting more customers.
Materials and Method: The aim of this study was to identify the factors affecting the development of health tourism. In this regard, first, literature review was used and opinions of experts in this field, who were employees in five hospitals in Rasht, including Velayat, PourSina, Aria, Pars and Qaem hospitals, were selected using the Snowball sampling method. Twenty-five effective factors were identified and using Delphi method, 14 factors were selected as the final factor. Then by used of the Best and Worst Method (BWM), the importance of each factor was determined. Finally, using DEMATEL method, the effect of this factor on each other was determined.
Results: After conducting two rounds of Delphi, 11 factors that had an average lower than the average of the total opinions of the experts and there was more disagreement about them were eliminated. Then, by implementing the best-worst method, the quality of medical services was determined as the most important factor, and the ease of booking an appointment in advance for admission and the status of the banking system were determined as the least important factors among the final factors. Also, based on the results of the DEMATEL method, the quality of medical services has the greatest effect and the ease of booking an appointment in advance for admission has the least effect on other factors. Finally, the quality of medical services is the most effective and appropriate advertising about health tourism in domestic and foreign chambers of commerce has the least effectiveness.
Conclusion: Health tourism in Iran despite the relative quality and cheap price, has not yet found its place in the market due to the lack of proper advertising is still taking the first steps. Considering the environmental conditions and the existence of tourism aspects of Rasht, carrying out measures such as improving the quality of medical services, appropriate marketing, and improving infrastructures will lead to the development and improvement of health tourism, and as a result, increasing satisfaction and attracting more customers.
Mohammad Jalali, Ehsan Zarei, Ali Maher, Soheila Khodakarim,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran.
Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method.
Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05).
Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.
Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method.
Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05).
Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.
Saeed Nateghi, Ali Ganjali Khan Hakemi, Soheila Damiri, Samira Raoofi, Elham Haghshenas, Sara Akhavan Rezayat, Shamsi Ekhtiyar, , Maryam Radin Manesh,
Volume 16, Issue 5 (12-2022)
Volume 16, Issue 5 (12-2022)
Abstract
Background and Aim: Effective monitoring and evaluation of human resources in countries require an agreed set of indicators and measurement tools. Due to the existence of different payment mechanisms, this study aimed to identify performance evaluation indicators in hospitals affiliated with the Tehran University of Medical Sciences.
Materials and Methods: A qualitative phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, purposive sampling, and participation of 23 members of the Senior executives and financial team of hospitals affiliated to Tehran University of Medical Sciences and analyzed by content analysis method using MAXQDA-10 software.
Results: Twenty-three experts participated in this research, 78.2% were men and 21.7% were women, and a total of 526 final codes were identified and according to the balanced scorecard management tool in 4 main themes of finance, customers, internal processes, and growth and Development. Also 8 sub-themes of resource efficiency with 86%, medical tourism with 52%, professional ethics with 65%, satisfaction with 78%, accreditation with 48%, diagnosis and treatment with 78%, education with 56% and The research was categorized with 78%.
Conclusion: The provision of optimal medical services requires managers to be aware of the performance of subordinate personnel, which makes it possible to choose the appropriate criteria, develop performance evaluation systems and conduct correct evaluation, informing Doctors regarding the indicators considered for more accurate evaluation are among the suggestions that can be a solution to the existing problems. Another important point considering the limited available resources is the role of doctors in the field of health tourism to which attention will lead to an increase in financial resources.
Materials and Methods: A qualitative phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, purposive sampling, and participation of 23 members of the Senior executives and financial team of hospitals affiliated to Tehran University of Medical Sciences and analyzed by content analysis method using MAXQDA-10 software.
Results: Twenty-three experts participated in this research, 78.2% were men and 21.7% were women, and a total of 526 final codes were identified and according to the balanced scorecard management tool in 4 main themes of finance, customers, internal processes, and growth and Development. Also 8 sub-themes of resource efficiency with 86%, medical tourism with 52%, professional ethics with 65%, satisfaction with 78%, accreditation with 48%, diagnosis and treatment with 78%, education with 56% and The research was categorized with 78%.
Conclusion: The provision of optimal medical services requires managers to be aware of the performance of subordinate personnel, which makes it possible to choose the appropriate criteria, develop performance evaluation systems and conduct correct evaluation, informing Doctors regarding the indicators considered for more accurate evaluation are among the suggestions that can be a solution to the existing problems. Another important point considering the limited available resources is the role of doctors in the field of health tourism to which attention will lead to an increase in financial resources.
- Zeinab Hashemzadeh, Farhad Habibi, Hossein Dargahi, Mohammad Arab,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: Home care is an alternative method of hospitalization, especially for chronic patients and is an innovative approach to improve care and reduce the costs of hospital readmissions. The present study was conducted with the aim of investigating the benefits and challenges of implementing the home care plan after being discharged from the hospital considering the perspective of health service recipients and providers at Tehran University of Medical Sciences in 2021.
Material and Methods: The present study is an applied research that was conducted qualitatively using structured and semi-structured interviews. The research sample was those responsible for the implementation of this project at the ministry and university level, the implementers of this project in 4 hospitals, 5 institutions providing home care services, and family of patients. Twenty-eight people from the research community were included in the study using the purposeful and snowball sampling method. Content analysis method was used to analyze the interview data. MAXQDA2020 software was used for data classification.
Results: The results were classified into two categories: benefits and challenges of the home care plan after discharge. A total of 61 open codes were extracted from the analysis of research interviews, so that 27 codes led to the identification of 5 themes (Including improving service delivery, reducing costs, achieving health goals, cultural and social benefits, providing the necessary infrastructure) in the benefits and 34 codes led to the identification of 7 themes (including policy-making, legal and ethical, economic, manpower, cultural-social-communication, service provision limitations and time and place limitations) in the challenges.
Conclusion: The result of this research showed that home care services after being discharged from the hospital play an important role in completing the provision of healthcare services. Home care services after being discharged from the hospital improves service delivery, reduces costs, and helps in achieving health goals. It also benefits patients, society and the government in various cultural and social fields. On the other hand, it seems that there are challenges in the political, legal, economic and cultural fields in the way of the optimal implementation of this plan. Therefore, planning to evaluate and solve the problems facing these services is essential.
Material and Methods: The present study is an applied research that was conducted qualitatively using structured and semi-structured interviews. The research sample was those responsible for the implementation of this project at the ministry and university level, the implementers of this project in 4 hospitals, 5 institutions providing home care services, and family of patients. Twenty-eight people from the research community were included in the study using the purposeful and snowball sampling method. Content analysis method was used to analyze the interview data. MAXQDA2020 software was used for data classification.
Results: The results were classified into two categories: benefits and challenges of the home care plan after discharge. A total of 61 open codes were extracted from the analysis of research interviews, so that 27 codes led to the identification of 5 themes (Including improving service delivery, reducing costs, achieving health goals, cultural and social benefits, providing the necessary infrastructure) in the benefits and 34 codes led to the identification of 7 themes (including policy-making, legal and ethical, economic, manpower, cultural-social-communication, service provision limitations and time and place limitations) in the challenges.
Conclusion: The result of this research showed that home care services after being discharged from the hospital play an important role in completing the provision of healthcare services. Home care services after being discharged from the hospital improves service delivery, reduces costs, and helps in achieving health goals. It also benefits patients, society and the government in various cultural and social fields. On the other hand, it seems that there are challenges in the political, legal, economic and cultural fields in the way of the optimal implementation of this plan. Therefore, planning to evaluate and solve the problems facing these services is essential.
Fatemeh Esmaili, Najmeh Ashouri, Seyedeh Mahboobeh Hosseini Zare,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: Antibiotics are one of the most commonly used drugs that help to heal and treat diseases, but improper administration and excessive use of them can increase length of stay and cost of hospitalization. The purpose of this study was to analyze relationship between experimental use of antibiotics and duration of stay of premature infants admitted to Mahdiyeh hospital in Tehran.
Materials and Methods: This descriptive-analytical and cross-sectional study was carried out in 2019 on 159 premature infants admitted to intensive care ward of Mahdiyeh hospital in Tehran were investigated. The study tool was a questionnaire that validity of questionnaire was measured by content analysis method and reliability of questionnaire was measured by Cronbach’s alpha method. Data analysis was done using SPSS software, with help of descriptive statistics of frequency and percentage and statistical test of one-way analysis of variance and independent t-test.
Results: The results showed that 52.2% of infants were girls and 79.9% of deliveries were performed by cesarean section. The average length of stay of infants was 31.47 days and average birth of infants was 30 weeks. According to results of study, there was a significant relationship between length of hospitalization of infants with duration of antibiotic treatment and number of periods of receiving antibiotics (P<0.05). The duration of hospitalization of infants with a period of receiving less than 14 days of antibiotics was almost half of duration of hospitalization of infants with more than 14 days of receiving antibiotics. Also, there was a significant relationship between number of antibiotic courses and length of hospitalization of patients (P<0.05). With increase in number of antibiotic sessions, duration of hospitalization of infants increased significantly. The results of study showed that there was a significant relationship between birth weight of babies, cost of bed, and total cost of experimental administration of antibiotics (P<0.05).
Conclusion: Considering that rational use of antibiotics reduce length of stay of hospitalized infants, Ministry of Health should develop an updated and transparent antibiotic adminstration protocol for premature infants and awareness physicians to inform particularly prescription of antibiotics and implementation of stewardship antibiotic programs in neonatal intensive care unit. Also the publication of standard treatment guidelines, instructions including importance of prescribing antibiotics with correct dose and clinical education of physicians are necessary.
Materials and Methods: This descriptive-analytical and cross-sectional study was carried out in 2019 on 159 premature infants admitted to intensive care ward of Mahdiyeh hospital in Tehran were investigated. The study tool was a questionnaire that validity of questionnaire was measured by content analysis method and reliability of questionnaire was measured by Cronbach’s alpha method. Data analysis was done using SPSS software, with help of descriptive statistics of frequency and percentage and statistical test of one-way analysis of variance and independent t-test.
Results: The results showed that 52.2% of infants were girls and 79.9% of deliveries were performed by cesarean section. The average length of stay of infants was 31.47 days and average birth of infants was 30 weeks. According to results of study, there was a significant relationship between length of hospitalization of infants with duration of antibiotic treatment and number of periods of receiving antibiotics (P<0.05). The duration of hospitalization of infants with a period of receiving less than 14 days of antibiotics was almost half of duration of hospitalization of infants with more than 14 days of receiving antibiotics. Also, there was a significant relationship between number of antibiotic courses and length of hospitalization of patients (P<0.05). With increase in number of antibiotic sessions, duration of hospitalization of infants increased significantly. The results of study showed that there was a significant relationship between birth weight of babies, cost of bed, and total cost of experimental administration of antibiotics (P<0.05).
Conclusion: Considering that rational use of antibiotics reduce length of stay of hospitalized infants, Ministry of Health should develop an updated and transparent antibiotic adminstration protocol for premature infants and awareness physicians to inform particularly prescription of antibiotics and implementation of stewardship antibiotic programs in neonatal intensive care unit. Also the publication of standard treatment guidelines, instructions including importance of prescribing antibiotics with correct dose and clinical education of physicians are necessary.
Saeed Nazari, Simin Taj Sharififar, Milad Ahmadi Marzaleh, Sanaz Zargar Balaye Jame, Somayeh Azarmi, Yousuf Akbari Shahrestanaki,
Volume 17, Issue 1 (3-2023)
Volume 17, Issue 1 (3-2023)
Abstract
Background and Aim: The field of pre-hospital rapid response teams is facing major challenges in the field of chemical, biological, radiation and nuclear accidents. Considering that the country of Iran is exposed to the occurrence of these incidents, the possibility of the danger of these incidents and threats cannot be ignored. This study was conducted with the aim of determining effective factors in the formation of pre-hospital rapid response teams in the field of health in response to CBRN accidents.
Materials and Methods: the current study is qualitative research with a content analysis approach; which was conducted using semi-structured in-depth interviews with 18 specialists and experts through purposive and snowball sampling. Sampling was done until data saturation. Thematic analysis method was used to analyze the data. The study aimed to extract effective factors in the formation of pre-hospital rapid response teams in the field of health in response to chemical, biological, radiation and nuclear accidents in Iran in 2022.
Results: The factors affecting the formation of the team were divided into 5 main classes and 5 subgroups including capacity building (Education, training), operational requirements (information and communication, command and control, emergency response operational plan, internal and external coordination), required resources (equipment, financing), team formation requirements (decontamination requirements, structural requirements) and team formation structure (general team composition, specialized team composition). The highest number of codes with 39% was related to the emergency response operational plan subcategory and the lowest number of codes with 8% was related to the equipment subcategory.
Conclusion: This study presented the design of the local pre-hospital rapid response team in the field of health in chemical, biological, radiation and nuclear accidents in Iran. This plan is for quick pre-hospital response to attend and intervene in the acute phase of these incidents. In order to increase the response capacity and capability of these teams, in addition to the general composition of the team, in order to improve the specialized preparation to deal with the health effects of these incidents, a specialized composition has also been provided. It is suggested; A separate team should be formed for each CBRN area based on the risk assessment of the offending areas of the country.
Materials and Methods: the current study is qualitative research with a content analysis approach; which was conducted using semi-structured in-depth interviews with 18 specialists and experts through purposive and snowball sampling. Sampling was done until data saturation. Thematic analysis method was used to analyze the data. The study aimed to extract effective factors in the formation of pre-hospital rapid response teams in the field of health in response to chemical, biological, radiation and nuclear accidents in Iran in 2022.
Results: The factors affecting the formation of the team were divided into 5 main classes and 5 subgroups including capacity building (Education, training), operational requirements (information and communication, command and control, emergency response operational plan, internal and external coordination), required resources (equipment, financing), team formation requirements (decontamination requirements, structural requirements) and team formation structure (general team composition, specialized team composition). The highest number of codes with 39% was related to the emergency response operational plan subcategory and the lowest number of codes with 8% was related to the equipment subcategory.
Conclusion: This study presented the design of the local pre-hospital rapid response team in the field of health in chemical, biological, radiation and nuclear accidents in Iran. This plan is for quick pre-hospital response to attend and intervene in the acute phase of these incidents. In order to increase the response capacity and capability of these teams, in addition to the general composition of the team, in order to improve the specialized preparation to deal with the health effects of these incidents, a specialized composition has also been provided. It is suggested; A separate team should be formed for each CBRN area based on the risk assessment of the offending areas of the country.
Maryam Aghajarinezhad, Yahya Salimi, Shahab Rezaeian, Ghobad Moradi, Mehdi Moradinazar, Fatemeh Khosravi Shadmani, Roya Safari_ Faramani, Mitra Darbandi, Farid Najafi,
Volume 17, Issue 2 (5-2023)
Volume 17, Issue 2 (5-2023)
Abstract
Background and Aim: All people living in a society are not equally at risk of COVID-19 infection and hospitalization. The current study is aimed to determine the factors related to COVID-19 infection and hospitalization among participants of Ravansar Non-Communicable Disease (RaNCD) cohort study.
Materials and Methods: The present study was conducted between 28th February, 2020 to 27th November, 2021. Data from the RaNCD study, morbidity and hospitalizations cases (extracted from the medical care monitoring system, SAMA system and the handwritten list of the health department) and positive serological results were used. For the case-cohort study, 626 confirmed and/or probable cases and 2107 randomly selected participants as sub-cohort were recruited. For the case-control study, 188 COVID-19 hospitalized patients from RaNCD (as cases) and 632 positive outpatients identified as controls. Data were analyzed using Cox and logistic regression, respectively.
Results: In case-cohort study, the hazard ratio of COVID-19 among people living in rural areas, in smokers and those in middle socioeconomic status was, 0.37 (0.24, 0.58), 1.50 (1.07, 2.11), as compared to the reference groups. While the hazard ratio of people aged 46-64 and those ≥65 years old, as compared to the reference group within the first year, was 3.47 (1.76, 6.86) and 6.45 (2.80, 14.85), the corresponding value after one year was 2.23 (1.13, 4.40) and 3.52 (1.53, 8.10), respectively. The hazard ratio among those with at least one comorbidity was 2.45 (1.53, 3.92) in the first year of study and after one year decreased to 1.82 (1.14, 2.92). In addition, moderate and vigorous physical activity decreased the hazard ratio. In case-control study the odds ratio of hospitalization increased by 0.03% (1.03(1.01, 1.05)) with an increase of one year in age and in people with at least three comorbidities was 2.43 (1.24, 4.73) times of those without comorbidity.
Conclusion: Overall, one year after starting the study the decrease in hazard ratio of COVID-19 was significant. Increase in age and having comorbidities are factors that increased the odds ratio of hospitalization. Such people can be considered for the next waves of COVID-19 prioritized for health care and booster vaccination.
Materials and Methods: The present study was conducted between 28th February, 2020 to 27th November, 2021. Data from the RaNCD study, morbidity and hospitalizations cases (extracted from the medical care monitoring system, SAMA system and the handwritten list of the health department) and positive serological results were used. For the case-cohort study, 626 confirmed and/or probable cases and 2107 randomly selected participants as sub-cohort were recruited. For the case-control study, 188 COVID-19 hospitalized patients from RaNCD (as cases) and 632 positive outpatients identified as controls. Data were analyzed using Cox and logistic regression, respectively.
Results: In case-cohort study, the hazard ratio of COVID-19 among people living in rural areas, in smokers and those in middle socioeconomic status was, 0.37 (0.24, 0.58), 1.50 (1.07, 2.11), as compared to the reference groups. While the hazard ratio of people aged 46-64 and those ≥65 years old, as compared to the reference group within the first year, was 3.47 (1.76, 6.86) and 6.45 (2.80, 14.85), the corresponding value after one year was 2.23 (1.13, 4.40) and 3.52 (1.53, 8.10), respectively. The hazard ratio among those with at least one comorbidity was 2.45 (1.53, 3.92) in the first year of study and after one year decreased to 1.82 (1.14, 2.92). In addition, moderate and vigorous physical activity decreased the hazard ratio. In case-control study the odds ratio of hospitalization increased by 0.03% (1.03(1.01, 1.05)) with an increase of one year in age and in people with at least three comorbidities was 2.43 (1.24, 4.73) times of those without comorbidity.
Conclusion: Overall, one year after starting the study the decrease in hazard ratio of COVID-19 was significant. Increase in age and having comorbidities are factors that increased the odds ratio of hospitalization. Such people can be considered for the next waves of COVID-19 prioritized for health care and booster vaccination.
Roya Balaghiinaloo, Alireza Noruzi, Mohammadreza Esmaeili Givi,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: It is not possible to provide health information services in health crises without a comprehensive understanding of these services and how to provide them due to the health crisis. Based on this, the aim of the current research was to obtain comprehensive information about the components of providing health information services in health crises.
Materials and Methods: The current research was conducted with a qualitative approach and a meta-combined method, using the seven-step method of Sandelowski and Barroso. The statistical population consisted of articles and theses published in persian and international databases between 1991 to 2022 AD and 1370 to 1400 solar. Out of a total of 8363 resources identified based on the critical skills assessment program, 40 resources were approved. Extracted information was coded and coding reliability was measured and confirmed using Kappa coefficient.
Results: From the results of the research, 74 codes were extracted in 21 concepts and 6 categories in the field of providing health information services to patients. which categories and codes include health information needs assessment (disease, health, health information sources, patients); accessibility and dissemination of health information (health information, access ways); Awareness and notification of health information (information, tools); Education (patients, managers and staff of hospital libraries, methods); Planning (health crisis, resources, budget, infrastructure, patients, librarians and Medical Information Specialists) and obstacles and limitations (expert force, budget, facilities and infrastructure and resources) were categorized.
Conclusion: Dealing with the issue and components of providing health information services to patients in health Disasters in hospital libraries can cause policymakers in this field to know more about the dimensions, concepts, and consequences of providing these services in order to provide access to health information for everyone, especially patients. According to the identified components, efforts can be made to prepare the necessary infrastructure in order to plan to strengthen the strengths and eliminate the existing weaknesses and make appropriate policies in order to play the role of health counseling and launch the health information service department in hospital libraries.
Materials and Methods: The current research was conducted with a qualitative approach and a meta-combined method, using the seven-step method of Sandelowski and Barroso. The statistical population consisted of articles and theses published in persian and international databases between 1991 to 2022 AD and 1370 to 1400 solar. Out of a total of 8363 resources identified based on the critical skills assessment program, 40 resources were approved. Extracted information was coded and coding reliability was measured and confirmed using Kappa coefficient.
Results: From the results of the research, 74 codes were extracted in 21 concepts and 6 categories in the field of providing health information services to patients. which categories and codes include health information needs assessment (disease, health, health information sources, patients); accessibility and dissemination of health information (health information, access ways); Awareness and notification of health information (information, tools); Education (patients, managers and staff of hospital libraries, methods); Planning (health crisis, resources, budget, infrastructure, patients, librarians and Medical Information Specialists) and obstacles and limitations (expert force, budget, facilities and infrastructure and resources) were categorized.
Conclusion: Dealing with the issue and components of providing health information services to patients in health Disasters in hospital libraries can cause policymakers in this field to know more about the dimensions, concepts, and consequences of providing these services in order to provide access to health information for everyone, especially patients. According to the identified components, efforts can be made to prepare the necessary infrastructure in order to plan to strengthen the strengths and eliminate the existing weaknesses and make appropriate policies in order to play the role of health counseling and launch the health information service department in hospital libraries.
Hamid Moghaddasi, Farkhondeh Asadi, Azamossadat Hosseini, Masoomeh Nouri Tahneh,
Volume 17, Issue 4 (10-2023)
Volume 17, Issue 4 (10-2023)
Abstract
Background and Aim: The Hospital Information System is a complete one to provide high-quality patient care and enhance community health, so it must be designed and produced accordingly. In this regard, the current research was carried out with the aim of providing the document of standards for producing Hospital Information System software for Iran.
Materials and Methods: In this study, following extraction of the features and services of the Hospital Information System from the texts, they were matched with the generalities of the document of standards compiled by the Statistical Data Management and Information Technology Office of the Ministry of Health, Treatment, and Medical Education (SDMITO). Also, the Hospital Information System was reviewed observationally, all defects of document of standards were identified, and the document was amended throughout. After providing the proposed document of standards, it was consulted by a group of experts, which included ten health information management professors, ten medical informatics professors (with at least seven years of experience as members of the academic staff), and five heads of the information technology field of the Ministry of Health. An agreement coefficient of 85% was considered to accept and approve the document of standards. After obtaining the agreement coefficient, The Hospital Information System software production document of standards was provided.
Results: The document of standards provided for the production of Hospital Information System software includes the Hospital Information System design meta model, Hospital Information System subtypes, standards for the structure and content of Electronic Health Record, information terminology standards, data classification standards, security data standards, data exchange standards, clinical services, and management services, which were placed in the four areas of “features”, “services”, “documentation requirements” and “rules and policies”.
Conclusion: The application of this document of standards leads to the production of a higher quality, efficient, and standard Hospital Information System software, which is effective in improving the health level of society and provides the conditions for the implementation of Electronic Health Record.
Mrs Fatemeh Rangraz Jeddi, Ehsan Nabovati, Shima Anvari Tafti, Parisa Yousefi Konjdar,
Volume 17, Issue 5 (12-2023)
Volume 17, Issue 5 (12-2023)
Abstract
Background and Aim: A medication dashboard could provide executive directors and managers with the ability to manage medication resources in hospitals. This study aimed to design, implement, and evaluate a medication resources management dashboard for general hospitals.
Materials and Methods: This study was of the development-applied type conducted in an academic therapeutic community center. Based on scientific sources, the dashboard’s key performance indicators (KPIs) and functional requirements were identified. The data collection tool was a questionnaire comprising demographic information, KPIs, and functional requirements. The dashboard conceptual model was designed using Rational Rose software, and then POWER BI software was used to develop the system. The usability of the dashboard was evaluated using the standard questionnaire for End User Computing Satisfaction by 10 users. The data were analyzed in SPSS software using descriptive statistics.
Results: The most important KPIs determined for a medication resources management dashboard in general hospitals were “the ratio of antibiotic consumption to total number of drugs”, “the ratio of the antibiotic prescribed by general practitioners to total number of drugs”, “the ratio of patients for whom antibiotics were prescribed to all patients”, and “the ratio of the number of drug items prescribed by specialists to all physicians”. The most important functional requirements determined were “updating information at specific intervals “, “checking the dashboard at different time intervals”, “defining access levels to view the information”, and “choosing between graphical and tabular displays”. Usability evaluation showed that users’ satisfaction with the dashboard content variable was “very high” and for the other variables was at a “high” level.
Conclusion: The KPIs associated with antibiotics and drug costs within the medication dashboard of general hospitals are high priority. Future studies should evaluate the impact of using a medication dashboard on hospital executive directors’ and managers’ decision-making.
Mehdi Raadabadi, Zahra Tolideh, Zahra Shoara, Zahra Yeganeh, Jamil Sadeghifar, Khalil Momeni,
Volume 18, Issue 1 (3-2024)
Volume 18, Issue 1 (3-2024)
Abstract
Background and Aim: There is limited evidence about the effect of the corona disease epidemic on the efficiency of hospitals in Iran. This study was conducted with the aim of investigating the effect of the Covid-19 epidemic on the productivity of public hospitals in Ilam province.
Materials and Methods: This retrospective descriptive research has investigated the performance of 9 hospitals in Ilam province during a four-year period(1397-1400) based on the Pabon Lasso graphic model. The desired data were extracted from the HIS system of the hospitals and the key performance indicators of BOR, BTR and ALOS were calculated. The Pabon Lasso diagram was drawn with Excel software.
Results: The results showed that the bed occupancy percentage in teaching hospitals is significantly higher than non-teaching hospitals (P<0.05). Based on the results, the percentage of bed occupancy and the rate of bed rotation after the covid 19 pandemic has decreased significantly (P<0.05). The average length of the stay of patients also increased after the pandemic (P<0.05). Overall evaluation of hospital efficiency based on the Pabén Lasso model shows that the frequency of hospitals located in Nakara district has decreased from 4 hospitals before the pandemic to 3 hospitals, although hospitals in Kara district have not changed during this period.
Conclusion: Most of the researched hospitals, especially non-teaching hospitals, have low bed occupancy. Weakness in the service delivery chain, especially diagnostic services and specialized and super-specialized services, is one of the main reasons for this situation. Moving towards a change in the way hospitals are managed and having more flexibility in the structure and implementation in the short term and prioritizing large hospitals with a complete chain of services can lead to a way out of the current inefficient situation.
Materials and Methods: This retrospective descriptive research has investigated the performance of 9 hospitals in Ilam province during a four-year period(1397-1400) based on the Pabon Lasso graphic model. The desired data were extracted from the HIS system of the hospitals and the key performance indicators of BOR, BTR and ALOS were calculated. The Pabon Lasso diagram was drawn with Excel software.
Results: The results showed that the bed occupancy percentage in teaching hospitals is significantly higher than non-teaching hospitals (P<0.05). Based on the results, the percentage of bed occupancy and the rate of bed rotation after the covid 19 pandemic has decreased significantly (P<0.05). The average length of the stay of patients also increased after the pandemic (P<0.05). Overall evaluation of hospital efficiency based on the Pabén Lasso model shows that the frequency of hospitals located in Nakara district has decreased from 4 hospitals before the pandemic to 3 hospitals, although hospitals in Kara district have not changed during this period.
Conclusion: Most of the researched hospitals, especially non-teaching hospitals, have low bed occupancy. Weakness in the service delivery chain, especially diagnostic services and specialized and super-specialized services, is one of the main reasons for this situation. Moving towards a change in the way hospitals are managed and having more flexibility in the structure and implementation in the short term and prioritizing large hospitals with a complete chain of services can lead to a way out of the current inefficient situation.
Marziyeh Najafi, Roya Rajaee, Hojjat Rahmani, Behrooz Pouragha, Nazanin Sheikh Mohammadi, Ghasem Rajabi Vasokolaei,
Volume 18, Issue 1 (3-2024)
Volume 18, Issue 1 (3-2024)
Abstract
Background and Aim: Patient falls are common in hospitals, leading to financial loss and potential harm to patients, staff, and the organization. They can often be prevented with proper planning. This study aims to identify strategies to prevent patient falls and provide evidence to develop safety initiatives.
Materials and Methods: Our review used the Arksey and O’Malley scoping review model to identify strategies for preventing patient falls. We conducted searches with relevant keywords in the PubMed and Web of Science databases until May 25, 2024. In the final stage, we consulted with 18 experts using the Delphi method to gather their opinions. The data were analyzed using the thematic analysis method.
Results: Out of the 4202 studies initially found, 19 articles were chosen. The solutions to prevent patient falls can be grouped into six general categories: planning (which includes quality improvement programs, establishment of patient safety culture, patient fall prevention guidelines and programs), physical space (involving patient room design and the location of treatment staff), equipment (such as monitoring and alarms, pressure sensors, and standard beds), human resources (including communication networks between nurses and other treatment staff, as well as factors like self-efficacy and responsiveness of nurses, and their motivation and job satisfaction), training (covering education and patient participation, training of nurses and treatment staff, and electronic training), and control of executive processes (involving evaluation of risk factors and process control). The highest level of agreement among the members was on the equipment dimension (9.76), and the lowest was on the human resources dimension (8.65).
Conclusion: Patient falls are a common safety concern in hospitals and can be prevented with proper planning. Each hospital should use a combination of prevention methods tailored to its specific conditions.
Materials and Methods: Our review used the Arksey and O’Malley scoping review model to identify strategies for preventing patient falls. We conducted searches with relevant keywords in the PubMed and Web of Science databases until May 25, 2024. In the final stage, we consulted with 18 experts using the Delphi method to gather their opinions. The data were analyzed using the thematic analysis method.
Results: Out of the 4202 studies initially found, 19 articles were chosen. The solutions to prevent patient falls can be grouped into six general categories: planning (which includes quality improvement programs, establishment of patient safety culture, patient fall prevention guidelines and programs), physical space (involving patient room design and the location of treatment staff), equipment (such as monitoring and alarms, pressure sensors, and standard beds), human resources (including communication networks between nurses and other treatment staff, as well as factors like self-efficacy and responsiveness of nurses, and their motivation and job satisfaction), training (covering education and patient participation, training of nurses and treatment staff, and electronic training), and control of executive processes (involving evaluation of risk factors and process control). The highest level of agreement among the members was on the equipment dimension (9.76), and the lowest was on the human resources dimension (8.65).
Conclusion: Patient falls are a common safety concern in hospitals and can be prevented with proper planning. Each hospital should use a combination of prevention methods tailored to its specific conditions.
Majid Jangi, Azade Shayan Babokan, Nasim Ghalili Najafabadi, Sedigheh Torki Harchegani,
Volume 18, Issue 2 (5-2024)
Volume 18, Issue 2 (5-2024)
Abstract
Background and Aim: Considering the limitation of resourses, improvement of the hospital efficiency is an absolute necessity. The Covid19 pandemic had a considerable effect on performance indicators of hospitals. This study aimed to investigate changes of indicators of hospitals affiliated to Isfahan University of Medical Sciences before and after Covid19.
Materials and Methods: This study was descriptive-cross sectional. The statistical population included all hospitals under the coverage of Isfahan University of Medical Sciences (38). The input data were related to the three years 2019 to 2021 (the year 2019 as the year before outbreak of Covid-19, the year 2020 as the first year of outbreak and the year 2021 as the second year of outbreak), which were collected using the researcher’s form based on reports extracted from the statistics and hospital information system available in the statistics and information technology management and finally the data analyzed through the PabonLasso model.
Results: Process of indicators during the years 2019-2021 shows that mean of indicators of bed occupancy rate and bed turnover rate as the first year of outbreak of Covid19 (2020) that was the peak of the disease has decreased as compared to the year 2019 and average length of stay has increased. In years 2019, 2020 and 2021, 24.32, 23.68 and 24.32 percent of hospitals were in the third area (efficient area). From 2019 to 2020, efficiency change was observed in 27 percent of the hospitals where 6 hospitals had positive trend and 4 hospitals had negative trend and from 2020 to 2021, efficiency change was observed in 16 percent of hospitals where 2 hospitals had positive and 4 had negative trend.
Conclusion: Considering the low efficiency of hospitals, it is suggested to carry out continuous and annual assessment of efficiency changes in hospitals in order to identify the causes of inefficiency early and preventing its drop and it is necessary for health managers and policy makers to take appropriate measures in the conditions of the outbreak of unexpected disease such as the outbreak of Covid-19 in order to use hospital resources more optimally.
Materials and Methods: This study was descriptive-cross sectional. The statistical population included all hospitals under the coverage of Isfahan University of Medical Sciences (38). The input data were related to the three years 2019 to 2021 (the year 2019 as the year before outbreak of Covid-19, the year 2020 as the first year of outbreak and the year 2021 as the second year of outbreak), which were collected using the researcher’s form based on reports extracted from the statistics and hospital information system available in the statistics and information technology management and finally the data analyzed through the PabonLasso model.
Results: Process of indicators during the years 2019-2021 shows that mean of indicators of bed occupancy rate and bed turnover rate as the first year of outbreak of Covid19 (2020) that was the peak of the disease has decreased as compared to the year 2019 and average length of stay has increased. In years 2019, 2020 and 2021, 24.32, 23.68 and 24.32 percent of hospitals were in the third area (efficient area). From 2019 to 2020, efficiency change was observed in 27 percent of the hospitals where 6 hospitals had positive trend and 4 hospitals had negative trend and from 2020 to 2021, efficiency change was observed in 16 percent of hospitals where 2 hospitals had positive and 4 had negative trend.
Conclusion: Considering the low efficiency of hospitals, it is suggested to carry out continuous and annual assessment of efficiency changes in hospitals in order to identify the causes of inefficiency early and preventing its drop and it is necessary for health managers and policy makers to take appropriate measures in the conditions of the outbreak of unexpected disease such as the outbreak of Covid-19 in order to use hospital resources more optimally.
Malihe Ghanaatjoo, Nader Jahanmehr, Dr. Hamed Dehnavi, Aida Samadi,
Volume 18, Issue 2 (5-2024)
Volume 18, Issue 2 (5-2024)
Abstract
Background and Aim: The increase in the amount of information and the need for their daily monitoring have led to the development of tools called management dashboards that have the ability to analyze graphical data. In addition to preparing quick reports in different time frames and user-specific format, the dashboard can be useful for providing dynamic updated information for accurate decision-making and quick response to changes.
Materials and Methods: The current research was carried out in the form of qualitative studies and participatory action research method in 9 steps. In this applied and developmental research that was conducted cross-sectionally using the data of the first half of 2022, 11 members of the leadership team of a super-specialized children’s hospital were selected as research participants. The data collection tool was an interview using a questionnaire to determine the importance of indicators and a usability questionnaire (usability) of the dashboard based on three independent variables (usefulness, ease of use and satisfaction). The Excel file of data needed for the dashboard was collected from the HIS system of the hospital, and the dashboard was designed with Power BI software, and the capabilities and access levels of users were determined based on their duties. Data analysis was done using descriptive statistics and Excel software version 2016.
Results: In the stage of determining key performance indicators, out of 39 indicators selected by the research team, 22 indicators scored an average score of 4 or higher (from 5 points) and 21 indicators were able to be implemented. The data repository in Excel format was used as an intermediate environment. The dashboard was displayed on six pages (indicators related to the performance of inpatient beds, mortality, emergency and other indicators) and the capabilities of each page were determined. After implementing the dashboard and determining the access levels of users, obtaining a high score from the questions of the usability questionnaire (5 out of 7 points) and obtaining an average score of 71.8 out of 5 questions related to usefulness variables, 70.5 out of 8 questions related to ease of use. And 71 out of 3 questions related to the satisfaction variable showed that the dashboard designed for the hospital had high usability.
Conclusion: Hospital management dashboard information can be a basis for informed decision-making to achieve benefits such as identifying the best performance, improving performance quality, making faster decisions, reducing errors, improving capacity management and work flow, allocating resources and planning for growth and development.
Materials and Methods: The current research was carried out in the form of qualitative studies and participatory action research method in 9 steps. In this applied and developmental research that was conducted cross-sectionally using the data of the first half of 2022, 11 members of the leadership team of a super-specialized children’s hospital were selected as research participants. The data collection tool was an interview using a questionnaire to determine the importance of indicators and a usability questionnaire (usability) of the dashboard based on three independent variables (usefulness, ease of use and satisfaction). The Excel file of data needed for the dashboard was collected from the HIS system of the hospital, and the dashboard was designed with Power BI software, and the capabilities and access levels of users were determined based on their duties. Data analysis was done using descriptive statistics and Excel software version 2016.
Results: In the stage of determining key performance indicators, out of 39 indicators selected by the research team, 22 indicators scored an average score of 4 or higher (from 5 points) and 21 indicators were able to be implemented. The data repository in Excel format was used as an intermediate environment. The dashboard was displayed on six pages (indicators related to the performance of inpatient beds, mortality, emergency and other indicators) and the capabilities of each page were determined. After implementing the dashboard and determining the access levels of users, obtaining a high score from the questions of the usability questionnaire (5 out of 7 points) and obtaining an average score of 71.8 out of 5 questions related to usefulness variables, 70.5 out of 8 questions related to ease of use. And 71 out of 3 questions related to the satisfaction variable showed that the dashboard designed for the hospital had high usability.
Conclusion: Hospital management dashboard information can be a basis for informed decision-making to achieve benefits such as identifying the best performance, improving performance quality, making faster decisions, reducing errors, improving capacity management and work flow, allocating resources and planning for growth and development.
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