مجله بیمارستان
سال دوازدهم شماره 1 (بهار 1392)

utilizing control chart in customer satisfaction evaluation is one of the effective tools in making results of customer analysis practical. This study was conducted to design the method of utilizing control chart in monitoring customer satisfaction in health care facilities. This prospective study measured service recipient's satisfaction in a three month period in a public hospital using a questionnaire in likert scale. After gathering initial data they were analyzed using SPSS and Excel soft wares. In order to evaluate customer satisfaction a ten parameter checklist and interview was used. The average and standard deviation of decuple and quintuple subgroups were compared. In a three month period the average patient satisfaction score was 4.5 in likert 5 score scale. There wasnt a significant statistical difference between 5,10,25 day duration in patient satisfaction. In addition there wasnt significant statistical difference between 5 samples per day and 10 samples per day and all samples in a day. R-X diagram was used for PSS monitoring. The results of this study showed that the average PSS in 20 and 25 day periods had no significant difference with 3 month PSS and also there wasnt significant statistical difference between average PSS in decuple and quintuple subgroups.

In case of disasters hospitals as one of the first centers to admit casualties need to be well prepared. This study aimed to determine the scale of preparedness of the hospitals located in the northern areas of Iran to deal with disasters. This applied and cross-sectional study was carried out in 2011. In this study all therapeutic-educational affiliated hospitals of Universities of Semnan, Shahroud, Mazandaran, Babol, and Guilan were investigated using the census method (53 hospitals). The data were collected using instruments were a manager's awareness Questionnaire (40 items) and a 141-item checklist which were filled using the self-assessment method. The data were analyzed using SPSS statistical software and Mann-Whitney, Kruskal Wallis and Pearson correlation coefficient statistical test. The average score of manager's awareness of the disaster confronting Preparedness status was 41.89±9.12 and hospital`s preparedness to confront disasters was 56.88±5.12 which show a mediocre level in all hospitals studied. There was a significant relationship (P=0.007) between the awareness of managers and receiving training on management of disasters. The least score was related to field of planning for decreasing structural risks (40.56±29.4).Significant relationships were observed between preparedness of hospitals in different universities and management plans for unanticipated events (P=0.047), hospital training program (P=0.019), planning for supporting vital services (P=0.005) and environmental health measures to deal with unanticipated events (P=0.001). Regarding the previous of disasters in the studied provinces and the mediocre preparedness of the hospitals, educational planning to confront disasters, strengthening the hospital buildings and organizing practical maneuvers will be effective in enhancing the preparation of the hospitals.

One of the most important advantages of calculating the cost and the bed-day expense is that the government can analyze and compare this cost among different centers and regions of the country and adjust an accurate plan and budget and require governmental units to perform it. this research has been done using a descriptive-analytic with a temporary and retrospective approach. sample selection has been done regarding the question that "whether the orthopedic section is beneficial or not" -based on hospital chief`s demands and with experts consultation. Related data has been gathered through studying documents, performing interviews and observing related checklists. initially all of the active centers were verified and then each activity`s cost was calculated using the ABC technique. in the year 1387, cost of each occupied bed for the orthopedic section of Imam Khomeini hospital has been 326818 rials per day. Considering the issue that this sector`s income is provided by selling services based on approved tariffs of ministry of health and medical education which has been 217500 rilas for a double-bed room of first grade hospitals in Tehran in the same year, we could conclude that the occupied Bed-Day cost is 109318 rials more compared to the approved tariff of the targeted year, which shows that the tariff's value is highly less than the bed-day cost. The enormous variance between Bed-Day cost and the tariff approved by the iranian cabinet will result in forfeit of service providing centers and this could make them serious problems in providing quality services in long term. Therefore, it is essential to set the diagnostic and treatment service's tariffs based on the real cost of these kind of services.

The family physician program is considered to be one of the most remarkable reforms in the health care system which will probably Increase accessibility to physicians especially in deprived areas. This study aims to assess the strengths and weaknesses of family physician program in Fouman and Shaft cities in 1390. This is a descriptive cross-sectional and applied study in which all of the health care team`s members including family physicians, midwives, health workers, experts, technicians and also 856 individuals of service recipients in these two cities were involved. Data collection method was questionnaire of which. Validity and reliability was verified. The most important strengths of family physician program and referral system from perspectives of service providers included: easy access of people to medical services and decreased medical cost for the patients and the main weaknesses were low salary for physicians, reverse referral and inaccessibility to family physicians round the clock. The main strengths from perspectives of service recipients were easy access to physicians and the main weaknesses were inappropriate reception of hospitals and lack of services through the 24 hours of the day. In order to eliminate the weaknesses and improve the quality of services, training the health staff in different levels of referral system, more comprehensive supervision, periodic assessments and effective supervision on the performance of family physician process owners is suggested.

Establishing an effective communication between health team professionals and diabetic patients is an important issue in living with type 2 diabetes. This study was conducted to assess communication between health workers as an obstacle in living with diabetes among type 2 diabetic patients referring to affiliated hospitals of Tehran University of Medical Sciences. This survey was a descriptive, analytic cross-sectional with 600 patients selected by a simple random method. Data were collected using a two part questionnaire including demographic information, health and disease related variables and HbA1C index (containing 10 questions) and communication of health workers with diabetic patients (containing 18 questions) which was measured by a five-level Likert scale [absolutely agree (5) to absolutely disagree (1)]. Validity and reliability of the questionnaire was verified. Questionnaires was filled by interview. SPSS software version 11.5 and descriptive statistical tests (mean and standard deviation) and inferential tests (chisquared, logistic regression model) were used for data analysis. Level of significance was assumed to be less than 0.05. Mean and standard deviation of communication between health workers and patients as an obstacle were 56.78± 7.17. Study results indicated that there were statistically significant relationships between sex(p<0.001), disease duration (p<0.001), level of education (p<0.001), type of treatment (p<0.001), occupation status (p<0.001), age categories (p<0.001), income status (p<0.001), marital status (p<0.001) and HbA1C index (p<0.001) and communication with health care as an obstacle. In addition results of the logistic regression model showed that the ratio of intensity of health worker communication as an obstacle was 0.38 times in 5-10 years and 1.32 times in more than 10 years diabetic patients compared to patients with less than 5 years disease duration. This ratio was significant in the group of diabetic patients with 5-10 years disease duration (p=0.004) and was effectively significant in intensity of health worker communication as an obstacle. Study results indicated that several factors affect communication between health workers and patients and the factor of years diabetic duration is related to ratio of the intensity of communication as an obstacle which can be helpful due to the planning health improvement interventions.

This study aimed to survey the relationship between job stress, self- efficiency and coping ability among staff of therapeutic- educational hospitals of Tabriz University of Medical sciences. This cross-sectional study was conducted in 2009 among therapeuticeducational hospitals of based on a two stage random sampling. Initially seven hospitals were selected using a simple random method and then 288 persons from the therapeutic and administrative staff were chosen as the sample to be studied using a classified random method. Data were collected using 4 questionnaires titled personal information, self-efficiency, Tores Theorell's job stress scale and Schwarzer's self efficacy and Coping Inventory for Stressful Situation CISS-21 (Dutch's coping). Data were analyzed Using SPSS software version 11.5 and also Chi-Squared test, T -test, One-Way Anova, Regression analysis and Pearson correlation coefficient. All the demographic variables including age, gender, marital status, working hours and work experience had a significant relationship with job stress. Pearson correlation test indicated a negative correlation between job stress and self- efficiency, working hours, age and work experience (P<0.001). Additionally there was a positive correlation between self- efficiency and working hours and age and coping ability with work experience (p< 0.05). Considering the importance of staff`s mental health issue it is suggested that background factors such as high work load, dignity level and social value and social supportive programs are taken into close consideration staff`s needs related to these issues are fully satisfied so that better health services are provided.

In the absence of medical facilities in Social Security Organization (SSO) hospitals in provinces, the patients will be dispatched to Tehran. This will dissatisfaction and intellectual and emotional tensions and imposes a lot of costs upon SSO for dispatching the patients. The objective of this study is to compare franchise elimination of medical services in hospitals in contract with social security organization in Provinces with costs of patients dispatching to Tehran. The study was done as retrospective and analytical research. The neurosurgical patients dispatched to Tehran were selected for the study (using the census method). The data were collected in information forms. Research finding were analyzed by SPSS software. Among studied provinces, Khuzestan province, with 233 cases, had the highest frequency ofpatients dispatched and Zanjan and Golestan provinces with 2 cases had the lowest frequency. There was a significant difference between average of dispatching costs paid by SSO and the average franchise paid by patients (p<0.001) such that patients dispatching cost was higher than the franchise paid by patients. There was also no significant difference between average dispatching costs and franchise margin among studied provinces. Considering the fact that cost of studied dispatching patients was higher than the franchise paid by them in exchange of medical services from hospitals in contract with SSO, elimination of medical services` franchise and treatment of patients in their provinces could decrease in the SSO costs compared with dispatching them to Tehran.

Patients are the raison detre of the hospitals therefore satisfying their needs and expectations is one of the most important duties of the hospitals. Consequently in recent decades patient satisfaction has been considered as a reliable measure for studying the quality of care and treatment. Hence in the present study, documents related to patient satisfaction in Iran was surveyed and the overall level of satisfaction was estimated using meta-analysis. Articles on patient satisfaction were identified by searching different data bases using appropriate key words. Twenty six studies were extracted after applying inclusion criteria measures. The results were analyzed using Meta-analysis commands in STATA11 software. 14058 cases were surveyed in this 26 studies by meta- analysis. Based on the random-effect model the patient overall satisfaction percentage was estimated at 70.5 (CI:63.3-77.6) though based on fixed effect model. The scale of patient satisfaction in Iran is in a proper level compared to other countries. Additionally, there has been an increasing trend in patient satisfaction in recent years, which might be attributable to measures such as using different methods of quality improvement, customer orientation and customer reverence.