مجله پایش
سال نهم شماره 2 (پیاپی 34، بهار 1389)

In this paper, an integrated approach including QFD and FMEA is proposed in healthcare systems. The main objective is to improve the quality of healthcare services and activities in order to maximum customers’ satisfaction and minimize costs. To develop the mentioned approach following stages have been done:1- Identifying the most importance service characteristics with regard to customer expectations. 2- Identifying the most importance measurable functions and activities and their target values with regard to the service characteristics determined from pervious stage. 3- Identifying the relative potential failures and their importance rate with regard to the output of previous stage. After determining the most important functions to carry out into the system, some potential failures will be happen into the system. The occurrences of these failures decrease the quality of healthcare services and finally the customer satisfactions. Then, to prevent the occurrence of them, the relative failures and their weights are identified in this stage. 4- To complete the proposed approach and also increase the customer satisfactions more, the corrective and preventive actions to prevent the failures from happening are suggested by the FMEA team. To understand the proposed structure, an illustrative example has been surveyed in this paper. Due to the space limitation, a small part of information is given. In this example, customers consist of patients and their families, doctors, hospital manager, employers, assurance concerns and government. The main results of the paper are the following: Identifying the different group of customers by the excellent approach, determining the importance rate of customer's requirements by means of the correlation rates between customer's requirements, identifying the qualitative functions and activities and also calculating the target value for healthcare, determining the potential failures and their weights with regard to the importance rate of healthcare functions and using the FMEA tool in healthcare systems to increase the customer satisfaction. Hospitals and other healthcare systems have problem creating and improving the quality in their systems. As the service systems have special characteristics, considering the QFD and FMEA models like what is done in industrial systems is impossible to create and improve the quality in such systems. Also, due to high healthcare services costs, there is a high competitive between healthcare system to provide services to meet the customer's requirements. Therefore, in this paper, an integrated approach in the healthcare system in accordance with QFD/ FMEA is suggested.

The purpose of this research, according to legal requirements for applying the model as national productivity model, has been assessment of empowerment in Tehran Social Security Organization Hospitals Based on The Organizational Excellence Model (EFQM). The method of this research is descriptive and cross-sectional. This research had been done in Alborz and panzdah khordad varamin hospitals. Data gathering tool was the EFQM questionnaire that had been completed during group working sessions, interview with leaders of the hospitals and referring to necessitous units. Research data had been gathered according to five empowerment criteria in the hospitals. Alborz hospital has had the higher score in leadership criterion (46.1%), policy and strategy (50.6%) processes (61%). Panzdah khordad hospital has had the higher score in people (47.39%), partnership and resources (49.5%). Totally, the finding shows that Panzdah khordad hospital had been higher score 254.35 and then Alborz hospital with 235.46 scores. Assessment of hospital performance based on empowerments, according to European Organizational Excellence Model, is the first empirical experience in hospitals of our country. The findings have showed that European Organizational Excellence Model and empowerment segment of the model is very applicable in health care. Benchmark and supervision to hospital performance will be possible by using the model especially in management attention and follow up to hospital and people empowering that facilitate to reach the organizational goals and results.

Socio-Economic status of people which has an impressive effect on their health, is itself impressed by many other factors. This variable is measured as a basic variable in all health and medical researches. Till now, there has been no means in the country to assist researchers in this area. In the present research, it is tried to provide an accurate and precise index that its validity has been tested and assessed, so measurement of this variable would be very subtle in health and medical researches. This is a cross-sectional study and the study population is the households living in Tehran. One thousand households have been recruited in the study. For the reliability of "Internal Consistency", the questionnaire has been checked applying Chronbach's Alpha.The "Content Validity" of questionnaire has been considered and modified under the supervision of the related academic references and The "Construct Validity" has been calculated by "Factor Analysis" and "Principal Component Analysis". For determining, both Socio-Economic statuses in two and four strata scale "Summed Lickert Scale" have been applied. In order to determine Cut off Point, the overall score by using three points, 1st Quarter, Mean and 3rd Quarter, has been divided into four strata, the scores under 1st Quarter, between 1st Quarter and the Mean, between the Mean and 3rd Quarter, and above the 3rd Quarter are considered as Weak, Average, Good and Very good, respectively. Facilities and leisure times (a=0.71), Householder and his spouse characteristics (a=0.67), property owner (a=0.66), income and expenses (a=0.34) showed the highest reliability. Reliability testing shows that the variables relating to facilities and leisure times comparing other variables have more correlation together. Making different changes on the weight of each groups of variables shows that at the most suitable condition, the result of reliability of all the variables stated in the questionnaire has been a= 0.6 Correlation of those variables related to the householder education, house area, site value of the house, possessing personal car and personal computer has been more than other variables. Therefore, by applying the whole set of mentioned variables, the Index is defined briefly. A standard questionnaire has been designed by applying Reliability Analysis Method, in a way that generally each group of its questions and also different sections of it have appropriate Internal Consistency. Also by applying Principle Component Analysis Method a valid dichotomous variable based on the overall standard score has been made and each household can be placed on an upper or lower class of the Socio-Economic situation.

To determine equality in safe delivery indexes (appropriate place for delivery, kind of delivery and appropriate attendant for delivery) and their relative factors in Iran. We did this descriptive-analytic study with the use of data of DHS (demographic and health survey), which was done in Iran in 2000. Our sample was internationally representative and includes 17991 Iranian married, 10-49 years old women that had delivered during 2 years before DHS. We calculated equality status by concentration index and its 95% confidence interval and we investigated relative factors to safe delivery indexes, by logistic regression. Our factors were age, job, residency (urban or rural) and education of mother and household economic status. Concentration index (95% confidence interval) for appropriate place for delivery, kind of delivery and appropriate attendant for delivery, were 0.111 (0.107, 0.115), -0.100 (-0.105, -0.095), 0.095 (0.091, 0.099) respectively. These results showed which opportunity of delivery in appropriate place and by appropriate attendant, were more in high economic and educational levels and proportion of natural delivery were less at those levels. Also, mother's age and education and household economic status, had significant relation with safe delivery indexes and in the all cases, mother's education was the most important factor. Despite developing in delivery cares in Iran, during 2 recent decades, there is a significant difference between existing situation of safe delivery indexes in Iran and complete equality due to economic status; and socioeconomic factors have contribution in this inequality.

To assess the effect of processes of change on resistance skills against substance abuse among petrochemical workers in Assaluyeh Plant in Iran. This was an experimental study (randomized intervention trial). In all 181 workers of petrochemical company in Assaluyeh were enterd into the study (90 participants in intervention group and 91 participants in control group). Data were collected by a questionnaire that was designed and validated by the researchers based on the Trans Theoretical Model (TTM). Both groups were interviewed before the intervention, based on which the educational needs were identified. One of the diagnostic surveys showed lack of resistance skills against substance abuse that required further education. To meet this requirement a TTM based education for intervention was applied. The study showed significant improvement in most of the resistance skills among the intervention group, while both groups showed no significant differences in use of processes of change before the intervention (except for construct self revolution, that was higher in control group). The results after the intervention showed that intervention group had used all elements of processes of change (except dramatic relief). This study showed that processes of change in the TTM would lead to improved knowledge, attitude, self efficacy and self control. It also confirmed that the training materials based on the trans theoretical model can develop resistance skills against substance abuse that will ultimately result in a better health among the workers and could create a drug free workplace (safe workplace). Based on these findings the investigators recommend that all studies on health–related change behavior should continually use the behavioral theories and models.

To determine which factors affects quality of life of patients with chronic liver disease. In this cross-sectional study, HRQL of patient with chronic liver disease was measured with SF-36 and demographic questions (age, sex, marital status, educational level) and severity and duration of chronic hepatitis were added to questionnaire.140 patients HRQL scores were compared with the 100 published norms. We used SPSS15and data were analyzed by Independent sample T test &One Way ANOVA & Pearson correlation with P value less than 0.05. In general HRQL in patient with chronic liver disease was lower than normal population (physical function:48.56 29.01, physical problem:21 30.69, bodily pain:41.58 26.17, general health 51.40 20.17, vitality 50.98 25.91,emotional problem:37.56 3.40, social functioning 50.23 30.20, mental health 60.76 24.03)there was meaningful linear correlation between age, education level, sex, marital status and quality of life. We conclude that chronic liver disease substantially reduces quality of life patient's especially in physical component but severity and duration of disease had not association with quality of life. Older age, male, lower level of education, singles have poorer quality of life. Regard to the goal of treatment of chronic disease is increscent of life span and improve of their abilities for having better quality of life. In this study we measured quality of life in patients with chronic liver disease maybe this result can change quality of life in this patient.

Contribute to a better understanding of the Iranian health financing system and draw some useful clues for policy makers are the aim of the study. We interviewed a purposeful sample of 25 participants from 7 main actors in Iranian health Insurance system in late 2007. We asked about three main tasks of health financing system: revenue collection, Risk Pooling and Purchasing and used a model suggested by Guy Carrin to design the study and the framework method for the analysis. Unknown insured rate, Regressive financing and, non transparent financial flow, Fragmented system and non compulsory insurance, Nonscientific designed BP, non health oriented and expensive payment system, uncontrolled demands and defect in administrative efficiency are seven themes which explain the defects of current universal coverage in Iran. A long term systematic approach plan is required in any reform in Iran’s health financing system. The plan should aim to respond the above problems systematically.

To examine the relationship between organizational culture and the extent of Quality Improvement Model implementation in a sample of hospitals in Tehran, Iran & Shahid Beheshti Universities of Medical Sciences.

This research is a cross sectional study. The statistical population consists of the clinical staff of Rrasoul- Akram, Shahid Modarres &Tehran Heart Center hospitals in which the Quality Improvement Model (ISO 9001-2000) has been implemented. To collect the data, a questionnaire based upon the competing values model was used to assess aspect of organizational culture in selected hospitals and quality improvement implementation questionnaire adopted from Malcom Baldrige National Quality Award was used to determine the extent of implementation of quality improvement initiatives.

Research findings indicate that the score average on clan culture is 31.6 in Tehran Heart Center, 19.8 in Rasoul-Akram hospital and 21.25 in Shahid Modarres hospital from 100 score and the extent of quality improvement model (in a likert scale 1-5) is 4.33 in Tehran Heart Center Hospital, 3/54 in Rasoul-Akram Hospital and 3.56 in Shahid Modarres Hospital. In addition, based on the correlation analysis, team (clan) culture has a significant positive correlation with the extent of implementation of quality improvement model in an organization.

The finding of this research, support the hypothesized linkage between team culture and quality improvement.

The purpose of this methodological research was to translate the Hopefulness Scale for Adolescents (HSA) into Persian and study its psychometric properties in a convenience sample of 120 Iranian institutionalized adolescents. Translation and back-translation of the original English scale and content validation through Waltz and Bussel Content Validity Index were initial steps of the study. The next step was the psychometric testing of the adapted scale by establishing construct validity (factor analysis), criterion-related validity, internal consistency (Cronbach’s alpha) and stability (test-retest reliability). Content validity procedure resulted in a final scale that consisted of 24 items (like the original version). Factor analysis yielded one factor. Correlation between HSA and Cooper-Smith Self-Esteem Inventory and Sherer’s Self-Efficacy Scale were r=0.59 (P<0.001) and r=0.487 (P<0.001). Internal consistency of the scale as assessed by Cronbach’s alpha coefficient was α=0.83, and test-retest reliability with a 2-week time interval was ICC=0.60. The Persian version of HSA is a valid & reliable scale to measure hopefulness in institutionalized adolescents.

First aid education constitutes a major priority area for the Iranian Red Crescent. The present study assesses student volunteer's knowledge of first aid procedures and their attitudes concerning strategies for community education. This survey involved 5287 volunteers selected by simple random sampling in 6 different provinces of Iran. Statistical analysis, based on a complex sampling design, was performed with the Stata 8.0 software package. At the time of the study, 3736 subjects (63.8%) were members of the Red Crescent and the remaining students worked in the Freelance section. A total of 3736 students (70.6%) had attended the Red Crescent's first aid training courses. The mean knowledge score of the sample was estimated at 8.53 out of a maximum of 18 (CI0.95 = 7.36-9.46), with only 773 subjects (14.6%) showing a high level of knowledge. Only previous training showed a statistically significant relationship with the knowledge score (p=0.01). The mean score in the attitude section was 34.73 out of a maximum of 45 (CI0.95 = 33.57-37.33), and it was found to be related to previous training (p = 0.01) and higher economic status (p = 0.01). Our research showed that the Red Crescent must extend the coverage of its first aid training programs targeted at the student volunteers. An effective way to ensure an adequate level of knowledge in volunteers would be to organize regular continuing education programs adapted to the needs of different target groups.

To assess the influence of different clinical and demographic variables on the quality of life (QOL) in patients with epilepsy in Iran. Seventy six patients with epilepsy in Sina neurology clinic within 6 months were included in this study.Quality of life was measured by the Quality of Life in Epilepsy Inventory (QOLIE-31) that was standardized for Iranian epileptic patients. Using multiple regression analysis, we determined the variables were associated with QOLIE-31 overall and subscale scores. Seizure frequency, was found to be risk factor for QOLIE-31 overall and subscale scores. Seizure frequency was a strong predictor for Energy/Fatigue, Seizure Worry and Medication Effects. Age had significant association with social function score. Higher education years in patient and caregiver had an association with QOLIE-31 overall score. This study confirms that seizure frequency, the education and older age are strong predictors of QOL in patient s with epilepsy. Interventions focusing on reduce seizure frequency, and identification of factors that intervene with the patient's education is necessary for improving QOL in these patients.

This study investigates the prevalence of dental fluorosis and its relationship with level of fluoride in drinking water among children aged 12-15 years old throughout a community in center part of Iran. The study was cross-sectional and cluster random sampling and performed on 300 students (150 female and 150 male) in the Aghda and its saburb, which belongs to city of Ardakan, (one of Yazd provinces city). The study shows that the high level of waters fluoride amount for prevalence and severity of dental fluorosis over there. For instance, the rate of waters fluoride in Mazrae No village (1.57 PPM) that compare to Aghda village (0.44 PPM) show more pervalance of dental fluorosis in Mazrae No than Aghda. Considering to statistical result, there are no clear relationship between age, upper jaw and lower jaw with fluorosis. Considering the average level of fluorid in water (1.05 PPM) and averge local temperature (26.1ºC) whit the community fluorosis index (CFI) for this area (0.86), we conclude that the rate of waters fluoride in drinking water for this area is well above the W.H.O recommendation.Finally, we suggest that the rate of fluorid should be reduced in local drinking water.