quality improvement

Value stream mapping (VSM) is one of the most important and widely used tools for lean thinking to identify non-value adding activities and improve the service delivery process. The aim of this study was to design a value stream map to improve the sonography service process in a military hospital..

Methods :

Value stream mapping (VSM) is one of the most important and widely used tools for lean thinking to identify non-value adding activities and improve the service delivery process. The aim of this study was to design a value stream map to improve the sonography service process in a military hospital.

The results showed that on average, the waiting time for sonography was 42.6 minutes and the main service cycle time was 30.6 minutes. On average, the total time for each sonography procedure was 73.3 minutes. The most frequently waste in the sonography process was related to “correction waste”, such as unclear sonography orders, incomplete registration of sonography orders, and mistakes in specifying the type and organ of sonography by the referring physician. Finally, the possibility of sending a prescription for appointment scheduling and receiving responses through social networks (such as WhatsApp, etc.), precise scheduling and appointment booking, and training clinic physicians for prescription and strengthening information technology infrastructure were introduced as some of the main solutions..

cause of time wastage, and most of the patient's attendance time is spent waiting. Therefore, it is necessary to reduce patients’ waiting time with management measures such as queue management and appointment scheduling systems as well as the use of new technologies.

 Hospitals are the most important elements of the care and treatment system. They attract a large part of financial, human, and capital resources, and are at the forefront of public health. Hospitals and medical centers are sectors that have shown rapid growth in the economy in recent decades, and this growth is higher in developing countries than in other countries because health services follow the global trend of moving from the public to the private sector. The main mission of hospitals is to provide high-quality care for patients and fulfill their needs and expectations. The hospitals must provide appropriate and high-quality services to meet the patients' needs. To his end, attention has been paid to the service quality at hospitals under the law and it is the main duty of the Ministry of Health and Medical Education. The provision of health services for the general public is an important criterion for social development and perhaps emergency care is the most important pillar of medical care at universities of medical sciences. The emergency department has a sensitive and exceptional position in the hospitals and the health care system of any country due to the need to perform fast, high-quality, and effective various and complex processes. The emergency department of hospitals is significantly important due to the reception of the largest, most diverse, most affected, and most sensitive group of patients. Patients, who visit this department, are in critical conditions in terms of physical condition, and taking care of them as soon as possible and with the highest quality is a duty of the medical and nursing staff who work in this department. In terms of structure, this department should be properly organized and the service delivery processes of this department should be regularly considered and reviewed so that applying efficient management can cause a proper performance in improving service capacity or providing desirable services for patients in need. It should be noted that measuring the quality of health services from the patients' perspective has become increasingly important in recent years because it is the patients' right to comment on the services they receive. Therefore, service quality is defined as the customer's demand, perceptions, and expectations as the main determinants of quality. The more appropriate, correct, and faster these services are, the more the public trust in the health system will increase. In this regard, obtaining customer feedback is a basic step to provide and improve quality and its review and prioritization can improve service and optimization methods in treatment.
The emergency department of medical sciences hospitals is an essential and crucial component in the treatment of emergency patients so that the health care systems usually first face emergency patients. One of these important and sensitive departments of hospitals is the emergency department. In this research, by examining the research background, the key indicators of improving the quality of services in hospitals and emergency departments have been studied, and then using fuzzy TOPSIS method, we have prioritized them and then proposed optimal methods in this field.

 The method used in this research is descriptive survey and practical in terms of purpose, the statistical population of this research included the emergency rooms of 16 selected hospitals in Hamadan province which have been a case study. The purpose of this research was to investigate the factors for improving medical services in the emergency department, which includes a combined approach and a network analysis process approach for prioritizing SERVQUAL and FUZZY TOPSIS criteria for prioritizing effective factors.
 This is a descriptive survey study and applied in terms of purpose. The statistical population including 400 patients who referred to 16 selected emergency departments in Hamadan hospitals were selected by random sampling method. The required data were collected using a researcher-made pairwise comparison questionnaire and analyzed using one of the most well-known multi-criteria decision-making methods, namely the fuzzy TOPSIS method In this model, closed answer questions were used in the preparation of the researcher-made questionnaire of the network analysis process. For this purpose, nine options of "same importance", "slightly more important", "more important", "very important" and "definitely more important" were used to evaluate the criteria affecting the quality of services in the emergency department. In the researcher-made questionnaire related to TOPSIS, closed-ended questions of very poor, poor, average, good and very good were used, so that the respondent can easily determine the degree of fulfillment of the desired sub-criterion after reading the relevant explanations. In this research, the Analytic Network Process method was used to determine the weight of the criteria and indicators of the model. First, the main criteria are prioritized based on the goal. Then, the internal relationships between the main criteria have been identified. Each of the sub-criteria has been compared and prioritized in its respective cluster. Finally, by calculating the initial super matrix the weighted super matrix and the limit super matrix, the final priority of the indicators have been determined.

 According to the above table, the criterion of reliability with a weight of 0.205 is the most important effective factor in the process of quality of medical care in the special care department, after that the criterion of responsiveness with a weight of 0.0199 among the effective criteria of service quality in It has dedicated the special care department. Professionalism, with a weight of 0.139, has won the last rank among the criteria related to the quality of medical services. Among the sub-criteria, behavior has been assigned the first rank among them, and the mental image sub-criterion was ranked second, and the timing sub-criterion was ranked third, and the security sub-criterion was ranked among the 19 sub-criteria. It was placed last.
TOPSIS method was used to prioritize the factors obtained from Delphi technique. In this question, the main indicator was the improvement of service ability, which had 6 factors affecting it. Decision matrix for lack of personnel (0.12), delay in transfer of patients (0.19), lack of drugs and equipment (0.13), weakness in the decision-making system (0.16), delay in paraclinical measures (0.9) 0) and inappropriate space (0.08) was obtained. Then the normalized matrix was formed and after that the balanced matrix was formed. Weighted matrix for the factors of lack of personnel (0.35), delay in transfer of patients (0.35), lack of medicine and equipment (0.24), weakness in the decision-making system (0.29), delay in paraclinical measures (16. 0) and inappropriate space (0.15) were obtained. Then the positive and negative ideals were formed, and the positive ideal was 0.35 and the negative ideal was 0.15. Based on this, the positive and negative ideal distances were determined. Finally, the factors were ranked. Based on this, lack of personnel, delay in transferring patients, weakness in decision-making speed, lack of medicine and equipment, delay in paraclinical procedures and inappropriate space have an effect on the ability to serve, respectively.

 This study was conducted with the aim of investigating the factors affecting the improvement of service quality in the emergency department and providing solutions for its optimization. The results showed that the criteria of reliability, responsiveness and professionalism are three important factors in improving service quality. According to the obtained results, the criterion of reliability with a weight of 0.205 is the most important effective factor in the process of quality of medical service in the emergency department, followed by the criterion of responsiveness with a weight of 0.0199 among the effective criteria of service quality in the emergency department. has assigned Professionalism, with a weight of 0.139, has won the last rank among the criteria related to the quality of medical services. Among the sub-criteria, the way of behavior has been assigned the first rank among them, and the mental image sub-criterion was ranked second, and the time sub-criterion was ranked third.
According to the results obtained from the scoring of the optimization methods, and determining the information registration system, the specialization of the nurses' performance and the implementation of the guidelines for the maintenance and transfer of patients hospitalized in the emergency department were known as the most optimal methods. Therefore, the framework presented in this research can be used as a criterion to evaluate the performance and improve the quality of services in the emergency department of hospitals.

Given the importance of the emergency department in providing prompt and high-quality services, the emphasis on lean management has increased to minimize non-value-added and wasteful activities within a process. The aim of the study was to determine the process of patient flow and identify opportunities for its improvement using the Six Sigma method as one of the most important subsystems of lean management, in the emergency department of the selected teaching hospital in Kerman.

Methods & Materials: 

The current research is a sequential mixed-method study conducted in 2022 within the cardiovascular and neurological emergency department in Kerman. The Six Sigma method, specifically the DMAIC approach consisting of four steps, was employed in conjunction with spaghetti charts to implement lean management principles. The research population included 180 patients referred to the cardiovascular and neurological emergency department. The data were collected using researcher-developed forms, and Excel software version 2013 was used to analyze the data.

By examining the processes and using the spaghetti chart, the main problems contributing to prolonged patient admission time in the cardiology and neurology emergency department were identified. The implementation of a strategy involving the presence of admission staff during triage for level 1 to 3 patients will eliminate the additional distance and time required for patient admission.

The use of lean thinking principles in the emergency department with the implementation of Lean Six Sigma and Spaghetti Chart by streamlining the service process, will result in improving patient flow, providing timely quality services, reducing service delivery time, and ultimately increasing patient satisfaction.

Considering the important role of doctors in the implementation of accreditation standards and the necessity of their involvement in this process, this study was conducted in order to identify the views of doctors regarding the challenges of participating in accreditation programs in social security hospitals in Mashhad.

This study is a cross-sectional descriptive-analytical research that was conducted in two hospitals of the Social Security Organization of Mashhad, Iran. in 2022. The participants were 56 full-time working doctors with at least one year of work experience in the hospital. Data analysis was done using SPSS version 26 software.

Among the challenges of doctors' participation in accreditation programs , the dimensions of the motivational mechanism (3.96±0.63) , provision of suitable resources for the implementation of accreditation (3.83±0.78), physician empowerment programs (3.78±0.73) and the role of the quality improvement office in attracting doctors' participation (3.75±0.74) were more important from the doctors' point of view, and  patients' demands (2.90±0.75) and role ambiguity 2.77±0.96), were less important in their opinion.

Managers should consider that employee motivation and resource allocation are necessary for the effective implementation of the accreditation standard. Empowering doctors in the implementation of accreditation standards as well as the participation of quality improvement offices to interact with doctors and attract their participation are very important factors.

Considering the benefits that a welcoming environment can have for the patients and their families, and specifically for people with mental disorders, this study aims to launch a welcoming program in the Iran psychiatric Hospital and assess its effectiveness in improving the quality of and satisfaction with the services for patients with mental disorders.

The welcoming unit of the hospital was officially launched and began to operate since September 2017. In the welcoming program, the nurse first introduced herself to the patients and their families, and if needed, made them familiar with the hospital and its goals and environment, how to reach psychiatrists, and regulations during hospitalization. This program continued by acquainting patients with their rights, the hospital's rules, treatment team, welfare amenities, inpatient wards, electroconvulsive therapy unit, clinics, support center, and by handling complaints and criticisms. For internal evaluation, a survey form with 5 open-ended questions was designed without including demographic characteristics and distributed among the hospital departments. The responses were collected and analyzed using the content analysis method.

The results of internal evaluation showed that 92% of the patients and their families were satisfied with the welcoming program and perceived it as very good and excellent. Half of the patients and their families (50%) believed that some nurses were caring and some were careless and did not take care of problems well. They perceived that psychiatrists and psychologists did not spend much time with the patient, and their visits were done very late.

Based on the perceptions of the patients and their families about the welcoming program, it seems that they are satisfied with the program in overall. The result can motivate other psychiatric and non-psychiatric centers in Iran for the implementation of a welcoming program.