فهرست مطالب

Hospital Research - Volume:6 Issue: 4, 2017
  • Volume:6 Issue: 4, 2017
  • تاریخ انتشار: 1396/10/09
  • تعداد عناوین: 8
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  • Maryam Tohidifard, Reza Yazdanparast *, Ali Bozorgi, Amiri, Ali Azadeh Pages 1-20
    Background and Objectives
    Emergency departments often encounter several risk and health issues which significantly impact on overall healthcare performance. Resilience engineering (RE) enables emergency departments to confront sudden changes and handling health risk issues. Patient trust (PT) is also one of the most effective factors which improve quality of care along with patient satisfaction.
    Methods
    This study integrates resilience engineering and trust to enhance the overall performance of emergency departments (EDs). A unique algorithm is introduced to demonstrate the superiority of the proposed integrated approach. It is composed of Z-number data envelopment analysis (DEA), fuzzy DEA, and statistical analysis. The required data are collected using standard questionnaires from a real-life emergency department. The obtained results are verified and validated by FDEA.
    Findings
    The results indicate that considering RE and trust increases ED efficiency significantly. Also, flexibility, fault-tolerance, reporting culture, and specialty level are the most effective factors. Moreover, trust and resiliency have similar statistical impacts on overall system efficiency.
    Conclusions
    One of the concerns of medical service providers nowadays is to build an efficient ED capable of providing services to a large number of patients. Therefore, to evaluate the performance of the ED, both concepts of PT and RE which are applicable to enhance the preventive safety and promote the performance, are simultaneously considered for the first time in this study.
    Keywords: Emergency department, Resilience engineering, Patient trust, Z-Number data envelopment analysis (ZDEA), statistical analysis
  • Afsoon Aeenparast, Faranak Farzadi, Farzaneh Maftoon *, Seyad Hosein Yahyazadeh Pages 21-31
    Background
    Appointment scheduling system is a critical component in controlling patients’ waiting time, so can increase the efficiency and timely access to health services. It is also an important determinant of patient satisfaction. The aim of this study was to assess the relationship of using a scheduling system and outpatients’ waiting time in a general teaching hospital in Tehran, Iran.
    Methods
    This was a descriptive-analytical study performed cross-sectionally among outpatients referred to clinics of a non-teaching general hospital in Tehran in 2013. 3836 samples were selected from different stations. The sampling method was stratified randomized. Data were gathered by check lists. SPSS statistical software v.24 was used for data analysis. In addition to descriptive measures, Mann-Whitney non-parametric test and Pearson correlation test were used for data analysis.
    Results
    The mean waiting time at admission was estimated 6.6 minutes. Analysing the waiting time of patients in admission indicated that walk-in patients wait more than scheduled patients for admission (P<0.001).
    Mean waiting time for physician visit was 75.7 minutes. Analysing the differences of waiting time of scheduled and walk- in patients for visit show their waiting time were not different (P= 0.206).
    Conclusion
    The studied appointment system was successfull in controlling patient arrival but failed to control waiting time for physicians visit. It seems that considering physician arrival schedules will be helpful for designing appointment system and reducing outpatients’ waiting time.
    Keywords: Outpatient, Appointment system, scheduling, Waiting time, Non-teaching hospital
  • Parvin Ebrahimi, Shahram Heydari, Aidin Arian Khesal, Kimia Zargari, Mohanna Rajabi * Pages 32-48
    Background and Objectives
    Considering the importance of the radiology department, which devours most of the financial resources, efficiency and effectiveness in this department is one of the main concern of policymakers in most health care systems. The aim of this study was to investigate the efficiency and effectiveness of a radiology department before and after the implementation of the digital system.
    Methods
    This was a descriptive analytical study. The research population included the staff and radiology departments of the eight hospitals affiliated with Social Security Organization in Tehran, Iran. In this study 80 staffs were surveyed and the census sampling was used. Data, from six months ago (July-December) and the same six months after the implementation of the digital radiology system in 2014-2015, were collected using two tools including a data collection form to evaluate the efficiency and a researcher-made questionnaire to investigate effectiveness. The collected data were analyzed using descriptive statistics, Wilcoxon nonparametric test, and single sample t-test, using SPSS software version 20.
    Results
    There was no significant difference between the ratio of patients to personnel, the ratio of patients to radiology apparatus, the ratio of images to personnel, and the ratio of images to radiology apparatus before and after the digital system implementation (P>0.05). The analysis of the data collected through the questionnaire showed an increase in the effectiveness of radiology department after the implementation of the digital system  in this hospitals (P<0.05).
    Conclusion
    The implementation of the digital system can help relevant authorities to make the right decisions and optimal allocation of resources in order to increase the satisfaction of the staff and patients, save costs and time, strengthen knowledge sharing and provide remote services in radiology departments
    Keywords: Efficiency, Effectiveness, Digital system, social security organization, Radiology Department
  • Rouhangiz Asadi *, Pejman Shadpour Pages 49-62
    Background and Objectives

    Outsourcing has been considered by hospital managers as a model to reduce the financial burden and modify the financial system. The external suppliers must be qualified for the services they ought to provide to the hospitals. The use of the Balance Scorecard and the Analysis of Hierarchical Process can help assessing suppliers' capability to solve existing problems in the field.

    Methods

    This qualitative study was carried out from January to March 2018 in one of the teaching hospital in Tehran city, Iran. The following steps were taken for designing the intended model. First, the Balanced Scorecard (BSC) aspects were adapted to the concept of the health supply chain using the Focus Group method with 10 hospital experts and suppliers. The criteria determined based on the previous studies, strategic objectives of the hospital and the opinions of 5 hospital experts through Delphi method. Then, the identified criteria were classified in four aspects of the BSC. Finally, the hierarchical model was presented in the form of an evaluation balanced scorecard.

    Results

    The results of the study led to identification of 19 criteria in four aspects of the BSC. In financial section, 5 criteria were identified for internal processes and innovation aspects, and 4 criteria for customers’ aspect. In the next step, a four-level hierarchical model was designed for evaluating performance of the supplier. The first level was evaluation of supplier, the second level contained the BSC aspects, the third level was the determined criteria and, finally, the fourth level encompassed the suppliers’ affaires.

    Conclusion

    The combination of the supply chain concept and the BSC offers useful and effective criteria for evaluation of suppliers. A hierarchical model is an appropriate tool for evaluating suppliers.

    Keywords: Supplier, evaluation, Supply chain, balanced scorecard (BSC), Outsourcing, Hospital service
  • Seyed Ehsan Samaei *, Shahram Vosoughi, Ebrahim Taban, Majid Bagheri Hossein Abadi, Ghasem Zia, Mohammad Hossein Beheshti Pages 63-75
    Background and objectives
    Nurses due to the nature of their job faced with significant mental workload. This can cause nursing occupational accidents. The aim of this study was to explore the effects of mental workload on occupational accidents in teaching hospital nurses.
    Methods
    This cross-sectional descriptive-analytic study was conducted from May to December 2017 in three teaching hospitals in Kerman (Iran). A total of 350 nurses were selected by random sampling method. Data were gathered by Nursing Occupational Accidents Questionnaire and NASA-TLX Index, and analysed by independent T-test, one-way analysis of variance (ANOVA) and Logistic Regression using SPSS v.18.
    Results
     In the research mental demand and frustration dimensions had the highest and lowest mean among NASA-TLX Index, respectively. Traumatic low back pain when changing the position or displacement of patients (64%), and Skin contact with blood or other body fluids (62%) were the most common accidents that were most frequent in nurses. Also there was a significant statistical relationship between overall workload and occupational investigated accidents.
    Conclusion
     The high workload is a characteristic of nursing job. Therefore, hospital managers should avoid excessive work pressure by identifying various causes of mental workload factors in their hospital environment and take an important step in controlling this type of accident
    Keywords: Nurses, Occupational accident, Mental Workload, Hospital, inpatient Department, Patient
  • Evaluation of Critical Thinking Disposition among College Students: A Study among Healthcare Management Students
    Roohollah Askari, Zahra Hatamizadeh, Fatemeh Sepaseh, Razieh Montazerolfaraj, Farimah Shamsi, Sima Rafiei Pages 76-90
    Background
    Today, most experts believe that critical thinking skill and dispositions among learners provide them opportunities for better understanding and evaluating new knowledge. Therefore most educational programs put an effort to develop such potentiality among students. Our study aimed to evaluate critical thinking disposition among healthcare management students of Shahid Sadoughi University of Medical Sciences in 2016.
    Methods
    This was a descriptive-analytical study which has been done in a cross-sectional form among healthcare management students of both BSc and MSc degree in Shahid Sadoughi University of Medical Sciences in 2016. To collect data, a standard questionnaire entitled “California Critical Thinking Disposition Inventory (CCTID) was used. Gathered data were analyzed by SPSS version 20 through the use of descriptive and analytical statistical tests including Pearson correlation coefficient, t-test and ANOVA.
    Results
    80% of the students were female and 56.6% were upper than twenty years old. Significant statistical relationship was confirmed between gender and truth seeking also between educational degree and systematicity (P<0.05). Furthermore a direct significant correlation was seen between critical thinking disposition and its seven dimensions (P=0.00). In addition, those MSc students who were studying in the first semester, had the highest level of systematicity (P=0.04).
    Conclusion
    Given the importance of critical thinking skill and the fact that such ability can help healthcare managers get success in the workplace, officials of educational deputies at the level of the health ministry and its affiliated medical universities should emphasize on the establishment and continuity of training courses regarding such an important skill among students. Furthermore student should be encouraged to apply what they have learned to promote their managerial skills.
    Keywords: Critical thinking disposition, university student, Health care management, Master Degree, bachelor degree
  • Mustafa Jahangoshai Rezaee *, Hadi Mahmoudzadeh, Maghsud Solimanpur, Samuel Yousefi Pages 91-112
    Background and objective
    The location of facilities is of great importance in healthcare and is of interest to researchers due to its importance. In this regard, a large proportion of classic location-allocation models concentrate on solving problems in an exclusive environment (non-competitive), but this assumption is rarely true in reality.
    Methods
    At first, a basic Non-Competitive Location Model (NCLM) is presented. Then, a Competitive Location Model (CLM) is developed based on the initial model. This study proposes a multi-objective integer programming model based on Nash bargaining game. The first objective function maximizes the two-person Nash product, which in turn maximizes the total number of patients covered by the newly established healthcare centers. The second objective function minimizes the sum of distances between population centers and the newly established healthcare centers.
    Findings
    The results obtained from applying the CLM on Tehran’s Health Centers revealed the abilities of this model in simulating the competitive situations. For instance, by comparing the results obtained from both models (non-competitive and competitive) it was clear that the total covered population was considerably increased in the CLM.
    Conclusions
    The proposed location model can be used as a basis for decision making by managers. Because of any wrong decision, in addition to raising the costs of the health system, can also lead to irreparable damage to human and social health.
    Keywords: Health centers location-allocation, Bargaining game, Multi-objective Programming, Competitive environment, Healthcare in metropolis
  • Assessment of factors affecting pregnant women’s satisfaction during natural and cesarean childbirth in a teaching hospital
    Mehrasa Pourfalah *, Sanaz Litkouhi, Ahmad Ekhlasi Pages 113-121
    Background and objectives
    Reduction in cesarean birth rates in Iran require certain conditions and necessities for realization. A fundamental aspect is the optimization and reinforcement of the physical structure, as well as the effect of psychological factors and the country’s maternity hospitals which are affecting pregnant women’s satisfaction during natural and cesarean childbirth.
    Methods
    This descriptive analytical study was carried out on 47 mothers with natural childbirth and 58 mothers with cesarean childbirth in three teaching hospitals in Iran between 2016 and 2017.  A standard questionnaire containing 16 main dimensions. Two of them; "Presence of the husband during childbirth" and "Privacy against strangers" which were related to Psychological dimension and total of 44 questions were applied. Chi-Square, sample t-test, and Friedman test were applied for data analysis. All data were analyzed with using SPSS software version 20.
    Results
    The presence of husband during childbirth (13.33%), the existence of window and view to exteriors (10.99%), and use of nature (10.95%) ranked the most important items for improvement of satisfaction of mothers at maternity ward while privacy against strangers (5.74%) was the less important parameter.
    Conclusions
    By confirming the results of previous research on better management of the delivery process; "in the presence of husband", "well-designed physical environment for the presence of husbands in the maternity ward"," privacy for mothers and companions", "Separate spaces for childbirth separately for each couple ) LDR, LDRP room)" and "husband training or using a midwife for better communication between mothers and healthcare staffs" can improve mothers satisfaction and their husbands and help to Achieve higher efficiency
    Keywords: Maternity Ward, Teaching Hospitals, Cesarean Childbirth, Natural Childbirth, Women’s satisfaction