فصلنامه پژوهش های سلامت محور
سال چهارم شماره 3 (پیاپی 14، پاییز 1397)

The analysis of costs and incomes is an important tool for planning, controlling, monitoring and evaluating hospitals to reduce abnormal costs. The purpose of this study was to analyze the profit margins of operating units in a selected educational hospital. This descriptive cross-sectional study was carried out in a selected educational hospital affiliated to Iran University of Medical Sciences, Tehran, Iran in 2019. Cost information was collected through a researcher-made checklist. At first, direct costs were calculated separately from cost centers and then absorbed into operational units by the absorption method. The income of operating units was extracted by studying the files of 65,817 outpatient cases and hospitalized patients in the study year and finally, the operating margin of the units was calculated. Calculations were done through Excel 2017 software. Direct and indirect costs accounted for 66% and 34% of the total operating costs of operational units. Total revenue from providing services in the studied units was 1674074 $ and the cost of these units was estimated about 3488888 $. Other than the sub-specialty units of Gynecology and Pediatrics, Reconstructive Surgery Which had operating margins of 39% and 36% respectively, the rest of hospital units had significant operational losses.  Improving the processes of supplying the required facilities and services, paying attention to the human resources management and labor force and increasing the quantity and quality of services seem to be necessary.

An effective health system can only fulfill its mission, which is providing community health, through providing desirable services; this is possible through the services of health centers. The aim of this study was to find the satisfaction rate of people referred to urban health centers of Bam/ Iran. This descriptive-analytic study was conducted on 447 clients referred to Bam urban health centers from May 2015 to June 2016 for receiving outpatient services. Data collection tool was a 26-item questionnaire for the satisfaction of clients of urban health centers. Data were analyzed through SPSS20 and using t-test and Kruskal-Wallis statistical tests. The majority of the study subjects were female, had a university degree, with more than 2 visits. In all aspects, the subjects expressed a high degree of satisfaction. The satisfaction rate showed significant relationship with the variables of education, number of visits, the reason for referral, occupation, but not with age.  Overall, the performance of the centers seems to have been successful and by upgrading some of the processes, they can get a higher level of satisfaction. Also, given the principle of continuous improvement, it is necessary to plan appropriately to maintain and improve the existing conditions.

Medication is the most commonly used therapeutic product in health care centers.The correct administration of medication orders is an important part of the treatment and care process, which is the major part of responsibility of nurses and medical staff. The occurrence of medication errors can cause serious health problems and threaten the safety of patients. This study was done to investigate the factors associated with nurses' medication errors and their refusal to error reporting in points of views of nurses. The present study was a descriptive-analytic study that was done cross-sectionally using error reports sent to the accreditation unit of a specialty cardiac hospital in Tehran during 2012-2018. Moreover, 102 nurses selected through randomized multistage sampling method were asked to complete a questionnaire. Mann-Whitney and Kruskal-Wallis statistical tests were used for data analysis. According to the nurses’ point of views, the most important barriers of error reporting were respectively crowded wards (29.6%) and fear of punishment (27.7%) and causes of medication errors were respectively high fatigue due to the nurses’ overworking (40.2%), high workload and shortage of nurses in comparison to the number of patients (38.2%). Use of an appropriate training program to estabilish the culture of paying attention to the patients’ safety as well as empowering the medical staff in this regard can be effective in reducing medication errors rate.

Oral and dental disorders have a significant role in the development of diseases such as respiratory and cardiovascular diseases and diabetes. So prevention of oral and dental problems should be one of the most important health system priorities. On the other hand, the fair distribution of dentists for a full coverage of the whole country is not suitable. In this study, the distribution of dentists and their density in Fars province were investigated. In this descriptive study, population statistics of Fars Province,  as well as the number of active dentists in the public sector in each county in 2015 And 2016 were obtained from the Iranian Statistics Center and the Deputy of Health of Fars province. Finally, using the Gini and Robin Hood indices, the distribution of dentists was studied. Gini index for dentists in 2015 and 2016 was calculated as 0.32 and 0.27, respectively, and 503 and 485 dentists had to be redistributed in order to achieve a complete equality. Accordingly, the number of dentists in the city of Shiraz should be reduced in order to be redistributed in other cities.  Health care policy makers should distribute dentists in different parts of the country according to their needs and based on the extent of deprivation of the areas, the success rate of past interventions in maintaining human resources, and the increasing or decreasing trend of the Decay-missing-filled teeth index in recent years.

Calculation of hospital services costs, especially the allocated costs, is a complicated process due to the great number of hospital services, as well as the interdependence between different centers. Considering the interrelationships between all departments in the hospital, cost analysis is possible only through the mutul sharing approach, which can provide more accurate information for researchers and managers in order to decide on a costs analysis. The present study was a descriptive study that was conducted in 2017 in a selected educational hospital affiliated to Iran University of Medical Sciences. Data collection was done through observation, interview and investigating financial documents.  After identifying the active centers and the appropriate cost drivers, the cost of important services in final sectors was calculated by using two methods of one-way sharing and mutual sharing through simultaneous equations. In comparison of one-way and mutaul sharing approach, all overhead, intermediate and total costs showed deviation. The greatest deviation between these two approaches was found in the parturition and ophthalmology departments and related to the cesarean with 16 million rials and the lacrimal duct cathetering with 13 million rials, respectively.  The findings of this study showed that if hospitals managers calculate their services costs by activity-based cost and through mutual cost sharing approach, they can benefit from the correct costreportings and by having a clear image can make management decisions appropriately.

Providing suitable urban spaces, especially open and natural spaces has an undeniable effect on reaching health-based cities and especially providing mental health for the elderly. To this end, the present study was conducted with the aim of assessing these spaces in Mashhad. This descriptive-analytic cross- sectional study was conducted on 480 elderly citizens selected through random stratified sampling from 13 districts of Mashhad/ Iran in summer 2018. Data collection tools included Goldberg’s General Health Questionnaire and a researcher-made questionnaire for functions of parks. Data analysis was done through SPSS 2019 software and using one-way analysis of variance, t- test as well as Pearson correlation test.  Mental health of subjects showed significant statistical relationship with functions of empowerment, preventing stress and anxiety, and air supply for parks and also with variables of ethnicity, employment status, marital status, income, and education. However, mental health of subjects did not show significant relationship with the functions of providing value and entertainment in parks as well as their age, insurance coverage, gender, place of birth, and the number of children.  Regarding the undeniable role of parks in mental and physical health of the elderly, policymakers in the health sector and urban planning should consider the specific needs of this group in designing these spaces, including the removal of up and downs of the paths and the design of special spaces for doing light exercises, fences alongside sloping paths and meeting places for discussion outside of traffic routes.

Medical Tourism is one form of health services export that has attracted much attention. This industry has positive outcomes, including increased health services exports, increased foreign exchange earnings, brain drain prevention, increased employment of health workers, and reduced outflow of patients from the country. The purpose of this study was to investigate the readiness of single-specialty hospitals affiliated to Isfahan University of Medical Sciences to attract medical tourists. This is a descriptive cross-sectional study that was conducted in two single-specialty hospitals affiliated to Isfahan University of Medical Sciences in 2017. Data were collected using a checklist developed by the Ministry of Health. This checklist consisted a total of 80 questions and 5 dimensions such as human resources, hoteling, process, general conditions, and information and communication technology. Data were imported into Excel 2013 software. Both hospitals were unacceptable in terms of compliance with the Ministry of Health standards. In terms of human resources and information and communication technology, both hospitals were at an unacceptable level. In terms of hoteling indicator and general conditions, both hospitals were moderate, and in terms of process indicators, one hospital was at medium level and another was at unacceptable level. Compliance with national standards developed by the Ministry of Health, and planning to provide resources for hospitals authorities seeking to enter the medical tourism industry seem essential.

It is necessary to utilize hospital scare resources to meet patients’ unlimited needs. Hospital managers should pay more attention to efficiency. This study aimed to examine the impact of strategic planning on hospital efficiency in 2012-2014. A participatory action research was used in this study. The hospital strategic plan was formulated and implemented. There was a goal and objectives for increasing hospital productivity and efficiency in the strategic plan. Hospital efficiency was measured before and after implementing the strategic plan using bed occupancy (BO), patients’ average length of stay (LOS) in the hospital, bed turnover (BT) and bed turnover interval (BTI) indicators. Data was analyzed using the SPSS software. The hospital BO and BT rates were increased by 16.7% and 25% respectively in 2014 compared to 2011. The average LOS and BTI rates swere reduced by 7.5% and 57% respectively during the same period. The case hospital’s BO and BT rates were respectively 3.2% and 79.8% higher than the average of all Iranian general hospitals’ BO and BT rates. Patient LOS and hospital BTI rate in the case hospital were 57% and 54% lower than the average of these indicators among the country’s general hospitals. Developing an appropriate strategic plan and implementing it properly help to improve hospital efficiency. Adopting and adapting industrial management theories and models could enhance hospitals’ performance. Hospital managers should be trained properly in strategic planning formulation and implementation.