فهرست مطالب

Hospital Research - Volume:7 Issue: 3, 2018
  • Volume:7 Issue: 3, 2018
  • تاریخ انتشار: 1397/06/10
  • تعداد عناوین: 8
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  • Pejman Peykani, Fatemeh Sadat Seyed Esmaeili, Mohsen Rostamy Malkhalifeh, Farhad Hosseinzadeh Lotfi Pages 1-17
    Background and Objectives

    The purpose of this paper is to suggest a novel method to measure the productivity changes of hospitals over time in the presence of linguistic variables along with fuzzy data.

    Methods

    Applying the popular and applicable approaches including data envelopment analysis (DEA), Malmquist productivity index (MPI) and possibilistic programming, the fuzzy Malmquist productivity index (FMPI) is proposed.

    Results

    In this study, the proposed fuzzy MPI is implemented for measuring productivity changes of 10 hospitals in Tehran. Notably, the input variables include the number of beds, the number of doctors, equipment & infrastructures and hospital location. Also, the output variables include the number of inpatient days, the number of outpatient, and overall patient satisfaction. According to the obtained results, the productivity of 5 hospitals has increased in 2014 in comparison to 2013.

    Conclusions

    The obtained results have shown the capability of the proposed index to calculate the changes in productivity of hospitals in the presence of ambiguity in data.

    Keywords: Hospital Productivity, Malmquist productivity index, Data Envelopment Analysis, Fuzzy mathematical programming, Fuzzy data
  • Fatemeh Semnani, Abbas Khorshidi *, Hamid Moghaddasi, Lotfollah Abbassi Sarvak Pages 18-32
    Background and objective
    Medicine is a combination of health and healingthat includes diagnosis, treatment and prevention of disease and many other aspects of health. Despite the fact that many improvements have been made in medical education, medical schools continue to face many problems in facing the community, patients, doctors And students who are not compatible with the strategies of medical education. As a result, medical schools need a model and a good tool for evaluating and ensuring the quality of the program and learning process.
    Method
    Since there is no common model for assessing the educational performance of Iranian medical schools, the present study was conducted in three areas: performance evaluation, educational evaluation and medical education evaluation. These models were studied and their positive and negative points were compared in the performance evaluation of medical schools.
    Findings
    Organizational Performance Assessment Concepts such as continuous development, stakeholder participation, innovation, and flexibility are important. While in educational evaluation models, emphasis is placed on learning process such as learning outcomes, behavioral change, training effectiveness, and return on investment. Assessment in medical education is less than other educational fields and in recent years, based on the topics of such subjects as biomedical sciences, behavioral and social sciences, decision making, communication skills, interpersonal collaboration, medical medicine and medical ethics, is done.
    Conclusion
    To evaluate the performance of medical education, one can not use a performance appraisal or evaluation model or even a medical education assessment model. Since each group of these models has positive and negative points, only a combination of these models can evaluate all aspects of the performance of medical education.
    Keywords: medical education, educational performance, medical education evaluation
  • Hassan Zamani Bajegani, Mohammad Reza Gholamian* Pages 33-48
    Background and Objectives

    In the real world, the obsolescence items are some items that lose their value over time due to the emergence of new technology. Because of rapid changes in technology, inventory management of such items is considered in recent years. Moreover, suppliers try to encourage the retailers for purchasing an item before it is outmoded with some policies such as discounts, rebates, bonus backs, and delayed payment and so on. Given the speed of medical advances in pharmaceutical industries and the successive release of new products to the market, and also the fact that delay in payment is the main marketing issue in selling the medicine products to the pharmacies in Iran, in this paper, the delay in payment policy for obsolescence items is studied and an inventory control model is developed to respond to these conditions.  

    Methods

    The model minimizes total inventory cost to achieve the optimal cycle time with respect to the constant demand rate and sudden obsolescence with exponential distribution over time. Numerical examples referring to a real case study in the pharmaceutical industry like drugstores are given to demonstrate the performance of the model in different states of delay in payment.  

    Findings

    Based on the results, according to the considered permissible payment period based on the actual market situation, the length of the optimal ordering cycle is usually smaller than that of the payment cycle. Besides, with the reduction of the expected lifetime, the inventory costs are concurrently reduced and on the other hand, the increase in the expected lifetime raises the inventory costs. Moreover, there is no exact relationship between credit time due date (i.e. payment time) and inventory cost; which shows the high sensitivity of this parameter in finding the optimal solutions.  

    Conclusions

    An inventory control model for obsolescence items in the pharmaceutical retailing industry is introduced under delay in payment policy. In the presented model, after determining the inventory cost functions regarding obsolescence, holding and delay in payment costs, which are related to the pharmaceutical supply chain, the total cost function is introduced during the lifetime of items and the optimality is checked by convexity test through the second derivative in two cases of delay in payment in the model.

    Keywords: Inventory control, delay in payment, Obsolescence, Perishable items
  • Mohammadali Beheshtinia*, Ali Mardani, Masood Kord Pages 49-61
    Background and Objectives

    One of the main concerns of hospital managers is their ability in improving their organization's performance. The use of quality management and decision-making techniques facilitates managers to achieve this goal. In this research, the corrective activities to increase the quality of hospital services are determined and selected using an integration of the QFD method with the kano analysis and knapsack problem mathematical model (KPMM). This approach is implemented in a private hospital in Iran.

    Methods

    First, the customers’ wants are identified. The corrective activities are then identified to meet these want, and the relationship between each corrective activity and each want is determined. Next, the types of the wants are identified based on the kano analysis, and their weights are determined using their degree of importance and type. Then, the final weight of each corrective activities is obtained based on the wants’ weights and the relationship matrix. Finally, KPMM is used to select the optimum list of corrective activities under budget constraint.

    Findings

    This study identifies 30 customers’ wants among them “Professional and experienced doctors and nurses" and " Healthy and sufficient consumables" obtained the highest weights. Results show that there are 2 “Attractive” customer wants, 15 “One-dimensional” customer wants and 13 “Must-be” customers’ wants. Finally, 30 corrective activities were identified which are placed at house of quality. The corrective activities "Training of physicians and nurses" and "Increasing staff sense of responsibility" obtained the highest weights.

    Conclusions

    Utilizing the kano analysis for determining the weight of customers’ wants in the house of quality approach causes the organization's strategies taken in to account in prioritizing corrective activities. Moreover, KPMM leads to an optimum selection of corrective activities.

    Keywords: Hospital, House of quality, Kano analysis, Functional expansion
  • Nasrin Taherkhani *, Roghaye Khasha Pages 62-79
    Background and Objectives
    Organ transplantation is an appropriate treatment for patients at the final stage of disease. The most important step in organ transplant is organ allocation. Decision making for organ allocation is a complex and multi-criteria problem. The demand for kidney is more than other organs. Donated kidneys in Iran are allocated by filtering the waiting list. This method is not optimal and efficient. Hence, the purpose of this study is developing a multi-media decision making model for kidney allocation based on a scoring method.
    Methods
    This study consists of two phases. The goal of the first phase is weighting the effective factors in kidney allocation. In this phase, the factors were extracted from the literature. Next, they were weighted using the Analytic Hierarchy Process (AHP) method. In the second phase, the patients on the waiting list were ranked using the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). The main contribution of this study is developing an integrated kidney allocation model using AHP and TOPSIS methods. It is the first study that consists of both factors weighting and patients ranking phases.
    Findings
    Results show that "Zero Human Leukocyte Antigen (HLA) mismatches", "High Medical Urgency", and "Identical blood type between donor and recipient" to be the three most important factors for kidney allocation, respectively. "Panel Reactive Antibodies (PRA) <80%" is the least important.
    Conclusions
    The proposed model may be used to develop an organ allocation system in countries that do not have an allocation algorithm, or intend to improve their allocation systems. On the other hand, the proposed method can be applied to other organs with little modification.
    Keywords: Organ Transplant, Kidney allocation, Multi-criteria decision making, AHP, TOPSIS, Iran
  • Bahareh Farahbakhsh, Seyed Hamed Moosavirad *, Yasaman Asadi, Alireza Amirbeigi Pages 80-97
    Background and Objective
    Hospitals and referral clinics are the most important departments to provide health care services in the health care system. Service quality evaluation is one of the most significant criteria for the performance success of the organization. The purpose of this study is to evaluate and rank the quality of service factors in a selected referral clinic.
    Methods
    A well-known referral clinic has been selected as case study in the research. The data collection tool is based on the standard SERVQUAL questionnaire, which has been customized based on the circumstances and status of the clinic. The Data were analyzed by nonparametric Wilcoxon and Friedman tests. For this purpose, SPSS23 software was applied. In this research, the quality gap was obtained from the difference between expectations and perceptions (E-P).
    Findings
    267 patients were examined in the sample. In each of the six dimensions evaluated in the SERVQUAL questionnaire, there was a significant difference between the mean expectations and the mean of the administrators. The greatest gap was the accessibility dimension (1.41) and the lowest disparity was in empathy dimension (0.86). Based on Friedman test results, patients ranked the accessibility dimension with 4.12 points as the most important dimension and the empathy with 2.90 as the least important dimension.
    Conclusion
    From the point of view of referring of the selected clinic, there is a significant gap in all dimensions of the service quality of clinic. Therefore, the expectations of the patients were not met by the clinic services. As a result, the clinic needs to improve its services in all of the studied quality dimensions.
    Keywords: Healthcare service quality, Servqual, Outpatient Clinic, Quality management
  • Ahmad Bahrami, Behnam Sobouti, Saeede Ghasemi, Mostafa Abdollahi * Pages 98-109
    Asthma and pneumonia are the common inflammatory diseases in children that have similar pulmonary symptoms such as coughing and shortness of breath. Due to the high similarity between the clinical symptoms of the diseases and the lack of appropriate paraclinical tools for the diagnosis of asthma, this study aims to consider the prevalence of asthma and pneumonia in children with acute respiratory symptoms. In this descriptive cross-sectional study, 155 children aged less than 5 years old who had been diagnosed with asthma or pneumonia in Ali Asghar Hospital were studied. A checklist was applied which contained the necessary information for the accurate diagnose of patients based on standard criteria and clinical features confirmed by a medical specialist team, including an infectious pediatrician and a pediatric asthma and allergy specialist. Eventually, the diagnosis results reported by the attending specialist’s team and the emergency physician were analyzed by SPSS software. 109 (70.3%) were males and 46 (29.7%) were females. There was a significant difference in the prevalence of asthma and pneumonia reported by the emergency physician and medical specialist team (k=0.31; p<0.001). Emergency physician reported 55 patients (35.5%) with asthma, 96 patients (61.9%) with pneumonia, and 4 patients (2.6%) with asthma and pneumonia. The medical teams reported 84 patients (54.2%) with asthma, 40 patients (25.8%) with pneumonia, and 31 patients (20%) with asthma and pneumonia. Due to the similarities in clinical symptoms of asthma and pneumonia, the reported incidence of asthma is less than the true level because of misdiagnosis with pneumonia.
    Keywords: : Asthma, Pneumonia, Pediatrics
  • Prioritize and quantifying the effect of factors affecting on the evaluation of membership medical faculty performance
    Pejman Shadpour, Rouhangiz Asadi, Mansoureh Naderi, Mohammad Mehdi Sepehri * Pages 110-124
    Background and objectives
    Evaluation and assessment of hospitals Medical faculty performance plays a vital role in improving organizational performance, patient and client satisfaction, learner satisfaction and increase of the brand in hospitals. So faculty evaluation in terms of all aspects is essential in hospitals.
    Methods
    In this study, a multi-dimensional model from different perspectives (hospital management, research department, students and faculty) is provided for evaluation of faculty in hospitals. For this purpose, the indicators influencing assessment were identified and categorized in four dimensions: education, hospital management, research and clinical. Then, to prioritize and weight factors as well as prioritize the faculty, a multi-criteria decision-making model was developed and was solved using triangular FAHP approach.
    Results
    The results indicate that timely and active presence in the clinic on patient bedside, sending patient to other medical centers, private and non-governmental, with no scientific reason, active cooperation with implementing quality improvement plans of health care in hospitals and etc. have the highest priority and factors such as active cooperation with the hospital committees, quality of theses, physical presence in the office hours and etc. received the lowest score.
    Conclusions
    he results show that all three aspects of physicians' performance are important and should be considered in their evaluation And the fuzzy hierarchical analysis method has shown this very well.
    Keywords: evaluation, Faculty of Medicine, fuzzy analytical hierarchy process (FAHP) approach, Hospital