نشریه مدیریت سلامت
پیاپی 2 (بهار 1377)

Tremendous technologic movements in recent decade have inspired a novel thinking in the need for hospital beds. This thinking is significantly reflected in the physical structure of hospitals, the ratio of building space to the bed, all area of the hospital from the viewpoint of hospitalization beds, extending the spaces related to the identification wards, outpatient operation wards and new ways in designing supporting sectors, special identification clinics and the use of outpatient operations, hospital services at home and finally the inclination towards the design of pavilion hospitals instead of present high-tech ones. However, there are trivial changes in the needs of population to the hospital beds statistically. The present study intends to answer the question of how future hospitals in 2000 will be designed, equipped and managed.

How can we reduce the hospital costs? How can we satisfy the customers? How can we improve the efficiency of hospital services? These questions do always occupy the minds of programmers and decision makers in health care organizations. They attempt to provide an appropriate answer to the above questions through designing patterns, strategies and different models. To this end, Hamedan university of medical sciences established a group entitled management committee (this committee was then renamed as quality enhancement committee) composed of some university officials and dynamic academic members having relevant specialties and tried to attain a proper pattern in order to solve the health-related problems especially in hospitals. Afterwards, this committee selected thorough quality management (TQM) model as the proper strategy for enhancing the quality and efficiency of hospitals through necessary investigations, studies and discussions with WHO experts and considering available experiences in managing hospital affairs. They applied this model as the appropriate model and strategy in accordance with the conditions prevalent in health care organizations. This article explains the affairs carried out in this committee, applying TQM model in hospitals and the results of projects done. Finally, TQM model will be applied in solving the problems via drawing a flowchart in one of the trials experienced in hospital.

Before considering facts and statistics related to the health systems, what is more important is to be aware of some holistic and principal realities. These realities are effective and applicable in health maintenance and promotion, diseases' prevention and control and service provision. Providing and keeping healthcare should be an objective for us and we must keep our eyes on health care as a human right. However, there are some contributing matters. Health has turned into a mirage and there are some restrictions to the quality and quantity of health care that can be provided. Moreover, there are some limitations in how we can measure the health, lack of health, disease, or even the causes of death. However it is very important that the main directions be determined for any decision making in order to make it possible to apply for priorities, assess the improvements and determine the shortages and deficiencies.

After the victory of Islamic revolution of Iran and nullification of contracts with foreign companies, ministry of health at that time called national specialists to contribute in the organization of designed hospital projects by national companies. This group endorsed nullifying those contracts and doing fundamental changes in their plans and programs. This group had then comprised the main core of construction industry of Iran. They could then design hospitals suitable with Iranian conditions which were named "Type hospitals". These hospitals have continuously been evaluated technically however the opinions of beneficiaries on the plan of hospitals are not assessed. The researcher intends to attain this aim.

This article is a report on the experiments carried out in Norway through the use of video conferences for the distance identification in the fields of pathology, otolaryngology, cardiology, and radiology. Distance medicine has passed trials and is going to transform into a medical practice.

How can we draw the attention of hospital staff to the improvement of quality of special care services to moribund patients? When a moribund patient encounters a problem, physicians and other staff in health centers who have passed training periods professionally, are called to save the patients. These individuals try their best and collect all their faculties and take the advantage of all available recourses and facilities orderly and artistically. However it is not easy for patients to accept their death. Moribund patients almost suffer from controllable pains such as anxiety, depression and suicide inclination.