فهرست مطالب

Hospital Research - Volume:2 Issue: 1, 2013
  • Volume:2 Issue: 1, 2013
  • تاریخ انتشار: 1392/05/10
  • تعداد عناوین: 8
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  • Reza Dehnavieh, Hossein Ebrahimipour, Mojtaba Jafari Zadeh, Mojtaba Dianat, Somayeh Noori Hekmat, Mohammad Hossain Mehrolhassani Page 1
    Background And Objectives
    The Iranian Ministry of Health and Medical Education has introduced clinical governanceas the accepted model of hospital healthcare improvement. Subsequently, a growing movement forimplementing clinical governance in health facilities has emerged. This study aimed to explore the opinions of therelevant experts and executives to provide insight into current challenges, barriers and inadequacies in implementationof clinical governance in Iranian health settings.
    Methods
    A qualitative approach was adopted. A purposeful sample of 17 participants was interviewed in thespring of 2012. The study sample was selected from among clinical governance executives of teaching hospitalsaffiliated with Kerman University of Medical Sciences and the academicians involved in administration of the clinical governance. The Framework method was adopted for data analysis.
    Findings
    Seven themes explain challenges of implementing clinical governance, including human resources,management, communication, training, culture, resources, and monitoring and regulations.Adequate quality human resources, particularly experts in clinical governance should be dedicated.Leadership commitment to support implementation of clinical governance should be improved. Administratorsneed to get more familiarized with the concept and requirements of clinical governance. High ranking authoritiesshould avoid rapid turnover of management teams.Adequate communication regarding of clinical governance is needed to be established among different deputies of theMinistry of Health and Medical Education. Hospitals must be encouraged to share their experiences in clinical governance.Training programs should be based on needs assessment, have definite goals, and focus more on practical aspectsof clinical governance.The felt need for change must be promoted among hospitals’ administrations and staff. Teamwork between staffmust be promoted. Expectation for rapid achievements and early frustration in time taking reforms must be addressedby appropriate training.Appropriate infrastructure and mechanisms for reporting, interpretation, and analysis of quality indicator datashould be developed. Adequate financial and physical resources should be appropriated.Efficient monitoring and assessment systems must be implemented. Progress in implementation of clinical governanceshould be appropriately supervised and evaluated. Constant feedback on staff performance and outcomesof interventions should be provided.Adequate supportive laws and regulations, legally guaranteeing implementation of clinical governance shouldbe developed.
    Conclusions
    Considering inter-relation of the identified themes and subthemes, our study recommends that a systemsapproach should be adopted for successful implementation of clinical governance. While fundamental solutionsto the identified challenges require long-term reforms in the health system, some obstacles such as inadequate leadershipsupport, rapid rotation of managers, lack of financial and physical resources, inefficient monitoring system, andinefficient training programs may be addressed in a relatively short run.
    Keywords: Clinical Governance, Quality Improvement, Hospital, Health Care
  • Hossein Jabbari, Fariba Heidari, Vahideh Ghorbani, Fariba Bakhshian Page 11
    Background And Objectives
    Violence toward healthcare workers has emerged as an important health problem.This type of violence has the potential to severely influence healthcare workers, patients, and the community. Thisstudy aimed to explore the prevalence of violence in emergency departments, and to identify associated risk factorsusing a sample of emergency department healthcare workers in Iran.
    Methods
    This cross-sectional study was conducted in emergency departments of five referral hospitals in Tabriz,the center of an Iranian north-western province. A questionnaire validated by experts was used to collectdemographic and violence-related data. The data were summarized using descriptive statistical methods. Logisticregression analysis was used to identify the potential violence risk factors.
    Findings
    The majority of participants (84.5%) expressed experiencing at least one violent event within thepast three months of conducting the study. Almost all respondents reported experiencing stress, anxiety,depressive moods, or job dissatisfaction. A statistically significant association was found between violentevents experienced by the respondents during work in emergency departments and their work experience(OR = 0.88, P = 0.02), age (OR = 0.86, P < 0.001), and sex (OR = 9.10, P = 0.005).
    Conclusions
    According to our results, a high proportion of workers in emergency department experience violentincidents during working hours. The statistically significant association between violent events and work experienceindicate limited work experience as a risk factor of violent incidents in emergency department. To compensatefor lack of adequate work experience in younger emergency departments employees, there is a need fortargeted training programs aiming to enhance communication and violence management skills in this group. Inaddition, male clinicians are the primary targets for violence reducing strategies.
    Keywords: Emergency Department, Violence, Healthcare, Hospital
  • Roghayeh Khasha, Mohammad Mehdi Sepehri, Toktam Khatibi Page 17
    Background And Objectives
    Surgical cancelation is a significant source of time and resource waste, patientsafety risk, and stress for patients and their families. In this study, a risk management-based approach is developedto prioritize factors contributing to surgical cancellation.
    Methods
    Factors leading to surgical cancellation were comprehensively classified based on literature review.A Fuzzy Failure Mode and Effect Analysis were developed for identifying the relative importance of the potentialsurgical cancellation factors. Validity of the results was examined by obtaining experts’ opinions.
    Findings
    Our analysis identified inadequacy of recovery beds, inadequacy of ICU beds, high-risk surgery, andhigh blood pressure and diabetes as the most important factors contributing to surgical cancelation.
    Conclusions
    According to our results, the Fuzzy Failure Mode and Effect Analysis can successfully rank thefactors contributing to surgical cancellation. Our results encourage further use of the risk management theory andtools combined with fuzzy set theory to support and facilitate the clinical decision-making process.
    Keywords: Risk Management, Failure Modes, Effect Analysis, Surgical Cancellation, Fuzzy Set theory
  • Marzieh Javadi, Shandiz Moslehi, Maryam Yaghoobi, Faezeh Seirani, Meshkat Abbasi, Zahra Tayyebi Page 25
    Background And Objectives
    Hospitals usually generate large amounts of hazardous waste. If not managedproperly, hospital waste can pose threats to public safety and damage the environment. Waste minimization isa waste management approach that focuses on reducing the amount and toxicity of hazardous wastes. This study pursues a two-fold
    Purpose
    1) to gain insight into hospital waste minimization performance in Iran usinga sample of public and private hospitals, 2) to compare WM performance between public and private hospitals.
    Methods
    Data were collected using a questionnaire, designed based on WHO measures of hospital wasteminimization. Ninety individuals from four public and three private hospitals were enrolled in this study usingstratified sampling. Data was summarized using descriptive statistical methods. T-test and ANOVA were usedto compare the mean values.
    Findings
    Average waste minimization score of the surveyed hospitals was 2.92 (from 5). No significant differencein overall waste minimization performance was found between public and private hospitals. Waste segregationperformance was found to be significantly higher in public hospitals, whereas private hospitals showedhigher performance in managing storage of chemicals and pharmaceutical products.
    Conclusions
    According to our results the status of waste minimization is unsatisfactory in Iranian hospitals. Ourresults also reflect on lack of employee familiarity with the concepts and practices of waste minimization in Iranianhospitals. Insignificant difference in score of waste minimization between public and private hospitals underminesthe role of hospital ownership as a determinant of hospital waste minimization performance. Overall, this study emphasizesthe the immediacy of devising effective strategies to address the challenge of hospital waste management.
    Keywords: Waste Minimization, Hospital Waste, Waste Management
  • Ali Gholami, Abasalt Borji, Pegah Lotfabadi, Amin Asghari Page 31
    Background and Objective
    Exposures to contaminated needlesticks and sharp devices are an important occupational hazard for morbidity and mortality from infections with blood-borne pathogens among HealthCare Workers (HCWs). The objective of this study was to evaluation the prevalence of NeedleStick and Sharps Injuries (NSSIs) and associated factors among Neyshabur’ HCWs.
    Methods
    A cross-sectional study of 384 HCWs was undertaken in Neyshabur hospitals, a city in north-east of Iran. A self-administered questionnaire was distributed to study the occurrence and risk factors of NSSIs that were happened from March 21, 2011 to Sep 22, 2011. The study population selected randomly from Neyshabur hospitals’ HCWs. Chi-square test and multivariate logistic regression model were conducted to determine the association between risk factors and occurrence of NSSIs.
    Findings
    More than 32% of HCWs reported having experienced at least one NSSI in the studied duration, 54.8% reported having sustained 1 injury and 45.2% reported more than 1 injury. Most prevalence (39.7%) of NSSIs was observed in the nurses. The syringe needles were responsible for most of injuries (35.71%). Multivariate Logistic Regression model showed that age (OR=0.551, 95%CI=0.325, 0.934) and shift number per month (OR=2.404, 95%CI=1.389, 4.160) are significantly associated with occurrence of NSSIs (P<0.05).
    Conclusions
    In total, the findings of this study indicate a slightly high prevalence of NSSIs among HCWs at hospitals in Neyshabur, so it is an important public health problem in these hospitals. Also, the most important risk factors associated to occurrence of NSSIs are age of HCWs and shift number (per month).
  • Mohammadkarim Bahadori, Seyed Meysam Mousavi, Jamil Sadeghifar, Mehdi Haghi Page 39
    Background And Objectives
    Considering the importance of medical education quality in achieving a healthycommunity, there is a need for the development of valid and reliable tools for efficient measurement of quality ofmedical education services. SEVQUAL is a popular services quality measuring framework used in assessmentof quality in various service sectors. The purpose of this study was to examine the reliability and performance ofthis measurement model in the context of medical education.
    Methods
    This study is a cross-sectional study conducted in 2012 in Kermanshah University of Medical Sciences,situated in western Iran. A sample of 383 students of medical sciences participated in this survey. SEVQUALservices quality framework was used as the measurement tool, which assesses quality of services in five relevantdimensions, including Tangibles, Assurance, Responsiveness, Reliability, and Empathy. The survey was adjustedto the medical education environment, before being administered. Validity of the construct was confirmed by apanel of independent experts. The internal consistency reliability of the survey was measured using Cronbach’salpha. Data were summarized using descriptive statistical methods. T-test and ANOVA were used to compare themean values. P < 0.05 was considered to represent statistical significance.
    Findings
    While a reliability of 0.88 was obtained for the overall construct, the reliability of all individual dimensionswas marginally (less that 0.1) below the threshold of 0.7. All items and dimensions showed a negative gap.A total gap of -1.58 was identified for the entire construct. The largest gap in medical education dimensions wasidentified for Responsiveness (-1.76), whereas the smallest gap was related to Reliability (-1.33). No significantdifference in the total gap was identified between different demographic groups. Tangibles dimension showed asignificantly wider gap as perceived by female students compared to their male counterparts (P = 0.034). In addition,the Tangibles gap dimension was significantly different among students in different disciplines (P = 0.004).
    Conclusions
    Cronbach’s alpha coefficients indicated an adequate reliability for the entire construct and a marginallyinadequate reliability for the individual dimensions. This observation calls for further large-scale studies toachieve certain conclusion about the reliability of SERVQUAL use in the context of medical education services.Observation of an absolute negative gap in all items and dimenions, highlights the need for immediate investigationof causative factors, followed by devising and implementing improvement strategies.
    Keywords: SERVQUAL, Medical Education Services, Quality, Gap Analysis
  • Azadeh Ahmadi, Ghassem Abedi, Farideh Rostami, Mohammadali Flah Page 45
    Background And Objectives
    Patient satisfaction is an important indicator of the quality of health and healthcareservices. Most relevant studies in Iran have been conducted in the nation’s capital, and there is a lack oflarge-scale studies in other regions of this country. In order to help filling this gap, this study was designed toundertake a relatively large-scale assessment of patient satisfaction with health and healthcare systems in Mazandaranprovince situated in northern Iran.
    Methods
    This cross-sectional study was conducted on a sample of 450 women who referred to health facilitiesin Mazandaran province. A quota random sampling method was adopted. Data were summarized using descriptivestatistical methods. Chi-square and Fisher tests were used to analyze data.
    Findings
    A satisfaction rate of 65.5% and 56.8% was identified among the patient with health and healthcareservices, respectively. A significant relationship was found between patients’ satisfaction with health services andtheir age, level of education, status as a homemaker, and number of children. Similarly, patients’ satisfaction withhealthcare services showed a significant relationship with their age and number of children.
    Conclusions
    Our results indicate a gap between maternal satisfaction with health/healthcare services and theideal situation. In addition, this study highlights the need for an in-depth analysis of the nature of relationshipbetween patients’ satisfaction with health/healthcare services and their demographic characteristics to enabledeveloping effective improvement strategies.Keywords: Patient, Satisfaction, Maternal, Health, Healthcare
  • Morteza Khavanin Zadeh, Mohammad Rezapour, Mohammad Mehdi Sepehri Page 49
    Background And Objectives
    Arteriovenous fistula is a popular vascular access method for surgical treatmentof hemodialysis patients. The method, however, is associated with a high rate of early failure varying in the rangeof 20-60%. Predicting early Arteriovenous fistula failure and its risk factors can help reduce its incidence, its hospitalizationrate, and associated costs. In this study, we examined performance of data mining in the predictionof early AVF failure and identification of its risk factors.
    Methods
    The data of 193 patients who underwent homodialysis in Hasheminejad Kidney Center were explored. Eightcommon attributes of the patients including age, sex, hypertension level, Diabetes Mellitus state, hemoglobin level,smoking behavior, location of Arteriovenous fistula, and thrombosis state were used in the machine learning process.Two learning operators including W-Simple Cart and WJ48 tree were used in data mining process.
    Findings
    Smoking was identified as a factor influencing the relationship between the outcome of vascular accesssurgery and hemoglobin level. Prediction accuracy varied within the range of 69.15-85.11%.
    Conclusions
    According to our results smoking is a crucial risk factor for early Arteriovenous fistula failure, evenat normal levels of hemoglobin. Our results provide further supports for the notion that data mining can helpmedical decision-making process by deciphering the complex interactions between various biological variablesand translating the hidden patterns in data into detailed decision-making criteria.
    Keywords: Data Mining, Prediction, Hemodialysis, Arteriovenous Fistula, Vascular Access, Knowledge Discovery