International Journal of Hospital Research
Volume:3 Issue: 4, Autumn 2014

Constant monitoring of healthcare organizations’ performance is an integral part of informed health policy-making. Several hospital performance assessment methods have been proposed in the literature. Pabon Lasso Model offers a fast and convenient method for comparative evaluation of hospital performance. This study aimed to evaluate the relative performance of hospitals in Tunisia, using Pabon Lasso Model. A cross-sectional descriptive study was conducted during 2011-2012 to measure the hospitals performance in Tunisia. A sample of 40 public hospitals was surveyed. The assessed hospital performance indicators included Bed Occupation Rate (BOR), Bed Turnover Ratio (BTR), Average Length of Stay (ASL). The relevant data were collected using a standard forms approved by the Tunisian Ministry of Health. For each hospital the data were extracted from the Hospital Information Systems. The data were plotted on Pabon Lasso diagram and the performance of each hospital was analyzed by visual inspection. The data were summarized using descriptive statistical methods. Average values of 62.3, 58.1% and 3.8 days, was observed for the BTR, BOR, and ALS, respectively. While nineteen hospitals (47.5%) were located in zone 1 of the Pabón Lasso diagram, three (7.5%) were located in zone 2, eleven (27.5%) in zone 3, and seven (17.5%) in zone 4. In addition, 50% of the studied hospitals had low performance in terms of either bed occupancy rate or bed turnover ratio or both. This study ranked the surveyed hospitals of Tunisia with respect to their overall performance and reveals the relative strength and weakness of each hospital. The speed and convenience of Pabon Lasso measurement method facilitate constant monitoring of overall hospital performance. Moreover, large-scale application of this method, can offer an overall view of the health system performance, which could be used by policy-makers in future plantings.

Angiography remains as the gold standard for the diagnosis of cardiovascular diseases (CVD). The aim of this study was to assess the quality of angiography services in Shahid Madani Hospital, Tabriz, Iran. A cross-sectional study was conducted in 2013 in Shahid Madani Hospital. A sample of 203 CVD patients who had received angiography services was surveyed. Data was collected using valid and reliable questionnaire with 42 items related to 12 aspects of service quality. Total score service quality was derived by combining the scores of Performance and Importance as perceived by the patients. Scores > 8 was considered as ‘High’, 6-8 as ‘Moderate’, and <6 as ‘Low’. A moderate overall score of 7.00 was given to the angiography services quality. While continuity, communication, and autonomy gained high scores, choice of provider, prompt attention, and quality of basic amenities, and confidentiality scored moderately, and support groups, dignity, safety, and prevention received low scores. The moderate assessment of angiography services quality shows that there is a considerable room for improving these services. To this end, prevention and safety should receive the first priority in services quality improvement plans. Possible useful strategies in this regards include briefing the patients about the adverse effects of the drugs, trading them training on control and prevention of cardiovascular disease, and empowering them for self-care.

Organizational citizenship behavior (OCB) is referred to as the voluntarily activities that are not included as duties in the job description or the formal system of rewards. Development of OCB can have a great impact on human resources performance and organization’s achievements. Similar with many other organizational variables, OCB as well is dependent on contextual factors. In this study, we explore the possible relationship between the Islamic ethics of business (IEB) and OCB among the health staff. A sample of 260 individuals was randomly selected from the health staff of Zabol University of Medical Sciences. OCB and IEB were assessed by Inventory of Oregon and Joseph’s standard seven-tem questionnaire, respectively, after ensuring their validity and reliability. The relationship between variables was examined by Pearson’s correlation test. Correlation analysis identified IEB as a significant predictor of OCB (r = 0.31, P < 0.05). In addition, significant correlations were identified between IEB and different dimensions of OCB, including social customs (r = 0.24, P < 0.05), altruism (r = 0.25, P < 0.05), Job awareness (r = 0.38, P < 0.01), individual mutual coordination (r = 0.21, P < 0.05), protection of organizational resources (r = 0.192, P < 0.05), chivalry (r = 0.18, P < 0.05), courtesy (r = 0.19, P < 0.05). Given the context-dependent nature of OCB, the health organizations in the Islamic countries can improve the OCB in their employees by promoting IEB among them.

Health human resources is the major asset of the health system. The status of human resources in upstream and regulatory health organizations can exert high impact on the effectiveness of health policies and the performance of health system. This study, hence, was designed to explore the possible area of human resource damage to the employees of the Iranian Ministry of Health and Medical Education (MOHME). A total of 316 MOHME staff was surveyed. A questionnaire containing 36 items related to three dimensions of human resources damage, including behavioral, structural, and contextual dimensions was designed and used as the study tool. The content validity of the questionnaire was ensured by applying the experts’ opinions. The reliability of the instrument was ensured by obtaining a Cronbach’s alpha of 0.93. T-test and Friedman test were sued for inferential analysis of the data. The behavioral dimension was perceived to represent the most vulnerable area of human resources damage, followed by structural and contextual dimensions. In regard to the behavioral dimension, ‘motivational factors’ was perceived to be the most important area of damage, followed by ‘job satisfaction’ and ‘job security’. Regarding structural dimension, ‘appointment and job promotion’ received the highest perceived significance, followed by ‘payment system’ and ‘recruitment’. This study ranks the area of damage to health human resources in MOHME. Our results support the previous studies highlighting the role of behavioral factors in bringing damage to human resources. Our findings, therefore, could be applied to development of human resources supporting plans aimed at improving the performance of upstream governmental health organizations. Specifically, providing motivating incentives and implementing strategies supporting job satisfaction and job security can bring significant protection to health human resources.

Traffic accident is the first cause of death in Iran. In 2004 and 2010, two laws aimed at facilitating delivery of healthcare services to the traffic accident victims were approved by the Iranian parliament. The enforcement of of these laws (92 and 37 articles) was considered as a part of Fourth and Fifth Socio-Economic Development 5-Years Programs. The present study was designed to explore the challenges and complexities associated with the implementation of these laws by surveying the experts’ views. A qualitative interview-based study design was adopted. Using snowball technique, thirty-six expert experts were targeted and invited for interview based on their relevant experience. Interviews were conducted by semi-structured questions. Framework method based on Grounded theory was used for analysis of the data and key themes. Financial integration, accumulation and distribution of financial resources, services purchasing, laws, monitoring health care providers, and the cultural issues were identified as the key challenging areas in effective implementing the healthcare financing law for the victims of traffic accident. Identification of the key barriers to effective implementation of the healthcare financing law for the victims of traffic accident, set a baseline for further detailed investigation of the issue.

Background and Nurses comprise a majority of healthcare professionals. Therefore, their quality of life can directly impact the performance of health system at different level. The aim of this study was to explore the potential impact of work shift on physical, mental, and social aspects of nurses’ health. A sample of 300 nurses from hospitals of the Rasht city situated in northern Iran was randomly selected. Demographic and physical, psychological, and social health data were collected using corresponding researcher-designed questionnaires. Data were summarized using descriptive statistical methods. The majority of subjects considered the effect of work shift on chronic fatigue (88.7%) and illness (85.3%) to be important. Work shifts was found to be a perceived cause of severe physical problems in 77.3% of nurses and a perceived causes severe psychological problems in 59% of nurses. Give the high proportion of shift working nurses suffering from physical and mental problems, there is an urgent need for revising the currently established work shift program in the healthcare settings.

Discharge against medical advice (DAMA), a source of ineffectiveness in the healthcare system, remains as a persistent problem in the health settings. To alleviate this problem, knowledge of the general related causative factor is crucial. Thus this study aimed to identify and rank the factors contributing to DAMA, based on a comprehensive literature survey. A systematic review of papers related to DAMA was carried out by searching literature in PubMed based on MeSH, as well as exploring Google Scholar, and SID. From the 1771 papers found, 51 which were directly related to the study objective were identified and reviewed. Descriptive statistical methods were used for summarizing the data. Patients with mental illness or a history of intravenous drug addiction were found as the most frequent DAMA patients. General hospitals and department of pediatrics and emergency face with the highest rate of DAMA. Personal or family problems, dissatisfaction with services providers, the perceived ineffectiveness of treatment, financial problems, feel of well-being, and dissatisfaction with the hospitalization conditions, were enumerated by the patients as the main causes of DAMA. On the other hand, healthcare staff identified the major factors leading to DAMA to be psychological and social problems, lack of proper communication of healthcare staff with patients, and reluctant of patients in completing the treatment period. Systematically identification of causes of DAMA in this study can be considered by the health policy-makers and hospital administrators to develop effective strategies aimed at alleviating the problem.

Patient Safety Culture (PSC) is the essential context for ensuring patients’ safety. While in many countries, nation-wide research has been conducted to identify context-specific PSC factors, there is lack of such large-scale studies in Iran and most researches into PSC are local, limited, and use different methodologies. In the absence of nation-wide research into the field, this study aimed at meta-analyzing the available scattered data to gain insight into priorities associated with development of PSC in Iran. Three major databases of references and abstracts, including PubMed, Google Scholar, Cochrane Library, Magiran, SID and Iranmedex were comprehensively searched. A total of 11 articles exploring PSC in Iran using the standard HSOPS instrument were reviewed. CMA2 standard was adopted for meta-analysis of the literature data. Data were summarized using descriptive statistics. An overall PSC grade of 50.5% was identified for the Iranian health settings. While “Teamwork within hospital units” scored the highest (67.4%), the lowest score was related to “Non-punitive response to error” (32.4%). Nearly 41% of surveyed samples in the publications perceived PSC status in their hospital to be “Very good” and 52.7% reported no adverse events during the past 12 months. Our analysis identified a low PSC grade and adverse event reporting score in the Iranian health settings. “Non-punitive response to error” was found to be the major challenge of developing PSC, hence the priority area for future relevant interventions.