مجله بیمارستان
سال سیزدهم شماره 4 (زمستان 1393)

Recently، hospitals in order to improve strategic and operational work have been under a lot of pressure; Nonetheless، lack of taxonomy researches have been noticed in Health care. The purpose is to present taxonomy of health care operational systems and strategies of Mashhad hospitals sections in correct order in the base of their aims and operational decisions and afterwards assign Proportionate strategies and systems with each other. Considering its objective، this study is applied. It is exploratory and based on survey regarding its method. 84 samples of remedial hospitals sections in Mashhad have been chosen by chance and after final survey and justifiability implement research to analysis data using from k-means cluster analysis and in order to assess the validity of this analysis، the multiple discriminant analysis has been used. The test of independence was used to assess the correlation between strategies and recognized systems. for each strategies and operational systems 3 clusters have reconnoitered that each of them in a correct order is emphasizing on goals and different decisions. Also the results of performing independence test is expressive the proportion between Leaders of service- centric strategy with operation leading system and cost- based follower strategy with creative cautious system. This study dose not only provides a useful description of the operational situation and operational position of a hospital، but also provides a necessary setting for more professional studies and theorizing.

Given the importance of quality in health care and meeting the needs of patients, it seems important to measure the quality of services and identify the weaknesses from the patient's perspective. The purpose of this study is to assess the service quality (SQ) of care as perceived by people with Type 2 Diabetes (T2D). A cross-sectional study was conducted among 180 people with Type 2 diabetes in diabetes clinic using convenience sampling method in Tabriz, Iran in 2012. Service quality was calculated using: SQ=10 – (Importance ×Performance) based on importance and performance of non-health aspects from the patient's perspective. Validity and reliability of questionnaire was reviewed and confirmed. Independent sample T-test and ANOVA were used to investigate relationship between service quality and categorical variables. Data analyzed bySPSS13 software. The average service quality score was 8.17 of 10. From the participant's perspective, of 12 aspects of service quality, communication and prevention had the highest score for importance. Dignity had the highest score for performance. However, the highest service quality values were for continuity of care, dignity and confidentiality. overall service quality achieved inadequate quality and there is an opportunity to improve quality of care.

Hospital waste need a very sensitive and cautious attention due to holding hazardous, toxic, and pathogenic factors such as infectious, pharmaceutical, pathological, chemical and radioactive left-overs. Thus, this study aimed to evaluate the observance of safety measures by workers responsible for collecting hospital wastes in the public hospitals affiliated to Tehran University of medical sciences. Methods and Materials: This cross-sectional and descriptive-analytic study was conducted in 1391. Data were collected through using a questionnaire. According to the frequency distribution, total score for participants was divided into three weak (<26), average (26-30), and high (>30) categories. Data were analyzed by the SPSS 18 software using T-Test, one-way ANOVA and regression analysis. Based on the results, 33.3% of hospitals received suitable, 55.5% received average and the remaining (11.2%) received a weak score regarding safety measures. Moreover, there was a statistically significant correlation between cleaning staff’s characteristics (education, age, work experiences and their training) with their safety status score. Implementing current national principles and standards and conquering shortages, proper planning, using young workers alongside with experienced ones, more training courses and respecting and paying enough attention to cleaning staff would help to improve the safety of collecting hospital wastes.

Hand hygiene is the simplest and most effective preventive measures to reduce cross infection in hospitals. However, compliance with recommended instructions is commonly poor among healthcare workers. The present study aimed to explore potential behavioral determinants of hand hygiene compliance among healthcare workers in intensive care units. Methods and Materials: A qualitative study was conducted, consisting of 42 semi-structures interviews with physicians (attending physicians, non-attending physicians, residents), nurses, nursing students and medical students, who worked in the intensive care units. Participants mentioned self protection as the main reason for the performance of hand hygiene. According to the participants, hand hygiene was often performed after direct contacts and tasks that were perceived to be dirty. Participants were most concerned about knowledge gaps in hand hygiene practice. Most participants believed that having a good theoretical knowledge of hand hygiene guideline may strengthen healthcare worker's attitudes toward hand hygiene. Junior practitioners believed that the superior's hand hygiene practice could influence their performance both negatively and positively. Participant also believed that the lack of formal and informal control may hinder compliance among healthcare workers. High workload, interruptions, and limited access to hand hygiene products were mentioned as primary barriers to hand hygiene. The findings revealed that a number of factors can influence had hygiene practice. Recommendations of the current study are of value to future researches aiming to improve compliance with hand hygiene behavior among healthcare workers.

There is now a global concern about significant numbers of patients who are harmed or faced financial problems.Therefor, interving in organized approach to provide safe services seems necessary. This study is aimed to assess the basic indicators of patient safety in hospitals affiliated with Tehran University of Medical Science. This descriptive–analytical study was conducted in the 5 selected hospitals affiliated with Tehran University of Medical Sciences. The data were collected using patient safety assessment protocol published by WHO(WORLD HEALTH ORGNAZIATION) tool.The questionnaires were filled using variety of different ways such as: interview, observation and documents investigation. The data were analyzed using SPSS software and also with descriptive and analytical tests. The results showed total average of maintaining the standards was 51.1% which categorized as weak level based on the protocol. The highest and lowest rates of the domains studied were safe environment (68.8%) and continuing education (24.8%) respectively. Farabi and Rasul Akram hospitals had the best and the worst levels of maintaining indicators of patient safety standards. It is worth mentioning that the status of all the hospitals was in the same level. Statistical tests indicate that maintaining the standards does not differ significantly between participating hospitals. All participating hospitals has a poor performance through developing basic patient safety indicators. Managers` support and staff participation can be helpful to solve the mentioned issues. Paying attention to patient safety in managerial plans and putting equal value to various aspects of patient safety are pivotal.

Services marketing mix (7Ps) is one of the most important concepts of management and marketing. This study has surveyed the role of services marketing mix components in patients` tendency towards the public and private hospitals in Sari. In this cross-sectional study, 900 patients were selected from sari`s public and private hospitals based on non-probability quota sampling. Data were collected using a questionnaire including the marketing mix components of which the validity and reliability was confirmed. The data were analyzed using the SPSS V.16 software with a multiple regression hypothesis. The results showed that among the components of the services marketing mix, the price had the maximum effect (49.2%) and the physical assets had the minimum effect (14.1%) on patients` tendency to public hospitals. On the other hand, staff had the maximum effect (48.4%) and the promotion had the minimum effect (18.6%)on the patients` tendency to private hospitals. Price is a determining factor in patient’s tendency to refer to public hospitals compared to private hospitals because of delivering services with lower rates. On the other hand, the main reason for patient’s reference to private hospitals is their staff that could be due to their sense of responsibility, accuracy and speed in providing services to patients.

According to reports, the nurses frequently and directly are faced with the deaths, suffering and pain, thus a major mechanism for administrators is empowering of staff. With this approach, the object of study was examining the role of ethical leadership at promote nurse's psychological empowerment. Considering the purpose of this study, it was applied & considering the data collection methods, it was descriptive –analytical. Statistical population was nurses in working in Sanandaj public hospitals (410 people) and 148 subjects were selected using random sampling. Data gathering tools were two questionnaires: Ethical Leadership (Salehnia: 2012) and psychological empowerment Questionnaire (Wooten & Cameron, 1998). Data analysis was performed by SPSS (Version 16) and Confirmatory Factor Analysis, Pearson correlation test and Multiple Regression ( Enter). Results showed that the items of questionnaires can be reduced to the fundamental dimensions. Results also showed that there was a significant relationship between ethical leadership and psychological empowerment. Finally, it was found that components of Pattern and Pragmatism are predictive of psychological empowerment. According to study findings, hospital Administrators can by display appropriate ethical behaviors and efforts to strengthen interpersonal relationships and encourage such behaviors among members provide Contexts improving nurse's Psychological Empowerment

The main mission of hospital is to promote care quality for patients and to meet their needs and expectations. The present study aims at identifying and prioritizing the patients’ expectations of the hospital services quality, which is considered to be the first step toward accomplishing such an important mission. The present study is descriptive and applied. The data was collected through pairwise comparisons questionnaire that was distributed among 150 patients in a public hospital in Bandar Abbas, 104 patients filled out the questionnaire. The obtained data were analyzed by the use of AHP. The results show that among the different dimensions of hospital service quality investigated in the present study, the patients listed 5 main dimensions in order of priority: accessibility (0.251), medical services(0.232), environment(0.202), administration(0.160), and relation(0.155). Among different criteria, access to medicine and blood(0.054) was the first priority and attention to the patient(0.010) was the low priority. Due to the key role of the patients in defining and assessment of service quality, the present study presents a framework for evaluation of hospital service quality according which the priorities of patients were determined. The managers are advised to prioritize the quality improvement practices based on the patients’ priorities in order to satisfy the patients and make the processes customer-oriented.

Different approaches have been suggested to improve the quality of health care and the clinical governance is one of the main models. In the country, Clinical governance is initiated as a national model in 2009 and hospitals were forced to implement it. Only two hospitals of Shahid Beheshti University of Medical Sciences were approved according to evaluation of clinical governance implementation. This study aimed to describe and explain the barriers of clinical governance implementing in educational hospitals of Shahid Beheshti University of Medical Sciences. In this qualitative study, conventional content analysis has been done. Twenty five participants involved in implementing clinical governance, including nurses, physicians, managers and the experts of hospitals and Ministry of Health, have been selected through purposive sampling method and interviewed in a semi-structural way till data saturation. Data were collected and analyzed simultaneously. Member check and peer check have done for data rigor. Nine themes include human resource challenges, financing resource shortage, incomplete records and documentation systems, inappropriate organizational culture, lack of awareness of managers and employees, incomplete documented policies and procedures, inappropriate monitoring and evaluation, lack of inter-sector coordination and weak leadership were obtained and were placed in two domains; input and process. The findings of this study indicate that there are several barriers for implementing clinical governance in hospitals that there is need to prioritize needs and to provide them appropriate solutions.

Today, one of the effective ways of providing services is contracting with outside of organization and outsourcing. The current study aimed to investigate effect of outsourcing on performance of nutrition unit in studied hospitals. The current descriptive – analytical study performed in 2013, in two non-military hospitals and two military hospitals. 602 patients and 930 personnel were selected by simple randomized sampling. Data gathering performed by Patient and personnel satisfaction questionnaire, check list of kitchen's hygiene condition and check list of assessing the time spent by hospital manager for nutrition unit. Data on personnel cost were collected through accounting department. Data analysis performed by spss19 software. Patient and personnel satisfaction with food services of non-military specialized hospital (4.03±0.45) were more than military specialized hospital (p= 0/03 for patients & p= 0/021 for personnel) and in non-military general hospital were more military general hospital (p= 0/039 for patients & p= 0/028 for personnel). Hygiene condition of non-military hospitals kitchen was better than military hospitals, the time spent by hospital manager for nutrition affairs in military specialized hospital was 1.5 times more than non-military specialized hospital and in military general hospital it was 6.5 times more than non-military general hospital. Personnel cost in nutrition unit of military hospitals were 1.5 times more than non-military hospitals. Regarding the positive impact of outsourcing on performance of nutrition unit in hospitals, it is recommended that this strategy be applied in nutrition unit of military hospitals.

Raising number of elderly people in Iran causes new concerns. One of the important issues is Social support. Social support can be critical for older adults because of their common disabilities and unavoidable dependency to maintain and improve of their health status. Questionnaires which had been used for measurement of health status and elderly social support has been collected and combined through searching resources in library and web. 5 district ions of Tehran were selected randomly in order to have a efficient sample size. The questionnaires were filled by 140 elders whom were staying in residential homes and 280 above 60 years elderlies whom were living with their families. The date were analyzed by SPSS software. 406 questionnaires among 420 questionnaires were filled which showed 96.6%. rate of responsibility. Data analysis showed a correlation between status of physical, mental and social health social support. There is a significant correlation between Social support and physical, mental, and social status of health

New manegerial approachfor hospital administration as one of the health system reforms with several goals including increased staff motivation were enforced. However, motivation and job satisfaction are two very important factors for survival of organisation. The purpose of this study was to investigate the relation between paying the fee for service, motivation and job satisfaction using the expectancy theory of Victor Vroom. The descriptive-analytic research conducted in a public hospital of Tehran city in 2013. The sample size was estimated 209 caseswhich selected by using Stratified sampling method.Information Through a three-part questionnaire containing personal informationwith 6 questions, expectations standard questionnaire with 25 questionsand job satisfaction standard questionnaire with 13 questions were collected. SPSS18 software was used for data analysis. In all occupational groups other than physicians, direct significant relationship was observed between the Fee for service and job motivation. In all occupational groups except paraclinic, directly significant relationship between motivation and job satisfaction was observed. Among all occupational groups only in the Administration– Finance Group Direct significant relationship was observed between the Fee for service and job satisfaction. In this study, hospital staff had Above-average job satisfaction and job motivation lower than average. improving skills through training opportunities, Codification of appropriate Politics and Policies of reward–function and situating favorable bonus from view of the employee (According to motivational differences) are Examples of strategies to improve motivation

Improving the quality of work life in hospital personnel is introduced as one of the important factors for ensuring the sustainability of the health system. The aim of this study was to investigate the relationship among organizational justice and commitment, and job satisfaction with quality of work life in Pour-Sina state hospital personnel. The study design was descriptive and cross-sectional, and statistical population included all of physicians, nurses, radiology and administrative staff and service workers of Poursina State Hospital in Rasht. 216 individuals were selected by quota sampling and filled the questionnaires on demographic information, quality of work life, organizational justice and commitment and job Descriptive Index(JDI).All data were analyzed with SPSS 16 software and by correlation coefficient and multiple regression. Among the demographic characteristics, only work history had a significant negative correlation with quality of work life (r=-0.155,P<0.05). All dimensions of organizational commitment (except continues commitment) and organizational justice had a positive and significant relationship with quality of work life(P<0.0001).in regression analysis variables of distributive justice(P=0.0001,β=0.318),pay satisfaction (P=0001.0,β=0.288), affective commitment (P= 0.007,β=0.144), promotion satisfaction (P=0.003,β=0.172), procedural justice (P=0.013,β=0.139), and normative commitment (P=0.003, β=0.172) significantly predicted the levels of quality of work life and totally explained 60% of shared variance(P<0.0001,F=46.913). individuals working in hospital are always at risk of burnout. Thus, it is proposed that much attention be paid to dimensions of job satisfaction, organizational commitment and justice in order to increase the quality of work life in hospital environments.

Nowadays, quality of working life as a universal concept of human resource management and organizational development have been regarded and improving it, is key to successfully managing any organization. This study was conducted to survey Relationship between Quality of working life and Work-family conflict among Nurses of Hospitals in Tehran. This study is descriptive –analytic that performed cross sectional. The study population was the nurses of the hospitals of the Tehran University of Medical sciences (N=215).The data was gathered using two questionnaires, Quality of working life components of Casio and questionnaire of work-family conflict prepared based on Carlson. Cronbach's alpha was used to assess the reliability of the questionnaire. Spearman correlation test was used for statistical analysis. There was no significant relationship between Education and work facilities (Quality of working life components) with the work-family conflict (p >0.05).but relationship between the democracy, participation in decision making, job design, workplace in organization with the work-family conflict was significant (p <0.05).finally, between Quality of working life and work-family conflict a significant relationship was observed (p <0.001). Because the significant relationship was observed between the Quality of working life and work-family conflict among the nurses, It can be concluded that Work-family conflict be reduced with improve of Quality of working life.