Iran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Clinical Governance: The Challenges of Implementation in Iran1103871ENReza DehnaviehResearch Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranHossein EbrahimipourHealth Sciences Research Center, Department of Health and Management, School of Health, Mashhad University of Medical Sciences, Mashhad, IranMojtaba Jafari ZadehDepartment of Health and Management, School of Health Services Management, Kerman University of Medical Sciences, Kerman, IranMojtaba DianatDepartment of Health and Management, School of Health Services Management, Kerman University of Medical Sciences, Kerman, IranSomayeh Noori HekmatResearch Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranMohammad Hossain MehrolhassaniResearch Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranJournal Article20120916Background and Objectives: The Iranian Ministry of Health and Medical Education has introduced clinical governance as the accepted model of hospital healthcare improvement. Subsequently, a growing movement for implementing clinical governance in health facilities has emerged. This study aimed to explore the opinions of the relevant experts and executives to provide insight into current challenges, barriers and inadequacies in implementation of clinical governance in Iranian health settings.
Methods: A qualitative approach was adopted. A purposeful sample of 17 participants was interviewed in the spring of 2012. The study sample was selected from among clinical governance executives of teaching hospitals affiliated 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. Administrators need to get more familiarized with the concept and requirements of clinical governance. High ranking authorities should avoid rapid turnover of management teams.
Adequate communication regarding of clinical governance is needed to be established among different deputies of the Ministry 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 aspects of clinical governance.
The felt need for change must be promoted among hospitals’ administrations and staff. Teamwork between staff must be promoted. Expectation for rapid achievements and early frustration in time taking reforms must be addressed by appropriate training.
Appropriate infrastructure and mechanisms for reporting, interpretation, and analysis of quality indicator data should be developed. Adequate financial and physical resources should be appropriated.
Efficient monitoring and assessment systems must be implemented. Progress in implementation of clinical governance should be appropriately supervised and evaluated. Constant feedback on staff performance and outcomes of interventions should be provided.
Adequate supportive laws and regulations, legally guaranteeing implementation of clinical governance should be developed.
Conclusions: Considering inter-relation of the identified themes and subthemes, our study recommends that a systems approach should be adopted for successful implementation of clinical governance. While fundamental solutions to the identified challenges require long-term reforms in the health system, some obstacles such as inadequate leadership support, rapid rotation of managers, lack of financial and physical resources, inefficient monitoring system, and inefficient training programs may be addressed in a relatively short run. https://ijhr.iums.ac.ir/article_3871_d16bc98fbb96db4e25b3ad4374a4ff3e.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Workplace Violence: A Regional Survey in Iranian Hospitals’ Emergency Departments11163872ENHossein Jabbari-BairamiDepartment of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IranFariba HeidariDepartment of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IranVahideh GhorbaniDepartment of Health and Management, School of Health, Tabriz University of Medical Sciences, Tabriz, IranFariba BakhshianVice-chancellor Office, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20130126Background 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. This study aimed to explore the prevalence of violence in emergency departments, and to identify associated risk factors using 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 collect demographic and violence-related data. The data were summarized using descriptive statistical methods. Logistic regression 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 the past 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 violent events 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 violent incidents during working hours. The statistically significant association between violent events and work experience indicate limited work experience as a risk factor of violent incidents in emergency department. To compensate for lack of adequate work experience in younger emergency departments employees, there is a need for targeted training programs aiming to enhance communication and violence management skills in this group. In addition, male clinicians are the primary targets for violence reducing strategies.https://ijhr.iums.ac.ir/article_3872_4dd437d858faa7802c3af76e135f879a.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301A Fuzzy FMEA Approach to Prioritizing Surgical Cancellation Factors17243873ENRoghayeh KhashaDepartment of Industrial Engineering, Tarbiat Modares University, Tehran, IranMohammad Mehdi SepehriDepartment of Industrial Engineering, Tarbiat Modares University, Tehran, Iran0000000299207452Toktam KhatibiDepartment of Industrial Engineering, Tarbiat Modares University, Tehran, IranJournal Article20121028Background and Objectives: Surgical cancelation is a significant source of time and resource waste, patient safety risk, and stress for patients and their families. In this study, a risk management-based approach is developed to 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 potential surgical 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, and high 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 the factors contributing to surgical cancellation. Our results encourage further use of the risk management theory and tools combined with fuzzy set theory to support and facilitate the clinical decision-making process.https://ijhr.iums.ac.ir/article_3873_38c913a809e6ef2011d6187cb29a47d9.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Waste Minimization: A Survey in Iranian Public and Private Hospitals25303874ENMarzieh JavadiHealth Management and Economic Research Center, Isfahan University of Medical Sciences, Isfahan, IranShandiz MoslehiDepartment of Health Services Administration,
School of Management and Economic Sciences, Islamic Azad University-Science and Research Branch, Tehran, IranMaryam YaghoubiHealth Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, IranFaezeh SeiraniDepartment of Health Services Administration, Isfahan University of Medical Sciences, Isfahan, IranMeshkat AbbasiDepartment of Health Services Administration, Isfahan University of Medical Sciences, Isfahan, IranZahra TayyebiDepartment of Health Services Administration, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20121027Background and Objectives: Hospitals usually generate large amounts of hazardous waste. If not managed properly, hospital waste can pose threats to public safety and damage the environment. Waste minimization is a 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 using a 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 waste minimization. Ninety individuals from four public and three private hospitals were enrolled in this study using stratified sampling. Data was summarized using descriptive statistical methods. T-test and ANOVA were used to compare the mean values.
Findings: Average waste minimization score of the surveyed hospitals was 2.92 (from 5). No significant difference in overall waste minimization performance was found between public and private hospitals. Waste segregation performance was found to be significantly higher in public hospitals, whereas private hospitals showed higher performance in managing storage of chemicals and pharmaceutical products.
Conclusions: According to our results the status of waste minimization is unsatisfactory in Iranian hospitals. Our results also reflect on lack of employee familiarity with the concepts and practices of waste minimization in Iranian hospitals. Insignificant difference in score of waste minimization between public and private hospitals undermines the role of hospital ownership as a determinant of hospital waste minimization performance. Overall, this study emphasizes the immediacy of devising effective strategies to address the challenge of hospital waste management.https://ijhr.iums.ac.ir/article_3874_da0327d32c2fece3e4ff5cd9619df334.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Risk Factors of Needlestick and Sharps Injuries among Healthcare Workers31383875ENAli GholamiNursing Department, Neyshabur University of Medical Sciences, Neyshabur, IranAbasalt BorjiNursing Department, Neyshabur University of Medical Sciences, Neyshabur, IranPegah LotfabadiNursing Department, Neyshabur University of Medical Sciences, Neyshabur, IranAmin AsghariStudents’ Research Committee, Neyshabur Faculty of Medical
Sciences, Neyshabur, IranJournal Article20121116Background and Objectives: Exposure to contaminated needlesticks and sharp devices is an important occupational hazard among healthcare workers. The objective of this study was to gain further insight into prevalence and risk factors of needlestick and sharps injuries among healthcare workers.
Methods: A cross-sectional survey was carried out among 384 healthcare workers of two hospitals in Neyshabur, a northeastern city of Iran. A self-administered questionnaire was designed and distributed among participants. Data were summarized using descriptive statistical methods. Chi-square test and multivariate logistic regression were used to examine the association between respondents’ demographic characteristics and occurrence of needlestick and sharps injuries.
Findings: More than 32% of healthcare workers reported experiencing at least one needlestick and sharps injury during the study period, 54.8% reported having sustained one injury, and 45.2% reported more than one injury. The highest prevalence of injuries was observed among nurses (39.7%). Syringe needle was responsible for the majority of incidental injuries (35.71%). Age (OR=0.551, 95% CI: (0.325, 0.934)) and number of shifts per month (OR=2.404, 95% CI: (1.389, 4.160)) were found to be significantly associated with occurrence of needlestick and sharps injuries.
Conclusions: In total, our findings indicate a relatively high prevalence of needlestick and sharps injuries among healthcare workers. Our results highlight the need for targeted training programs for young nurses to decrease risk of needlestick and sharps injury incidents. In addition, adequate healthcare staffing and appropriate number of shifts per month are prerequisites to preventing a high risk of needlestick and sharps injuries in hospitals.https://ijhr.iums.ac.ir/article_3875_bfedf23c9fdfaada895808b0a365191c.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Reliability and Performance of SEVQUAL Survey in Evaluating Quality of Medical Education Services39443876ENMohammadkarim BahadoriHealth Management Research Center, Baqiytallah University of Medical Sciences, Tehran, IranSeyyed Meysam MousaviHealth Management and Economics Research Center,
School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IranJamil SadeghifarResearch Center for Modeling in Health, Institute for Future Studies in Health, Kerman University of Medical
Sciences, Kerman, IranMehdi HaghiResearch Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranJournal Article20130121Background and Objectives: Considering the importance of medical education quality in achieving a healthy community, there is a need for the development of valid and reliable tools for efficient measurement of quality of medical education services. SEVQUAL is a popular services quality measuring framework used in assessment of quality in various service sectors. The purpose of this study was to examine the reliability and performance of this 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. SEVQUAL services quality framework was used as the measurement tool, which assesses quality of services in five relevant dimensions, including Tangibles, Assurance, Responsiveness, Reliability, and Empathy. The survey was adjusted to the medical education environment, before being administered. Validity of the construct was confirmed by a panel of independent experts. The internal consistency reliability of the survey was measured using Cronbach’s alpha. Data were summarized using descriptive statistical methods. T-test and ANOVA were used to compare the mean 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 dimensions was 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 was identified for Responsiveness (-1.76), whereas the smallest gap was related to Reliability (-1.33). No significant difference in the total gap was identified between different demographic groups. Tangibles dimension showed a significantly 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 marginally inadequate reliability for the individual dimensions. This observation calls for further large-scale studies to achieve 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 investigation of causative factors, followed by devising and implementing improvement strategies.https://ijhr.iums.ac.ir/article_3876_6ba0d97b6b112e45a4a11b00441055ae.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Maternal Satisfaction with Health and Healthcare Services: A Survey in Northern Iran45483877ENGhassem AbediHealth Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, IranAzadeh Ahmadi DashtianIslamic Azad University, Science and Research Branch, Tehran, IranFarideh RostamiHealth Sciences Research Center, School of Health, Mazandaran University of Medical Sciences, Sari, IranHamed NorrollahiDepartment of Health Educations, Ghaemshar Heath Center, Ghaemshar, IranMohammadali FlahDepartment of Health Educations, Ghaemshar Heath Center, Ghaemshar, IranJournal Article20121215Background and Objectives: Patient satisfaction is an important indicator of the quality of health and healthcare services. Most relevant studies in Iran have been conducted in the nation’s capital, and there is a lack of large-scale studies in other regions of this country. In order to help filling this gap, this study was designed to undertake a relatively large-scale assessment of patient satisfaction with health and healthcare systems in Mazandaran province situated in northern Iran.
Methods: This cross-sectional study was conducted on a sample of 450 women who referred to health facilities in Mazandaran province. A quota random sampling method was adopted. Data were summarized using descriptive statistical 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 healthcare services, respectively. A significant relationship was found between patients’ satisfaction with health services and their age, level of education, status as a homemaker, and number of children. Similarly, patients’ satisfaction with healthcare 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 the ideal situation. In addition, this study highlights the need for an in-depth analysis of the nature of relationship between patients’ satisfaction with health/healthcare services and their demographic characteristics to enable developing effective improvement strategies.https://ijhr.iums.ac.ir/article_3877_665057834d9ad3e892c23f11b7d40453.pdfIran University of Medical SciencesInternational Journal of Hospital Research2251-89402120130301Data Mining Performance in Identifying the Risk Factors of Early Arteriovenous Fistula Failure in Hemodialysis Patients49543878ENMorteza Khavanin ZadehHasheminejad Clinical Research Development Center (HCRDC), Iran University of Medical Sciences (IUMS), Tehran, IranMohammad RezapourDepartment of Industrial
Engineering, School of Engineering, Tarbiat Modares University, Tehran, IranMohammad Mehdi SepehriHospital Management Research Center (HMRC), Iran University of Medical Sciences (IUMS), Tehran, Iran0000000299207452Journal Article20120919Background and Objectives: Arteriovenous fistula is a popular vascular access method for surgical treatment of hemodialysis patients. The method, however, is associated with a high rate of early failure varying in the range of 20-60%. Predicting early Arteriovenous fistula failure and its risk factors can help reduce its incidence, its hospitalization rate, and associated costs. In this study, we examined performance of data mining in the prediction of early AVF failure and identification of its risk factors.
Methods: The data of 193 patients who underwent homodialysis in Hasheminejad Kidney Center were explored. Eight common 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 access surgery 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, even at normal levels of hemoglobin. Our results provide further supports for the notion that data mining can help medical decision-making process by deciphering the complex interactions between various biological variables and translating the hidden patterns in data into detailed decision-making criteria.https://ijhr.iums.ac.ir/article_3878_f6ef903a0cafa1bb1e1ba5a99adc762b.pdf