HOSPITAL
Year:2016 | Volume:15 | Issue:2 (57)|Papers Count:14

Background: Improper distribution of medical care creates access inequality to the services in developing countries. This study aimed at investigating inequalities in access to medical facilities in Kermanshah's Metropolitan Area.Materials and Methods: The study was an applied and descriptive – analytical one. Due to the spatiotemporal nature of current research, Geographic Information Systems (GIS) were used. Research data was included hospital addresses and demographic data from statistical blocks of Kermanshah based on Iran’s 2011 census report.Results: The study results represented that spatial distribution of hospitals was concerned on a random pattern in metropolitan of Kermanshah and there was not a special mechanism in hospitals' spatial distribution. In total, Kermanshah city has 13 hospitals with 2342 hospital bed till 2014 which the most of them were related to general hospitals. In existing situation, the statistics revealed that only 48.51% of population has covered by hospitals and 51.49% of households have no standard access. The number of existing hospitals cannot response to the citizen's needs.In this study; current location of the most hospitals was not compatible with scientific criteria; standards and usage requirement.Conclusion: It is concluded that all residents had not equal access to hospitals; and also their distribution was not proportionate with population distribution and households. There is inequality in access to medical facilities focused on hospitals of Kermanshah's Metropolitan Area.

Background: Since, energy consumption per square meter in hospitals is much higher than other types of service institutions; in this study, some actions performed toward optimizing energy consumption improvement projects based on the definition and prioritization in hospital.Materials and Methods: The necessity of optimizing energy consumption in hospitals were described according to some scales including the average consumption and cost of water, electricity and gas for bed days and active bed, and these indices calculated in the case. Then, improvement actions were identified using energy audit, interviews with hospital experts and conducted studies in hospitals. Next, projects with high importance were extracted regarding to impact on energy consumption indices, expert opinion, aggregation, feasibility, and limitations such as prerequisite, synchronicity and post-requisite. Finally, specific criteria were identified in three dimensions, i.e., factors affecting the level of energy consumption, trying to execute project and risk and the projects were prioritized using questionnaire and FAHP.Results: The study results revealed that energy consumption was higher than the world standards in the studied hospital; this confirmed the necessity of optimizing energy consumption and using energy management systems. The results of prioritization also showed the first four priorities.Conclusion: It seems necessary to save energy consumption through improvement projects implementation in the hospitals. Regarding the number and resources limitation, hospitals can choose to implement some low risk and payback period projects based on existing priority and budget annually.

Background: Nowadays, Patient Safety is considered as a fundamental concept of the healthcare system. Hence, recognizing the effective factors such as illegible orders, dosage errors, and drug usage can reduce serious side effects leading to the patients' disability, prolonged hospitalization and even death.Materials and Methods: This descriptive-analytical study performed as a cross-sectional one. 1800 inpatient records selected in a teaching hospital during one year. The physician first order was examined through a self-adminstrated checklist including physicians’ ID and workshifts, and variables like legibility and recorded dosage. Data analysis conducted via SPSS using descriptive statistics and analytical statistics tests.Results: Among 1800 studied records, there were 66.3% recorded by male, 17.6% illegible, 3.2% with no stamp, 8.2% without signing, 11.9% without time and 4.9% with no date.23% of physician records didn't have coherence and logical sequence, 69.5% did not indicate to the primary items, 17.8% with no medicine dosage, 21.8% without pharmaceutical forms, 11.5% with no usage time, 25.9% without usage method, 14.3% had scribbles and 13% were devoid of numbering. Also, there were a significant relation between demographic variables and some medical recording errors.Conclusion: it is necessary to endeavor physicians in patient records documentation improvement and can be used some strategies such as educating the newly arrived residents, considering commendatory techniques and record periodic evaluation.

Background: Todays, hospitals are facing with shortage of resources and increasing costs challenges, So, cost information and cost calculation of hospital delivered services can be effective in efficient resources allocation and tariff rates reforming and budget. This study aimed at calculating the cost of services and physiotherapy department's income of Sina hospital and comparing with approved tariffs in 2013-2014.Materials and Methods: This study was a cross sectional and retrospective one. The cost price of 13 physiotherapy services calculated using Activity Based Costing method for physiotherapy unit of Sina hospital of Tehran in 2013-2014. Data collection tool included some forms related to services costs of physiotherapy and related activity centers. Also, in order to estimate cost proportion of other wards in physiotherapy unit, the proportional allocation bases was determined, then direct allocation method was utilized.Results: The most costs of 13 provided services were less than tariffs in 2013. Generally, the costs pertain of physiotherapy services computed 794286777 Rials which workforce costs (48.4 percent) was the most proportion and then energy buildings depreciation and equipment costs. This issue is due to equipment dependency in physiotherapy unit services.Conclusions: study results revealed there was difference between real cost of services and approved tariffs, therefore, in order to more accurate pricing, exact calculation methods such as Activity Based Costing recommended. Considering high personnel and capital costs pay special attention to these resources, appropriate use, identifying and omitting wasted costs can be effective in increasing efficiency and saving costs.

Background: Intravascular imaging is a tool to detect coronary artery atherosclerosis which plays the major role in vessel stenosis degree determination and plaque pathology as a supplement of invasive angiography. This study aimed at comparing Intravascular imaging with invasive angiography.Materials and Methods: For retrieving second type studies, PubMed, Cochrane Library and Centre for Review and Dissemination (CRD) were searched up to September 2013. Searching was carried out by two persons using angiography and intravascular imaging keywords. Studies which compared intravascular ultrasound technology with invasive angiography were analyzed.Results: Based on studies which reported the rate of target lesion revascularization (TLR) after one year of follow-up, there was a statistically significant difference between intravascular ultrasound and invasive angiography alone. It seems that TLR rate was lower with intravascular ultrasound (P = 0.02).In terms of cost effectiveness, approximately 54, 000 USD spend per each QALY using IVUS method.Conclusion: Although, intravascular ultrasound could be able to detect coronary arteries damages and help out physician in selecting the most appropriate treatment, but due to the high cost of an intravascular ultrasound catheter, the invasive angiography is choice of physicians and patients in coronary intervention.

Background: Nosocomial infections due to mortality and economic costs are one of the main challenges in current century. Gram-negative bacilli infections acquired in hospitals and hospital environment is one of the most important places of residence and publication of these types of bacteria. This study aimed to investigate the prevalence of gram-negative bacilli from the equipment of hospital in Western region of Golestan province in 2015.Materials and Methods: During this descriptive study, 1210 devices were examined with sterile swab of environment and equipments which used in various wards of seven teaching hospitals of Golestan province using census sampling. After identification of the isolated colonies based on biochemical standard tests, results analyzed using SPSS version 22.Results: Based of isolated samples, 352 positive microbial cultures (29.1%) contaminated with gram-negative bacilli which the highest bacterial contamination was related to Enterobacter (10.7%). among different hospital wards the highest bacterial contamination observed in ICUs (19.32%) and among assessed equipment, the highest contamination was related to laryngoscope blades (10.51%), phone (7.1%) , ECG sensor device and monitoring interface (6.25%).Conclusion: The study findings confirmed that microbial contamination with gram-negative bacilli of hospitals equipment is highly considerable in West of Golestan province. Periodic assessments can be effective in nosocomial infections prevention.

Background: The organizational learning has been influenced in different theories and model based on theoretical and practical dimensions in organizations development and provides a favorable context for changing and development. Organizational learning capacity can play a main role in clinical governance implemention.Materials and Methods: This study was a descriptive- analitical and cross-sectional one which performed during the first six months of 2014. Study population included staff of Ardabil Social Security hospital. One hundred and seventy participants selected using simple random sampling. A four dimensional standard questionnaire of Gumejeet et al and a seven dimensional self administrated questionnaire were conducted to examine organizational learning capacity and clinical governance assessment, respectively. Data analysis was carried out using Pierson Correlation Coefficient and Mulivariate regression analysis. Data was analyzed by SPSS18 software.Results: Study results revealed that there was a positive and significant relation between organizational learning capacity and clinical governance implementation (R= 0.507). This correlation coefficient was 0.644 in management commitment, 0.498 in systematic approach, 0.446 in open climate and 0.261 in knowledge transfer.Conclusion: According to the main role of organizational learning on implementing clinical governance, providing an essential background to enforce organizational learning capacity in four components especially management commitment and systematic approach to implement efficient clinical governance is recommended.

Background: Concerning to the importance of team learning and process change, the clinical laboratories employees should be familiar with organizational learning. This study aimed at assessing and determining organizational learning capability among clinical laboratories employees of Tehran University of Medical Sciences hospitals.Materials and Methods: This study was a descriptive-analytical and cross-sectional one which conducted among 85 employees of clinical laboratories using Cochran formula at five general teaching hospitals of Tehran University of Medical Sciences. The research instrument was Gomez et al. questionnaire consisted of four dimensions such management commitment, systematic approach, open climate and knowledge transfer in 17 questions. Five point Likert scale was used to rank questions. SPSS software 19 version was utilized to data analysis using t- test, Pearson Correlation Coefficient and Welch method.Results: The average score of organizational learning among employees of studied clinical laboratories was 3.11 which showed relative desirable situation. Also, management commitment as an element of organizational learning had significant difference among the clinical laboratories (p=0.002). There was a significant relationship between employees education level with knowledge transfer and integration capability (p=0.04).Conclusion: The process of organizational learning capability of the studied clinical laboratories was not desirable. Therefore, in order to complete establishment of organizational learning in clinical laboratories, should pay attention to some elements such establishment of patient safety system, initiation of error registration system and encouraging employees to report the errors.

Background: Today, due to the diversity of organizational structure and culture, the diversity is one of the basic principle in crisis management. Crisis management consists of six components including flexibility, inclusion, trust, risk perception, adaptability and equity.This study aimed at investigating the managers' perception about components of crisis management in hospitals affiliated to Tehran and Iran University of Medical Sciences.Materials and Methods: This study was a cross-sectional one. A questionnaire was used to collect data using five likert scale. Validity and reliability of questionnaire assessed by content validity and Cronbach's alpha coefficient. Sixty six questionnaire were collected. Data analysis was performed by SPSS software using ANOVA and independent t-test.Results: The highest and the lowest level of managers' perception were inclusion and equity(3.19 ± 0.51) and adaptability(2.73 ± 0.75), respectively. There was a statistical significant difference between crisis management components with gender and job type. The highest level of importance was regarded to inclusion and mutual trust between personnel and managers, and the lowest level was related to flexibility in hospital crisis management.Conclusion: Employees in diverse positions have different definitions of adaptability in crisis. It is necessary to perform further research and educate hospital manager’s duties.

Background: Medical centers and hospitals need to expand internet, Application Service Providing (ASP) to convert it to a long-lasting choice to compete. Hence, the present study carried out with the aim of determining the relationship between quality of service providing software systems and customer satisfaction in selected hospitals of Tehran University of Medical Sciences with similar hospital information systems.Materials and Methods: This study was a descriptive-analytical and correlation one. The study population consisted of revenue and clearance employees' unit in selected hospitals. Study method was census using Kim et al questionnaire. Descriptive statistics such as frequency, percentage and average; and inferential statistics like Kolmogorov-Smirnove Test and Pearson correlation coefficient utilized in order to data analysis.Results: There was a significant positive correlation between quality of Application System Provider variables and users satisfaction in order of severity in system quality (r = 0.734, P = 0.01), service quality(r=0.721, P = 0.01) and information quality(r=0.521, P = 0.01). As, system quality had the most impact on users' satisfaction.Conclusion: There was a significant relationship between the quality of Application Service Providing (ASP) with the users' satisfaction in selected hospitals of Tehran University of medical sciences. Although, all variables had positive and significant relationship with user satisfaction, their average was less than moderate limit. So, the health managers are advised to consider these issues in management methods.

Background: Partnership between public and private section is the cooperation between institutions in these sectors which perform to attain common goals and eliminate the limitations. This study aimed at investigating the important criteria for attraction of private section in health sector.Material and Methods: Based on studies and sample surveys, governments have essential role for codification of health policies and special programs in any country. In recent years, the costs of delivered health services increased exponentially and governments are looking for alternative mechanisms for cost reduction; meanwhile, the increased capacity in social programs is accompanied with considerable investments in infrastructures. This article investigated the utilization of different models by previous literature assessment in public- private partnership field and determined key and substantial criteria for these projects' success /failure. Although, the experience of their implementation is still very limited in our country and there is no accurate assessment based on case studies.Results: Based on study results, some criteria like possibility of returning part of participation costs in tendering for tender, goals and responsibility's clarity, fair and correct mutual risk attocation , lower public costs through less incumbency, private section motivation, clear mechanism monitoring ,conflict resolution and supporting policies from private investment have essential role for successful publicprivate partnership which special attention should be drawn.Conclusion: Governments can have a suitable partnership with private sector in order to prevent increasing costs in rebuilding, maintenance and operation of public facilities like hospitals, considering budget limitations in public sector, providing innovation through opportunism in private section and more efficient risk management.