Hakim Journal
Year:2013 | Volume:16 | Issue:2|Papers Count:15

Introduction: Iranian National Productivity and Excellence Award is an Excellence model for self-assessment of organizations in a professional and classic pathway in the frame of Total Quality Management. The aim of this study was to evaluate performance of Vice-Chancellery for Health of universities of medical sciences based on Iranian National Productivity and Excellence Award.Methods: This cross-sectional study was carried out in 2010-2011. Thirteen universities out of 41 medical sciences universities were selected using convenience sampling method. An educational workshop was held and nine criteria of organizational performance were assessed using workshop approach. The criteria were scored based on the RADAR logic by all trained managers.Results: Evaluation scores of all studied universities were more than 200, except one university (8%) which obtained a score more than 350. Difference between results and enablers was between 19.4 and 102.5. Key performance result and society result obtained the highest and lowest scores, respectively. There were no significant differences between total scores of the results, enablers, and also the nine criteria according to the type of the universities.Conclusion: The results showed that the situation of universities evaluated in this study was in the level between primordial and improved organizations.

Introduction: Health status of societies is amongst the basic indices of economic and social development and hence investment in this section has direct impacts on social welfare and economic growth.Low quality of health care and inequality in health care expenditure contributions can lead to different forms of social and economic consequences. This is the main concern of the public policy makers, in particular those who are engaged with health care services. The main purpose of this study was to measure inequality in health care expenditures in rural and urban areas of Iran. In order to compare the results of the country's 5- year economic and social plans, we measured the inequality in the first years of the plans.Methods: In this study, Gini coefficient, concentration index, Kakwani and Atkinson indices were used to measure inequality in health care expenditures in urban and rural areas of Iran for the selected years. We used the household expenditure survey data collected by the Iran Statistical Center.Results: The results of the study showed that concentration of health expenditures for urban, rural and the whole households of the country had small fluctuations and few changes were made during the study period. Calculation of the total national health expenditures showed that Kakwani index was positive during the mentioned period. Based on the calculations of the Atkinson index, inequality did not improve during period of the study.Conclusion: Health care inequality scores were relatively high and there were volatility in inequality figures. This fluctuation indicates that health policy could not have effective influence on health care expenditures inequality. Increasing inequality is due to the relatively high inflation plagued the society and regional discrepancy in access to the services.

Introduction: Sexual risk behaviors in people with HIV- AIDS who were aware of their infection status, is very common. The aim of the present study was to develop a valid and reliable instrument to assess reproductive health behavior in People Living with HIV (PLWH) based on the Health Belief Model.Methods: In this study, we used the exploratory method to design the instrument. Semi-structured interviews were conducted with 34 individuals with HIV/AIDS. The instrument was developed using literature review and qualitative analysis with 51 items. The developed instrument was validated using face validity, content validity, and construct (exploratory) method. For reliability of the instrument, we used the internal consistency and test-retest.Results: Using the cut-off point=79% of the content validity Index and the cut-off point=0.42 of the content validity Ratio, four questions were deleted and the items decreased to 47 ones. Exploratory factor analysis was used to assess construct validity. The exploratory factor analysis identified five factors with five Health Belief Model constructs explaining 42 percent of the variance. The Chronbach's Alpha (0.70-0.85) and r (0.77-0.88) for all constructs of the model were high and acceptable, respectively.Conclusion: The "Reproductive Health Behavior in People Living with HIV (PLWH) based on Health Belief Model" instrument with five dimensions and 36 items is a valid and reliable instrument for using in the PLWH, high risk and at risk men.

Introduction: HIV is a potential risk in different countries around the world. Having detailed information of HIV positive patients is essential. The aim of this study was to estimate the number of infected individuals during a selected period of time.Methods: We gathered the data from three sources including hospitals, voluntary counseling and testing center, and the prisons from 1990 to 2010. We identified common cases within the three resources using capture-recapture method. Eight models were presented using the log-linear method.Results: A total of 5167 HIV positive patients were identified. The number of male patients was 10 times more than females. Most of the patients aged 15 to 44 years old. The most recorded cases (3347) belonged to the involuntary counseling and testing center. The lowest recorded cases belonged to the common cases of the prisons and hospitals. Annually, 550 more cases had been identified within the resources. The highest estimate belonged to the common cases of the three resources. The estimated number of HIV positive patients was about 18914 in Fars province.Conclusion: Lack of proper coordination between health system sectors, along with the social issues such as stigma and discrimination of HIV positive patients are the most important reasons of weakness in the information systems. Providing high quality information is essential for HIV-infected patients and should be the priority of the health policy.

Introduction: Development is a main goal for governments. The development process is influenced by several factors. Countries at different stages of development have different cost structures. This study aimed to determine the impact of government consumption and investment expenditures on human development index (HDI).Methods: This was an analytic-retrospective study. Based on available data, we included the data of 119 countries from 2000 to 2006. We used a checklist to collect data from valid international websites. Using Eviews software, the regressions were estimated by generalized method of moments (GMM). To confirm the results, we used the Sargan and Wald tests.Results: Initial levels of development showed positive relationship between government expenditures and the HDI. In more than certain levels (optimum level), there was negative relationship between the government consumption expenditures with the HDI. This finding was contrary in countries with low GDP per-capita. Elasticity of consumer expenditures to the HDI for both groups of countries with high and low GDP per-capita was higher than investment expenditures.Conclusion: In the early stages of development, increasing consumer expenditures result in improving the HDI. However, in the late stages of development, countries need to invest in the infrastructure to change their HDI rank.

Introduction: Medical errors threaten health and welfare of patients in health systems. Root cause analysis is an important way to identify errors and causes. This technique is a systematic analysis of cause and effect which tries to determine how patients’ issues, staff, policies, environments and processes are involved in occurrence of medical errors. The present study has analyzed root causes of an adverse event (death of a 21 year old patient who was admitted to hospital with abdominal pain) in Mashhad, 2011.Methods: This was a descriptive study conducted with qualitative approach within six steps. These steps included: defining the event, collecting the data, drawing causal factors, analyzing data and identifying root causes, and implementing recommendation. Root cause analysis was performed using tools such as brain storming and cause and effect diagram from August 2011 until October 2011.Results: Lack of immediate access to professionals and experts in different medical fields, unavailability of up-to-date guidelines, unawareness about CPR rules and insufficient number of ICU beds, inadequate personnel in push time, and lack of standard equipments for identifying and preventing risks were identified as causes of this medical error.Conclusion: Due to the usefulness of root cause analysis in patients' safety, this technique should be used systematically in health care providing unites for critical events management. Reporting and analyzing medical errors needs structural and cultural changes.

Introduction: Waiting time affects medical services quality and patients' satisfaction. Quality Function Deployment (QFD) method is the most effective instruments for improving quality, and is used to assess customers' needs and increase their satisfaction. We used the QFD method to identify strategies to reduce waiting times in the emergency department of faghihi hospital in Shiraz, 2012.Methods: The major steps of the study included determining the mean of the clients' waiting time, identifying the customers' needs and expectations through interviews (n=80), identifying the service elements through interviews (n=15), determining relationship between the patients' expectations and the service elements, determining relationship between the service elements based on the house of quality analysis through QFD Designer software, designing the service quality model, and presenting strategies.Results: The mean waiting time of the clients of the emergency department through 20 processes was 335±98 minutes. Through identifying 13 customers' needs and expectations and 20 service elements, nine service elements were prioritized as the components of service quality model in three levels including: 1) physical space of physician's room, 2) improvement of nursing services, hoteling facilities, inpatient room, and triage space, and 3) improvement of guide systems, providing welfare facilities for patients' companions, and improving waiting room.Conclusion: Considering patients' expectations, the quality model designed in the present study can be used as a comprehensive guide to improve quality of services provided by the emergency department.However, complexity of the model and time-consuming procedures are among the limitations of using the QFD method.