مجله بیمارستان
سال دوازدهم شماره 3 (پاییز 1392)

Abstract Hospital Emergency ward plays a pivotal role in hospital and health care system regarding necessity of immediate،qualicative and effective performance due to numerous and complicated processes happens in the emergency ward. QFD is one of the most effective methods used for designing and improving the quality in order to fulfill customers'' expectations and improve their satisfaction from provided service. This study is aimed to investigate following subjects: 1)identifying the customers'' expectations (n=80) and service`s components (n=15) through interviews، 2) defining the relationship between patients'' expectations and the service`s components، and also relationship between the service`s component themselves 3) designing the service quality model based on the house of quality diagram” After identifying 13 components of customers'' expectations and 20 components of service، 9 components of service were prioritized as parts of service quality model in 3 levels: 1) Physician''s office physical environment 2) Improving Nursing performance`s and hospital hotel`s service facilities، equipping inpatient` room، physician`s room and triage space 3) Improving guide systems، providing adequate welfare for the patients'' families، and facilitating the waiting room. The current quality model designed in this study can be a general guide to improve the quality of services provided by the emergency ward. However، using this model has its limitations such as being complex and time-consuming.

Abstract Family physician plan is a form of health care delivery system which its correct implementation results in health promotion. Being aware of family physicians’ viewpoints towards their occupation would play an important role in its better implementation. The present study aims to to investigate family physicians` attitude who are working in health centers affiliated with Tehran University of Medical Sciences towards their profession. This qualitative study was conducted in 2011. In order to reach information saturation، the data were collected by performing two singular interviews and four focus group discussions among all 33 physicians working at health care centers of Tehran University of Medical Sciences. Eventually، data were analyzed using conceptual framework method. Data analysis indicated three general concepts. The first issue is the factors that encourage physicians to choose family physician profession and continue doing it (including economical، cultural and environmental factors and work conditions). The second one is the study challenges (including preparation to implement the plan، work conditions and professional limits) and the final one is the reforms needed for its correct and proper implementation (in policy making and administrative level). Regarding the issue that economical، cultural and environmental factors and work atmosphere have the main role in motivating family physicians، the most important challenges the plan confronts are also related to these factors and major and minor reforms are needed to overcome these challenges. Moreover preparing society’s culture would surely result in better implementation of the plan.

Abstract Today there is still a shortage of postgraduates of medicine for multiple reasons. This study aims to determine factors related to Tehran، Shahid Beheshti and Iran Universities students'' educational and career tendencies. This is a descriptive cross-sectional study. The study population consists of medical students of Tehran، Shahid Beheshti and Iran Universities of Medical Sciences. A sample of 510 individuals was selected using simple random sampling method proportional to the category size. Data were collected using a structured questionnaire of acceptable validity and reliability. Descriptive statistical methods were used for data analysis. Medicine was selected due to its social dignity، motivation to serve the people and interest in medical sciences affect studying medicine as a major. Existence of Medical Universities، improving information and abilities and the need for medical services in different areas affect physician’s choice of working location. Simultaneous activity in both private and governmental sectors، disorganized in governmental sectors compared to well organized and well equipped private sector، affect physicians` choice of working sector. Realistic thinking instead of idealism، lack of adequate support from students and differences between the academic environment with student`s interest affect changing the students'' educational and career tendency. Actions like regulating the capacity of medical students admission، improving the quality of studies، modification of human resources، better familiarity of students with medicine field while choosing the university field and financial support for young physicians could improve the situation.

Abstract Hospital managers'' decision-making styles indicate the usual pattern managers use to make their decisions. This paper is aimed to determine the variety of managers'' decision-making styles` in public and private hospitals in Shiraz. In this cross-sectional study، 106 administrative، financial، internal and nursing managers were selected from 28 public and private hospitals through census sampling technique to participate in this study. The data were collected by a 22-item questionnaire (α = 0. 86) and analyzed using T-Test and ANOVA in significance level of 0. 05. Studied managers used rational decision-making style more often than avoidance of decision-making style. Older and official managers and private hospital managers used the intuitive decision-making style more often. Managers who had not attended management training courses used the intuitive and dependent decision-making styles more often. Managers who were teaching in the fields of nursing and midwifery used rational decision-making patterns more often. It seems necessary to provide sufficient ground for scientific and evidence-based decision making for all hospital managers. Therefore identifying present obstacles and providing an environment in which managers could improve their decision-making skills is recommended.

Abstract Medical tourism industry as one of the tourism dimensions results in a sustainable development and dynamic economy in countries. This study was conducted to examine performance of Tehran’s selected public and private hospitals in attracting medical tourists from foreign costumers’ points of view. This cross - sectional study was conducted in Tehran’s selected public and private hospitals in 2011. The study population included 79 foreign patients who referred to four hospitals in Tehran as medical tourists. Data were collected using a self-made questionnaire which consisted of 23 questions which evaluated eight hospital performance components in attracting medical tourists. Descriptive and analytic statistics was used for data analysis. Overall، the hospitals` performances were evaluated to be in an appropriate level. Through Patients` viewpoint، three components including staff number، staff performance quality and staff`s up to date knowledge and skills were in a proper level. Moreover، Staff’s acquaintance with foreign languages and giving proper notifications were reported to be in a very poor level. There was a significant relationship between all of the performance components in attracting medical tourists and hospital ownership excluding staff’s acquaintance with foreign languages and their familiarity with the facilities. Teaching international languages to key staffs and empowering their communication skills can be effective in attracting medical tourists. Considering this، both public and private hospitals must have a serious plan to achieve this goal.

Abstract Several factors have an impact on hospitals` crisis preparedness including the status of “internal factor”. This study is aimed to investigate the relationship between the status of hospitals `internal factors and their level of preparedness in crisis. This correlative، applied، and cross-sectional study was conducted in 12 hospitals of Kurdistan University of Medical Science in 2008. The data were collected using the standard Weisbord questionnaire and hospital preparedness checklist to measure the status of internal factors and the hospitals` level of crisis preparedness، respectively. The data were analyzed using descriptive and analytical statistical methods. Changing internal factors would result in 74% of the changes in level of hospital preparedness in crisis in all studied hospitals. The preparedness level and the organizational structure of the hospital had strongest relationship and preparedness level and personnel’s attitude to changes had the weakest respectively. Hospitals should analyze their internal factors status in order to improve their preparedness level in crisis. Concentrating on different aspects of internal factors، reviewing objectives، improving increasing teamwork، involving personnel in decision-making، using performance-based rewards، forming communication committee، improving leadership styles، training organization `s managers and leaders، and facilitating internal and external coordination could be effective.

Abstract There are different attitudes about family presence during CPR. This study was conducted in order to compare the attitudes of physicians، nurses and patients` immediate family towards presence of family members during adult resuscitation in teaching hospitals of Mazandaran University of Medical Sciences. In this descriptive survey، the attitudes of 120 physicians، 200 nurses and 148 patients` immediate family were compared. Random stratified sampling was used as the sampling method. The data were collected using a self-developed questionnaire which its validity and reliability had been confirmed by “Content validity” and “Test-Retest” respectively (r=0/83). This questionnaire included some questions about demographic characteristics، positive and negative experiences and the attitudes towards family presence during CPR. Data were analyzed using Chi-square x2 and Fisher tests by the SPSS 16 software. The majority of physicians and nurses (92/5% physicians، 80%nurses) believed that family presence during CPR is harmful. Fisher exact test showed significant difference between physicians and nurses views (x2=9. 037 df=1 p value=0/002). The most important reason of negative attitudes of physicians and nurses has been interference of family members in CPR (90/8% physicians، 86/5% nurses). Less than half of the patients` immediate family (48%) wanted to be present during the CPR. There was a significant difference between attitudes of patients` immediate family and physicians and nurses (p=000) Regarding differences between physicians، nurses and patients` immediate family` attitudes towards family presence during CPR، it would be better to provide a determined plan identifying the family presence`s conditions during CPR in every hospital respectively.

Abstract Job environment is a strong stimulus for created of emotions and there are several stressful situations which could causes dissatisfaction، low work performance، quit or job-changing. The purpose of this study is to determine the relationship between sensation seeking with job stress among emergency medicine workers and non emergency medicine workers. In this cross-sectional study، 60 emergency medicine workers chosen the census method and 60 non emergency medicine workers chosen the convenience sampling method، in border cities of KUMS، were selected for study. Data were collected by valid and reliable questionnaires of job stress and sensation seeking. Data were analyzed using descriptive and analytical statistics. The most rate of job stress among emergency medicine workers was in the level of moderate (46. 6percent) and in the non-emergency medicine workers was the low level (56. 4percent) and the most rate of sensation seeking among emergency medicine workers was in the level of lower the moderate (35 percent) and in the non-emergency medicine workers was lower the moderate level (40 percent). There were indirect relationship between job stresses with to be thrilled، to be experienced and to be diversity of the variable of sensation seeking and there was a direct relationship between to be blues and to be scope of inhibition of the variable of sensation seeking. Results can be regarded managers to decrease of losses due to job stress and increase productivity، especially in emergency medicine workers across the country

Abstract: Today one of the main problems low or middle income families face is financing healthcare costs. This article studies the methods of of financing health care costs among hospitalized diabetic patients in different types of insurances. This is a causal-comparative study. The variables consist of comparative (health care costs) and categorical (different insurance types including: Iran health insurance، social security and others) variables. A researcher-made questionnaire was used to collect needed data. The data were analyzed by one-way ANOVA، Duncan`s statistical test test of Danken and T-test. The results indicated a significant statistical differences between all types of insurance assessed by cost variables. Also the significant differences between patient`s out of pocket expenses ratio of direct costs (p<0. 01،F=19. 37) and their ratio of total costs (F=25. 36، p<0. 01) were detected in three types of insurances. Patient`s out of pocket of total cost was 59. 55%، 50. 34% and 32% in Iran health insurance، social security and other types respectively. In spite of all invested deal of efforts to improve health indices and health care services availability، health care system is still faces main challenges of providing financial resources and protecting against financial burden on families. Developing a public health insurance and improving health insurance coverage would be helpful for providing financial resources of health care system.

Abstract

Hospitals are the most important health organization and consume major part of health system`s budgets. Downsizing is one of the strategies used for providing suitable services in hospitals. This study was conducted to do a systematic search for hospital downsizing methods and theirs consequences in order to choose suitable method for Iran.

Related Articles were identified by systematic search on databases such as Medlib، SID، Pub Med، Science Direct and Google Scholar meta search engine using keywords like Downsizing، Hospital Downsizing، Hospital Rightsizing، Hospital Restructuring، Staff Downsizing، Hospital Merger، Hospital Reorganization and Persian equivalents. 379 articles were extracted and refined step by step. Finally، 25 articles were selected according to study`s goals.

The identified downsizing methods included reducing the number of employees and hospital beds، outsourcing، merging hospital wards and combination of fore mentioned methods. The most important consequences of using these methods were: cost، revenue، outpatient visits and surgery، length of stay and hospital admission rates، mortality rate، stakeholder satisfaction، workload of employees mental health and absenteeism.

study results indicated that different methods of downsizing are used for providing suitable services and decreasing costs in hospitals. Using Merger and outsourcing are suggested among different methods in hospital wards according to current situation of our country.