مجله بیمارستان
سال هفدهم شماره 3 (پاییز 1397)

Evidence-based Management (EBMgt) has been developed as a management model to improve the quality of management decisions. Hospital managers’ decisions can have a significant impact on service effectiveness and hospital success. Hence, this study aimed to survey sources of evidence among public hospitals' managers for decision-making in Iran. This cross-sectional study was conducted with 183 managers of public hospitals in eight educational centers of the Ministry of Health and Medical Education in 2017. The research tool was an evidence-based management questionnaire with 20 items and 6 main domains. Data analysis was performed using descriptive and inferential tests by SPSS21. One hundred seventy-two (94%) out of 183 participants were male. The mean age and work experience were 45.28 and 19.30 years, respectively. The lowest score was related to "the academic journals" (52.56%), While managers relied heavily on "Ministry of Health programs" (80.98%). The average use of scientific-research evidence, fact and hospital information, political-social development plans, managers’ professional expertise and ethical-moral evidence and values and expectations of all stakeholders were 59.70%, 62.43%, 75.30%, 71.36%, 71.83% and 73.7%, respectively. The study results revealed that hospital managers utilized the scientific-research evidence less than other evidence, which it is a matter of concern; so, managers need to improve their education and research level. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and they make the best decision in the process of evidence-based decision making.

Whistleblowing as a control tool should be encouraged in organizations to deter organizational illegal and immoral wrongdoings that finally are harmful to the society. Personality traits of people are influential factors on their intention to disclose the wrongdoings. This study aimed to assess the relationship between four personality traits (internal locus of control, ethical identity, extroversion and responsibility) and employees' intention to whistleblowing among the employees of central department of Mashhad University of Medical Sciences. This cross-sectional study is a descriptive-analytic one. This research conducted on 251 employees of the central department of Mashhad University of Medical Sciences. A researcher-made questionnaire based on previous literature used to collect the data. Analysis of the data processed using the Partial Least Square (PLS) with Smart PLS software. Since, the amount of standardized coefficients between independent variables (locus of control, ethical identity, extroversion and responsibility) and whistleblowing intention were statistically significant (P<0.005), all of these independent variables have positive and significant influence on the employees' whistleblowing intention. Given that individuals with internal locus of control, ethical identity, responsibility and extroversion characteristics cannot be able to ignore the organizational wrongdoings, it is better organizations use employees with these characteristics at more sensitive or critical places, where the possibility of organizational wrongdoing is high, in order to prevent potential harm to the organization and society as a result of wrongdoings.

Accreditation is one of the health sector evaluation methods that used to promote healthcare quality. The study aimed to identifiy the strength and weakness of accreditation surveyors and the impact of their performances. This study is a qualitative research which conducted between hospital accreditation stakeholders in 2016- 2017. Data were gathered using semi-structured interviews and analyzed by a thematic analysis method. The findings of in strengthen were categorized in 7 themes. The main strengthen was acceptance of accreditation by surveyors, educational approach, reputation, personal effort to develop knowledge and skills, and existence of senior surveyors. Our results for weakness were classified in 8 themes. The main weaknesses were lack of sufficient knowledge, experience, skills and weakness in personal characteristics. Based on the findings, the accreditation surveyors’ performance was evaluated as under-moderate in past two periods of hospital accreditation. The interviewees announced that weakness of surveyors’ performances was one of the main effective factors of low stability of accreditation results. Recruitment of surveyors based on main competence, education and empowerment of surveyors, and assessing the surveyors can lead to more validity of accreditation results and finally lead to increasing the commitment of hospitals to quality.

Hospitals are the most important and largest institution in each country's health system which health care services are carried out on a large scale. One of the most important processes to improve the quality of health services is accreditation in the country. This study aimed to identify challenges, obstacles and providing solutions in hospital accreditation. This research is a qualitative one which conducted using content analysis approach in the north of the country in 2017. Twenty-five people consisted of two heads of hospitals, three hospital managers, three matrons, four supervisors, ten nurses, three people responsible for accreditation selected as contributors to the study using a targeted sampling approach. After the interview with Maxqda software, coding was performed and necessary analysis was carried out. In order to obtain data validity, two methods of reviewing the participants and reviewing experts were used. Analyzed data was categorized in the 98 initial codes, 16 concepts and 5 main categories. The main issues included resource challenges, organizational challenges, technical challenges, negative consequences and solutions. Pathology helps the organization to focus on problems and by collecting and analyzing data and identifying risky spots, managers and planners will find methods to develop and solve the problem. Particularly, the correct implementation of the accreditation process can lead to comprehensive clinical excellence.

One of the hospitals’ goals is providing high quality of health for patients and patient satisfaction is one of the indicators of quality of health care in hospitals in all countries. The present study aimed to evaluate patients’ satisfaction about performance of health transformation plan in teaching hospitals affiliated to southern Khorasan province in 2016. This study was a cross-sectional, descriptive-analytic one which 410 patients admitted to seven public hospitals of south Khorasan province were evaluated using a standard questionnaire on patient satisfaction during one month. Data analysis was performed by SPSS22 software using descriptive and inferential statistics. level of 51.5% patients ‘satisfaction was assessed high, 37.1% in a good, 9.9% moderate and 1.6 low level. Regression analysis revealed that average score of satisfaction with education level and economic situation had a significant association (p <0.05) which patients with higher education level and better economic status had less satisfaction. There was no significant relationship between other demographic variables and satisfaction level. According to study results, it can be concluded that the health transformation plan can achieve its goals and success regarding patients’ satisfaction and patient costs reduction due to patients' perspective. In order to increase patients’ satisfaction, paying more attention to welfare and nutrition and evaluating satisfaction in other groups (nurses, physicians and personnel) recommended.

Administrative violations are a person-centered behavior that violates the accepted organizational norms, and thus, can threaten the organization health. Therefore, the present study aimed to identify the causes of prolonging the time of taken to deal with administrative violations were at the staff of Ministry of Health and Medical Education. This study was a qualitative content analysis one. For sampling, convenience, purposeful and snowball sampling methods were used. The sample size continued to saturate the interview data with each group of people. Data collection was performed with open questions and interviews using semi-structured interviews. Finally, all interviews were analyzed using MAXQDA software. After implementing and data analysis, the causes for prolonging the time spent on administrative violations in primary and recruiting boards were divided into five main categories including "member characteristics"; "actual proceedings"; "Inevitable factors"; " legal factors "and" organizational factors". According to the findings and experts’ opinions, the most problems in the process of handling administrative violations are related to the time lag in the notification process, investigation and expertise. Membership training, teamwork, and the use of members with different expertise can prevent employees from handling administrative offenses.

The Health Promoting Hospitals (HPH) initiative emphasizes on changes in traditional hospitals’ approach in care provision. This study aimed to provide scientific evidence required for successful planning and implementation of the HPH in the country’s educational hospitals. In this descriptive-analytical study, opinions of 300 frontline health professionals working in the ten educational hospitals affiliated to the Tabriz University of Medical Sciences were examined using validated tools in 2016. Descriptive data analysis procedures and logistic regression analysis (using Enter method) were applied by SPSS software version 22. The level of significance was considered less than 0.05. The mean scores and SD for applicability of the HPH standards were 66.06±17.51. Gender (OR=3.19 95%CI: 1.33- 8.40), occupation type (OR= 1.50 95% CI: 0.65- 0.70), hospital type (general vs. specialized) (OR= 1.59 95%CI: 1.10- 1.25), number of active beds (OR=3.84 95% CI: 1.56-9.42) and having prior knowledge about the HPH program (OR=2.81 95% CI: 1.31-4.80) were identified as significant predictors of the HPH standards’ feasibility in the studied hospitals. Given that study findings, at least the baseline subjective inclination to adapt the HPH standards in the educational hospitals do not exist through the Iranian health care providers’ points of view. As the first step in progress towards preparation for implementing the HPH standards, planning of tailor-made educational programs for hospitals’ staff in Iran is recommended.

Job burnout is a result of long-term job stress, which can reduce the quality of education and provision of services. This study aimed to investigate the relationship between job burnout and its dimensions with occupational stress in Isfahan University of Medical Sciences in 2018. The present study was a descriptive-analytic one. The sample of study consisted of 137 staff in faculties of Management and Medical Information, Advanced Technologies in Medicine, Rehabilitation and Nursing and Midwifery in Isfahan University of Medical Sciences using convenience sampling method in 2018.The study tools were demographic s , Maslach and OSIPOW questionnaires. Data was analyzed using SPSS version 23 software by descriptive statistics and inferential statistics such as ANOVA, T-test and Pearson correlation coefficient. Emotional exhaustion calculated in low level (45.2%), depersonalization in high level (45.2%), personal accomplishment in high level (75.3%) and the most participants had normal stress (54.8%). Similarly, based on Pearson Correlation Coefficient, there was a positive significant relationship between job stress and job burnout and its dimensions, but there was no significant relationship between personal accomplishment and job stress. Study results revealed that the higher job stress among employees, the higher job burnout among employees. As a result, implementing the interventions to reduce occupational stress and strengthen some resources can be helpful to reduce the burnout of employees.