مجله بیمارستان
سال هفدهم شماره 4 (زمستان 1397)

  Brand loyalty is one of the most important factors in maintaining and success of huge organizations such as hospitals. This study aimed to survey the factors that affect the patients’ loyalty to hospital brands in teaching hospitals affiliated to Shiraz University of Medical Sciences (SUMS).

This cross-sectional descriptive-analytic study conducted in 2017. The study population consisted of 385 clearance patients who were admitted to educational hospitals in Shiraz using stratified sampling method in February 2017 to March 2018. Information was collected using a researcher-made questionnaire and data analyzed by descriptive statistics, T-test, ANOVA, and multiple regressions using SPSS version 23 at a significant level of α = 5%.

Patients’ satisfaction (β=0.333, P<0.001), trust in brand (β=0.265, P=0.007), and commitment (β=0.181, P=0.011) had a direct and positive effect on the patients’ loyalty to the hospital brand.

According to this study results, hospital managers should pay an attempt to inform the patients about their treatment procedure, follow up the patients’ health after discharge, and increase the communication between personnel and patients. These could contribute to better image and experience for patients resulting in loyalty to the hospital brand.

Today, hospitals have faced many requests for quality services, while their costs are increasingly growing as well. These facts; Therefore, necessitate much more attention from hospital mangers in order to reduce healthcare costs. Moreover, the urgent need for a precise costing approach is more evident. Activity-based costing provides useful information on the activities required to achieve services with desirable quality. However, given that the basic information for ABC system is provided under conditions of certainty, the possibility of using this approach in terms of uncertainty would be greatly decreased. This study aims to propose a new framework called FL-ABC. Since, costing processes environment happen under conditions of uncertainty in the hospital, fuzzy logic in the ABC model was used in order to make more accurate estimates of hospital costs and increase the reliability of the results. This proposed model was used in a hospital lab unit and the results were compared with the standard ABC system. The results showed that the maximum difference in the prescribed costs was 77708951.89 and 67508112.57 IRR in serology and parasitology tests, respectively, mostly due to uncertainty in the assigned costs to each activity. The FL-ABC system, in terms of taking into account the uncertainty in the parameters of cost, provides more accurate estimates of the cost of activities under conditions of uncertainty which estimates the costs of health care services more accurately.

  Need to assess the health system performance, various models and frameworks have been developed by different groups and organizations. This study explores health system performance assessment frameworks using the comparative-analytical study.

This is a comparative-descriptive study conducted using descriptive-prescriptive method based on comprehensive comparative analysis. The scope of research includes health system frameworks. The study results compared and interpreted based on identified factors in comparative tables.

Overall, 11 frameworks out of 16 ones described, analyzed and compared to each other. Some of the frameworks in addition to providing insight about the health system have focus on assessment of health system performance. Each framework follows especial goals which focus on importance the health systems assessment.

During the time, health system frameworks have changed and developed according to the health systems changes. Developed Frameworks in recent years are more comprehensive than others which have been presented at first. Utilizing these frameworks in order to identify health system goals, assess based on responsibility (organizational actions or outside the organizations) and ways to reach them can be effective. Using the developed frameworks based on their domains and objectives can be considered in health system performance.

  One of the main important factors which affects nurses' job performance and potentially influences their capability in accomplishing their tasks and responsibilities is job burnout (JB). This study aimed to investigate the moderating role of JB on the relationship between QWL and job performance among nurses' employees in emergency departments of five training hospitals affiliated to Qazvin University of Medical Sciences in 2017.

This descriptive, cross-sectional study was conducted among 178 nurses' employees in emergency departments of five teaching hospitals affiliated to Qazvin University of Medical Sciences in 2017. In order to assess main variables of present study, three standard questionnaires consisted of Walton QWL, Maslach and Jackson job burnout and Paterson job performance were used. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression analysis were used to analyze data. The level of significance was set less than 0.05.

Study results revealed that most of the nursing staff had a low level of QWL, experienced a considerable JB with a moderate to high level of performance. Furthermore, QWL predicted 21% of variances regarding to job performance (R2=0.21, p=0.04). The moderated multiple regression results supported the hypothesis that JB had a significant effect on the relationship between QWL and nurses' job performance (β≠0, p=0.02).

Considering the importance of QWL and efforts to develop an appropriate condition to promote different aspects of QWL would play an important role in nurses' productivity and accomplishment of their performance goals.

  The operating rooms in each health center are one of the most sensitive units in the center, whereas scheduling and scheduling operations are in particular importance and their optimization has a significant effect on the optimization of the whole complex. The scheduling of heart surgery in addition to the limitations of manpower, time, and facilities includes the limitation of the patient's surgical deadline, which is the purpose of the surgical scheduling given this parameter. In this quantitative study, an algorithm containing 3 + 1 function was proposed. This algorithm also addresses uncertainty while monitoring the limitations of available resources and the maximum delay for surgery. In this study, patients categorize to emergency and non-emergency patients which only the scheduling of non-emergency patients is considered. In this study 343 patient was studied. Based on a six-month period information reviewing from Shahid Rajaie Cardiovascular Center in Tehran, a 11% improvement has been made in respecting the maximum delay for the patient's referral process. The optimization rate is often related to the difference in patient selection based on their deadline for surgery, which in the present algorithm has been a major contributor to the denial of service patients. Another advantage of the proposed algorithm is the dynamic process of the algorithm and appropriate response to the changes. The longer the length of the queue, the lower the chance of accepting non-emergency patients with the shorter maximum delays.

  The admission unit is the main entrance of the hospital and the first patient communication with the hospital is through this unit. The waiting time of patients, which is one of the main consequent of this unit, is not only one of the important factors affecting the satisfaction of the patients, but also is one of indicators of the quality of service of the hospital. This study aimed to provide scenarios at reducing patients’ waiting times. This research in terms of methods and goals was a descriptive and an applied one, respectively. This study performed on 110 patients who had been admitted to the Mohb-e-Mehr hospital during 70 days and were uniformly trained on all days of the week. Information was also obtained using observation and data recording in prepared forms. The simulation model was designed and implemented with the Arena 14 software. Based on research findings, the para-clinical unit and the waiting room for hospitalization were two main bottlenecks in the studied system. In order to solve the problem, for each of the above units, a scenario designed and simulated. The implementation of these tests revealed that the proposed scenarios in comparison with the existing conditions had better results in reducing the waiting time and also increasing the number of admitted patients.   Improvement of the therapeutic processes will occur through the recognition of the hospital services system and analysis of the bottlenecks and its weakness points. According to the results, an increase in the number of para-clinical unit staff and hospital beds improves the hospital admission function. The implementation of mentioned scenarios reduces waiting time for patients by about 78% and reduces the waiting time for emptying the bed by about 50%.

  Femoral fracture surgery is one of the most common and expensive surgical procedures and forearm fracture surgery is common performed by Ilam Imam Khomeini Therapeutic Center. This study conducted to analyze the difference in actual cost and global surgery tariffs in this hospital.Also, the related factors acutal cost of mentioned surgery were identified.

This cross-sectional and descriptive study was conducted on factors related to the actual costs of femoral and forearm fractures. The Activity-Based Costing approach identifies the related cost associated with these surgeries in through six steps. Data analysis was performed using Excel 2016 software.

The avarage actual cost of the femur fracturs , the code 2 forearm and the code 1 forearm were 953 thousand and 700 tomans, 444 thousand and 400 tomans and 337 thousand and 800 tomans , respectively. The actual cost of surgery for femoral fracture per unit surgery was 406,000 and 400 tomans lower than the Ministry of Health's tariff. But ,the real cost of the code 2 forearm was 33 thousand tomans higher, as well as the code 1 forearm 20 thousand tomans higher than the global tariff.

Overall, there are significant differences between hospital costs and the Ministry of Health's global tariff. That can be corrected by improving the hospital's performance, as well as carefully examining the cost of global surgical procedures for amending the system of tariff regulation and make the actual amount closer to the tariff level.

  Development of the tourism sector and health tourism specifically can improve the Non-Oil GDP. In this regard, in accordance with the policies of the Ministry of Health and Medical Education, international patient department establishment has been facilitatated health tourism development in the affiliated hospitals. This study aimed to evaluate the performance of international patient department and its effect on the attraction of medical tourists among hospitals affiliated to Medical Sciences Universities in Tehran City.
Matrials and This analytical cross-sectional study was designed and conducted in 2017. Study population consisted of all hospitals affilliated to Tehran University of Medical Sciences (TUMS), Iran University of Medical Sciences (IUMS) and Shahid Beheshti University of Medical Sciences (SBMU). In this study, hospital entrance criteria was certified by the Health Tourism Department of MOHME. Data was collected using the health tourism assessment checklist which approved by the MOHME. SPSS version 24 utilized to data analysis using descriptive and Inferential statistics. The study results revealed that the overall performance of international patient department was evaluated at a desirable level (87.5 score) in hospitals of Tehran city. Hospitals had the highest rank of hoteling indices (95/100), in compliance with the regulations and functional indicators gained 87.03 and 82.2 score, respectively. Also, data analysis highlighted that there was no significant difference between hospitals of TUMS, IUMS and SBMU. The establishment of international patient department had no effect on health tourists attraction. Considering the purpose and mission of international patient department to facilitate the provision of quality and satisfactory services in health tourists, management and oversight mechanisms for the standards implementation such as patient admission, follow up in the origin country and development of hospital marketing policies in order to attract international patients and increase hospital incomes are recommended.

Women's health has a broad concept that various biological, social, political, economic and environmental factors affect it. This study aimed to prioritize the factors affecting women's health promotion, provide a model for decision making and choose the best option for decision makers and health system planners to achieve the goal of promoting women's health.

In this descriptive-analytical study, the factors affecting women's health were extracted based on theoretical background and Farmehr's conceptual model. Then, the points of view of five women's health experts on the criteria and options of the model were collected and analyzed using paired comparison tables and Likert measure, and analyzed according to the hierarchical decision-making process. After analyzing the experts 'opinion individually, two methods of computing the geometric meanings and the experts' opinions were combined and the priorities were determined based on group views. The Excel software was utilized to perform the calculations.

Among the four main factors, priorities included the individual factors (subcategory of lifestyle), family factors (family relationships) and underlying factors (attitudes and beliefs). In the first level of decision making related to intervention methods in women's health promotion, the multidisciplinary approach was determined; and in the second level of decision-making related to health management, the partnership of governmental and nongovernmental organizations established in the first priority.

Based on study results, designing and planning interventions with the prioritization of individual, family and infrastructure factors using multi-disciplinary approach and participation of governmental and nongovernmental organizations for promoting women's health are recommended.