International Journal of Hospital Research
Volume:1 Issue: 2, Summer 2012

Effective nurse-physician communication is essential for provision of high quality clini­cal care. Research into nurse-physician communication is a new field in Iran, and the importance of the issue calls for further investigation. In response to this necessity, this study aimed to assess nurses’ perception of nurse-physician communication in teaching hospitals affiliated with Hormozgan University of Medical Sciences, situated in Bandar Ab­bas, at the shore of the Persian Gulf. In this cross-sectional study, 155 nurses were invited to complete the Persian version of the nurse-physician communication questionnaire, originally developed by Schmidt and Svarstad [Soc Sci Med 2002, 54:1767-1777.] The questionnaire comprises 18 items related to four dimensions of the construct, including Frustration with Interaction, Mutual Understanding, Openness, and Relevance and Satisfaction. One hundred and thirty valid questionnaires were returned and used for data analysis (response rate = 83.8%). Data were summarized using descriptive statistics, and t test and ANOVA were used to compare the mean scores between demographic groups. Data were analyzed using SPSS Version 13 Software. P < 0.05 was considered as statistically significant. Nurse-physician communication scored marginally higher than mid-level (53.8%). The dimensions of nurse-physician communication (sub-scales) were rated as follows: Frustration with Interaction: 77%; Mutual Understanding 65%; Openness: 47%, and Relevance and Satisfaction: 42%. Hence, the two latter dimensions can be considered as the prime points of focus for interventions, based on both absolute and relative ratings. In comparison with their male counterparts female nurses perceived their communication with physicians to be more positive (P = 0.017). Nurses with professional work experience more than 20 years had a better perception of nurse-physician communication relative to other work experience groups (P < 0.01). No significant difference in perception of nurse-physician communication was identified between different educational and age groups. Within the limitations of the study, this quantitative evaluation of nurse-physician communication in Iran does not represent a satisfactory outlook. Survey results indicate the need for large-scale and in-depth studies to determine the nationwide situation of this important health care issue.

Medical Tourism Tourism is emerging as a fast growing healthcare industry with the potential to open a new economic opportunity for developing countries. Iran has been the treatment destination of many medical tourists from Middle Eastern countries for many years, yet this field of services remains underdeveloped. The best judges for the challenges facing development of medical tourism are the travelling patients themselves. Thus, this study aimed to explore the quality of Iranian public and private hospitals as perceived by patient tourists who travelled to the country for treatment. Using a cross-sectional design, the study surveyed the perception of 39 medical tourists who referred to two public hospitals, and 40 medical tourists who referred to two private hospitals in Tehran, between May to September 2011. The survey was carried out using a self-designed questionnaire with 16 questions asking about the different aspects of the hospital quality including Staff, Communication, Expertise Level, Standards, and Facilities. The reliability of the measurement tool was examined using Cronbach’s alpha. T test was used to compare score mean of hospital quality and the related dimensions between public and private hospitals. The relationship between dimensions of hos­pital quality was calculated using Pearson correlation coefficient. Total hospital quality scored 73.29%. The hospital quality dimensions were rated as follows: Staff, 80.89%; Communication, 56%; Expertise Level, 80.67%; Standards, 75.44%, and Facilities, 71.67%. The overall hospital quality and all related dimensions except communication were rated significantly higher in private health settings as compared to public hospitals. A significant correlation was found between all dimensions of hospital quality as perceived by medical tourists, except between communication and facilities. The strongest correlation was found between Standards and Expertise Level. The former dimension was also found on average the strongest predictor of other dimensions. While the overall quality of hospitals is generally satisfactory in terms of the measured dimensions, employee communication with tourist patients is challenged by their poor English language skills. Therefore, both private and public hospitals need to address this deficiency by appropriate strategies. Our results also suggest that promoting hospital standards could significantly improve other aspects of hospital quality.

Clinicians in many countries increasingly use Personal Digital Assistants (PDAs) as an assisting tool in clinical practice. The pattern of PDA usage by clinicians in Iran has not been characterized. This study explored the attitudes of Iranian residents and interns toward medical uses of PDA. An interview-based qualitative study was carried out in 2011. A purposive sampling method was ad­opted. Interviews were conducted with 11 interns and 10 residents at two teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS). Data was collected using semi-structured questions. Constant Compara­tive Analysis was used for data analysis. All surveyed clinicians used the PDAs in medical applications. Usage themes were decision support resourc­es (95%), drug references (76%), electronic books (72%), web browsing (48%), medical dictionaries (38%), anatomy and medical atlases (33%), and laboratory applications (19%). UpToDate® was by far the premier decision support resource used by subjects. iPharm® and Lexi-drugs® were the most-referred-to pharmaceutical guides. Google was the only search engine for online information retrieval. Clinicians expressed their highest satisfaction with decision sup­port resources and e-books. Within its limitations, this study indicated that the most frequent medical uses of PDAs are those more directly associated with patient care (decision support resources and drug references). This finding encourages further large-scale studies to examine whether a similar practice pattern is prevalent among Iranian clinicians and to which extent it influences patient outcome. If a high prevalence and high impact is revealed, the barriers to PDA use by clini­cians should be identified and overcome.

Evidence shows that transfer of hospital governance to board of trustees can positively influence hospital performance. Iran has initiated implementing such a transformation and a number of hospitals have been involved in this reform. This study aimed to explore the effectiveness of such a reform by examining performance profile of a sample hospital across the intervention time segment. Data was collected in 2011 from a university hospital affiliated with the Ministry of Health and Medical Education. Bed Occupation Ratio, Average Patient Stay, and Real Hospital Income were selected as the target per­formance measures. Data was collected on a seasonal basis by reviewing hospital performance reports within the period of 3.5 years prior and 3.5 years after the intervention. The data were analyzed using the interrupted time series analysis. P < 0.05 was considered as statistical significance. Transfer of hospital governance to the board of trustees per se does not lead to improved hos­pital performance. Realizing the advantages of board-of-trustee-based hospital governance would be contingent on identifying and fulfilling prerequisite conditions. To this aim, further research at both government and organizational levels is required.

Military hospitals play a crucial role in delivery of healthcare services to patients during emergencies. Despite that, limited studies have attempted to characterize factors affecting quality of work life in em­ployees of military health settings. To contribute in filling this gap, this study explored employee occupational stress in a military hospital, situated in the western region of Iran. A descriptive-analytical study of cross-sectional design was conducted in 2011. All employees work­ing in the 597 Army Hospital (n = 76) were surveyed. Data was collected using questionnaire. Reliability of the scale was ensured by Cronbach’s alpha of 0.94. Descriptive statistics was employed for data summarization. T test and ANOVA were used to compare mean scores of occupational stress between demographic and professional groups. Occupational stress among employees averaged 46% ranging from 26% to 91%. While 25% of sub­jects reported low occupational stress, 58% showed moderate stress levels, and 17% expressed high stress lev­els. Clinicians showed significantly higher occupational stress as compared with administrative staff (P = 0.029). No significant effect was identified for other demographic and professional characteristics including age, sex, marital status, educational level, and work experience either between entire employees, or between clinicians. By finding considerable or high stress among three forth of the employees, our study support the notion that employees of military hospitals are more prone to occupational stress as compared with the personnel of civilian health set­tings. In addition, expression of higher stress levels by healthcare employees compared to their administrative counterparts shows that working conditions in military health settings are even more stressful for clinical staff. These findings add weight to the urgency of devising coping strategies to alleviate occupational stress in clinicians of military hospitals.

Stress among students of the health sciences can lead to reduced performance of future healthcare human resources. To address this threat there is a need to develop a robust understanding of the nature and inten­sity of stress in these professionals. To help approaching this goal, the present study assessed stress-induced life change in students of Tehran University of Medical Sciences by quantifying their stressful life events. A cross-sectional descriptive-analytical study was carried out. Using a cluster sampling method, 248 stu­dents were randomly selected from the students of medicine, nursing, dental medicine, pharmacy, allied-medicine, health, midwifery, medical management and information, and rehabilitation disciplines. Based on the concept of Life Change Units (LCU), a questionnaire was developed to quantify the stressful events in student life. The questionnaire contained 54 weighed items about stressful life events related to four groups of interpersonal (10 items), personal (16 items), academic (14 items), and environmental (14 items) stress sources. Validity of the questionnaire was determined by expert opinion. The questionnaire reliability was ensured by Cronbach’s alpha of 0.88. The mean LCU loading of demographic groups was compared using t test and ANOVA. The average LCU loading in student was 71. Twenty seven percent of the students reported an average LCU loading < 50, 46%, LCU loading between 150-300, and 27%, LCU loading > 300. The highest reported life changes were related to personal factors (86), followed by interpersonal (79), environmental (63), and academic (55) factors. Male students showed significantly higher life change as compared with their female counterparts (P < 0.01). Students of medical and graduate courses jointly expressed significantly higher life change as compared with the under graduate students (P < 0.01). Students of nursing showed significantly higher life change in comparison to other students except medical students (P < 0.01). Upper-year students reported higher life change as compared with freshman students (P < 0.01). LCU loading was found significantly higher in students with sleeplessness (P < 0.05) and muscle spasm (P < 0.05), whereas no significant effect was observed for other clinical symptoms. Our study indicated that a considerable percentage of students are exposed to a high risk of health problems. This observation points out the urgent need for implementing effective stress management strategies to assist students in coping with stress. Such a strategy should primarily focus on enhancing students’ personal life man­agement and communication. Male and upper-year students need to receive particular attention. Stress in students of medical and nursing disciplines needs to be specifically characterized and addressed.

Balanced Scorecard is an increasingly popular tool for performance evaluation. Health­care organizations have broadly adopted this method for implementing their strategic plans. There is, however, increas­ing concerns on barriers to balanced scorecard implementation. Built on the fundamental impacts of organizational culture on hospital performance, this study explored the relationship between balanced scorecard effectiveness and organizational culture. A descriptive analytical study of cross-sectional design was conducted within the period of August 2009 to June 2010. One hundred and fifty employees of Hasheminejad Kidney Center were enrolled. The questionnaire com­prised two items addressing balanced scorecard effectiveness and 60 items related to four dimensions of organizational culture, including Involvement, Consistency, Adaptability, and Mission. Validity of the questionnaire was examined by seeking expert opinion. A high reliability of the questionnaire was ensured by obtaining a Cronbach’s alpha of 0.94. Sur­vey results were summarized using descriptive statistics. The relationship between organizational culture and balanced scorecard effectiveness was measured using Pearson’s correlation coefficient, and modeled via regression analysis. Balanced scorecard effectiveness showed significant correlations with Involvement (r = 0.44, P < 0.01), Consistency (r = 0.27, P < 0.01), Adaptability (r = 0.28, P < 0.01), and Mission (r = 0.35, P < 0.01). Multiple regression analysis identified Involvement as the only predictor of BSC effectiveness (β = 0.431, P < 0.01). While all factors of organizational culture can influence balanced scorecard effectiveness, employee involvement holds prime importance. Hence, hospital leadership needs to strongly encourage employee involvement in organizational processes, in order to achieve high effectiveness of balanced scorecard.

Standard clinical documentation is an integral part of quality patient care. This study aimed to explore compliance of two Iranian teaching hospitals with the clinical documentation standards. A total of 400 records were surveyed. Data were collected using a checklist of standard measures. The checklist comprised 15 items selected from relevant guidelines from either the American Health Informa­tion Management Association or Iranian Ministry of Health and Medical Education. Data were analyzed using descriptive statistics. On average, 50.2% of medical records were provided in high compliance with standard measures, 26.4% in moderate compliance, and 23.4% in non-compliance. The average highest frequency of compliance with documentation standard was received by “Only blue ink is used for writing” (92%), followed by “Consent forms are completed” (79%) and “Highlighter pen or correction pen is avoided” (71%). The average lowest frequency of compliance with standards was identified for “Admission form is typed and inserted as first page” (0.5%) followed by “Unusable elements for patient are mentioned” (0.75%), and both “Error corrections (if any) are signed and dated by the editor.” (2.52%), and “Cause of error reporting (if any) is mentioned.” (2.52%). Our results indicated an unsatisfactory level of compliance with clinical documentation standards in the studied hospitals. In addition, some of the lowest rated measures were related to documentation of errors in data re­cording and their subsequent correction, which can potentially lead to adverse patient outcome or legal consequences. Hence, our study provides further evidence for the urgency of developing strategies to improve commitment of Iranian hospitals to clinical documentation standards.