مقالات رزومه دکتر نیوشا شهیدی صادقی

Similar to many countries, Iran is committed to achieving universal health coverage. As such several laws have been approved regarding rehabilitation services. Examining these laws shows that there are many legal challenges in the functions of the health system including procurement, financing, resource production, service delivery and accountability, and service quality. Also, the problems of governance in Iran include unbalanced policies and laws, irresponsible intervention, weak all-round supervision, lack of thoughtful and compassionate management, and inconsistency within and between departments. In addition, rehabilitation financing in Iran is unbalanced. In the third chapter of the law of the sixth development plan, the challenges and problems of supportive institutions, especially the lack of credit and coverage gaps were brought into attention. It was emphasized that the needs cannot be met with direct support approaches. Contrary to many countries that have specific laws for recording and analyzing information for disabled people, Iran is in its initial stages of forming a database for them. Furthermore, the comprehensive law on the protection of the rights of the disabled in 2013 is not a right-oriented law emphasizing the recognition, and does not guarantee their rights equal to ordinary people; instead, it has a welfare perspective on the issue. The presence of government organizations such as Ministry of Cooperatives, Labor and Social Welfare, and the National Welfare Organization has caused the law to become a support-economic with the dominant discourse of rehabilitation instead of empowering disabled people and becoming a budget-oriented law.

Clinical Governance (CG) is an organizational strategy for maintaining and improving the quality and safety of patient care and increasing employees’ and managers’ responsiveness and accountability through developing an appropriate organizational structure and culture as well as developing, implementing and monitoring clinical guidelines, pathways and standards. This study aimed to examine the success of CG implementation in university hospitals, in Tehran, Iran.

In this descriptive analytic study, a researcher-made questionnaire was filled out by managers and CG executive managers of 39 university hospitals in Tehran/ Iran. Data analysis was done through SPSS software and using Pearson, Spearman and logistic regression.

Clinical Governance was moderately successful in Tehran university hospitals (58%). The most success was achieved in patient involvement and risk management dimensions and the least success was observed in clinical effectiveness and clinical audit dimensions. Management and leadership and clinical audit had the most effect on CG success. The involvement and commitment of managers and employees in implementing CG were moderate and physicians’ involvement and commitment was poor. The length of CG implementation time had significant relationship with managers’ and employees’ commitment and CG success.

Clinical governance was not successful in Tehran university hospitals. Active involvement and commitment of top managers, staff empowering, patient centeredness, evidence-based practice, and clinical audit are necessary for successful CG implementation.

This study was conducted via a systematic review of causes and solutions to reduce insurance deductions of hospitals in Iran. This study was conducted via a systematic review. The researchers reviewed studies that investigated the causes or solutions to hospital deductions or both of them up to 2017, based on keywords that included deductible, hospital, bill of insurance, and hospital records through databases, search engines, and related journals. The extracted data form for each article was completed and finally, the data were categorized, summarized, and analyzed. In the initial search, 114 articles were found. After reviewing the inclusion and exclusion criteria, 21 articles were analyzed. The main categories of the reasons for deductions were comprised of 15 areas that were classified into the two main areas of documentation flaws during the provision of services and the difficulties with the preparation, adjustment, and sending documents. Analyzing the articles for the reduction of deductions showed that these solutions were classified into 9 main areas of reforming the planning, training, monitoring, reforming the registration process, governance issues, reforming the documentation process, reforming the structure, complying with the rules of the insurance organization, and modifying the process. Computational errors, lack of hospital supervision, and errors related to the date and time of the documents constituted the main causes of deductions, and the reform of planning, education, and supervision were among the most important suggested ways to reduce deductions. Reviewing professionally related papers showed that specialist doctors and nurses are professionals who are more involved in making deductions. In terms of the type of offered services, the surgery, paraclinical services, and the drug were at the top of the reasons for deductions. The hospitals affiliated to the Ministry of Health, which are faced with the problem of inadequate hospital revenues, as well as chief executives, can benefit from the results of this study to understand the financial performance of these centers.

Implementation of clinical governance (CG), as a strategy for improving the quality, safety and effectiveness of health services, has encountered challenges in Iranian hospitals. This study aimed to identify barriers to clinical governance implementation in Tehran hospitals, Tehran, Iran. This descriptive cross-sectional study was carried out in 92 hospitals in Tehran that had implemented CG in 2014. Data were gathered using a researcher-made questionnaire assessing the human resource, managerial, cultural, procedural and structural barriers of CG. Data analysis was performed through SPSS software (version 20) and using descriptive and inferential statistics. The mean score of CG implementation barriers in Tehran hospitals was 3.36 out of 5. Human resource (mean score: 3.69) and cultural barriers (mean score: 3.02) were the most and least barriers of CG implementation respectively. Simultaneous implementation of accreditation, lack of a continuous improvement culture, staff insufficient motivation, CG bureaucracy and lack of time had respectively the most negative effects on CG implementation. Commitment and participation of senior managers, staff and doctors were low in CG and indeed had a significant relationship with the CG managerial barriers in hospitals. Tehran hospitals encounter many barriers in implementing CG. Policy makers should consider the structure and culture of the hospitals and staff organizational maturity to develop an appropriate CG model. Besides, hospital managers should address the existing barriers and create an appropriate organizational structure and culture to facilitate CG successful implementation.

Successful implementation of clinical governance improves the quality and safety of healthcare services and enhances the accountability of managers and employees. This study aimed to examine the success of clinical governance implementation in Tehran hospitals.
A valid and reliable questionnaire was used for the aim of this study. 144 questionnaires were distributed among the hospital managers. Data analysis was performed using SPSS software and descriptive and analytical statistics.
92 questionnaires were returned and analyzed. Clinical governance implementation was moderately successful in Tehran hospitals (the mean score of 2.82 out of 5). The most and least success were achieved in patient involvement and clinical audit respectively. Managers and employees’ commitment in implementing clinical governance was assessed as moderate. The involvement of about 70 percent of physicians was less than average. There was a statistical meaningful correlation between managers’ commitment and clinical governance success.
Implementation of clinical governance in Tehran city hospitals was not successful. Using an appropriate model for implementing clinical governance, management and leadership commitment, clinical staff involvement and information and process management are necessary for successful implementation of clinical governance.

Manpower is the most important input in any organization. Unfortunately, despite the importance of this issue in organizations such as hospitals, few studies have addressed this topic. The aim of this study was to determine the correlation between trust and organizational identification and characteristics of the nursing practice environment and their dimensions in Tehran City hospitals. In this descriptive-correlational study, 200 of nurses from nursing management categories according to Morgan table and simple random selection method were participated. Data were collected by "Trust and Closure Audit Questionnaire created by Learning Center" and “Measuring organizational traits of hospitals: The revised Nursing Work Index". The validity of the instruments were measured by content validity and reliability was assessed by Cronbach's alpha of 0.90. Data was analyzed by SPSS/20. The proportion of high-level (2.51) trust and organizational identification and characteristics of the nursing practice environment is at the lower level (2.30). Trust and organizational identification and characteristics of the nursing practice environment and all of its dimensions (P<0.05, r=0.474) except the employment relationship (P>0.05, r=-0.020) have a direct linear relationship. Moreover, characteristics of the nursing practice environment and trust and organizational identification and all of its dimensions (P<0/05, r=0.474) have a direct linear relationship. Trust and organizational identification and characteristics of the nursing practice environment, also characteristics of the nursing practice environment and trust and organizational identification and all of its dimensions have a direct correlation. The hospital managers can improve performance and ultimately a positive step in improving the quality of nursing care and safety, by the promotion of trust and organizational identification and characteristics of the nursing practice environment.