جستجوی مقالات مرتبط با کلیدواژه « مدیریت کیفیت » در نشریات گروه « پزشکی »

Equitable geographical distribution of healthcare system initiatives, aimed at increasing quality and economic efficiency, is a crucial aspect of ensuring access to healthcare services. This study seeks to elucidate the contextual, procedural, and outcome factors of health marketing in Iran, with a focus on enhancing and improving health services.

This research was conducted using a qualitative approach. The sampling method employed was purposive, resulting in the participation of 51 experts. The study data were analyzed using content analysis.

The findings of this study have been categorized into conceptual subgroups, including causal conditions, foundational components, strategies, contextual factors, intervening factors, and consequences of implementation.

Adopting an effective health marketing model can create opportunities for service providers to generate sufficient income, thereby motivating them to deliver high-quality services. Attracting ample income, in addition to ensuring service quality for recipients, will also lead to their satisfaction with the healthcare system and contribute to the continuous provision of desirable services.

Clinical Governance (CG) is a strategy for providing responsive, accountable, patientcentered, high quality, safe and effective healthcare services through creating an appropriate organizational structure and culture. Development, implementation and monitoring clinical standards are also included in CG. This study aimed to assess the success of clinical governance implementation in hospitals in Khuzestan province, Iran.

This descriptive questionnaire survey was conducted in 2014 in 40 hospitals using a valid and reliable questionnaire covering seven dimensions of CG (i.e., management and leadership, employees’ education and management, clinical effectiveness, clinical audit, risk management, patient involvement, and information management). All clinical governance officers of hospitals were asked to complete the questionnaires. Overall, 40 questionnaires were returned. Data analysis was done using SPSS software. Ethical issues such as informed consent, voluntary participation, participants’ anonymity, information confidentiality and researchers’ objectivity in data collection, analysis and reporting were all considered.

The mean score of CG implementation success was 65.6 percent in Khuzestan province hospitals. About half of the hospitals were moderately successful in CG implementation. Hospitals achieved more success in employees’ education and management and less success in clinical effectiveness dimensions of clinical governance. Top managers’ and employees’ commitment and involvement in CG activities was critical for CG successful implementation.

Clinical governance was slightly successful in Khuzestan hospitals. However, strong management and leadership, managers’, employees’ and physicians’ participation, education and training, patient centeredness, evidence based practice, and clinical audits are necessary for successful implementation of CG in hospitals.

Primary care governance has been in force since 1999 with the introduction of general practices into local primary care groups in the United Kingdom. The aim of primary health care (PHC) governance is to ensure the use of evidence-based medicine in PHC groups and to reduce the variability in access to PHC services to improve health outcomes and promote the standards of services provided to customers. This study was conducted to validate the primary health care governance model of Iran.

This is a qualitative study. The primary health care governance model components came from the literature review, focus group discussions, and interviews were sent to 40 qualified professionals through the Delphi form. Based on the median score and by holding four experts’ panel sessions, the model was approved. Evaluation indicators of the model were proposed through literature review and expert meetings. By sending these indicators along with other components of the model in the Delphi questionnaire to 30 qualified specialists, the final model was confirmed with the calculation of CVR and CVI in two Delphi rounds.

Proposed Iran’s PHC governance model, with a fundamental pillar, leadership, five main pillars (quality management, community involvement, health information management, human resource development, monitoring and evaluation), 22 components, and 64 assessment indicators, was designed to reduce the weaknesses and challenges by relying on strengths and opportunities of the system.

Iran’s primary health care governance model has the potential to improve the quality and increase accountability level in the health system of the country and to evaluate the progress of the health care system toward the excellence.

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.

Quality management, as an organizational strategy, helps enhance hospital effectiveness and efficiency. This study aimed to examine the effect of a quality management model on the efficiency of the respiratory intensive care unit in Labafijejad Hospital, Tehran in 2013-14.
This was a participatory action research conducted in the respiratory intensive care unit in Labafijejad Hospital, Tehran in 2013-14. A quality improvement team was formed to implement the quality management system and promote working processes. The team identified and standardized working processes, determined the quality goals for the processes, and improved the processes based on the 10-stage Mosaddeghirad Quality Management model. Performance indicators of the unit (bed occupancy, bed turnover, and bed interval rates; patient average length of stay in the ward) were calculated and compared before and after the intervention.
Implementing quality management brought about an increase of 2.8% and 19.2% in bed occupancy rate and bed turnover rate, respectively, as well as a decrease of 14.1% in patient average length of stay and a decrease of 35.6% in bed interval rate in the respiratory intensive care unit of the hospital.
Implementing quality management can increase the efficiency of the respiratory intensive care unit of a hospital. A suitable quality management system and the commitment of the hospital manager and staff can result in enhancement of efficenicy in a hospital.

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.

Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.

Patient satisfaction is an important indicator of healthcare quality and effectiveness. Quality management as an organizational strategy enhances the quality of hospital services through continuously improving hospital structures and processes. This study aimed to examine the impact of quality management on patient satisfaction.
A participatory action research was conducted in respiratory intensive care unit, at Labafinejad hospital, Tehran, Iran, in 2013. A quality improvement team was established. Operational processes were improved using a quality management model. The quality improvement team standardized processes, identified quality goals for the processes and improved them until achieved quality goals. Patients’ satisfaction data was collected before and after the intervention using a valid and reliable questionnaire.
Patients’ satisfaction was 75 percent at the beginning of the study. Patients were mostly dissatisfied with the nutrition services, amenities, lack of attention to their personal needs and lack of involving them in their treatment processes. An action plan was developed for improving patient satisfaction. After the quality management intervention, patient satisfaction reached to 81 percent at the end of this study. The quality management model improved the quality of services by 54.5 percent and consequently increased patient satisfaction by 7.2 percent. Almost half of the patients at the beginning of this study were definitely willing to recommend the hospital to their friends and relatives. This figure increased to 76 percent. The rest of patients stated that they may recommend the hospital to others.
Implementing an appropriate quality management model appropriately in a supportive environment helps improve the quality of services and enhance patient satisfaction and loyalty.

The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.
A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department. Related data were collected before and after the intervention to determine the effect of quality management system on deductions.
The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.
Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively

Identification and removal of the barriers of putting clinical governance into practice facilitate its successful implementation. This study aimed to identify the barriers of clinical governance implementation in Khozestan province hospitals in 2014.
A valid and reliable questionnaire was used for conducting this descriptive cross-sectional study. The questionnaire assessed five issues including managerial, cultural, human resource, procedural, and structural barriers of clinical governance. Questionnaires were completed by clinical governance officers in 40 hospitals of Khuzestan province. All statistical analyses )descriptive and analytical( were done using SPSS. Ethical issues such as informed consent, confidentiality of information and researchers’ objectivity were all considered.
The mean score of clinical governance implementation barriers in studied hospitals was 2.92 out of 5. Structural and managerial barriers were respectively the most and least barriers of clinical governance implementation. Lack of doctors’ involvement in clinical governance, insufficient financial resources for implementing clinical governance and the bureaucracy involved in clinical governance had created the greatest obstacle in implementing clinical governance.
Hospital managers should overcome the barriers of quality management techniques such as clinical governance before implementing these techniques. In addition, they have to create an appropriate structure and organizational culture in order to facilitate the successful implementation of clinical governance. Besides, health policy makers should develop an appropriate clinical governance model considering the structure and organizational culture of the hospitals.

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.

The ability of managers to use accurate, reliable, and up-to-date information is an important factor for organizational success. The aim of this study was to investigate the role of information management in the successful implementation of clinical governance in the hospitals of Khuzestan province, Iran.
This descriptive-analytical study was conducted in 40 hospitals of Khuzestan province in 2014, using a valid and reliable researcher-made questionnaire included 35 questions about 7 dimensions of clinical governance. All clinical governance managers of the hospitals were asked to complete the questionnaire. Data were analyzed using descriptive statistics and inferential statistics (such as correlation coefficient and logistic regression) by SPSS 19.
The mean success rate of clinical governance in the hospitals of Khuzestan was 65.6 percent. The mean score of information management of clinical governance was 62.4 percent. There was statistically significant relationship between information management and successful implementation of clinical governance (P=0.01). Appropriate use of health technology and information systems by the staff, staff training in data documentation, and using hospital information in decision-making process, planning, control, and evaluation had great effect on the successful implementation of clinical governance.
Due to the important role of accurate, reliable, and up-to-date information and information management system in the successful implementation of clinical governance, hospital managers should provide necessary facilities for collection, analysis, and use of hospital information. Hospital staff should be trained in data documentation.

Employees’ job satisfaction has a significant effect on providing high quality services to patients. The aim of this study was to examine the impact of quality management on job satisfaction of Operating Theatre Department employees of Valiasr Hospital in Tehran in 2014.
This participatory action research was performed on employees of Operating Theatre Department of Valiasr Hospital in Tehran in the first six months of 2014. Employees’ job satisfaction was measured using a reliable questionnaire and the causes of employees’ dissatisfaction were determined. Then, the employees’ working processes and job satisfaction were improved using a ten-step quality management model provided by Mesdagh Rad. Employees’ job satisfaction was statistically compared before and after the quality management intervention using SPSS 18.
Employees’ job satisfaction was 51.2 percent. High work pressure, compressed shift schedule, high job stress, lack of organizational justice, reward system, and inappropriate encouragement, and lack of attention to the employees’ needs, especially on the night shift, were the main causes of employees’ dissatisfaction. Employees’ satisfaction after intervention was 59.2 percent. The results showed that quality management improved employees’ satisfaction by 15.6 percent. Employees’ job satisfaction before and after the intervention was significantly different (P=0.000). Quality management principles such as management commitment, employees’ empowerment, teamwork, trust and cooperation, effective communication, continuous training and learning, customer focus, and continuous quality improvement have positive effect on employees’ job satisfaction.
Implementing an appropriate quality management model enhances job satisfaction of hospitals employees.

Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity.
This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle.
The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation.
Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.

Quality management as an organizational strategy helps enhance hospital efficiency, effectiveness and productivity. This study aimed to examine the impact of quality management on employees’ job satisfaction at Respiratory Intensive Care unit, Labafijejad Hospital. A participatory action research was used for the intervention in 2013. A quality improvement team was established and operational processes were improved using a quality management model. The quality improvement team identified and standardized working processes, identified quality goals for the processes and improved them until achieved quality goals. Employees’ job satisfaction data was collected before and after the intervention. The quality management model implementation improved employees’ job satisfaction at the Respiratory Intensive Care unit. Employees’ job satisfaction was increased from 56.6 percent in 2013 to 68.3 percent in 2014. Integrating employees’ needs in quality improvement activities helps sustain the benefits of quality management. As a result, employees’ moral and satisfaction increase. Implementing an appropriate quality management model appropriately in a supportive environment helps enhance employees’ job satisfaction and morale. Manager's and employee's commitment and involvement in quality improvement activities are required for successful quality management implementation.

Improving quality and safety of hospital services is a challenge for managers. Utilizing an appropriate nosocomial infection management model can improve the quality of safety procedures; quality of care and reduce the nosocomial infections. This study aimed to survey the effect of nosocomial infection management model on reduction of nosocomial infections at Hospital of Jahrom 2014: performing an action research study. The undergone action research study through necessary intervention was performed in 6 months. Two valid & reliable checklists including “Hand Hygiene Checklist “and “Sterilization of Surfaces and Patient Care Units Checklist” were completed and scored before and after the intervention. Data were analyzed using SPSS/22. With the implementation of “Nosocomial Infection Management Model” due to structural problems, infections was increased three times during the last 6 months of this survey compared to similar months in past year. However, implementation of the model decreased the nosocomial infections’ rate by 39% compared to the first three months of the same year. Utilizing “Nosocomial Infection Management Model”, plays a significant role in reducing the nosocomial infections. Hence applying this model in hospitals is recommended.

during last decades, attention to ergonomic factors has been increased. Nowadays, most ergonomic assessors in workstations, assess ergonomic factors, considering either technical requirements or workers needs, both of which can affect design efficiency. But it seems an integration model of these two factors can be more effective. So this paper aims to present a pattern to assess work place ergonomically, considering both technical needs and workers’ needs. present study is a kind of descriptive model solution studies, which uses a joining method of Kano model and Quality Function Development (QFD) to develop workstation optimal design. A survey was performed among 350 workers at industrial plants to identify problems of ergonomic factors in their work stations. Data gathering was translated into Kano questionnaire. Then it was clarified and used in the House of Quality matrix. Finally in a joining model, a method is presented which is able to prioritize ergonomic requirements and technical characteristic in to an optimal design. the most important factor of workers requirement was safety tools and healthy conditions, such as air pollution and temperature stresses. The most important factor of technical requirement was cost and presence of national valid standards and attention to comfort in during the jobs. Industrial managers should choose optimal strategies concerning their workers requirements and information feedback from them. Also they should provide their workers comfort and satisfaction concerning technical needs to gain most profit and less cost.

Considering the role of nurses in health organizations and the transcendent goals of organization, their intention to leave is among the most important managerial concerns of human resource management. The aim of this study was to determine and compare nurses’ intention to leave in hospitals of execute/non -execute organizational excellence model in Tehran University of Medical Sciences. This comparative descriptive cross-sectional study was conducted in 2013. The study population included all nurses working in hospitals of execute/non-execute organizational excellence model in Tehran University of Medical Sciences. A total of 248 nurses were selected by random stratified sampling method. Data was collected by Hinshaw “Turnover Prediction Scale” and analyzed by descriptive and inferential statistics (Independent T-Test) using SPSS-PC (v. 17). The results showed that the mean score of intention to leave in the nurses working in hospitals of execute/non-execute excellence model was 33.64 ± 5.58 and 35.59 ± 4.94 respectively. Moreover, the findings revealed that 21.6 % and 18.7 % of the studied nurses from non-execute and execute hospitals had a high level of intention to leave respectively. The independent “t “test indicated significant difference in the mean score of turnover intention (P = 0.004). According to the findings, it can be concluded that the organizational excellence models by providing an appropriate activity context for nurses and enhancement of their motivation and satisfaction, could prevent their intention to leave.

Implementation of quality management system in hospitals could lead to improved performance of the services. This study evaluated the effect of a quality management system (ISO 9001-2000) on services effectiveness in Shohada hospital at Kermanshah, Iran.

This was a before and after quasi-experimental study. The mean duration of hospitalization, hospital infection rates, mortality, and patient and staff satisfaction was measured. Data were analyzed using SPSS software.

The results indicated an increase in staff and patient satisfaction mean score and reduction in hospital infection rates, hospitalized patients mortality rate, and the mean duration of hospitalization after implementation of the system.

It seems that ISO 2000-9001 system implementation could be useful in improving hospital efficiency. It was an appropriate cost-benefit economical project.

The higher education system of each country plays the major role in economic, social and the cultural development. The purpose of the present study was to determine the performance self-assessment score of Islamic Azad University at Qom Branch based on EFQM Excellence model. In this descriptive cross-sectional study, 207 staffs of managers, experts and faculty members of Islamic Azad University at Qom Branch were selected using stratified random sampling method in 2011. The modified version of EFQM questionnaire was used for data collection. Data was analyzed using SPSS 16 software and stusent T test. The University’s performance self-assessment mean score in the area of enablers was 229 and in results area was 233. The highest score obtained in enablers’ area was associated with leadership criterion (4.80 ± 2.22) and the lowest score was related to strategy and policy (4.41 ± 2.18). Population results criteria obtained the highest (5.08 ± 2.28) and the staff’s results obtained the lowest (4.10 ± 2.18) scores of the results area. In view of managers, experts and faculty members, Islamic Azad University at Qom Branch obtains 462 out of 1000 possible sores of EFQM Excellence Model. Moreover, it is at an average but desirable status.