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سال هجدهم شماره 2 (تابستان 1398)

Intensive Care Unit (ICU) in hospitals is one of the most sensitive and costly units which is really important due to safety and health of patients during their stay in these units. Hence, considering the potential risks in this unit, treatment operations for eliminating or decreasing risks are very important. Among these intensive care units, the most important one is the open-heart surgery unit which may have irreparable damages due to vulnerability of these patients in the process of their transfer, care, and discharge. The present study aims to identify the potential risks and offer solutions for eliminating or decreasing them. In this research, we used Failure Mode and Effect Analysis (FMEA) method, which is a very useful method for evaluating and managing the risks, to prioritize risk factors. Due to some limitations of the method, fuzzy FMEA and fuzzy TOPSIS methods were also used in order to have more precise results and then the results were compared with each other. The suggested approach was implemented in ICU-OH (open-heart) unit of Kowsar hospital in Semnan. Finally, nineteen factors were recognized as major risk factors. Also, corrective actions were determined for all detected risks that can be pursued according to their priorities. Factors including not observing hemodynamic signs, not considering patient safety and security, and inability to interpret arterial gas valve abnormalities are the three top risk factors that can be addressed through training and having more control on nurses.

One of the main concerns of managers is work deviant behaviors of employees. Workplace deviance is voluntary behavior that violates significant norms and in so doing threatens the well-being of an organization, its members or both. The study aimed to explore the relationship between emotional intelligence and organizational citizenship behavior with work deviant behaviors.
  This study was a cross-sectional descriptive analytical one. This study was conducted on 290 employees (administrative workers and nurses) working in four selected hospitals in Tehran city including Shahid Motahati, Shahid Rajaii, Hazrat-E-Rasol, and Dr. Shariati. Sampling method was stratified random sampling method. Data collection instruments were three questionnaires including Schutte’s emotional intelligence, Padsakof organizational citizenship behavior, Bennett and Robinson’s work deviant behavior. Validity and reliability of the questionnaires has already been verified in studies before. Data analysis was performed using independent T-test, ANOVA, Tukey and parametric Pearson's Correlation Coefficient.
  Among demographic and organizational variables, There was a significant relationship between age and work deviant behavior (P=0.012). Reverse significant statistical relationship between emotional intelligence, organizational citizenship behavior and courtesy with work deviant behavior was observed (P=0.0001).
  The study results revealed that personnel with higher emotional intelligence will have a more positive attitude and more allegiance and commitment toward the organization; therefore they will show more organizational citizenship behavior and less inclined to abuse in the workplace.

Iranian health system transformation plan has been implemented since 2014 with the aim of financial protection of people, equity establishment in access to health services and quality improvement of hospital services. Hospital performance evaluation is essential in order to monitor the health system transformation plan. One of the tools for evaluating hospital performance is the dynamic multi-attribute decision-making method. The purpose of this study was to use the dynamic multi-attribute decision-making method to evaluate the performance of the hospital before and after the implementation of the health system transformation plan. In this cross-sectional study, the performance of Shariati Hospital in Tehran was evaluated for 48 consecutive months (24 months before and 24 months after the Health System Transformation plan, 2012-2016). Each month was addressed as an option in the decision-making matrix and ,with considering six important health indicators, the hospital performance was dynamically assessed  using the weighted aggregated sum product assessment and through EXCEL software 2010.  Hospital performance scores had some fluctuations over time; however, in general, it had an increasing trend over forty-eight months. The highest and lowest values were for months 42 and 13 (0.4932 and 0.9408, respectively). In addition, in the first month of the solar year, the hospital performance score declined significantly for each year. Changes in hospital performance scores during the study period show improvement in hospital performance. Nevertheless, this incremental process cannot be considered as a positive outcome of the health system transformation plan. Therefore, while improving the current process, continuing the hospital performance evaluation can lead to the hospital's performance promotion.

One of the most important ways to promote the quality and attractiveness of the journal for readers is the accurate evaluation of the published articles research methodology in the journals. The purpose of this study was to investigate the research methods of the articles published in the Journal of Hospital.
  In this descriptive study, the research methods of all articles published in the Journal of Hospital from Fall 2016 to Fall 2018 including qualitative or quantitative, field or library research , data collection methods, data analysis software, location of research, nature of the research (descriptive or analytical, etc.), topics, as well as the number of authors were investigated.
  Data of 55.29% of papers was qualitative that was turned to quantitative, 47.06% of articles had descriptive-analytical method, and 68.24% of papers had employed a field research method. In addition, 51.76% of articles had used questionnaire and the SPSS software was used in 52.08% of the articles. The location of 45.45% of researches was in Tehran province. Finally, the subject of 23.53% of papers was policy making, planning, leadership, and management in hospitals.
  Most authors of the articles have followed a very similar research method during the mentioned period. So, creating diversity in the nature of the researches, using other methods of collecting information rather than questionnaires, doing more library research, and not limiting the researches to Tehran province are the most important suggestions for future researchers.

The complexity and intensity of environmental fluctuations combined with unexpected accidents and dangers have increased the probability of hospital supply chain disruptions. Supply chain resilience has been suggested as a strategy for dealing with such challenges and for continued provision of appropriate and efficient services in hospital at the time of disaster. The present study intends to identify the factors influencing hospital supply chain resilience.  This qualitative study was based on the content analysis of semi-structured interviews with 14 experts in the university hospitals in Bandar Abbas in 2018. Participants were selected through purposive and snowball sampling. The interviews continued until data saturation was reached. The obtained data from interviews were coded and analyzed using MAXQDA Software. After analyzing the data, the factors influencing hospital supply chain resilience were identified and classified into six main components and 30 themes. The main components included: staffs’ attendance, suitability, infrastructures safety, disaster management, support and capacity systems, and external factors. Based on the obtained results, it can be concluded that staff training, disaster management planning, command system, and surge capacity are the key factors influencing hospital supply chain resilience. Therefore, they should be taken into consideration while planning to promote hospital supply chain resilience.

One of the basic issues in health care organizations is the development of appropriate and correct cost information that can be used as a foundation for strategic decisions and proper pricing. Health care administrators should always be able to utilize existing resources in the most efficient and effective possible way. The calculation of the cost of services makes possible to achieve this goal.
Materials & The present research is a practical and quantitative study that was done retrospectively and cross-sectional in a descriptive-analytic manner. The information was collected in Excel format, and calculated costs of services using Time- Driven Activity Based Costing (TDABC) method. The cost of most radiology services and total CT scan services in the government unit was more than the delegated to private sector, and the average difference between the percentage of the cost of the two hospitals with tariffs was 17.7% for radiology services and 22.6% for CT scan services. The unused capacity of resources in the public sector was more than private. The time of services in the two hospitals was same except technician's career. The results of the application of the model showed that the government department needs for human resources management and in the delegated department to private sector, improving the processes of providing the service seems necessary. The standards of the most effective services provider centers are often worth the benchmarking. Assignment and replacement of low-cost resources is another solution that is effective in reducing costs.

Considering the increasing growth in health care costs along with the resources finitude; therefore, improving the efficiency and efficient use of resources is considered as one of the main priorities of the health system. The aim of this study was to determine the efficiency of direct medical services affiliated with Iranian Social Security Organization using Stochastic Frontier Analysis (SFA) Method in 2008-2015.

Materials & Methods

 In this descriptive- analytical study, performance of 30 units of direct medical services affiliated with Iranian Social Security Organization was analyzed using Stochastic Frontier Analysis (SFA) Method. The number of active beds, physicians, nurses and staff were used as inputs and combined variables obtained from factor analysis were selected as output. Frontier version 4.1 was used to determine the efficiency and Stata version 14 was used to study the effective factors on efficiency.

The average technical efficiency of studied units was 0.816. Based on the value of index of likelihood ratio test ( LR = 100.45 ), Cobb-Douglas production function was selected as the best model.
 

Based on the findings of this study, adjusting surplus manpower, congenital planning for increasing efficiency and resource management should be the priority of the managers so that they can increase the level of efficiency of studied units and reduce the costs to the least possible.

The present research aimed to assess the readiness of selected hospitals of Tehran University of Medical Sciences to implement quality improvement programs and clinical audits from the viewpoint of managers.

A descriptive-analytic study was conducted in May 2017 in four selected hospitals of Tehran University of Medical Sciences. The study population of this study was 20 managers of selected hospitals who were selected by census sampling method and entered the study. The data gathering tool was a two-part questionnaire whose validity and reliability were confirmed. In this study, we used SPSS software version 23 and statistical tests to analyze the data.

The effectiveness and readiness of hospitals to implement a clinical audit program was equal to 60% in the field of data and information, cardiology and feedback; 55% in resources, design and implementation, clinical audit management, and evidence and standards; 50% in illness and education; and 45% in manpower. Also, with increasing frequency of clinical audits, hospital readiness for quality improvement processes increases.

Due to the effectiveness and low readiness of hospitals in implementing a clinical audit program, especially in the field of human resources (45%), it is necessary that managers and planners of clinical audit programs in hospitals have a precise knowledge of these factors in order to control the organizational environment and help improve the effectiveness of audit programs.