مجله بیمارستان
سال نوزدهم شماره 4 (زمستان 1399)

The present study aimed to determine the causes of patients' readmission in hospitals affiliated to Bam University of Medical Sciences in 2019.

The current study was a descriptive-analytic study and the study population included patients readmitted in Pasteur Hospital in Bam, Javad Al-Aimeh Hospital in Narmashir, and Ayatollah Hashemi Rafsanjani Hospital in Regan in 2019. The samples consisted of 312 patient records which were chosen randomly. Data were collected by a checklist and were analyzed using SPSS software version 23 and descriptive and analytical tests (Chi-square and one-way analysis of variance).

The results showed that the internal medicine department received 34% of readmissions. The average readmission cost was 17,265,353 Rials. The most common reasons for readmissions were having a new disease (46.2 percent) and recurrence of the former disease (39.8 percent). Findings of inferential statistics revealed no significant relationship between the causes of readmissions and gender (P = 0.566), age (P = 0.065), or costs (P = 0.625), but there was a significant relationship between the causes of readmissions and marital status (P = 0.049) and married people had more readmissions than single people.

It is necessary to pay more attention to readmissions caused by disease recurrence. It is also possible to prevent such readmissions and improve the quality of medical services by standardizing hospital processes and tools, standardizing staff training, and employing new diagnostic and treatment methods.

The aim of this study was to investigate the factors affecting the physicians' decisions in prescribing medicine and in using national and foreign brands of medicine with the help of decision-making styles of Sprolls and Kendall models among physicians in Urmia. Given the prevalence of COVID-19 disease worldwide, physicians' decisions and preferences in prescribing medication are considered vital.

The present study is an applied survey.  The study population included 400 general practitioners, specialists and subspecialists in Urmia. The normality of data was measured using Kolmogorov-Smirnov test. Cronbach's alpha was also used for reliability of the questionnaire. Regression analysis was used to measure the strength or degree of linear relationship between two independent variables. SPSS software was also used for data analysis.

The results showed that out of six influential factors, five factors (quality, brand, newness, price, and loyalty) were identified among physicians. In addition to identified factors, a new factor namely "time and energy saving" was also a determining factor.

Considering the 7 factors influencing physicians 'decision-making, the results showed that physicians pay a great amount of attention to prescribing quality medicine in their preferences. On the other hand, the brand has a special place in physicians' decisions; therefore, drug companies and manufacturers should also care about branding their products.

Identifying the challenges of Quality Improvement Offices (QIOs) not only helps in planning the quality of hospital services and in trying to provide a suitable solution to solve the problems of these offices but also plays an important role in strengthening the offices and increasing the quality of clinical and non-clinical services of hospitals. This study aimed to investigate the challenges of quality improvement offices in hospitals and provide appropriate solutions.

The present qualitative research was conducted using semi-structured interviews with 40 managers and hospital boards, matrons, quality improvement experts of hospitals and accreditation offices experts of medical universities in Tehran. Content analysis method was used to analyze the data obtained from the interviews. Then, the collected data were analyzed and classified by MAXQDA10 software.

By analyzing the interviews in the field of challenges and solutions, the extracted codes were classified into four areas of management, standards, evaluation and staff. The most codes were related to management with 5 themes and 21 sub-themes. In addition, most of the solutions were related to the field of management.

The findings of the study showed that most of the challenges and solutions were in the field of management. Focusing on this field could be helpful in improving the quality of offices performance.

Clinical governance is one of the important frameworks for continuous quality improvement and safety in health care systems. Identifying the axes of this approach according to local conditions is one of the important priorities of the health system. The aim of this study was to identify the views of stakeholders on the axes of clinical governance in primary health care based on family physicians in Mazandaran province.

The present qualitative study was conducted using the conceptual framework analysis method in 2018-2019. The study population were key policy makers of Ministry of Health, Health deputy of the University, the county health network, family physicians association, family physicians, and the parliament research center. Participants were selected using purposeful and snowball sampling methods. Data were collected through semi-structured interviews and were analyzed and coded using MAXQDA 11 software.

According to the interviewees' views, the research findings were classified into 4 main dimensions: dimensions of clinical governance, requirements and structures, decision-makers and dimensions of quality and safety assessment. 17 sub-themes including community participation, clinical audit, clinical effectiveness, personnel management, training, information use, risk management, guidelines and procedures, promotion of health indicators, equipment and facilities, referral system, financing, policy makers, effectiveness, efficiency, human aspects of services and justice were identified and extracted.

According to the research findings, to facilitate the implementation of clinical governance, solutions such as the existence of appropriate infrastructure, commitment of managers, supportive culture, sufficient knowledge, monitoring and evaluation, appropriate culture building, facilities and equipment and sufficient financial resources are suggested.

In addition to providing effective and equitable services to low-income groups, teaching hospitals must obtain a significant share of the demand of high-income groups in order to have a balanced and positive operational performance. The aim of this study was to investigate the market orientation of teaching and medical hospitals in Qazvin.

This descriptive-analytical study was conducted at teaching and medical hospitals of Qazvin University of Medical Sciences in a cross-sectional manner in 2020. Data were collected in a one-month period through a questionnaire survey. The study population was the total staff working in 6 hospitals of this university who were selected using quota-random sampling method. The required data were obtained by collecting 411 market orientation questionnaires (Ahmad and Eqbal 2013) and were analyzed in SPSS 16 software. One-way analysis of variance with 95% confidence interval was used to compare the means.

The market orientation of all studied hospitals was 2.88 out of 5. Also, customer orientation had the highest average (3.32 out of 5) and paying attention to competitors had the lowest average (2.80 out of 5). The mean for dimension of coordination between tasks was 2.86 out of 5. Apart from paying attention to competitors, there was a statistically significant difference in terms of market orientation, customer orientation and coordination between tasks(P <0.05).

The status of the studied hospitals were in medium, high and below the average in terms of market orientation, customer orientation and attention to the competitor, respectively. To achieve a profitable service market, hospitals must implement a strategic plan against competitors and direct staff duties to strengthen market orientation.

Considering the importance and position of the health sector in socio-economic development programs, it is necessary to be aware of the current situation and to recognize its issues and problems. Determining costs and the amount of profit or even loss in the health sector helps in managing costs. The purpose of this study was to evaluate the cost of common laboratory services and compare them with the tariffs approved by the Ministry of Health and Medical Education in the selected hospital of Tehran University of Medical Sciences.

The present study was a cross-sectional and retrospective study. In this study, activity-based costing technique was used. The study population was the laboratory of the selected hospital of Tehran University of Medical Sciences. Data collection tools were information forms, software, interviews and direct observation. The analysis was performed using Excel 2016 software and finally, the cost price was compared with the approved tariff.

The findings indicated that the highest and lowest costs were related to the cost of manpower and energy carriers, respectively. The highest cost was related to the urine analysis test and the lowest was related to the sodium and potassium tests.

The results of this study showed that the cost of conventional laboratory services in the selected hospital of Tehran University of Medical Sciences and the tariffs approved by the Ministry of Health and Medical Education in 2019 were different.

In Iran, the accreditation system is mainly focused on hospitals and has not yet succeeded in providing standards for independent medical centers such as independent clinics. The present study reports the development of an accreditation framework for independent clinics affiliated with the country's armed forces.

This is a mixed (qualitative-quantitative) study. Experts' agreement (30 people) on the results of a systematic review (201 items) was obtained using a questionnaire and through holding three expert panels. The necessity of each item was calculated using the method of content validity ratio and the weight of standards and headings based on the average.

The existing 201 items were converted into 75 standards in 13 headings as final standards with the weight of each item.

This framework can be used as a comparison tool between independent medical centers and it is necessary to train evaluators, and prepare legal and organizational requirements in order to implement it.

Narcissism is a type of personality disorder in which a person considers himself great and important and exaggeratedly feels capable and worthy. One of the places in which this disorder can occur is at the university level. The symptoms of this type of disorder can be seen in some faculty members and it seems that these people also have some kind of scientific-academic narcissism disorder. In this type of narcissism, the person has a sense of overconfidence and is fascinated by power and dominance, becomes disinterested in others, demands the attention of others, and believes that he deserves special attention. At the scientific and academic level, these people try to promote themselves in various ways and by abusing students (using their ability to write essays and making them do research with threats and intimidation). These people often claim to be superior in terms of scientific literacy and have a high IQ, and constantly slander their colleagues and criticize their performance unfairly. It is necessary that while preventing them from holding any managerial positions, they should also be evaluated through academic counseling centers and, if necessary, be cured through informing colleagues and family.