International Journal of Hospital Research
Volume:1 Issue: 1, Autumn 2012

Quality of work life is an increasingly important organizational factor in health facilities. Most studies on quality of work life in hospitals have been conducted in developed countries. The few studies performed in developing countries have targeted low- and middle-performance hospitals, and they have not explored the relationship between quality of work life and other organizational factors. The purpose of this study was to gain insight on how Quality of Work Life (QWL), Leadership Behavior (LB), and Human Resources Productivity (HRP) would be inter-related in the high-performance hospitals in developing countries. A cross-sectional study was carried out over the period of July to September 2011 in Hasheminejad Kidney Center, which is one of the largest Urology hospitals in Iran. Two scales were developed for measuring LB and QWL based on the literature review, and HRP was measured using a simple questionnaire with single-item questions for each dimension. The scales were distributed to 403 healthcare employees and 316 valid questionnaires were returned. The data was analyzed using exploratory factor analysis to examine the similarity of the factor structure between scales and collected data. An iterative model improvement procedure was adopted for improving the LB and QWL measurement models, and the final models were validated against the collected data using confirmatory factor analysis. The reliability of scales and dimensions was determined by calculating Chronbach’s alpha. Correlation analysis was carried out to examine construct validity, and the relationship between constructs was studied by regression analysis. (1) Employees had high positive perceptions of the LB (73%), QWL (70%) and HRP outcome variables (78%); (2) LB was positively correlated with QWL (β = 0.78, P < 0.001) and HRP (β = 0.74, P < 0.001); (3) QWL was positively correlated with HRP (β = 0.68, P < 0.001). All individual dimensions of LB were found positively and significant correlated with QWL. Our Results indicate that satisfactory levels of QWL are achievable in hospitals of developing countries. In addition, higher employee perception of QWL was found to correspond with higher employee perception of LB. Leadership style, treating subordinates with trust and respect, motivating and in-person recognition of subordinates, and promoting organizational values were identified as strong predictors of QWL and HRP.

Patient Safety Culture is increasingly recognized as an essential driver of patient safety. To establish patient safety culture, firstly the current status of the construct should be assessed. Valid assessment of patient safety culture is contingent on the availability of appropriate measurement tools. Hospital Survey on Patient Safety Culture (HSOPS) developed by the Agency for Healthcare Research and Quality (AHRQ) is frequently used for patient safety culture assessment. Dimensions of patient safety culture may vary between different cultures and this affects the utility of popular measurement models in different countries. This study aimed to examine the extent to which the dimensions of patient safety culture in Iran can be explained by the factor structure of HSOPS. Healthcare workers in all university hospitals of Qazvin, the center of Qazvin province in Iran, were asked to complete the HSOPS survey (n = 231). Descriptive statistics were used for data summarization. Reliability of the questionnaire was evaluated by calculating Chronbach’s alpha. Validity of the construct was assessed by correlation analysis among the factors. Exploratory factor analysis was used to investigate the extent to which HSOPS factor structure underlies our dataset. ANOVA and t-test were used to compare the score means between professions. HSOPS’s factor structure was not replicated by factor analysis. Reliability analysis yielded generally unacceptable internal consistency. By contrast, correlation analysis provided evidence for validity of construct by reproducing meaningful patterns of interrelations observed in precedent studies. The relative magnitude of factor scores generally followed the pattern in the benchmark study by AHRQ. Based on our results, the reliability of HSOPS for use in Iran seems questionable. Our results, therefore, point to the necessity of large-scale studies to understand the dimensions of patient safety culture in Iran, and to develop a reliable and valid tool for its measurement.

Efficient hospital management requires appropriate cost and price strategies. Informed decision on costs and prices of healthcare services needs estimation of costs of unit services using microeconomic techniques. There is lack of knowledge and skills for such costing methods in the healthcare sector of developing countries such as Iran. This study aims at detail description of a relatively simple microcosting method by cost analysis of unit healthcare services in Bou Ali Sina University Hospital affiliated to Qazvin University of Medical Sciences, Iran. A cross-sectional descriptive study was conducted in Bou Ali Sina hospital over the period of October-December 2010. A volume-based top-down microcosting approach was adopted to calculate the average costs of unit services in the facility. Hospital departments were identified and clustered into three categories of general/overhead, intermediate, and final cost centers. The costs were classified into two direct and indirect groups. Data was collected using standard operational budgeting sheets. Costs were prorated using a step-down allocation method. Final units’ bed-day indices and the revenue generated from medication services were determined by reviewing hospitalized patient records. The net profit of each medication unit was calculated based on services cost data and occupied bed-day data. Hospital financial performance was analyzed using break-even analysis. Over half of the hospital costs were found to incur in intermediate departments (Nutrition, Laboratories, Pharmacy, and Diagnosis Testing departments), and the rest were equally related to general/overhead and final units. Over 75% of the hospital expenditures were direct costs, half of which being related to human resources expenses. An 80% bed-day occupancy rate was identified, with CCUs having the highest, and Ophthalmology Ward having the lowest rate. The hospital turned out to be in net loss with the majority of losses caused by ICU, CCU 2 and Internal Ward 1. The data suggests that the hospital can make significant revenue by activating unoccupied bed-day capacity of Ophthalmology and Heart wards. Microeconomic analysis of unit services is instrumental to identifying the areas requiring strengths and areas for improvement in hospital financial management. Such an analysis can also provide insight into practical strategies for improving hospital financial performance.

Medical Errors and adverse events have recently turned into one of the predominant concerns of health-policy makers and health services providers. Promoting safety culture is fundamental to sustainable safety improvement in healthcare settings. The purpose of this study was to examine the effect of training on nurses’ attitudes towards safety culture. A cross-sectional study was conducted over the period of April to September 2011. The nursing staff in Shahid Modarres Hospital were invited to participate in the study (n = 143). A Persian version of Safety Attitude Questionnaire (SAQ) was developed and used for measuring safety culture. To evaluate the effect of training on nurses’ safety attitudes, the safety culture survey was carried out twice on the sample, ones before training and once after training and the results were compared. The training course contained material on causes of failure in safety systems, harms due to unsafe medical conditions and their outcomes, and concepts and dimensions of safety culture. The second safety culture measurement was carried out three months after the end of the training course. The results of the two evaluations were compared using analytical statistics. Significant improvement in nurse attitudes towards most safety culture dimensions was observed after training. While the highest improved dimension was Perception of Management (43.3%), Stress Recognition showed the lowest increase (7%) following the training. The training was found to enhance the average nurses’ safety attitudes by 44%. Meanwhile, the results of path analysis showed a similar pattern of interrelations between safety attitude dimensions and overall measure of safety culture before and after training. Training is an effective strategy for improving nurse attitudes towards safety.

There is a growing tendency in Iran’s healthcare sector for adoption of standard excellence models for improving quality in healthcare organizations. The European Foundation of Quality Management (EFQM) model is a widely used framework for continuous quality management within healthcare facilities. The purpose of this article is to extend the view of current status of quality management in Iran’s hospital industry by reporting the details of an EFQM-based self-assessment of quality management in hospitals of Kerman University of Medical Sciences. A cross-sectional study was conducted over the period of October to December 2011 by enrolling heads of departments and chief executive officers of all the four university hospitals of Kerman, the capital of Kerman province in southern Iran (n = 69). The standard EFQM questionnaire was used to measure quality management. Reliability of the assessment tool was determined by calculating Chronbach’s alpha coefficient. The data was analyzed using descriptive statistics. The criteria ‘Process’ and ‘Customer results’ scored above 60%, and other criteria scored within the range of 50% to 60%. While ‘Process’ gained the highest score of 62.9%, the lowest score of 52.1% was received by ‘Key performance results’. Scores appeared to be overestimated compared to those gained by pioneer healthcare settings in developed countries. However, the scores were found more realistic in comparison with those in precedent domestic studies, suggesting a trend of gradual improvement of quality management knowledge and self-assessment skill. The data suggest that the criteria ‘People’ and ‘Resource and Partnership’ are of a high priority for improvement in order to reach satisfactory ‘Key performance results’.

Today, management is one of the most important factors in hospital effectiveness and performance. The objective of this study was to assess the management skills of administrators in hospitals of Tehran University of Medical Sciences and to identify how these skills are related to effective management. A cross-sectional descriptive study was carried out over the period of February to April 2011 by enrolling 15 administrators from hospitals of Tehran University of Medical Sciences (TUMS). The tool for data collection was a self-constructed questionnaire of managerial skills containing the measures of leadership ability, effective use of organizational teams, employee motivation, change management, and effective management. The validity of the questionnaire was confirmed by expert opinion method. The reliability of the scale was also confirmed by obtaining a Chronbach’s alpha of 0.81 for all items. The collected data was analyzed using correlation analysis. Our results identified relatively high self-assessment score on leadership ability and effective management, but the scores for effective use of organizational teams, employee motivation and change management were low. In addition, among considered dimensions of management skills, only leadership ability showed significant correlation with effective management. A lack of relationship between effective management and most assessed managerial skills depicts an unsatisfactory picture of the overall management skills in hospitals’ administrators, which in turn suggests the need for relevant training programs.

Application of ICT in health (eHealth) has become an integral part of modern healthcare systems. Electronic health information management has proven useful in improving quality of health care, reducing costs and facilitating health research. However, the increasing complexity of healthcare and the growing demand for high quality healthcare delivery has created a need for eHealth systems with the capability of anticipating the future need for information, delivering the information timely to patients and professionals, supporting communication, facilitating coordination and enhancing the performance of decision support systems. Agent-based systems, which operate by artificial intelligence, have shown great promise to meet these challenging needs and to realize the full potential of eHealth systems. In this paper we provide a brief review of application of agent-based systems in chronic disease care.