[ performance of referral system from the perspective of family physicians of Kashan University of Medical Sciences: 2007-20012]

Introduction: Access of needy people to special services is achieved through referral system. The aim of this study was to determine the function of referral system from the perspective of family physicians of Kashan University of Medical Sciences between 2007 to 2012.

Materials and Methods: This descriptive study was conducted in all health centers of Kashan and Aran Bidgol, which implement the family physician program. From total of 118 family physicians who were involved in the study period, the researcher were contacted with 100 census statistical methods family physicians. 40 family physicians participated in the pilot test and ultimately 56 physicians participated in the study. The data gathering instrument was "The Function of Referral System from the Perspective of Family Physicians Questionnaire" with two parts. Part one is on demographic information and part two contains20 items in 4 dimensions. Content validity of the questionnaire were validated through 10 experts. Internal consistency was confirmed. Data analysis was performed using Excel and SPSS/16.

Findings: The average age and duration of employment as a family physician was 33/3 +/- 6/32 and 55/4 +/- 9/6 years. In addition, the average of awareness and culture was 2.05 equivalent inappropriate, knowledge and skills of health team was 3.45 equivalent appropriate, level of specialist cooperation was 1.67 equivalent inappropriate, equipment of family doctors was 2.66 equivalent inappropriate and statues of referral system was 2.45 equivalent inappropriate.

Conclusion: The situation of referral system was unacceptable. It is recommended to improve easy access to specialist services, training and related interventions in the field of public and health staff to become familiar with the goals of the family physician.

[Comparison of direct and indirect nursing care time in 8-hour and 12-hour shifts]

Nurses are the largest and one of the most important groups of health care providers. The quality of health care mostly depends on the quality of direct and indirect nursing care. Measuring the average nursing care time is an objective measure for assessing the quality of patient care. The goal of the present study was to compare the time being devoted to professional - nonprofessional activities by nurses in 8 hours and 12 hours working shift in Shahid Modarres teaching hospital in Tehran. A descriptive- comparative study was conducted on 30 nurses [27 female, and 3 male] working in medical and surgical wards of Shahid Modarres teaching hospital in Tehran. The nurses were working 8 and 12 hours shifts and in rotating schedule. Data were collected by direct observation of nurses' activities, using a checklist with list of direct, indirect and nonprofessional nursing activities. The reliability of the checklist was assured by calculating inter observers' agreement [The duration of time which nurses spent for each activity was recorded. Data were analyzed using SPSS and Wilcoxon test. The findings of the present study revealed that, nurses working 8 hour shift duration, spent 64.99% of their time on professional and 35.3% on nonprofessional activities [41.21% on direct nursing care, 23.78% on indirect nursing care, 22.53% on personnel affairs and 12.5% on administrative activities]. Nurses with 12 hour shift duration, spent 65.59% of their times on professional activities and 33.92% on nonprofessional activities [41.57% on direct healthcare, 24.02% on indirect healthcare, 20.94% on personnel affairs and 12.98% administrative activities]. Nurses working in both 8 and 12 hours shift spend most of their times for professional activities [direct and indirect healthcare] and devote less time to nonprofessional activities [administrative and personal affairs], and these activities are independent of their shift duration

[ model for evaluation and validation of different dimensions of accountability in teaching hospitals in Iran: 2012]

Introduction: Monitoring and assessing the quality of health services in relation to accountability is the first step in providing proper services in hospitals which as the most important health organizations entail the need for evaluation. The aim of this study was to validate the ethical, legal, financial, operational, political, structural, cultural and information dimensions of accountability [notification rules of hospital] in teaching hospitals

Method: This was a method validation study. A sample of 580 participants, working in teaching hospitals, was selected by quota random sampling using Krejcie - Morgan formula. An 8 item questionnaire with 34 indicators on the basis of Likert scale was distributed among the staff. The data were analyzed by the Lisrel software using confirmatory factor and path analysis and multiple regressions

Results: The findings showed that comparative fit index of different dimensions of the questionnaire, showing the degree of consistency of the model with real data, was equal to 1. This suggests the strength of the one-dimensional model. Cronbach's alpha for the internal consistency of different dimensions was 0.791 for financial and 0.901 for information aspects

Conclusion: The present study provides a systematic process and model to validate and assess different dimensions and components of accountability for managers. The innovations and special features of this study will help present a new model to identify better dimensions and indicators for improving accountability in health care sector

[ effect of supervisors and work group on hospital information system acceptance model]

Issues related to organizations and users are among factors influencing successful implementation of information systems. These factors should be taken into account by managers. The purpose of this study was to examine the influence of supervisors and workgroup on Hospital Information System [HIS] acceptance by users in medical hospitals of Tehran [former Iran] University of Medical Sciences. After the literature review, a primary model including seven variables influencing HIS acceptance was proposed. A questionnaire including 121 questions based on the variables was developed, the validity and reliability of which were tested and confirmed by an expert panel and through Chronbach Alpha. The population of the study were 400 HIS users in hospitals selected by stratified random sampling method. To confirm the model and determine the relationship between variables, Structural Equation Modeling [SEM] method was used by applying LISREL Software. The result of Normed Chi Square Index [x[2]/df= 2.49] showed that the model had fitness with the collected data. According to the model, supervisers and workgroup influenced Perceived Ease of Use, Perceived Usefulness, and Satisfaction which affected users Behavioral Intention to use Hospital Information System in these hospitals [P-value= 0.0054]. Considering the goodnesss of fit indices, it is concluded that supervisors and workgroup factors have the potential to influence HIS acceptance. The application of the suggested model could increase the possibility of HIS acceptance in hospitals under the study

[Measurement of the components of community-based rehabilitation [CBR]: a factor analysis]

Community-based rehabilitation is a strategy that can help satisfy the needs of people with disabilities within the community in every nation. Measurement of the components effective on the community-based rehabilitation in Iran. This descriptive, analytical and cross-sectional study was performed in two stages in 2011. The owners of qualitative step were 45 expert and factor analysis step were 564 CBR experts CBR responsible expert rehabilitation authorities of 31 provinces CBR experts and rehabilitation assistant of the studied city. Data were collected by a developed questionnaire. The validity of its content was assessed as Expert panel and their credit structures by exploratory factor analysis [main component analysis] using alpha internal parallelism of Coranbach. For adequacy of sample size Keiser Mayer Olkin scal and for suitable data, Bartlett test were used. In exploratory factor analysis we identified 7 acceptable factors with special values more than1and total variance of%61/84. 54 items with acceptable factor load[more than 0/4] were under this 7 factors. These 54 items are considered as effective factors on community-based rehabilitation and finding trust step for all 7 factors with respective items achieved appropriate reliability coefficient [greater than%0/84]. The use of semi-professional [expert community], social and political support, educational services, financial supply, health services, medical services and social integration of the disabled people, approperiate for cultural, economic, political and social contexts of our country can empower the disabled people, promote human dignity of them and their families in the community

[Financial statements analysis medical universities in Iran]

Evaluation of financial performance of organizations is regarded as an important financial function of managers since this allows them to make the right decisions and maintain the organizational productivity and control. The aim of this study was to assess the financial performance of medical universities in Iran employing financial ratio analysis. This was a cross-sectional descriptive study. Qualitative and quantitative data analysis techniques were used. Content analysis and Delphi panel qualitative data collection techniques were applied to enrich our understanding of the financial statements and ratios in medical universities in Iran. Additionally, a questionnaire was used to collect quantitative data on the financial statements and ratios of all 38 medical universities. The sampling method used was purposive, and for data analysis standard deviation variation, mean central tendency and frequency were used. Financial ratios [12], grouped in two categories of liquidity ratios, activity ratios and productivity of resources, were identified. The most important financial ratios were: quick ratio [mean=2.53], current ratio [mean=3.58], collection period ratio [mean=114], operating income, divided by total hind [mean=0.44], budget productivity [mean=0.79] and the assets return rate [mean=0.84]. The results indicate that the mean of liquidity ratios in medical universities in Iran was higher than the other sectors. This was due to the inappropriate year-end allocation of annual funds by the government. The other findings on activity ratio and operating cash flow ratio indicate lack of financial resources management regarding the assets conversion and resources and capitals combination within the universities studied. This shows that medical universities in Iran have not used the authoritative power of the board of trustees. We recommend further research on the development and standardization of financial reports in accordance with the type of services, disposable incomes, trade, and financial regulations in medical universities

[Correlation between nurses' communication skills and inpatient service quality in the hospitals of Kashan University of Medical Sciences]

Introduction: Today studies have shown that communication between the physician/or the nurse with the patient treated as a clinical skill and considered as one of the main effective factors in improving both client's satisfaction and health care outcomes. The aim of this study was to determine the correlation between nurses' communication skills and inpatient service quality in the hospitals of Kashan University of Medical Sciences, 2011

Methods and Materials: In this correlation study using a stratified sampling, 384 patients from hospitals of Kashan University of Medical Sciences were selected. A three-section questionnaire for assessing respectively demographic characteristics, nurse's communication skill, and inpatient service quality was used to collect the data. For communication skills, instrument validity and reliability were tested by content validity method and Cronbach's alpha coefficient of 0.92, respectively on 20 patients in the hospitals under study. In measuring the service quality, SERVQUAL Scale was used. With regard to analyzing the data, Freedman's statistical test was applied to study the service quality dimensions versus inpatient service quality. Also Spearman's rank correlation coefficient was applied to detect the type and level of relationship among the nurses' communication skills

Findings: Results showed that there was a significant correlation between communication skills and inpatient service quality in the hospitals [P-value=0.001 and R=0.782]. The patients noticed a positive and significant correlation between communication skills and service quality dimensions. The intensity of the relationship between the two variables from the highest to the lowest is 0.708, 0.689, 0.637, 0.552, and 0.514, respectively for the assurance, reliability, responsiveness, empathy, and tangibles

Conclusion: Consequently, improving the communication skills for the hospital personnel can improve the service quality contribution of hospitals

[ efficiency of the head offices of medical-services insurance organization in Iran using AP-DEA: 2009]

Medical-Services Insurance Organization [MSIO] is one of the major financial health institutions in Iran. The obligation of the optimal use of the resources has made the evaluation of the efficiency of this organization necessary. The purpose of this study was to measure the efficiency and the ranking of all the head offices of MSIO in Iran. This applied cross-sectional study was descriptive in nature. The study population constituted all the 31 head offices of MSIO. To determine the efficiency through Data Envelopment Analysis, the information related to the inputs and outputs in 2009 were collected from the Office of Statistics and Information of MSIO by means of self-developed checklists. APDEA Model was run in EMS software to estimate the efficiency. The mean values of the three types of efficiency of the head offices of MSIO, namely; technical, managerial, and criterion were 0.5093, 0.5851, and 0.8292, respectively. Considering the findings of AP-DEA model of Data Envelopment Analysis, the capacity of efficiency promotion at these head offices- using the same amount of inputs without any increase in fees- is approximately 17 percent. The findings indicated that AP-DEA Model could better measure the efficiency capacity of MSIO head offices compared with the basic DEA models. It was also found that those offices showing efficiency capacity less than one bear a surplus of inputs in human resources, physical space, and overhead expenses. The development of a comprehensive plan aiming at reducing these inputs can help reach the optimal efficiency

Development and compilation of strategies and preventive measures for medical errors in public hospitals in Tehran

Patient saieiy is one of the most important issues in health care systems of developed countries. This study attempted to develop strategies and preventive measures for medical errors in public hospitals in Tehran. This is a descriptive survey in which the population included all process owners [12 person teams] of public hospitals in Tehran. The sample size was 396 individuals selected by stratified sampling. A questionnaire was used for data collection. Following the data collection, factor analysis was used to analyze the data. The process owners [12 person teams], acknowledged the use of 12 strategies, accounted for 48.24% of the total variance, to prevent medical errors. The most and the least powerful strategies were related to human resources management and teamwork with the percentages of 7.81 and 1.93% respectively. The public hospitals in Tehran can improve the quality of clinical services by applying preventive measures, especially in the area of human resources management, through persuading health service providers to take an initial diagnostic test and to participate in periodic competency and empowerment courses

[Factors affecting human resources productivity in Guilan University of medical sciences using path analysis]

Human Resources productivity is one of the important subjects among managers of organizations. To increase the productivity of human resources, universities as training centers play a significant role. Path analysis is one of the best practical and cost effective methods to assess various factors influencing productivity of human resources. This study aimed to investigate the importance of different factors which affect the productivity of human resources in Guilan University of Medical Sciences. This descriptive, analytical and periodical research was carried out in 2009. To determine various factors involved in human resources productivity, 45 experts and specialists in management and also to verify the importance of recognized factors 321 academic staff and educational experts from different faculties of the Guilan University of Medical Sciences were selected. Data were gathered through library and guidance research methods. Content validity was assessed by referring to expert panel viewpoints using factor analysis [main headings] and construct validity was obtained by complementary factor analysis [maximizing reality]. Reliability of analysis of the results was ensured using Lisrel 8/80 software. Path analysis of the results regarding various factors which influence the productivity of human resources indicated that organizational culture with path standard of 0.51, motivational factors with path standard of 0.25, environmental conditions with path standard of 0.17, as well as empowerment of human resources and methods of leadership with path standard of 0.08, were outstanding factors which affect the productivity of human resources in Guilan University of Medical Sciences. Organizational culture, motivation factors, environmental conditions, empowerment of human resources and leadership methods have impact on the productivity of human resources in Guilan University of Medical Sciences and organizational culture is the most important item

Factors affecting human resources productivity in Guilan University of Medical Sciences using path analysis

Human resources productivity is one of the important subjects among managers of organizations. To increase the productivity of human resources, universities as training centers play a significant role. Path analysis is one of the best practical and cost effective methods to assess various factors influencing productivity of human resources. This study aimed to investigate the importance of different factors which affect the productivity of human resources in Guilan University of Medical Sciences. This descriptive, analytical and periodical research was carried out in 2009. To determine various factors involved in human resources productivity, 45 experts and specialists in management and also to verify the importance of recognized factors 321 academic staff and educational experts from different faculties of the Guilan University of Medical Sciences were selected. Data were gathered through library and guidance research methods. Content validity was assessed by referring to expert panel viewpoints using factor analysis [main headings] and construct validity was obtained by complementary factor analysis [maximizing reality]. Reliability of analysis of the results was ensured using Lisrel 8/80 software. Path analysis of the results regarding various factors which influence the productivity of human resources indicated that organizational culture with path standard of 0.51, motivational factors with path standard of 0.25, environmental conditions with path standard of 0.17, as well as empowerment of human resources and methods of leadership with path standard of 0.08, were outstanding factors which affect the productivity of human resources in Guilan University of Medical Sciences. Organizational culture, motivation factors, environmental conditions, empowerment of human resources and leadership methods have impact on the productivity of human resources in Guilan University of Medical Sciences and organizational culture is the most important item

[Relationship between organizational culture and knowledge management in Zanjan teaching hospitals, 2008]

Nowadays, The knowledge management is an undeniable necessity so that without the knowledge management, organizations are nearly repulsive of competition and survival. The main purpose of the present study was to determine the relation between organizational culture and the knowledge management in teaching hospitals of Zanjan university of medical sciences. This was a descriptive study which carried out in 3 teaching hospitals of Zanjan university of medical sciences [Vali-Asr, Ayatollah Mousavi and Shahid Beheshti]. Statistical population of this study included the whole staff of hospitals with the level of B.A and upper education. 190 individuals were selected and replied the questionnaire which consisted of 3 parts: Demographic information, knowledge management and organization culture. SPSS 13 was used for analyzing the data. The staff of hospitals offered an average grade to organization culture. Five features or organization culture was examined which the highest grade or concession was given to: "The organization belonging ", "management style", "individual creativity", "management support" and aggression tolerance". The knowledge management was measured weak by the staff. The acquired concession by 3 features of knowledge management respectively was: "knowledge transfer", "knowledge creation" and "knowledge protection and saving". There was a positive meaningful relationship between the organization culture and the knowledge management [P=0.0006, r=0.43]. The most correlation relation was between the management supports, the individual creatively, the management style, the organization belonging and the aggression tolerance with knowledge management. Strong and dynamic organization culture is one of the main tools for successful manipulation of the knowledge management in organizations. Changes in organization culture in order to establish knowledge management must be paid more attention and support the knowledge, personal creativity development and management style

Comparative study of organizational performance measurement in iran and developed countries

Background and Purpose: Organization Performance, particularly in health and treatment sectors, is considered as a basis for qualitative and quantitative development. Health and treatment systems, also, need performance improvement and measurement in order to grow and develop. This study is a comparative study of performance measurement in Iran and some developed countries with the purpose of application in the Iranian health and treatment system

Methods and Materials: In this descriptive comparative study, countries with successful experiences in measuring the performance such as Australia, Canada, Netherlands, Sweden, England, and the United States, were chosen. In order to collect information from these countries, different sources like journals, textbooks, internet databases, and e-mail communications were used. Collected information about these countries was summarized and classified according to intended variables, and were analyzed finally in comparative tables

Results: Majority of the countries in the research had employed criteria such as credibility, reliability, realness, timing, relevance, accuracy, and appropriacy in their performance measurement programs, and had used the findings in budgeting process. Applying the results of performance measurement has also been stressed in decision making and budgeting. Performance measurement is conducted in two dimensions in Iran: general and specific

Conclusion: The results of this study has shown that in most developed countries, good performance indexes, performance appraisal models, and the use of performance measurement findings in decision making and budgeting are applied

Occupational stress among rural health workers in Mashhad district, northeast Iran

This study explores the level of Occupational Stress and main sources of occupational and personal stress among Rural Health Workers [RHW] of the health network of Mashhad district. The first part of the Occupational Stress Inventory [OSI] [called the Occupational Roles Questionnaire [ORQ]] was used to measure the Rural Health Workers occupational stress [N=172]. A number of extra questions were also added to measure their specific sources of stress. The questionnaires were distributed among RHW in a meeting held in the Health District Center in the city of Mashhad. The mean score of stress for the investigated subjects on OSI and all of its dimensions was within the normal range. On some dimensions such as role overload and role ambiguity however, about 40% of the Health Workers had middle to sever stress. Type of employment, distance of the village to the nearest city, number and combination of Health Workers in rural health clinics showed to have a significant impact on the RHW stress as well. As the RHW Job is concerned, role overload and role ambiguity are the main sources of stress, which may have an adverse effect on the quality of their services. Type of employment, distance of the village to the nearest city, number and combination of Health Workers at the health center also put pressure on RHW that need to be taken under consideration in planning for improving RHW quality of work Life

[5S Methodology: introduction and application in health services]

5S is a well known Japanese management method. This is applied in different parts of health sector organizations. It has shown good results in work field organizing, increasing safety versifying tasks, reducing wasting and making higher coordination. A well organized and clear work area promotes employees' incentive, and its main characteristic is simplicity. First S, Seiri, implies to good storing and keeping only essential materials and tools. Seition, the second, indicates storing in order and foucusing on efficiency. Seiso means cleaning of workplace and Seikatsu is to standardize tasks. Thelast is Shitsunke meaning sustain the discipline, maintaining and reviewing standards. In this article 5S methodology is discussed with regard to health services

Designing an administrative model for Iranian Charity Hospitals

Healthcare is considered as one of the most important indicators for determining the level of development in all societies. To this end, hospitals play an important role and the role of the charity hospitals which provide healthcare for poor patients is of great importance. Therefore, understanding and analyzing the administrative manner of these hospitals is crucial. The main goal of this study is to design an administrative model for charity hospitals in Iran. Information from Library documents including books, scientific magazine, and domestic foreign texts; documents as e-mail, electronic database; and also contact with several charity hospital executive in several countries; and visiting charity hospitals in other countries were used. Further information gathered about weaknesses and strengths of charity hospitals in Iran, and several foreign countries charity hospital models. The primary model was designated and after analyzing various view points, reviews and criticism by scholars and experts, the final model was presented using the Delphi method. This study showed that charity hospitals in Iran are managed in different ways without any specific model and do not supported financially by the government. A number of these hospitals are not autonomous. In charity hospitals outside Iran, different management styles were being used, but they were not managed like Iranian charity hospitals and most of them were foundations or companies. Furthermore, a number of them were not managed as charity hospital since the nationalization of healthcare had taken place. Whereas the cost of healthcare in private sector is very expensive and most of them do not have contracts with insurance companies, charity hospitals can have an important role in providing healthcare for the society. Using model described in this paper could be helpful in responding to the needs of poor clients

Management development in health care setting: a training model for hospital managers

This study was conducted to design an on job-training model for the managers of the Iranian Social Security Organization [ISSO] hospitals and any other similar setting. A five dimensional model [i.e. knowledge, ability, managerial skills, personality attributes and attitudes] with 187 components was designed. The model was validated through seeking the view of experts and a field test. For the field test, a survey was done on 31 ISSO hospital managers to explore their views on the structure of the model and its components. The managers were asked to score each component on a five- point Likert scale as they thought it would affect their job per- formance. The model with 5 dimensions and 165 components was verified in the field test, and 104 out of 165 components of this model got high, 52 medium and nine low mean scores for influencing job performance of the managers. These findings reveal that most of the components selected in this pro- ject are justified to be included in the model. It also reflects the managers' needs for any formal and informal training program in future. The needs of hospital managers at work go far beyond the knowledge and skills, which they have gained, via formal education in school. Therefore, in designing a training program for this group of professionals one should consider a multi-dimensional model in which "knowledge, ability, managerial skills, personality, and attitude dimensions" are all taken under consideration