Key performance indicators in hospital based on balanced scorecard model

Introduction: Performance measurement is receiving increasing verification all over the world. Nowadays in a lot of organizations, irrespective of their type or size, performance evaluation is the main concern and a key issue for top administrators. The purpose of this study is to organize suitable key performance indicators [KPIs] for hospitals' performance evaluation based on the balanced scorecard [BSC]

Method: This is a mixed method study. In order to identify the hospital's performance indicators [HPI], first related literature was reviewed and then the experts' panel and Delphi method were used. In this study, two rounds were needed for the desired level of consensus. The experts rated the importance of the indicators, on a five-point Likert scale. In the consensus calculation, the consensus percentage was calculated by classifying the values 1-3 as not important [0] and 4-5 to [1] as important. Simple additive weighting technique was used to rank the indicators and select hospital's KPIs. The data were analyzed by Excel 2010 software

Results: About 218 indicators were obtained from a review of selected literature. Through internal expert panel, 77 indicators were selected. Finally, 22 were selected for KPIs of hospitals. Ten indicators were selected in internal process perspective and 5, 4, and 3 indicators in finance, learning and growth, and customer, respectively

Conclusion: This model can be a useful tool for evaluating and comparing the performance of hospitals. However, this model is flexible and can be adjusted according to differences in the target hospitals. This study can be beneficial for hospital administrators and it can help them to change their perspective about performance evaluation

Using queuing theory and simulation modelling to reduce waiting times in An Iranian emergency department

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department [ED] is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time

Methods: This is a cross-sectional study in which simulation software [Arena, version 14] was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them

Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run [actually these patients received services out of their defined capacity]. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients

Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution

study of urban family physicians performance and its related factors in the south of Iran

Introduction: The Family Physician Program is one of the most important plans for increasing the equitable access and affordable health services. This study aimed to examine the performance of Urban Family Physicians and associated factors in the third year of its implementation

Method: A cross-sectional study was conducted on all Family Physicians [31 persons] working in the private and public polyclinics and clinics in the Firoozabad, from October to December 2014. The population of the study consisted of all the physicians [31 persons] who were involved in the Family Medicine Program. The main instrument for data gathering was a standard questionnaire developed by Ministry of Health and Medical Education [MOHME]. Validity and reliability of the questionnaire have been confirmed by MOHME. The questionnaire had four parts including medical equipment, informing the patients, referral system rules, and protocols. The data were analyzed using SPSS statistical software, version 16, through appropriate statistical tests including Independent T-test, Pearson Correlation, One sample T-test, in a significance level of<0.05

Results: Findings of the study showed that there was not a significant association between performance of physicians and equipment [77.20 +/- 22.80]. Their performance based on informing patients [81.59 +/- 16.69], protocols [82.42 +/- 12.05], and total performance [82.41 +/- 13.42] was good. Their performance in terms of referral system [69.35 +/- 16.15] was weak. There were not any association between the performance and marital status, age, career, and sex. In contrast, there was a significant relationship between nativity and performance so that the performance of native physicians was better

Conclusion: The Urban Family Physician is an outstanding step for improving the public health but its successful implementing needs to develop an appropriate solution for employing the native physicians. It seems that applying various incentives and employing the native physicians in terms of their ability and training them about the importance of referral systems in public health will be helpful

Relationship between family-work and work-family conflict with organizational commitment and desertion intention among nurses and paramedical staff at hospitals

Background: High turnover intention rate is one of the most common problems in healthcare organizations throughout the world. There are several factors that can potentially affect the individuals' turnover intention; they include factors such as work-family conflict, family-work conflict, and organizational commitment. The aim of this research was to determine the relationship between family-work and work-family conflicts and organizational commitment and turnover intention among nurses and paramedical staff at hospitals affiliated to Shiraz University of Medical Sciences [SUMS] and present a model using SEM

Methods: This is a questionnaire based cross-sectional study among 400 nurses and paramedical staff of hospitals affiliated to SUMS using a random-proportional [quota] sampling method. Data collection was performed using four standard questionnaires. SPSS software was used for data analysis and SmartPLS software for modeling variables

Results: Mean scores of work-family conflict and desertion intention were 2.6 and 2.77, respectively. There was a significant relationship between gender and family-work conflict [P=0.02]. Family-work conflict was significantly higher in married participants [P=0.001]. Based on the findings of this study, there was a significant positive relationship between work-family and family-work conflict [P=0.001]. Also, work-family conflict had a significant inverse relationship with organizational commitment [P=0.001]. An inverse relationship was seen between organizational commitment and turnover intentions [P=0.001]

Conclusion: Thus, regarding the prominent and preventative role of organizational commitment in employees' desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase people's organizational commitment must be considered by health system managers more than ever

Optimization the number of nurses in the emergency department using linear programming technique

Introduction: Aim of current study is determination of optimal number of nurses in the emergency department of Shiraz Ali Asghar Hospital

Method: Current study is an applied study and belongs to operational research [OR] studies. The population has been studied in this research, includes records of referred patients to the emergency department of hospital in 2008. Sampling was performed in the forms of stratified [monthly] and simple for all of the records and each of months respectively. Required data collection was performed from statistics notebook and also patient's records using data collection forms. After average determination of entering patients in a day at eight period in three hours, determining the type of provided services and also the period of offering nursing services [with using time information]determine optimum number of required nurses in different periods of hospital with using of linear programming technique by lingo 8 software

Results: The minimum number of nurses needed in emergency department of Ali Asghar hospital regarding to desired services to the patients were obtained 1 and 3 nurses for each shift and a day respectively

Conclusion: According to the results the used number of nurses in the emergency department was more than optimum number. It seems that, obtained number of nurses from quantitative methods such as linear programming technique is much less than the calculated number experimentally by the directors of nursing

[Cost of diabetes in type II diabetic patients]

Objective [s]: To determine economics cost of diabetes in type II diabetic patients under the cover of Naderkazemi clinic in Shiraz in the first half of 2008

Methods: this study is an applicable one and the way of study is descriptive-analytic.the study society includes type II diabetic patients that referred to Naderkazemi clinic and made file. in this study among the 4900 files related to type II diabetic patient, at first, in the pilot study,30 files chosen by the way of systematic sampling and examined. standard deviation these files was +/-/38.that in respect to received standard deviation,220 files were chosen as samples that eventually with the help of statistics advisor,288 file were chosen as samples and were studied in a systematic way. the needed information in this study were gathered from observing the existing information in patient´s files, interviewing with personnel and manager and also from existing information and ducuments in provision, accounting and personnel departments. results were classified as charts and graphs and were expressed descriptively

Results: in this study, total economic costs of type II diabetes calculated 37942315040 Rials [4079818.8 dollar], that medical direct costs and indirect costs share was 3994348680[429499.9 dollar] and 33947966360[3650319 dollar] Rials, respectively. Medical direct and indirect costs of diabetes in a type II diabetic patient in first half of 1387 was 815173/2[87.65 dollar] and 6928156/4[744.96 dollar] Rials respectively, and altogether was 7743329/6 Rials [832.61 dollar]

Conclusion: Economic cost of type II diabetes is very high and complications of this disease can important influence on patient and their family. Because of restricting resources of medical-health in society, diabetes is one of medical-health priority in our country and should have large actions to reducing costs and complications of this disease