[ 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

[Managerial skills from the viewpoints of "Robert L.Katz" based on the healthcare organizations]

For each organization, its management is the most important factor among the other elements and has a particular interaction with the organization's goals. Therefore, taking the managers' skills into consideration has become a competitive criterion. Robert L. Katz has introduced three management skills: technical, human, and conceptual skills. This is a review article based on library resources to explain such skills. After an introduction on the managerial skills, these skills will be discussed and they will be studied in relation to the organization. Finally, these skills are discussed in health care organizations. Providing services in medical centers and health organizations is a complex and specialized task which needs professional management and these skills can be taught to the managers. This article attempts to improve the managers' capabilities and to promote the quality of organization activities by explaining such skills

[Factors affecting the human capital development in hospitals of the Iranian social security organization]

Development of human capital within the healthcare organizations is of vital importance due to their dealing with health and lives of people. The aim of this study was to recognize the main factors affecting the Human Capital Development in hospitals affiliated to Iran social security organization. This was a descriptive and applicable study carried out within the hospitals affiliated to Iran social security organization in 2010. Initially, a conceptual model was designed based on comparative study of Human Capital Development models which was later confirmed by a group of expert. In addition, a questionnaire was designed based on conceptual models of components and variants and filled out by the organization's Education authorities [n=68] in two stages with a 20-day interval to assess the current state of the Human capital Development. After determining the adequacy of sample volume by Kaiser Meyer Olkin method and meaningfulness of coefficient matrix with Bartlott test, the exploration factors analysis using maximum probable method as well as the interpretation of variants by Varimax method were performed. Later, to confirm the acquired factors verifying factor analysis and to determine the direct and indirect relationships of components, the structural equations model method was used. Factors-related commitment component [organization development and management commitment] showed a direct relationship with planning component [career development path and plan for education]. The factors of career development path and master plan for education demonstrated a bilateral relationship in which a direct correlation between these factors and the factors of Human Capital Development [education and personal development] was established. Also, it was found that the Evaluation factor is an effective independent factor influencing all other factors. The factors recognized in this research are suitable for Human Capital Development in hospitals affiliated to Iran social security organization

[ impact of medical emergency base on the quality of services to passengers in Tehran metro station]

Providing medical services to injured passengers and personnel in a short time is the major goal of Tehran metro superior services regarding the progressive increase in population in metropolises; the importance of public transportation network development; and also the role of metro in transporting a large number of passengers. This research aims to study the effect of medical emergency bases on the quality of the passenger services in Tehran metro stations. In this cross-sectional research which is case study, about 402 persons including emergency personnel [37]; customers of main stations [185] and customers of secondary stations [180] were surveyed by using three separate kinds of questionnaires, which their validity was confirmed by Cronbach's Alfa test [0.82 for emergency personnel and 0.90 for customers of the main and secondary stations]. The scoring system was determined based on Likert and the related experts' viewpoints. The findings show the major factors of satisfaction are as follows: the quality indicator of "providing services" in viewpoint of personnel [p value = 0.004]; the indicator of "transportation" in the viewpoint of the main stations customers [p value = 0.000] and also passengers were more satisfied with medical emergency bases than the referred personnel [p value = 0.096]. According to the results, establishment of medical emergency base is the major factor of customers' satisfaction from main stations and it has a great effect on the quality of passenger services despite less satisfaction of personnel

Cost-benefit and effectiveness of newborn screening of congenital hypothyroidism: findings from a national program in Iran

In this study, the cost-benefit of a screening program based on the rial, the unit of currency used, was analyzed. The intelligence quotient [IQ], and height and weight were evaluated as indices for a population of children suffering from congenital hypothyroidism [CH]. The total cost for the screening program, including hormone tests, diagnosis, medicine, treatments and care was identified and calculated up to the age of seventy years and this was compared to the costs related to training and caring for patients suffering from mental retardation, who had not been screened. The screening test was done using S and S filter paper and thyroid stimulating hormone [TSH] was determined by the ELISA test. The future costs and benefits with an annual rate of 3% discount of their current value was estimated. To evaluate the effectiveness of the screening program, IQs of 32 patients were identified and compared to 36 healthy children between 2004-2005. The IQs were evaluated according to "Good Enough" and "Proteus Maze" tests. During 2008, 1165169 of 12489136 newborns [51% male, 49% female] underwent screening for CH, 92% cover-age of all newborns for that year. Four percent of recalled infants, with TSH>5 were subjected to diagnostic tests [T4, TSH, T3RU] and finally 2745 patients were identified. Benefit to cost ratios, based on a 3% annual discount rate, were 22, 41, 32, 34, 47 and 60 times lower, respectively. No significant differences were found with regard to differences in IQ scores between cases and controls [cases: 105 +/- 19.3, controls: 111 +/- 19.4], height [cases: 106 +/- 0.7, controls: 102 +/- 4.9 cm] and weight [cases: 15.6 +/- 4.6, control 15.3 +/- 3.2 kg]. The national Newborn Screening [NBS] program for CH has been successful and quite effective in Iran. The method not only has economical advantages but also reduces capital expenditures and preserves normal IQ of the patients under treatment and prevents mental retardation and growth complications

[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

[Performance evaluation of Ayatollah Kashani hospital based on baldrige organizational excellence model]

Aimed to systematic self-assessment, with main performance criteria, Organizational Excellence Models make it possible to evaluate performance of Health Care Sector within a fundamental and systematic framework, leading to development of management skills in the field of performance evaluation. Performance of the concerned hospital was evaluated based on Baldrige Scoring System with process and results criteria. For process criteria, the hospital was evaluated in specific areas with 13 process sub criteria, based on four factors of "Approach", "Deployment", "Learning", and "Integration". For result criteria, the hospital was evaluated in specified areas with six results sub criteria based on four factors of "Performance level", "Rate and breadth of performance improvement", "Appropriate Comparisons and/or benchmarks", and "Linkage of evaluation results measures". The hospital obtained 231.35 scores out of total 550 scores fir process criteria in the model and 111 scores out of 450 scores for results criteria, as its performance results in 2006. In sum, the hospital obtained 347.35 scores out of 1000 scores for both criteria as its performance in 2006. Using Baldrige Model in evaluation of performance of country's hospitals can provide a continuous and systematic self-assessment, facilitating organizational learning and improvement and continuously providing hospitals with inputs, outputs, system components, process and feedbacks

Designing a model of drug quality assurance for Iran

To take up the project for designing a Drug Quality Assurance Model [GMP] for Iran. It is a descriptive and comparative study. GMP models from USA, EU, Australia and Iran, and WHO, ICH and PIC/S were selected for the comparative study. Internet sites and scientific journals were used for data collection. The comparative study determined the primary proposed model. Then, based on Delphi technique, the primary model was evaluated by experts and eventually the final model was designed, for application in Iran. The comparative study and feedbacks of experts determined the final proposed model for pharmaceutical quality assurance [GMP] for Iran, which consisted of two parts. The first part included thirteen chapters consisting sixty-two major titles. The second part consisted of sixteen annexes. Establishment of standards of the final model of GMP in the drug industry could lead to the improvement of quality of national manufactured drugs, hence, promoting the population health levels

evaluation of the outsourcing strategy in supportive services in the hospitals affiliated to the Ministry of Health and Medical Education

After more than two years of the implementation of outsourcing support services strategy in hospitals affiliated to the Ministry of Health and Medical Education, an assessment for the attainment of objectives and the evaluating this strategy was very necessary. This study is aimed to evaluating of above mention strategy, and its results. This is a descriptive, cross-sectional, and applied study for evaluating outsourcing support services strategy in three supportive services [catering, cleaning and laundry] in pilot hospitals [one hospital from each Medical Universities] during 2005-2007. During the years 2005-2007 on the average 86.29% of caterings, cleaning and laundry services of the hospitals have been outsourced, 89.62% of these hospitals have put out these services to tender. The activities that were outsourced during this time and the average were 94.05% through holding volume contracts and participation of contractors in supplying the consumable goods, equipment and maintenance repairing these equipments was 46.51%. The mean satisfaction rate of outsourced services was 76.89% and the payment average to the contractors based on the assessment controlling check-lists was a mean 78.71%. The mean price for each meal in these years was 5341.15 Rials. The cleaning price for each square meter was 12078.66, and for washing each kilogram of clothes or bed sheets was 2929 Rials. The increase of price for the basic services during some years differed from the priced rise of the estimated price. There is no significant correlation between the situation of tenders and satisfaction rate; which was in the case of paying based on the assessment controlling checklists and the rate of satisfaction. But there was a correlation between the amount of monthly contract and human resources working in the contract. Also there was a correlation between the human resources and monthly volume of the work. There was no correlation between the basic price of services and the rate of satisfaction. Also there was no significant correlation between condition of supplying the usage materials, equipments and maintenance these equipments, and satisfaction rate. It seems that outsourcing the services can lead to improvement of hospital efficacy and enhancing the patients and personnel's satisfaction

[Influencing factors on implementation of total quality management at teaching hospitals affiliated with Iran university of medical sciences]

Perspective to retrieval of equity, access to services, effectiveness, efficiency, social acceptability, and strive for continuous improvement of services, Total Quality Management [TQM] has broadened new horizons in health sector. Hence it can result in efficiency and renovation of health services delivery system. Therefore we aimed to determine the influencing factors on implementation of TQM at teaching hospitals affiliated with Iran University of Medical Sciences in Tehran, Iran. We assessed the views of all the 90 managers and supervisors of the hospitals under investigation about the eight factors influencing on implementation of TQM. In a descriptive cross-sectional study, we used an eight-part questionnaire with 75 Likert-type questions for data collection. Validity of the questionnaire was verified with Delphi method. Chi square and t tests and analysis of variance were used for statistical analysis. We assumed an average of 50% for responses indicative of desirability as the minimum acceptable level in each of the eight factors. Of the eight factors studied customer orientation [59.7%], organizational communication [55%], and appropriate organizational structure [50%] proved to be acceptable. The other five factors ranked average [40-50%]. There was significant difference among the total means of influencing factors in the studies hospitals [p = 0.001]. After five years have passed since the implementation of TQM in the studied hospitals, attention of managers to organizational culture, staff participation, human resources development, teamwork, and leadership commitment can result in improvement of the services, effectiveness of the activities, and social acceptability of hospitals

[Simulation in healthcare systems: application in outpatient settings]

To define the main criteria for application of simulation in healthcare systems, especially in outpatient settings. This was a systematic review of the literature. The search involved the use of 3 keywords, namely simulation models, health care systems and outpatient services. The articles were categorized into 3 main groups:- Changes in patients arrival patterns, - Changes in resource allocation methods, - Changes in service delivery processes. The findings are presented in the light of the above headings. Literature show that simulation can be an effective decision-making tool and it can be employed usefully to improve the performance of the health system. It should be kept in mind, however, that a proper information system must be in place to facilitate access to information and to encourage participation by simulation experts and stakeholders such as clients, service providers, and decision makers

[Fuzzy goal programming model in resource allocation at education section of the ministry of health]

Nowadays in almost all organizations, resources are allocated based on traditional methods, personal experiences and mental reasoning power. This causes some dissatisfaction among people and have no generalization ability and mathematical basis. The objective of this research was to propose a fuzzy goal programming model in resource allocation at the university-education affairs of ministry of health and use of mathematical theory method to make the quantity and quality of human reasoning closer to mathematical reasoning. This is a cross-sectional objective-based research for resource allocation taking into consideration the goal limitations. The objective goal function was on the basis of minimum square goals deviation. Decision making matrix questionnaire was used for data collection and the data were analyzed using expert-choice software Matlab. After running the model, the optimal results from each goal were obtained with some modifications compared with that in 1384. In the model [F[x] =1/2 x[T] HX + f[T]x]. Each general variable of the number of students and the number of academic staff in comparison with goal [117000 in comparison with 116690 and 10850 person in comparison with 9855 person respectively] is obtained using quadratic programming method. Use the fuzzy goal programming lead to making optimal resource allocation. The goals of program with respect to resource allocated contains contradictions in comparison with optimal condition. According to this study, it seems that goal programming has a significant effect on optimizing and increasing the level of satisfaction and conformity with conditions and positions

Designing a model of administration structure for Iranian women's health development

Women's health status and awareness of their biological, mental and social characteristic and needs planning, health system reforms and primary health care, are main priorities in strategic areas of health development. In the past two decades researchers and policymakers have paid special attention to women's health development activities and administration. This article compares the women's health development administration in United States, Canada, United Kingdom, and Japan as developed countries, with focus on their organizational structures. This article is based on a descriptive and comparative study. The results have been used to design and develop an appropriate and applicable model for women's health administration in Iran. The designed model has been finalized using Delphi Technique. The countries were divided in two categories. United States and Canada had a focused and advanced administration system in their women's health activities. They have strategic in women's health priority issues and special organizational structures which relatively has been successful. United Kingdom and Japan used different policies focused on the mother and children's health and their administrative policies were based on this view. An appropriate structural designed for women's health in Iran was formulated on results of this study