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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
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Models, Theoretical , Hospitals , Health Care Evaluation Mechanisms , Evaluation Studies as TopicABSTRACT
Introduction: Patient satisfaction is crucial to the long-run success in health care center. With regard to the highest patients' referral to the emergency department and the existing challenges due to the patient s need to urgent care, we aimed to evaluate health care services quality in this unit to find out whether the patients have different expectations from health care providers and if they perceive some dimensions of care more important than others
Method: The SERVQUAL scale method was used in this cross-sectional study on 100 patients in June 2015. Patient satisfaction questionnaire based on SERVQUAL model was evaluated with high content validity and the reliability was 0.97 and 0.81
The data collected were analyzed using SPSS, version 20.0 [IBM, USA]. Statistical analyses included descriptive statistics, paired and independence sample t-test and ANOVA at the significance level 0.05
Results-.The results showed that the quality gap in all dimensions was significant [P<0.001]. The largest quality gap was related to responsiveness [-1.08] and the lowest belonged to assurance [-0.8]. Demographic characteristics were analyzed and the number of referrals was significant in tangibility and assurance dimensions [P = 0.04]; also, in all cases the patients' expectations [total Mean=4.35] were higher than their perception [total Mean = 3.295]
Conclusion: In order to improve emergency services, it is recommended that the hospital management should provide appropriate facilities, reduce waiting time, increase in attention to ordering system based on the patients' condition, and improve the behavior of health care personnel to patient is placed on the agenda of hospital management
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Introduction: Surgical ward is one of the main wards of each hospital that its efficiency is a leading factor in determining the hospital costs. Health care reform plan has been implemented to increase the public satisfaction with health care system and reduce the hospital costs. The aim of this study was to evaluate performance of the operating rooms, before and after implementation of the health care reform plan
Methods: In this descriptive-analytical study, the extracted information from hospital records of all patients [64370 cases] who had undergone surgery from July 2013 to March 2015, were recorded in a researcher-made checklist. Data were statistically analyzed using paired t-test by SPSS 19
Results: The average number of surgical procedures performed in all wards of the teaching hospital was increased after implementation of the health care reform plan. There was also statistically significant difference between all the inpatient surgeries and all the scheduled and unscheduled ones [P<0.05]
Conclusion: Health care reform plan had a significant effect on supply and demands for services in the teaching hospital that can be due to financing through the plan that increased the demand for surgical service delivery
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Introduction: intraoperative radiation therapy device [IORT] is one of the several options for partial breast irradiation. IORT is sent to the tumor bed during surgery and can be replaced with conventional standard therapy [EBRT]. The aim of this study was to evaluate the safety and effectiveness of IORT machine compared with EBRT and to determine the dominant option in terms of the cost-effectiveness
Method: this study was conducted in two phases; the first phase was a comprehensive review of the electronic databases search that was extracted after extraction and selection of the articles used in this article on effectiveness outcomes. Data collection form was completed by professionals and experts to estimate the cost of treatment, intraoperative radiotherapy and radiotherapy cost when using external radiation therapy process; direct costs were considered from the perspective of service provider and they were calculated in the second phase to determine the option of cost-effective ICER. Excel software was used for data analysis and sensitivity analysis was performed to determine the strength of the results of cost-effectiveness
Results: 18 studies were selected but only 8 of them were shown to have acceptable quality. The consequences like "rate of cancer recurrence", "seroma", "necrosis", "toxic", "skin disorders and delayed wound healing" and "spread the pain" were among the consequences used in the selected articles. The total costs for each patient during a course of treatment for EBRT and IORT were estimated 1398 and $5337.5, respectively. During the analysis, cost-effectiveness of the consequences of cancer recurrence, seroma, necrosis and skin disorders and delayed wound healing ICER was calculated. And IORT was found to be the dominant supplier in all cases. Also, in terms of implications of toxicity and prevalence of pain, IORT had a lower cost and better effectiveness and consequently the result was more cost effective than EBRT
Conclusion: according to the results of this study, the difference between the two devices in terms of effectiveness was much lesser than that in terms of the cost of the two devices. According to the results of IORT machine, it is the dominant supplier compared with EBRT. From the cost-effectiveness perspective, Iran Ministry of Health can consider IORT system as an option for entering Iranian health system. But the ethical and cultural considerations in the use of the device must be taken into account
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Introduction: New organization's success depends on the efficient use of human resources In this study, we aimed to estimate the staffing needs in hospitals of Shiraz University of Medical Sciences [SUMS] according to model proposed by the Ministry of Health and Medical Education in 2012
Method: This is a cross-sectional definitive study conducted in three general and six specialized SUMS hospitals. The research tool used was a checklist that determines the number of nurses, paraclinic and service employees and finally the decrease and increase of human resources in the departments of the hospitals regarding Iranian Ministry of Health [MOH] issues. The data were collected and analyzed using SPSS software to determine the differences between the current situation in accordance to MOH issues
Results: Results showed that of the nine teaching hospitals of SUMS in 2012, Namazi hospital had 288 redundant staff and Khalili hospital had a shortage of manpower in 8 places . We observeda deficiency in human resources in all the studied hospitals. Also, the distribution of human resources among most of the hospital departments was not conform with MOH issues
Conclusion: Various models have been proposed for estimating human resources of hospitals. Because of better ergometer and time to estimate the correct manpower, the model introduced by the Department of Health is suitable for planning to increase the efficiency and effectiveness of the hospitals
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Introduction: Due to the vital role of nurses and the effects of scientific advances on nursing care, providing high quality nursing services is not possible without participating in the in-service training programs and becoming familiar with the new techniques. This study aimed to determine the motivational factors influencing the participation in the in-service training courses among nurses working in the teaching hospitals affiliated to Shiraz University of Medical Sciences in 2013
Method: This was an applied, cross-sectional and descriptive-analytical study. A sample of 216 nurses working in the teaching hospitals affiliated to Shiraz University of Medical Sciences was selected using stratified sampling proportional to size and simple random sampling methods. The required data were collected using a questionnaire determining the motivational factors influencing the nurses' participation in the in-service training courses, including personal factors, organizational factors, and those related to the profession and the training courses planning. SPSS 18.0 and some statistical tests including ANOVA, Independent-Samples T-Test, as well as Pearson Correlation Coefficient were used to analyze the collected data
Results: The results showed that the mean score of nurses' motivation for participating in the in-service training programs was 3.41 +/- 0.5. Also, the highest and lowest means of motivational factors affecting the studied nurses' participation in the in-service courses were associated with the factors related to the profession [3.75 +/- 0.71], and those related to the training courses planning [3.20 +/- 0.59], respectively. In addition, there were significant associations between the personal factors [p=0.037] and factors related to the profession [p=0.047] and the studied nurses' positions, between the organizational factors and their employment status [p=0.007], and between the factors related to the training courses planning and the nurses' service unit [p=0.014]. Furthermore, there was a significant and negative correlation between their nursing job experience and organizational factors [r= -0.21, P= 0.004]
Conclusion:: According to the results and in order to increase the studied nurses' motivation for participating in the in-service training courses, the following suggestions can be offered: making a proper educational needs assessment, paying careful attention to the nurses' educational needs, determining the suitable time and place for providing training courses, and encouraging the nurses' participating in the in-service training courses, etc.
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Introduction: The quality of education sector is worth considering as this system has a significant effect on the economic growth of the country. This study aimed to determine the quality gap and rank the student's expectation of educational services provided in Shiraz University of Medical Sciences in 2013
Method: This research included two cross-sectional phases. The sample size of both phases included 220 students selected using multistage sampling. Servqual questionnaire was used in the first study which was designed to find the quality gap of the education system's services. The data were entered into the SPSS statistical software and analyzed using descriptive statistics and Paired-Sample T-Test. Kano's two-dimensional questionnaire was used in the second phase. Each indicator of quality which had a negative gap at a significance level of 5% in the first study was introduced to Kano's two-dimensional questionnaire. Finally, better value and worse value formulas were used to analyze the data obtained in this step
Results: The results revealed that all quality items had a significance negative gap which were recognized as the voice of customers [P<0.05]. Frequency analysis was done to determine the frequency of repetition. Accordingly, 11 out of the 30 requirements were identified as must be requirements and 19 as one-dimensional requirements
Conclusion: This study can help the authorities prioritize their policies, strategies and decisions in order to improve and guarantee the higher education quality and extremity obtains customer satisfaction
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Introduction: Today, shift work is considered as a necessity in many jobs and for some 24-hour services the use of shift-work is growing. However, shift work can lead to physiological and psycho-social problems for shift workers. This study aimed to determine the effects of shift work on the associated health problems, together with the demographic and job characteristics underlying the problems, among the medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2012
Method: This study was an applied, cross-sectional and descriptive-analytical one. The study employed a sample of 205 employees from the medical and diagnostic staff using stratified sampling proportional to the size and simple random sampling methods. Data were collected using the Survey of Shift workers [SOS] questionnaire, validity and reliability of which have already been confirmed. Finally, the collected data were analyzed using SPSS 16.0 software through ANOVA, Chi-square, Independent-Samples T-Test, as well as Pearson Correlation Coefficient. A P<0.05 was considered statistically significant
Results: The results showed that among the demographic and job characteristics studied, the individual, family and social problems had significant associations with work schedules, shift work and job satisfaction. In addition, there were significant associations between musculoskeletal disorders and the satisfaction of shift work; cardiovascular disorders and marital status and occupation; digestive disorders and the work schedules; sleep disorders and the satisfaction of shift work; musculoskeletal disorders, cardiovascular disorders and sleep disorders and age, job experience and shift work experience. And finally, there were significant associations among sleep disorders and age, job experience and the shift work experience
Conclusion: Based on the findings of this study, demographic characteristics such as age, marital status, as well as job characteristics can increase the individual, family and social problems, and cardiovascular, musculoskeletal, digestive and sleep disorders. Therefore, in order to reduce these problems and disorders, the following suggestions are made: allowing voluntary shifts for the staff, shortening the hours of night work, limiting the employment of older people in the shift work systems, etc.
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Introduction: The application of organizational ethics in hospitals is one of the novel ways to improve medical ethics. Nowadays achieving efficient and sufficient ethical hospital indicators seems to be inevitable. In this connection, the present study aims to determine the best indicators in hospital accreditation
Methods: 69 indicators in 11 fields to evaluate hospital ethics were achieved through a five-step qualitative and quantitative study including literature review, expert focus group, Likert scale survey, 3 rounded Delphi, and content validity measurement. Expert focus group meeting was conducted, employing Nominal Group Technique [NGT]. After running NGT, a three rounded Delphi and parallel to Delphi and a Likert scale survey were performed to obtain objective indicators for each domain. The experts were all healthcare professionals who were also medical ethics researchers, teachers, or Ph.D students. Content validity measurements were computed, using the viewpoints of two different expert groups, some ethicists, and some health care professionals [n=46]
Results: After conducting NGT, Delphi, Likert survey, 11 main domains were listed including: Informed consent, Medical confidentiality, Physician-patient economic relations, Ethics consultation policy in the hospital, Ethical charter of hospital, Breaking bad medical news protocol, Respect for the patients' rights, Clinical ethics committee, Spiritual and palliative care unit programs in the hospitals, Healthcare professionals' communication skills, and Equitable access to the healthcare. Also 71 objective indicators for these 11 domains were listed in 11 tables with 5 to 8 indicators per table. Content Validity Ratio [CVR] measurements were done and 69 indicators were highlighted
Conclusion: The domains listed in this study seem to be the most important ones for evaluating hospital ethics programs and services. Healthcare organizations' accreditation and ranking are crucial for the improvement of healthcare services. Ethics programs would also motivate hospitals to improve their services and move towards patients' satisfaction. In this regard, more involvement of bioethicists can help healthcare organizations to develop ethics programs and ensure ethicsbased practice in hospitals
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Humans , Male , Female , Adult , Middle Aged , Accreditation , Hospitals , Ethics , Delphi Technique , Surveys and QuestionnairesABSTRACT
Assessment of quality of life [QOL] is of paramount importance for improving postpartum QOL which will in turn enhance QOL of mothers, children, individuals, and the community. The present study aimed to evaluate and compare postpartum QOL after Cesarean Section [CS], Normal Vaginal Delivery [NVD], and water birth delivery. This descriptive analytical, cross-sectional study was conducted on postpartum women referred to urban health centers and two public hospitals in 2012-13 in Shiraz, Iran. Overall, 59 women with NVD, 39 with CS, and 39 with water birth, all at 2 months postpartum, were recruited into the study through multi-stage sampling. Postpartum QOL was measured using Short Form Health Survey [SF-36] which hadbeen adapted previously in Iran. Then, the data were analyzed using descriptive statistics and one-way analysis of variance [ANOVA] in SPSS, version 18. The results showed that the NVD group had the highest mean score in physical health domains; the women with water birth had the highest mean score in mental health domains and total QOL. Regarding postpartum QOL the results of one-way ANOVA showed no statistically significant differences between the three modes of delivery. Women with water birth and NVD had the highest and second highest total QOL mean scores, respectively; women with NVD and water birth experienced better physical health. Thus, providing more information to pregnant women to encourage them to use NVD and water birth is suggested
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Background: Despite the enhancement in health outcomes worldwide, health inequity and inequality is one of the most relevant topics both for health policy and public health. This research was designed to decompose the health inequality of people living in Shiraz, south-west Iran
Methods: Data were obtained from a multistage-sample survey conducted in Shiraz from April to May 2012, to find determinants of health related quality of life [HRQoL]. General health [GH] and mental health [MH] were used as health status. As a measure of socioeconomic inequality, a concentration index of GH and MH was used and decomposed into its determinants
Results: The overall concentration indices of MH and GH in Shiraz were 0.023 [95% CI: 0.015, 0.031] and 0.016 [95% CI: 0.009, 0.022], respectively. Decomposition of the concentration indices indicated that income made the largest contribution [39.92% for GH and 39.82% for MH] to income-related health inequality. Education [about 25% for GH and 34% for MH], insurance [about 14% for GH and 11% for MH], and occupation [about 12% for GH and 11% for MH] also proved important contributors to the health inequality in Shiraz
Conclusions: There exist MH and GH inequalities in Shiraz. Apart from insurance, most of the health inequalities in Shiraz can be explained through factors beyond the health sector. Hence, implementing redistributive policies and education expansion programs as well as providing an insurance scheme and secure career conditions could decrease these unethical health inequalities
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Humans , Male , Female , Adult , Middle Aged , Social Determinants of Health , Quality of Life , Mental Health , Cross-Sectional Studies , Health Status , Socioeconomic FactorsABSTRACT
To estimate the total annual cost due to chronic hepatitis B [CHB]-related diseases imposed on each patient and his/her family in Iran. Economic burden of CHB-related diseases [CHB, cirrhosis, and hepatocellular carcinoma] were examined. In this retrospective study, 100 Iranian patients were identified to obtain their socioeconomic status, utilization [direct and indirect costs] and costs of treatment, and work days lost due to illness with a structured questionnaire during 2012. Costs of hospital admissions were extracted from databases of Nemazee Hospital, Shiraz, Iran. The outpatient expenditure per patient was measured through the rate of outpatient visits and average cost per visit reported by the patients, while the inpatient costs were calculated through annual rate of hospital admissions and average expenditure. Self-medication and direct non-medical costs were also reported. The Human Capital Approach was used to measure the work loss cost. The total annual cost per patient for CHB, cirrhosis, and hepatocellular carcinoma were US[dollar sign] 3094.5, US[dollar sign]17483, and US[dollar sign] 32958 during 2012, respectively. CHB-related diseases impose a substantial economic burden on patients, families, and the society. This study provides useful information on cost of treatment and work loss for different disease states, which can be further used in cost-effectiveness evaluations
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Introduction: Health care systems depend critically on the size, skill, and commitment of the health workforce. Therefore, researchers have a close observation on the subjects which leads to an increase in the productivity of human resources. This study aims at determining the relationship between the quality of work life and the productivity of knowledge workers of the central field of Shiraz University of Medical Sciences, in order to determine the factors effective in the quality of their working life
Method: This cross-sectional study was conducted on 300 individuals selected by stratified random sampling method. On 761 knowledge workers of the central field of Shiraz University of Medical Sciences by using Timossi questionnaire of Quality of Work Life and Knowledge Worker Productivity Assessment questionnaire of Antikainen, during May and June 2011 The collected data were recorded by SPSS version 15 software and then it underwent statistical analysis using Pearson correlation. The P value level for statistical significance was set at 0.05
Results: In general, 50% of the knowledge workers were dissatisfied about their quality of work life, and the other 50% had little satisfaction. 18% of the staff were in an unfavorable condition and 82% had a poor productivity. Also, the quality of work life had a positively significant relationship with the productivity of human resources [r=0.568; P>0.001]
Conclusion: Most of the knowledge workers in the central field of Shiraz University of Medical Sciences had low productivity and quality of work life. Considering the relationship between the two variables, taking measures to improve the quality of work life can lead to more creative and profound planning in presenting services and, as a result, improving the productivity of the knowledge workers