Investigating medical tourism development indicators in Yazd Reproductive Sciences Institute: A cross-sectional study.

Background: Payingspecial attention to the development indicators of medical tourism (MT) can lead to the further development of this industry and tourists' satisfaction. Objective: This study aimed to investigate MT development indicators in Yazd Reproductive Sciences Research Institute, Yazd, Iran in 2021. Materials and Methods: In this cross-sectional study, 430 medical tourists referred to the Yazd Reproductive Sciences Institute, Yazd, Iran in 2021 were studied. A researcher-made questionnaire with 46 questions and 10 dimensions was used in both internal and external environments to collect data. The Spearman correlation coefficient was also used to assess the correlation between the quantitative factors. Results: The reliability and validity of the scale were confirmed. The mean ± SD of the advertising and marketing index scored was lower than the other internal environmental indices (15.05 ± 2.16). Also, the economic factors and tourism infrastructure were lower than the other external environmental factors (9.8 ± 1.99, 8.53 ± 2.11, respectively). Conclusion: Given the importance of MT, top managers and relevant authorities should pay close attention to the criteria of advertising, marketing, and tourism infrastructure. MT demand can be improved by increasing the importance of advertising, implementing realistic advertising strategies, and developing adequate urban infrastructure and services.

Managerial competencies of head nurses: a model and assessment tool.

Head nurses' performance plays an important role in the successful operation of hospitals. Identification and prioritisation of managerial competencies required for these supervisors and evaluation of their performance on this basis are necessary. This study aimed to provide a valid tool for assessing managerial competencies of hospital department head nurses. First, through literature review, Delphi technique and expert panel, a competency model was developed. Then using the analytic hierarchy process, competencies were weighted and prioritised. Finally, based on the model, an instrument was designed to measure the competencies of head nurses. Validity and reliability of the instrument was also checked. The proposed framework included 27 competencies categorised by four main managerial tasks: planning, organising, leadership and control. Findings revealed that the highest priority was given to strategic thinking (0.1221) and the lowest priority was given to evidence-based decision making (0.007). Based on impact score and content validity ratio results, the content validity of all questions has been proved. Furthermore through the use of a content validity index, 11 questions were omitted or modified. The study presents a valid and comprehensive model for assessing managerial competencies of hospital department head nurses in order to take an important step towards improving their performance.

Failure mode and effect analysis: improving intensive care unit risk management processes.

Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services - their frequency and severity - were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.

Assessment of Service Quality in Teaching Hospitals of Yazd University of Medical Sciences: Using Multi-criteria Decision Making Techniques.

OBJECTIVES: Hospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS). METHODS: A literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards. RESULTS: Six dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851). CONCLUSION: Findings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients' security and plan effectively for its promotion.

Comparing Performance Indicators of Obstetrics and Gynecology Ward at Yazd Educational Hospitals with Expected Limits of Indicators, 2015.

OBJECTIVES: The purpose of this study was to evaluate the performance indicators for obstetrics and gynecology wards in Iran. METHODS: This study was designed as a cross-sectional study and was carried out in obstetrics and gynecology wards of Afshar and Shahid Sadoughi hospitals in 2015. The information required for the performance indicators was gathered through questionnaires, statistical forms, and direct observation. In several tables, performance rating and performance status are presented using the Likert scale index based on the expected limits. RESULTS: According to the results of the categories of input indicators, the bed occupancy rate of Afshar Hospital's obstetrics and gynecology ward was, at 83%, higher than expected (79%), and that in Shahid Sadoughi Hospital (at 69%) was lower than expected. For medicinal methods and nonmedicinal methods of pain alleviation, the index process at Afshar Hospital was much lower than expected (40%). In Afshar Hospital, patient satisfaction at discharge was about 66.74%. CONCLUSION: Effective steps can be taken to improve the input and output criteria: allocating appropriate physical space, examining the reasons for low bed occupancy rate by using complex analytical models, and in order to study the reasons for large number of cesarean section childbirth, it was recommended to place more emphasis on training of pregnant mothers and to inform them about the side effects of cesarean section and advantages of natural childbirth.

Performance Analysis of Hospital Managers Using Fuzzy AHP and Fuzzy TOPSIS: Iranian Experience.

BACKGROUND AND OBJECTIVES: Hospitals are complex organizations that require strong and effective management. The success of such organizations depends on the performance of managers. This study provides a comprehensive set of indicators to assess the performance of hospital managers in Iranian Ministry of Health owned hospitals. METHODS: This research was a cross-sectional study. First, reviewing the literature and using experts' viewpoints and convening a panel of experts, the dimensions of performance have been selected and came in the form of a performance model. Then, using Fuzzy Analytic Hierarchy Process (FAHP), the chosen dimensions were weighted. Finally, based on the weighted performance dimensions, a questionnaire was designed and after confirming the reliability and validity, through a census, 407 senior and middle managers from 10 hospitals in Yazd, Iran completed it and performance of CEOs in these hospitals was evaluated using the Fuzzy Technique for Order Preference by Similarity Ideal Solution (FTOPSIS). RESULTS: To measure the performance of hospital managers, a performance assessment model consisted of 19 sub-dimensions in 5 main dimensions (Functional, Professional, Organizational, Individual and Human) was developed. The functional area had the most weight and the individual area had the least weight, as well. The hospital managers had different performance levels in each category and sub-dimensions. In terms of overall performance, the hospital managers C and H had the best and the worst performance, respectively. CONCLUSIONS: The use of appropriate dimensions for performance, prioritizing them and evaluating the performance of hospital managers using appropriate techniques, can play an effective role in the selection of qualified managers, identifying strengths and weaknesses in performance and continuous improvement of them.

Equity in Distribution of Health Care Resources; Assessment of Need and Access, Using Three Practical Indicators.

BACKGROUND: Equitable distribution of health system resources has been a serious challenge for long ago among the health policy makers. Conducted studies have mostly ever had emphasis on equality rather than equity. In this paper we have attempted to examine both equality and equity in resources distribution. METHOD: This is an applied and descriptive study in which we plotted Lorenz and concentration curves to describe graphically the distribution of hemodialysis beds and nephrologists as two complementary resources in health care in relation to hemodialysis patients. To end this, inequality and inequity were measured by calculating Gini- coefficient, concentration and Robin Hood indices. We used STATA and EXCEL software to calculate indicators. RESULTS: The results showed that inequality was not seen in hemodialysis beds in population level. However, distribution of nephrologists without considering population needs was accompanied with some sort of inequality. Gini- coefficient for beds and nephrologists distribution in population level was respectively 0.02 and 0.38. Hence, calculation of concentration index for distribution of hemodialysis beds and nephrologists with regard to population needs indicated that unlike beds distribution, equity gap between nephrologists distribution against patients distribution among the provinces was considerably significant again. CONCLUSION: Our results imply that although hemodialysis beds in Iran have been distributed in connection with the population need, nephrologists' distribution is not the same as hemodialysis beds one and this imbalance in complementary resources, can affect both efficiency and equitable access to services for population.

Telemedicine and its potential impacts on reducing inequalities in access to health manpower.

Human resources for health have many diverse aspects that sometimes bring about conflicts in the healthcare market. In recent decades issues such as attrition, migration, and different types of imbalances in health workers were not only considered as international problems, but also took on new particular dimensions and complications. Rapid growth in establishing infrastructure of communications and many diseases such as human immunodeficiency virus/AIDS and malaria, as well as shortages in skilled healthcare providers in developing countries, interested many health economists and health professionals to consider telemedicine as an approach to deliver some healthcare and to pursue its effects on human resources management in healthcare. The objective of this communication is to offer a better understanding of the value of telemedicine in human resources management in healthcare. This article briefly reviews related literature on potential contributions of telemedicine in mitigating four different types of imbalances in health workers and points out some of its capabilities. Although there is a great need for systematic, scientific, and analytical studies in effects of telemedicine on health workers, expansion of communication infrastructure throughout and especially in remote areas, political commitment, and provision of useful information and education to reduce problems of human resources for health are beneficial.