A study of factors affecting the length of hospital stay (LOS) of COVID-19 patients: A qualitative evidence in Iranian hospital.

BACKGROUND: The present study aimed to identify the administrators' and physicians' experiences and viewpoints about the factors affecting the length of stay (LOS) of COVID-19 patients and provide valid operational evidence. MATERIALS AND METHODS: The current study was carried out qualitatively and phenomenologically on experts, officials, and administrators of hospitals in 2021. Purposeful sampling was performed with the maximum diversity. To achieve a comprehensive view, snowball sampling was conducted. Twenty-one experts in the field of healthcare and emerging diseases participated in this study. Semi-structured interviews were used to collect the data. The study sites were universities of medical sciences and hospitals of the Ministry of Health of Iran. The interview questions included questions about the factors affecting the LOS and strategies for controlling the LOS of COVID-19 patients in infectious units. Text analysis was performed through the content analysis method in MAXQDA-10 software. RESULTS: Based on the experts' viewpoints, several factors affected the LOS in COVID-19 patients. These factors were divided into five clinical, preclinical, economic, social, and management subcategories. The proposed solutions included policy solutions (supportive policies, development of home care services, training and culture building, and establishment of clinical guidelines) and operational solutions (drug management, promotion of equipment and facilities, telehealth or telemedicine services, and promotion of clinical and support processes). CONCLUSION: One of the main tasks of hospital administrators is identifying the factors affecting the reduction of LOS. Among these factors, clinical and management factors in the hospital are more important and need more planning and attention by hospital officials.

Establishing clinical governance model in primary health care: A systematic review.

Clinical governance is a systematic approach to enhancing the quality of primary health care and ensuring high clinical standards, responsiveness to performance, and continuous improvement in service quality. The objective of the current study was to investigate the global experiences of clinical governance in primary health care. In the present systematic review, relevant articles from different countries were searched in various databases such as MD PubMed from Medline portal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult until April 2019. The searched articles were checked through CASP and PRISMA checklists, and their results were extracted. Of the 17 selected studies, 16 belonged to developed countries, including England (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were divided into three general categories: (1) principles of effectiveness and risk management, (2) deployment requirements such as structural and organizational needs, resource and communication, and information management, and (3) barriers of clinical governance toward providing primary health care. it is recommended that a suitable framework or model be developed and designed adapted to the local culture and taking into account all effective dimensions for a proper establishment and implementation of clinical governance in primary health care.

Assessment of performance in teaching hospitals: Using multicriteria decision-making techniques.

BACKGROUND: It is essential to evaluate the performance of hospitals in the health system. Hospitals need a performance evaluation system to develop and compete in order to measure the efficiency and effectiveness of their programs, processes, and human resources. This study aimed to evaluate the performance of teaching hospitals using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method and hierarchical analysis. MATERIALS AND METHODS: This was a cross-sectional and descriptive study conducted in 2019 in all teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences. The required data were collected using a standard checklist. The collected data were analyzed using the analytic hierarchy process (AHP) and TOPSIS. In the first phase, annual indicators of hospital evaluation were collected. Following the AHP, key performance indicators (KPIs) were selected and prioritized in hospitals. RESULTS: The questionnaires were provided to 15 experts to weigh KPIs, and the most important indicators were selected. The results of hierarchical analysis showed that three main indicators in evaluating the performance of hospitals were bed turnover rate, emergency clients, and length of stay. CONCLUSIONS: One of the problems in evaluating hospitals is the use of key indicators that alone measure the quantity or quality of their performance. Multicriteria decision-making can be used to determine key indicators first, and then by combining these indicators into a multicriteria decision-making model, a better assessment of the role and performance of hospitals can be provided.

Training needs assessment of nursing managers for achieving university health coverage.

BACKGROUND: University health coverage gives everyone accesses to health services focused on the most important causes of illness and death and ensures that the quality of services is high enough to improve the health of those receiving services. Nurses as the largest group of staff in the health system play an important role in achieving UHC. This study aimed to determine the training needs of nursing managers in universities of medical sciences of Iran in achieving UHC. MATERIALS AND METHODS: This study was a qualitative study conducted in 2019 using the framework method. There were 15 experts in nursing management, health management, and nursing authorities at the national level using the purposive random sampling. Data were collected from the expert panel. We used the Atlas.ti software version 7.2 and using the framework method for the analysis of qualitative data. A set of codes organized into categories that were jointly developed by the researchers involved in the analysis. The UHC framework used to summarize data in a way that could support answering research questions. RESULTS: This study showed that three educational modules leadership and strategic thinking, management, and decision-making, achieving excellence in nursing management to capacity building of nursing managers in the country. CONCLUSION: Training leadership skills and strategic thinking in the nursing empowerment modules illuminate global and national health roadmaps and policies and change attitudes to the model of nursing service delivery. Since nurses are the largest group of professionals in the health system, it facilitated by changes in the role and functions of the hospital and nurses to reach UHC.

Factors affecting patient safety: a qualitative content analysis

Background: Patient safety is one of the main components of good-quality health services. The main objective of this study is to explore the most effective factors relating to patient safety in Iran. Methods: This qualitative study was done using content analysis. Data were collected using semi-structured interviews. Through purposive sampling, 14 participants were selected by experts who were familiar with the patient safety friendly hospital program. Interviews were recorded and then analyzed by framework analysis using MAXQDA software. Results: Of 2,474 initial codes, 10 main themes and 53 sub-themes were identified, including importance of human resources; organization and management; interactions and teamwork; medication; equipment and physical environment; patient-related factors; patient safety and quality improvement; the importance of documentation; assessment and monitoring; medical errors; barriers and challenges. Conclusion: Factors affecting patient safety can be divided into two groups: facilitators and barriers. Hospitals can improve the implementation of patient safety standards, reduce the adverse events and enhance patient safety by strengthening facilitating factors, such as providing human resources, adequate medical equipment and facilities, increasing employee participation in quality improvement programs, improving staff training, communicating with patients and their families, and addressing the existing challenges and barriers

Factors affecting sentinel events in hospital emergency department: a qualitative study.

Purpose A sentinel event is an unexpected occurrence resulting in death or serious physical or psychological injury or the risk thereof. The purpose of this paper is to investigate the influencing factors of sentinel events in the emergency department of a military hospital in Tehran to find out some of the effective solutions. Design/methodology/approach In this qualitative study with content analysis approach, 20 hospital healthcare personnel participated as participants from the fields of medicine and nursing. Purposive random sampling and semi-structured interviews were used for data collection. Atlas.ti software version 5.2 was used for data analysis. Findings Four themes and 32 subthemes were identified by numerous revisions and combining the codes. The four main themes of sentinel events were: causes, incidence barriers, cause prevention solutions, and barriers' improvement solutions. Moreover, these main factors were related to these issues: staff and patients' education, communication, assessment, patients and their companions, employee rights, leadership, care continuum, human factors, physical environment, information management and medication use. Some solutions were also suggested according to these factors and a policy was recommended. Practical implications Hospital managers and authorities should try to find the main causes of sentinel events by periodical analysis to find ways to prevent them in the future, using logical and reasonable solutions. Originality/value This study confirms that strategies to reduce the sentinel events in emergency departments should focus on empowerment of all staff.

Conceptual Models of Social Determinants of Health: A Narrative Review.

BACKGROUND: There are several conflicting conceptual models to explain social determinants of health (SDH) as responsible for most health inequalities. This study aimed to present these models in historical perspective and provide main component of SDH models as an SES indicators. METHODS: This was a narrative study using international databases to retrieve literature dealing with conceptual models of SDH. All publication in English language until Mar 2015 was included. The CASP and PRISMA were used to summarize the literature. RESULTS: Overall, 248 publications were retrieved and screened. After exclusion of irrelevant and duplicates, 94 citations were found to be relevant and 21 publications included in this review. In general, 21 models of SDH were found: some models presented before year 1995(n=4), some models presented between 1995 and 2005 (n=13) and some models presented after 2005 (n=4). However, we found three categories of indicators that contribute to SDH models and that were classic factors, fixed and demographic factors and proxy factors. CONCLUSION: Reduction of socioeconomic inequalities in health requires understanding of mechanisms and causal pathways; therefore, every country needs to design the specific model. As the available models are for developed countries, lack of a specific model for developing ones is tangible. As there is no gold standard related to SES indicators, therefore, it is proposed to use the various indicators based on life course approach, which leads to understanding and adopting effective policy interventions.

Barriers to and Facilitators of Inter-Organizational Coordination in Response to Disasters: A Grounded Theory Approach.

OBJECTIVE: Coordination is a major challenge in the field of health in disasters, mostly because of the complex nature of health-related activities. METHODS: This was a qualitative study based on the grounded theory approach. A total of 22 experts in the field of health in disasters participated in the study. The data were collected through in-depth interviews and literature review. The collected data were then analyzed by use of MAXQDA 2010 software (VERBI Software GmbH). RESULTS: The lack of a strategic view in the field of health in disasters, a lack of coordination of necessities and infrastructures, insufficient enforcement, a higher priority given to an organizational approach rather than a national approach, and the field of disasters not being a priority in the health system were noted as barriers to inter-organizational coordination. The facilitators of inter-organizational coordination noted were the importance of public participation in the field of health in disasters, having a process and systematic view in the field of health in disasters, the necessity of understanding and managing resources and information in the field of health in disasters, and having a feedback and evaluation system in the health system after disasters. CONCLUSION: It is recommended that developing common beliefs and goals be given priority in making plans and policies in the field of health in disasters. (Disaster Med Public Health Preparedness. 2017;11:318-325).

Factors Affecting Quality of Emergency Service in Iran's Military Hospitals: A Qualitative Study.

INTRODUCTION: Quality is a key factor for the success of any organization. Moreover, accessing quality in the emergency department is highly significant due to the sensitive and complex role of this department in hospitals as well as the healthcare and medical treatment system. This study aimed to identify, from the perspective of medical experts and nurses serving in the military health and medical treatment system, the factors that affect the quality of emergency service provided in selected military hospitals in Iran. METHODS: This qualitative research was performed in Valiaser Hospital of Tehran (Iran) in 2015, using the framework analysis method. The purposive sampling technique was used for data collection. A total of 14 participants included two emergency medicine specialists, four general physicians, two senior nurses (holding M.Sc. degrees), and six nurses (holding B.Sc. degree). Data were collected through semistructured interviews. Sampling continued until data saturation occurred. The Atlas/Ti software was employed for data analysis. RESULTS: Four basic themes emerged as the effective factors on the quality of emergency services, namely, structural themes, process/performance themes, outcome themes, and environmental/contextual themes. Moreover, through a framework analysis, 47 subthemes were specified and summarized as indicators of the different aspects of the main themes. CONCLUSION: The factors affecting the quality of emergency services in Iran's selected military hospitals are especially complicated due to the diversity of the missions involved; thus, different factors can influence this quality. Therefore, an effort should be made to tackle the existing obstacles, facilitate the identification of these effective factors, and promotion of the quality of healthcare services.

Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study.

INTRODUCTION: Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. METHODS: This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. RESULTS: After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. CONCLUSION: Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment.

Analyzing and Prioritizing the Dimensions of Patient Safety Culture in Emergency Wards Using the TOPSIS Technique.

BACKGROUND & AIM: Doubtlessly, permanent development in patient care services is not feasible without paying attention to the culture of safety by health and treatment institutes. The present study is an attempt to analyze the cultural aspects of patient safety in the emergency wards of hospitals affiliated with the Tehran Medical Science University. The viewpoint of the nurses and hospital officials and their priorities were studied. For prioritizing the results of this study the TOPSIS technique was chosen. METHODS: The study was conducted as an analytical-descriptive and cross-sectional one. It was carried out in two parts: at first the cultural aspects of the patients were measured using a questionnaire for a six months period in 2011 in emergency wards of the hospitals under study. The study population was constituted of physicians and nurses of the emergency wards. The sample group (n=270) was selected through a cluster sampling and its size was determined by using the sample size formula. For data gathering, the standard questionnaire of Hospital Survey on Patient Safety Culture (HSOPSC) was used. The data were analyzed in SPSS. The aspects of the safety culture were prioritized using the TOPSIS model. The criteria were ranked by using the MATLAB software. RESULTS: There was a significant relationship among the aspects of performance, teamwork, feedback, mistake relationships, and the support of the managers (P ? 0.05). The total point of the patient safety culture in the majority of the hospitals were at a mean level of 3. The maximum score was 5. The maximum and minimum mean points were obtained by the Hasheminejad and Sina hospitals respectively. The results of the multivariate decision-making analysis indicated that human, managerial, organizational, and environmental factors were at the top of priorities in a descending order. The factors were extremely effective in the improvement of safety in hospitals. CONCLUSION: Human factors were the most effective and important factors in the improvement of safety in emergency wards. Therefore, there is a need to pay more attention to such factors in safety improvement programming. Training, cultural works, preparation of organizational environments, and motivating environmental factors were of the main measures that must be taken into account by the managers.

Evaluation Indexes of Military Hospitals From the Experts' Perspective: A Qualitative Study.

Given the importance of evaluation in an organization and considering the objectives and missions of military hospitals, we aimed to extract some indexes (in addition to common evaluation indexes) for use in evaluating military hospitals. This was an applied-type qualitative study. The participants were 15 health experts who were first chosen by a purposeful sampling, which was then continued by theoretical sampling. The data obtained were analyzed by using MAXQDA11 software and the content analysis method. After 290 obtained codes were analyzed, 17 indexes in 6 domains were extracted, including capacity development for crisis periods, equipment and facilities, training and research, passive defense, treatment, and services, from which 8 indexes were related to capacity development for crisis periods and equipment and facilities (4 indexes each), 3 indexes were related to services, and 6 indexes were related to training and research, passive defense, and treatment (2 indexes each). The results of the present research, as a supplement to current evaluation methods such as accreditation, can be used for the comprehensive evaluation of military hospitals.

The relationship between learning style preferences and gender, educational major and status in first year medical students: a survey study from iran.

BACKGROUND: Identifying and employing appropriate learning styles could play an important role in selecting teaching styles in order to improve education. OBJECTIVES: This study aimed to determine the relationship between learning styles preferences and gender, educational major and status in first year students at Isfahan University of Medical Sciences. PATIENTS AND METHODS: A cross-sectional study employing the visual-aural-read/write-kinesthetic (VARK) learning style's questionnaire was done on 184 first year students of medicine, pharmacy, dentistry, nursing and health services management at Isfahan University of Medical Sciences in 2012. The validity of the questionnaire was assessed through experts' views and reliability was calculated using Cronbach's alpha coefficients (α = 0.86). Data were analyzed using the SPSS ver.18 software and x(2) test. RESULTS: Out of 184 participants who responded to and returned the questionnaire, 122 (66.3%) were female; more than two-thirds (68.5%) of the enrolled students were at the professional doctorate level (medicine, pharmacy, dentistry) and 31.5% at the undergraduate level (nursing and health services management). Eighty-nine (48.4%) students preferred a single-modal learning style. In contrast, the remaining 95 students (51.6%) preferred multi-modal learning styles. A significant relationship between gender and single modal learning styles (P = 0.009) and between status and learning styles (P = 0.04) was observed. CONCLUSIONS: According to the results, male students preferred to use the kinesthetic learning style more than females, while, female students preferred the aural learning style. Knowledge about the learning styles of students at educational institutes is valuable and helps solve learning problems among students, and allows students to become better learners.

Macroeconomic policies and increasing social-health inequality in Iran.

BACKGROUND: Health is a complex phenomenon that can be studied from different approaches. Despite a growing research in the areas of Social Determinants of Health (SDH) and health equity, effects of macroeconomic policies on the social aspect of health are unknown in developing countries. This study aimed to determine the effect of macroeconomic policies on increasing of the social-health inequality in Iran. METHODS: This study was a mixed method research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect the data along with a multiple attribute decision-making method for the quantitative phase of the research in which the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was employed for prioritization. The NVivo and MATLAB softwares were used for data analysis. RESULTS: Seven main themes for the effect of macroeconomic policies on increasing the social-health inequality were identified. The result of TOPSIS approved that the inflation and economic instability exert the greatest impact on social-health inequality, with an index of 0.710 and the government policy in paying the subsidies with a 0.291 index has the lowest impact on social-health inequality in the country. DISCUSSION: It is required to invest on the social determinants of health as a priority to reduce health inequality. Also, evaluating the extent to which the future macroeconomic policies impact the health of population is necessary.

Prioritizing the Determinants of Social-health Inequality in Iran: A Multiple Attribute Decision Making Application.

BACKGROUND: One of the main challenges of healthcare systems of developing countries is health inequality. Health inequality means inequality in individuals' ability and proper functioning, resulting in inequality in social status and living conditions, which thwarts social interventions implemented by the government. OBJECTIVES: This study aimed to determine and prioritize the social determinants of health inequality in Iran. MATERIALS AND METHODS: This was a mixed method study with two phases of qualitative and quantitative research. The study population consisted of experts dealing with social determinants of health. A purposive, stratified and non-random sampling method was used. Semi-structured interviews were conducted to collect qualitative data along with a multiple attribute decision making method for the quantitative phase of the research in which the TOPSIS technique was employed for prioritization. The qualitative findings were entered into NVivo for analysis, as were the quantitative data entered into MATLAB software. RESULTS: The results approved the suitability of the conceptual framework of social determinants of health suggested by the WHO (world health organization) for studying social determinants of health inequality; however, this framework general and theoretical rather than a guideline for practice. Thus, in this study, 15 themes and 31 sub-themes were determined as social determinants of social health inequality in Iran. Based on the findings of the quantitative phase of our research, socioeconomic status, living facilities such as housing, and social integrity had the greatest effect on decreasing health inequality. CONCLUSIONS: A major part of the inequality in health distribution is avoidable because they are mostly caused by adjustable factors like economic conditions, educational conditions, employment, living facilities, etc. As in the majority of developing countries the living and health conditions are the same as Iran, the findings of this study may be applicable for other developing countries.

Major incident experience and preparedness in a developing country.

BACKGROUND: Research shows that having previous experience of major incidents has a positive impact on awareness and preparedness of organizations. We investigated the effects of major incident experience on preparedness of health organizations on future disasters in Iran. METHODS: A qualitative study using a semistructured interview technique was conducted with 65 public health and therapeutic affairs managers. Analysis of the data was performed used the framework analysis technique, which was supported by qualitative research software. RESULTS: The study found that prior experience of major incidents results in better performance, coordination, and cooperation in response to future events. There was a positive effect on policy making and resource distribution and an increase in (1) preparedness activities, (2) raising population awareness, and (3) improving knowledge. However, the preparedness actions were predominantly individual-dependent. CONCLUSIONS: Our findings showed that to increase system efficiency and effectiveness within health organizations, an appropriate major incident management system is needed. The new system can use lessons learned from previous major incidents to better equip health organizations to cope with similar events in the future.

Early Warning System for Disasters within Health Organizations: A Mandatory System for Developing Countries.

BACKGROUND: Disaster identification and alert systems can be processed in dif-ferent ways. An early warning system is designed to detect impending danger and send appropriate and clear signals to at risk communities and organizations at the right time and in an unambiguous way. This study aimed to determine early warning system for disaster within health organization in Iran. METHODS: This article presents the findings of a mixed-methods study of early warning systems for disaster management within the health organizations in Iran. During the years 2011 to 2012, a sample of 230 health managers was surveyed using a questionnaire and 65 semi-structured interviews were conducted with public health and therapeutic affairs managers who were responsible for disaster management. RESULTS: A range of problems were identified. Although there is a multi-agency alert system within the health organizations, other indicators of early warning system are not satisfactory. Furthermore, standard messages which are used to alert organizations are not used under the current system. CONCLUSION: Some activities such as memorandum of understanding among different stakeholders of disaster response and education of staff and communities could improve the response to disasters within the health organizations.