Determine the Level of Organizational Learning Capability in Teaching Hospitals in Bandar Abbas City—Iran

Background: The hospital is a scientific organization that despite much progress, today, is also dependent on manpower. One of the main requirements for the proper functioning of manpower is that through learning, they be updated in terms of knowledge. Thus, the aim of this study was to determine the level of Organizational Learning Capability in hospitals in Bandar Abbas City—Iran. Methods: In 2014, this descriptive-analytic study was conducted in hospitals in Bandar Abbas City. The data was collected through the Gomez questionnaire for organizational learning from 290 employees of hospitals. Data analysis was done using software SPSS V.20 and by the Mann-Whitney U test and the Kruskal-Wallis test. Results: Organizational Learning Capability in governmental, private and social security hospitals were 0.31 ± 53.06, 9.38 ± 47.38 and 0.27 ± 50.74, respectively. The results of the Kruskal-Wallis test showed that the relationship between the variables of employment status (p = 0.034), occupational categories (p = 0.043), and type of ownership (p = 0.02), was significant with the organizational learning capability but such a significant relationship was not observed in terms of age, educational level and employment status. The results of the Mann- Whitney U-test indicated a significant association between marital status (p = 0.029) and type of hospital (p = 0.049) with the organizational learning capability. Conclusion: Need to up-to-dating of staff’s knowledge has made undeniable the role of organizational learning. According to the results, managers have to provide conditions for improving the status quo through promoting or-ganizational learning and extend the ability of the organization for growth and progress.

Analysis of Nosocomial Infections in Selected Teaching Hospitals, Qazvin, Iran

Introduction: Hospital infections prolong patient hospitalization, necessitate additional treatment, increase mortality rate, raise hospital expenses, and even reduce the level of health in the society. The purpose of this research was to study hospital infections in selected hospitals of Qazvin. Methods and Materials: This was an analytic-cross-sectional study. The research population consisted of 25,628 hospitalized patients in the first eight months of 2012 in three selected hospitals of the Qazvin Province. The algorithm of reporting hospital infections, the National Program of Controlling Hospital Infections, and 223 patient files hospitalized due to hospital-acquired infections were used to collect information. The collected information was analyzed using the SPSS V. 17 software;the descriptive statistics was used to analyze the qualitative variables;and the descriptive statistics together with chi-square and t-test were employed for the quantitative variables. Results: The ICU units had the most cases of hospital infections. Respiratory pneumonia and urinary infections topped the list of hospital infections. The most invasive treatments carried out on patients with hospital infections were surgery, urinary catheter, and venous catheter, respectively. More than 50 percent of patients with hospital infections were hospitalized for 2 to 21 days. Results and Conclusions: Because of the high rate of hospital infections, especially in the ICU ward, authorities must give top priority in their plans to designing suitable educational programs to inform hospital staff and patients of hospital infections and to provide suitable resources for dealing with this problem.

An Investigation on the Barriers and Facilitators of the Implementation of Electronic Health Records (EHR)

The application of technology in health care, in the form of electronic health records (EHR), is the most important and necessary issue in order to improve the quality of health care, and studies have shown that, not only is it a way to integrate information and represent the condition of patients, and a dynamic source for health care, however it leads to gain access to clinical information and records, electronic communications, comprehensive training and management, and ultimately enhancing the public health;the aim of this study is to investigate the factors influencing the implementation of EHR, which are known as barriers and facilitators. The research is conducted in the form of a review research, and with the help of the Keywords of EHR;barriers and facilitators, articles, from 2008 to 2013, were searched and studied in the Internet-databases. The results of the studies show that the most effective factors include: efficiency, motivation, management, and the participation of end users. Factors such as technical aspects ease of use, available resources, and human resources, have limited effects. And security and privacy, the expected output, lack of time, and workload have relative effects, and also the relation between the patient and clinical staff, has no effects in the process of implementing EHR.

A Comparative Assessment of Patient Safety Culture between Iranian Selected Hospitals and Agency for Healthcare Research and Quality (AHRQ) Report

Establishing a culture of patient safety can be effective in reducing the incidence of medical errors and solving concerns of safety inadequacy in health systems. The purpose of this study was to assess the culture of patient safety in the selected hospitals, and compare the results with published reports of AHRQ. This study was approved by the Ethical Committee of BPUMS. The subjects signed the informed consent form to participle in the study. Confidentiality was maintained throughout the study reports. Cross-sectional study was conducted in 2012;the study sample was composed of 364 staffs working at two selected hospitals affiliated to Bushehr University of Medical Sciences. Hospital Survey on Patient Safety Culture was used to collect data. Descriptive statistical analysis was used to analyze the data. No reports of events in both studied hospitals and benchmark were accounted for the most of the reported errors, although this indicator in studied hospitals was nearly 23% higher than that of the benchmark report. The highest patient safety grade in studied hospitals and benchmark was “acceptable” and “very good”, respectively. The highest percentage of positive response to patient safety dimension was organization learning and then teamwork within units in studied hospitals. Teamwork within units also was the highest average percent in benchmark report. Non-punitive response to errors had the lowest positive percentage of participant responses in both studies. To achieve the patient safety culture, we do not need to blame individual and apply punitive approach when errors occur. This makes person accept responsibility for their actions honestly and report errors in a timely manner to prevent reoccurrence of similar errors.

Evaluation of Patient Satisfaction and Factors Affecting It: A Review of the Literature

Patient satisfaction with hospital services is one of the most important indicators of effectiveness and quality of hospital services. Patient satisfaction surveys can provide valuable data for evaluating the current status, awareness of quality and quantity of process improvement programs and quality improvement to health managers and policy makers. The present study discusses previous studies conducted in this area, and presents recommendations to improve patient satisfaction. The method of this study is review. Selected papers were identified by searching keyword in Persian and English in different databases and after applying the inclusion criteria, 19 studies were extracted and analyzed. 23,793 patients in 12 studies entered into this research were investigated. Generally, satisfaction of the patients in this study was estimated at an average level. Continuous evaluation of patient satisfaction and identification of the factors affecting it requires establishment of comprehensive and accurate data system in this area;that by application of the results of previous studies steps can be taken to improve patient satisfaction. Patients’ satisfaction in Iran, compared with other countries, is desirable. In addition, the overall satisfaction of patients in recent years has increased compared to previous years and the reason can be measures like different ways of improving the quality, customer orientation, and applying the results of research conducted in this area.

Evaluating the average access to care and continuity of care patients in Tehran teaching hospitals

Background: Standards of Joint Commission International emphasize on the organizational performance level in basic functional domains including patient right, patient care, medical safety and infection control. These standards are focused on two principles: expectations of the actual organizational performance and assessment of organizational capabilities to provide high quality and safe health care services. The aim of this study is to evaluate the possibility of improvement in Access to Care and Continuity of Care for patients (ACC) in teaching hospitals of Tehran University of Medical Sciences. Methods: This cross-sectional study was conducted in hospitals affiliated to Tehran University of Medical Sciences during 2012. Data collection was performed using author-designed questionnaire of “Access to Care and Continuity of Care patients” based on JCI standards (2013). A total of 171 questionnaires were sent to 26 hospitals and 154 (90%) questionnaires were successfully completed and used for data analysis. The questionnaire was reviewed by experts and the Cronbach’s alpha was calculated to be 0.967. The effects of the two variables of hospital type (general, specialty) and the number of beds on mean scores of ACC standards and each of its domains were analyzed using T-test or Mann-Whitney test depending on the distribution due to Kolmogorov-Smirnov test result. Results: In general, the mean of ACC standards was found comprehendible and applicable by 82.3 (SD = 11) of the respondents. The highest and lowest mean scores of ACC questions belonged to hospitals H21 (90 ± 6) and H14 (67 ± 12), respectively. There were not any significant effects of hospital type and the number of beds on the ACC scores. Conclusion: There was not any important effect of hospital type and bed numbers on ACC, although there was a 9%-15% possibility of improvement in accreditation scores of ACC standards in hospitals of Tehran University of Medical Sciences. A complete accreditation score in this domain didn’t seem achievable in these hospitals. However, it is proposed that future managerial planning of the studied hospitals lead to a complete accreditation score.

Self Evaluation in Department of Communicable Diseases, Faculty of Medicine, Tehran University of Medical Sciences

Introduction: Self evaluation is a process that defines and collects required data to judge about decision making issues at educational system on whether the educational department is fit to educate students? The objective of this study was determining the quality of the structural elements of the department of Communicable Diseases & determining the strengths, weaknesses, opportunities and threats to improve the quality of activities in the department under research. Materials and Methods: The employed method was Mixed methods (qualitative & quantitative research), on the basis of 10 procedural steps and within 8 sections dealing with evaluated factors;such as 1) organizational and management structure 2) scientific board members 3) students 4) Manpower 5) Space of educational research and health care 6) Equipment 7) curriculum 8) satisfaction of graduates, which were studied using 61 criteria and 172 indicators. Five-point Likert Scale was used for the responses in the questionnaire (1 - 1.75 = undesirable, to 4.2 - 5 completely desirable). Finally the data were analyzed using descriptive statistics indices and the assessment software of the Educational Development Center of TUMS. The instruments used in this method included assessment software, interview, observation and self-prepared questionnaire which consisted of 7 questionnaires and 2 check lists. Finding: The results of the research showed that general average of 8 investigating sections was 56.9% as a rather desirable research work. Conclusions: Therefore, it was concluded that function of the educational management in that group was directly in line with evaluation process, but continuing the process of evaluation seems necessary.

Evaluation of International Standards of Management of Communication and Information Technology (MCIT) in Khorasan Razavi Hospitals from the Perspective of Managers

The general goal of the management of communication and information technology (MCIT) in the health sector, is to accelerate collecting, achieving and supporting the health system processes, and effective decision-making for managing this system;because preparing and providing health care services for society is very complex, and highly dependent on the information system. The aim of this investigation is to determine the mean scores of the possibility of implementing the MCIT standards in Khorasan Razavi hospitals, from the perspective of managers. This was a cross sectional descriptive-analytic study conducted in two steps in all hospitals. In the first step, the applicability of the standards in hospitals was studied. In the second step, the current status of hospitals was compared with international standards MCIT. In order to determine the validity of the questionnaires, opinions of professors and experts were acquired. Regarding the reliability, the SPSS V. 12 calculated the value of Cronbach’s to be 0.95 for the first questionnaire and 0.86 for the second questionnaire. Data were analyzed using statistic tests of one way ANOVA and t-test. The level of significance was fixed at 0.5. In the 16 hospitals studied, the mean and standard deviation of MCIT were (57.25 ± 13.74). The MCIT standards are applicable in hospitals of Khorasan Razavi according to half (49.4%) of managers;nonetheless, their application requires greater efforts by the hospitals.

A Study on the Feasibility of Total Quality Management Model and the Awareness and Attitude of the Managers of Health Care

Total Quality Management is not just an admirable phenomenon but it is any client’s right and can be done through contribution of the staff and the managers as well as the client’s of an organization. The purpose of the present study is to investigate the feasibility of TQM model and the attitude of the managers of health field of Yazd medical sciences university towards it. The present study was a descriptive and analytical one which was cross-section ally conducted from 2010 to 2011. The population under study consisted of the managers of the unit of staff vice-chancellor for health and treatment, the managers of health system and centers of cities and also the managers of Yazd’s public hospitals. 64 people were chosen using the formula for calculating the number of samples. A questionnaire with 48 questions was used. The questionnaire’s validity was approved by the faculty members whose major is management and its reliability by using α-cronbach 87%. To analyze the data, the software SPSS V.17 was used. Scoring method was based on likert. The findings of the study show that, considering feasibility of TQM, there is a significant relation between the awareness and attitude of the managers of health and treatment field on one side and the variables, age and University degree, on the other side p = 0.001. Considering binary logistic regression and the results obtained in the form of inter and backward stepwise, the most important factors affecting the feasibility of TQM among the managers of health and treatment field are the level of awareness and attitude with the predicted accuracy 79.3% and 87.9% respectively.

The Effect of the Family’s Socioeconomic Factors on Nutrition of Elementary School Children

Introduction: Anthropometric indices are used for assessing the nutrition status of people and societies. The indices determine the growth of the child’s nutrition status, his socioeconomic status and his quality of life. This research aims to study the anthropometric indices of elementary school children in the Iranian city of Piranshahr using the Body Mass Index (BMI) and waist circumference in the first six months of 2011. Methods: In this descriptive-analytical cross-sectional study, 1803 students aged between 7 and 11 in Piranshahr were studied. Multi-stage cluster sampling was used. The research setting was an elementary school in Piranshahr. Demographic data were collected through interviews and record in questionnaires. A Secca stadiometer was used to measure the height of each student standing without shoes (accuracy of 0.1 centimeter). The weight was measured using a spring scale with an accuracy of 0.1 kilogram with the least possible clothes on. The weight was divided by the square of height (square meter) to calculate BMI. To determine overweight and obesity, BMI percentiles of Center for Disease Control (CDC) were used. In order to use appropriate tests, the normality and equality of variances were measured by Leven and K-S tests, respectively. Results: The study found that 231 children (12.8%) were at risk of overweight and 96 children (5.3%) were overweight. Conclusion: There was a meaningful difference between boys and girls in terms of nutrition status of BMI, father’s higher education level, shortness, abdominal obesity and family history of obesity, and father’s jobs

Accreditation Maternity and Obstetric Services (MOS), Based on the Accreditation Standards of the Joint Commission International (JCI)

Background: In recent years various standards have been proposed for assessment and supervision of healthcare systems. One of the most popular of them in health care area is Joint Commission International (JCI) standards of US. This study has been conducted to investigate executive potentials related Accreditation Standards of Maternity and birth services of this commission in hospitals providing maternity and birth services in Ardebil Province. Methods: This is a descriptive-analytic study conducted as cross-sectional on 232 employees of three hospitals in Ardebil including Alavi, Arta and Sabalan who were randomly chosen. This is a multi-stage study that in stage 1, an accreditation tool for maternity and birth services was designed based on JCI standards. Validity and reliability of questionnaire was measured by Alpha Cronbach. In stage 2, score of different dimension of Accreditation Standards of MOS was calculated using data obtained from questionnaires distributed among a sample of 232 hospitals personnel;all of them were working in maternity and birth field. Statistical tests used are one-way analysis of variance (ANOVA), dunnets post hoc and correlation test that all of them were calculated by SPSS V. 18. Results: Result showed that all of the MOS accreditation standards components were capable in selected hospitals. Arta hospital earned the highest score of standards (mean = 149/4) and Alavi hospital received the lowest score (mean = 128/04) of the maximum attainable score (186). Also, significant difference was observed between selected hospitals in total score of MOS standards (F = 50/432, p < 0/00). Conclusion: Based on study findings, there is an inequality between Ardebils hospital in field of MOS accreditation standards. Public hospitals are in more difficult situation compared to private hospitals, therefore Health Care System policy makers must pay attention systematically and specially to implementation of international standards in order to improve health care impacts in public hospitals.

Assessing Demographic Factors Related to Maternal Mortality in Tehran Province, Iran from 2008 to 2011

The rate of maternal mortality due to complications of pregnancy and delivery is one of the most significant indicators showing the development state of countries. The purpose of the present study is to assess important indicators of maternal health and predisposing factors of maternal mortality in Tehran province from 2008 to 2011. The present study is a case-control one. All mothers who had lost their life (n = 113) were selected through census and survived mothers (n = 327) through randomized stratified sampling. Statistical analysis was performed using SPSS V.22, X2 test, Fishers exact test and Logistic regression. The rate of maternal mortality was the highest (29.2%) in 2009 and the lowest (20.4%) in 2011. Variables type of maternity hospital (P-value = 0.036), maternal education (P-value < 0.001), husband’s education (P-value < 0.001) had a significant relation to maternal mortality. Logistic regression analysis showed that there is a relationship between the education level of the husband and maternal mortality. Considering the factors affecting maternal mortality, promoting hospital services, improving skills and knowledge of doctors, midwives and nurses and strengthening educational programs for the illiterate are the most effective measures to reduce maternal mortality.

The Relationship between Quality of Life with Demographic Variables of Elderly in Golestan Province-Iran

Quality of life subscales was influenced by different factors including age, gender, and financial status and more importantly by health, education, financial and marital status. The main goal of this study was relationship between (QOL) with demographic variables of elderly in Golestan province-Iran. This research was an analytical cross study that conducted on 193 individuals going to Jahandidegan geriatric charity institution of Golestan-Iran. The data were collected from questionnaire SF-36 for QOL the elderly indicators through interviews and observation and then analyzed using SPSS V.17 Software. Among QOL dimensions, only general health status showed a significant association with supporting organizations covering status (P = 0.01). The relationship between QOL with current employment status in both genders was observed.

Evaluation of Comparative Management of Expanded Program Immunization for Children in Iran and in the World

Background: EPI is one of the most cost-effective public health interventions that have already been identified. Mass vaccination is one of the most effective public health strategies that lead to a dramatic reduction in the incidence of many infectious diseases. This is a descriptive study (eco-logical exploratory) where data about the status of routine immunization of children under 6 years in 6 selected countries in terms of the routine immunization programs in each country, the coverage and reported cases of vaccine-preventable diseases from 2006 to 2008 were collected assuming that each country is a representative of a Continent;data about the status of Iran were also collected and a comparative study was performed in the next step. It is worth mentioning that selecting these countries was according to health experts to consolidate the data. Collection tools are data of international (WHO and UNICEF) and national organizations of the above countries. In all countries surveyed, triple vaccine, vaccines of polio, hepatitis B, measles, rubella and mumps are part of the routine immunization program for children under the age of 6 years, with the explanation that in South Africa only measles vaccine is injected instead of measles, rubella and mumps vaccines. The coverage rate of the vaccine and other vaccines in Iran was the best compared to other countries. This represents the widespread activity of health care systems of the country in the field of vaccination and tireless efforts of healthcare workers and health centers.

Investigating Dimensions and Impairments Caused by Shifts in Nurses Who Work in Constant Shifts

The purpose of this study was to investigate the dimensions and conditions caused by shifts in nurses who worked in constant shifts in non-governmental selective hospitals in Tehran in 2014. In this cross-sectional and applied research, the shifts standard questionnaire was used. After confirming the validity and reliability (Cronbach’s alpha 0.73), the questionnaires were distributed among 305 nurses of 6 non-governmental selective hospitals in Tehran, based on stratified random sampling. In the research, the data analysis was conducted in two levels of descriptive and inferential statistics. The response rate was 0.91. 74.4% of the participant nurses were female and 25.6% were male. The results showed that there was a significant relationship between age and physical health (P = 0.008), gender and physical health (P = 0.015), education and health (P = 0.014), gender and physical-cognitive anxiety (P = 0.006), age and social-familial status (P = 0.001), Marital status and social-familial status (P = 0.001), having a second job and social-familial status (P = 0.001), education and sleep-fatigue (P = 0.002). Planning with respect to standards of nurses’ working hours and avoiding overtime, especially nurses who have more experience, can prevent severe complications of shifts and improve health level and ultimately the quality of care.

Going toward Green Hospital by Sustainable Healthcare Waste Management: Segregation, Treatment and Safe Disposal

Hospitals have always been the focal point of social systems identity. Thus, they acte as the mirror of the community and should be responsible for it. Hospitals have been recognized as a significant source of contamination all around the world, therefore helping to endanger public health on an unintentional process. Although, the main mission of the hospital is to promote human health, it cannot be assumed as an island apart from its urban environment. “Green Hospital”, as an approach to address environmental challenges and to meet communities need in health issues, has emerged recently as a try to improve the health, in line with its main mission. In this approach, all the environmental aspects of waste management are important and to be addressed. Hospitals’ administrators can manage wastes disposal through composting, recycling and better supplying methods (downsizing packaging, using reusable products instead of disposables and using recycled products). This article is a review of the subject matter, in nature, using many library and online sources;it discusses about the need to move towards the green hospital approach, the administration and leadership role in its establishment, the environmental impact of hospital operations and assessment of the effects, wastes management and control, and also the methods in wastes disposal and treatment.