Performance Evaluation of the Operating Rooms in the Largest Teaching Hospital in South of Iran, before and after Implementation of the Health Care Reform Plan

Performance Evaluation of the Operating Rooms in the Largest Teaching Hospital in South of Iran, before and after Implementation of the Health Care Reform Plan Performance Evaluation of the Operating Rooms in the Largest Teaching Hospital in South of Iran, before and after Implementation of the Health Care Reform Plan Bastani Payvand1, Kavosi Zahra2, Ahmadzadeh Mahdieh Sadat3, Rezaee Zohreh4* Received: 20. 07. 2015 Revised: 07. 09. 2016 Accepted: 11. 09. 2016 Abstract 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. Key¬words: Operating Room, Surgical Procedures, Teaching Hospital, Health Care Reform Plan ¬Citation: Bastani P, Kavosi Z, Ahmadzadeh M, Rezaee Z. Performance Evaluation of the Operating Rooms in the Largest Teaching Hospital in South of Iran, before and after Implementation of the Health Care Reform Plan. Journal of Health Based Research 2016; 2(2): 197-205. 1. Assistant Professor, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran. 2. Associate Professor, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran . 3. MSc Student, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran 4. BSc Student, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran *Correspondence: Health Care Management & Informatics School Almas Building, Alley 29, Qasrodasht Ave, Shiraz, Iran Tel: 07132340775 Email: [email protected]

Perceptions of Organizational Justice Among Nurses Working in University Hospitals of Shiraz: A Comparison Between General and Specialty Settings

Background: Justice has gained much attention in social and human studies and has many consequences on employees and the organizations, especially on health system workers such as nurses who are among the key factors in health care systems. Objectives: The purpose of this study was to investigate perception of organizational justice among nurses in educational hospitals of Shiraz University of Medical Sciences (SUMS), and to compare the results of general and specialty hospitals. Materials and Methods: In this research, 400 nurses at SUMS hospitals were selected by random sampling method. A 19-item questionnaire was applied to measure distributive, procedural and interactional justice. Data analysis was performed using descriptive statistics, including percentage, frequency, mean, and standard deviation. Also, the t-test and one way ANOVA were used to measure the differences between different hospitals and wards. Results: Of 400 nurses, 66% perceived a high level of organizational justice. In this study the mean scores of total perceived organizational justice (P = 0.035), procedural justice (P = 0.031), and interactional justice (P = 0.046) in specialty hospitals were higher than general ones. Furthermore, the mean score of interactional justice was higher than the other components of organizational justice, respectively 3.58 ± 1.02 for general and 3.76 ± 0.86 for specialty hospitals. Significant differences were observed between overall perceived justice (P = 0.013) and its components (P = 0.024, P = 0.013, and P = 0.036) in different wards. Conclusions: Most nurses who participated in this study had a high perception of organizational justice. The mean score of organizational justice was higher in specialty hospitals. Health care policy makers and hospital managers should support their employees, especially nurses through fairness in distributions, procedures, and interactions

Determinants of Life Expectancy in Eastern Mediterranean Region: A Health Production Function

Background: Determinants of health or health production function in health economics literature constitute noticeable issues in health promotion. This study aimed at estimating a health production function for East Mediterranean Region (EMR) based on the Grossman theoretical model. Methods: This ecological study was performed using the econometric methods. The panel data model was used in order to determine the relationship between life expectancy and socioeconomic factors. The data for 21 EMR countries between 1995 and 2007 were used. Fixed-effect-model was employed to estimate the parameters based on Hausman test. Results: In estimating the health production function, factors such as income per capita (β=0.05, P<0.001), education index (β=0.07, P<0.001), food availability (β=0.01, P<0.001), level of urbanisation (β=0.10, P<0.001), and employment ratio (β=0.11, P<0.001) were specified as determinants of health status, proxied by life expectancy at birth. A notable result was the elasticity of life expectancy with respect to the employment rate and its significance level was different between males (β=0.13, P0.001). Conclusion: In order to improve the health status in EMR countries, health policymakers should focus on the factors which lie outside the healthcare system. These factors are mainly associated with economic growth and development level. Thus, the economic stabilisation policies with the aim of increasing the productivity, economic growth, and reducing unemployment play significant roles in the health status of the people of the region

Managers' Perceptions of Diversity Dimensions in Crisis Management at Shiraz Teaching Hospitals

Background & Objectives: Today, the diversity is one of the basic principles in crisis management process in the hospitals. This process requires serious attention due to its complexity and diversity. This study aimed at investigating the managers' perception about diversity dimensions of crisis management in hospitals affiliated to Shiraz University of Medical Sciences. Methods: This cross-sectional descriptive study was conducted in 10 educational hospitals of Shiraz University of Medical Sciences in 2017. A total of 40 executive, administrative, financial and accounting, and nursing directors were selected through census method and participated in the study. Data were collected using the questionnaire of diversity dimensions in crisis management and analyzed using descriptive statistics, correlation coefficient, t-test and ANOVA tests and through SPSS23 software. Results: The mean score of managers' perceptions of crisis management dimensions was 3.44. The highest and lowest levels of perceptions of managers were respectively obtained for the "inclusion and learning" dimension (Mean=3.75) and "recognition and risk management" (Mean= 3.29). There was a significant relationship between the mean scores of "mutual trust between staff and managers" and "work experience" (P = 0.04). Conclusion: Managers' perception of the "recognition and risk management" dimension was lower compared to other dimensions. Therefore, hospital managers should be more sensitive to using risk assessment results and follow a systemic attitude in their risk management plannings. Key¬words: Perception, Crisis Management, Teaching Hospital, Hospital Managers Citation: Yusefi AR, Kavosi Z, Nikmanesh P. Managers' Perceptions of Diversity Dimensions in Crisis Management at Shiraz Teaching Hospitals. Journal of Health Based Research 2017; 3(3): 227-236

Public Health, Life Satisfaction And Quality Of Life Of Elderly Patients With Coronary Artery Disease Admitted To Hospitals In Gonbad-e Qabus 2015

Background & Aim: According to the increased prevalence of heart disease in the elderly and the importance of this disease on all aspects of people's lives, the study aimed to determine the quality of life, life satisfaction and general health of the elderly with coronary artery disease (CAD). Material & Methods: This descriptive-analytical cross sectional study conducted in Gonbad-e Qabus (North Eastern, Iran) in 2015. Research sample was 300 elderly people who were selected randomly. The data collected using Goldberg & Williams General Health, Dinner Life Satisfaction, and Quality of Life questionnaires. Data was analyzed by Descriptive and analytical statistics; t test, Pearson coefficient and ANOVA (P<0.05). Results: In terms of general health, 42% of participants were healthy and 58% of them had impaired general health. In terms of life satisfaction, 39% of them had enough satisfaction, and 61% were dissatisfied with their life. 36% of elderly had strong and good quality of life and 64% had poor quality of life. Conclusion: More than half of elderly patients with cardiovascular diseases, had no good quality of life, life satisfaction, and general health. As age increases the risk of cardiovascular diseases increases, then more supportive intervention and elderly empowerment with aim of improve quality of life, general health and life satisfaction life is necessary

The Effect of Fiscal Decentralization on Under-five Mortality in Iran: A Panel Data Analysis

Background: Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. Methods: We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. Results: According to the findings of this research, fiscal decentralization in the health sector had a negative impact on U5M. On the other hand, fiscal decentralization in provincial revenues had a positive impact on U5M. In addition, U5M had a negative association with the density of physicians, hospital beds, and provincial GDP per capita, but a positive relationship with Gini coefficient and unemployment. Conclusion: The findings of our study indicated that fiscal decentralization should be emphasized in the health sector. The results suggest the need for caution in the implementation of fiscal decentralization in provincial revenues

Seroprevalence of positive hbsag and its associated factors in pregnant women referred to health centers of agh-ghala city in 2010-2012

Introduction: The mother's infection to HBV viruses can expose the baby to the risk of next infection to chronic hepatitis, on the other hand, the prevalence of hepatitis is related to the health and socio-economic factors of the people in an area.This study was performed with aim to determine the seroprevalence of HbsAg+ and its relation with some effective factors in pregnant women referred to health centers of Agh-Ghala city. Methods: In this descriptive, and cross-sectional study, 1057 pregnant women were studied during two years of 2010 until 2012 in terms of prevalence of HbsAg+ in Agh-Ghala city. Data was recorded in the questionnaire with blood samples. Data were analyzed using SPSS statistical software (version 16) and Fisher, Chi-square, and T-Test. P0.05). Conclusions: The prevalence of hepatitis B is somewhat high in Agh-Ghala city and suggests the need for screening and treatment. Therefore, tests must be performed as one of the routine tests for searching hepatitis B virus during the perinatal period. © 2014, Mashhad University of Medical Sciences. All rights reserved

Evaluation of Prescription Appropriateness of CT Scan for Low Back Pain in Shiraz’s Referral Trauma Hospital Using RAND Appropriateness Method

Introduction: This study aims to identify the appropriateness of CT Scan prescriptions for Lumbar Spine using the RAND Appropriateness Method in Shiraz University of Medical Sciences (SUMS). Methods: A total of 281 patients referred to the hospitals affiliated with Shiraz University of Medical Sciences were selected as sample of the study in 2016. The scenarios derived through the RAND Appropriateness Method were compared with medical records of these patients by educated physicians. Results: Out of 281 cases of lumbar spine MRI prescriptions, 57.7% were appropriate, 32.7 % were uncertain, and 9.6 % were considered to be appropriate. In addition, some related factors to appropriateness of prescriptions were identified. Conclusions: Clinical guidelines developed using RAND Appropriateness Method can be an appropriate instrument for policy makers, health care providers, and health insurance companies in order to reduce inappropriate cares and quality improvement, especially in developing countries. It is recommended that appropriateness of prescriptions will be considered as the criteria for payment and reimbursement to prescribers. In this way, inappropriate cares may be reduced

A Study of the Performance of Referral System in Urban Family Physician Program in Fars Province, Iran

Introduction: The family physician referral system has been determined as a major goal to economic, social, and cultural development in the field of health in Iran. The necessity of implementing this system has been explicitly stated in high-level documents. Hence, the aim of this study was to evaluate the overall performance of the referral system in Fars Province in 2015. Methods: In this cross-sectional study, 20% of family physicians (75 doctors) were randomly selected; then, all patients of these physicians (1289 patients) in one work shift were studied. The data were collected in three parts containing the questions related to the physician and patients using data collection forms. Finally, data analysis was performed through SPSS, version16, using descriptive statistics and Chi-square test. Results: The results showed that 70.3% of the patients (906 patients) had used the referral system to visit specialists. Most of the referral forms had been completed correctly (63.6%). Most of the referrals (820 cases) were recognized as necessary (59.4%) and from the first level of referral, i.e. by the family physician (96.3%: 1241 cases). The patients aged 70 and over had the minimum self-referrals, whereas young people aged lower than 20 had the maximum selfreferrals (P=0.03). Also, more self-referrals were observed among highly educated patients (P=0.001). Conclusion: Based on the findings, the most important problems of the referral system included self-referrals, incomplete referral forms, and unnecessary referrals. Self-referral could be solved through education, establishment of an electronic referral system, and legal measures. Also, educating doctors, making an electronic referral system, and using auxiliary staff and incentive measures can reduce the incompleteness of the referral forms. To reduce the patients’ unnecessary referrals, development of referral guidelines might be very effective

Negotiation, Centering Ability and Transportation of Three Glide Path Files in Second Mesiobuccal Canals of Maxillary Molars: A CBCT Assessment

Introduction: The aim of this study was to compare negotiation, centering ability and transportation of three path finder rotary instruments (ProGlider, ScoutRace and M3 Pro-Gold Path File) to create glide path in second mesiobuccal (MB2) canals of maxillary molars with cone-beam computed tomography (CBCT). Methods and Materials:  In this in vitro study, 66 maxillary molars with separate second MB2 canals were selected with the following criteria: having 18-21 mm root length, without any resorption or calcification in radiography, without previous treatment and 20-40ºcurve according to Schneider’s method. Then MB2 canals were randomly divided into three groups (n=22). CBCT scan before and after root canal negotiation was taken. A #10 K-file for determination of working length was inserted into all canals. In group1; ProGlider file, group2; ScoutRace file and in group 3; M3 Pro-Gold Path file was implemented. The calculated data from CBCT based on reaching full working length (RFWL) or not (NRFWL) were analyzed using the Pearson Chi-square test. Centering ability was calculated by Fisher’s exact test and amount of transportation was determined with the Pearson Chi-square test in SPSS software. Results: ProGlider file had the least RFWL and ScoutRace was the best, but the results were not statistically significant (P&gt;0.05). Regarding the centering ability and transportation, all 3 groups showed no significant differences (P&gt;0.05), except at level of 2 mm from the apex in buccopalatal direction for ProGlider and ScoutRace files (P&lt;0.05). Conclusion: In spite of insignificantly different results, ScoutRace file was better than other groups in negotiating and centering ability in mesiodistal direction of the MB2 canal in maxillary molars. Also, ProGlider file was significantly better than ScoutRace regarding transportation at level of 2 mm from apex in buccopalatal direction.Keywords: Centering Ability; Cone-Beam Computed Tomography; ProGlider; Second Mesiobuccal Canal; Transportation