A survey of clinical governance success in Khozestan province

Background and Aims: Clinical Governance (CG) is a strategy for providing responsive, accountable, patient-centered, high quality, safe and effective healthcare services through creating an appropriate organizational structure and culture. Development, implementation and monitoring clinical standards are also included in CG. This study aimed to assess the success of clinical governance implementation in hospitals in Khuzestan province, Iran.Materials and Methods: This descriptive questionnaire survey was conducted in 2014 in 40 hospitals using a valid and reliable questionnaire covering seven dimensions of CG (i.e., management and leadership, employees’ education and management, clinical effectiveness, clinical audit, risk management, patient involvement, and information management). All clinical governance officers of hospitals were asked to complete the questionnaires. Overall, 40 questionnaires were returned. Data analysis was done using SPSS software.  Ethical issues such as informed consent, voluntary participation, participants’ anonymity, information confidentiality and researchers’ objectivity in data collection, analysis and reporting were all considered.Results: The mean score of CG implementation success was 65.6 percent in Khuzestan province hospitals. About half of the hospitals were moderately successful in CG implementation. Hospitals achieved more success in employees’ education and management and less success in clinical effectiveness dimensions of clinical governance. Top managers’ and employees’ commitment and involvement in CG activities was critical for CG successful implementation.Conclusion: Clinical governance was slightly successful in Khuzestan hospitals. However, strong management and leadership, managers’, employees’ and physicians’ participation, education and training, patient centeredness, evidence based practice, and clinical audits are necessary for successful implementation of CG in hospitals.Keywords: Clinical governance, Hospital, Successful change, Quality managemen

The Role of Information Management in the Successful Implementation of Clinical Governance

The Role of Information Management in the Successful Implementation of Clinical Governance Mosadeghrad Ali Mohammad1, Sadoughi Farahnaz2, Ghorbani Moloud3 * 1. Assistant Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2. Professor, Department of Health Information Management, School of Health Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran. 3. MSc, Department of Health Information Management, School of Health Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran. *Correspondence: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences. Tel: 021-42933006 Email: [email protected] Abstract: Introduction: The ability of managers to use accurate, reliable, and up-to-date information is an important factor for organizational success. The aim of this study was to investigate the role of information management in the successful implementation of clinical governance in the hospitals of Khuzestan province, Iran. Methods: This descriptive-analytical study was conducted in 40 hospitals of Khuzestan province in 2014, using a valid and reliable researcher-made questionnaire included 35 questions about 7 dimensions of clinical governance. All clinical governance managers of the hospitals were asked to complete the questionnaire. Data were analyzed using descriptive statistics and inferential statistics (such as correlation coefficient and logistic regression) by SPSS 19. Results: The mean success rate of clinical governance in the hospitals of Khuzestan was 65.6 percent. The mean score of information management of clinical governance was 62.4 percent. There was statistically significant relationship between information management and successful implementation of clinical governance (P=0.01). Appropriate use of health technology and information systems by the staff, staff training in data documentation, and using hospital information in decision-making process, planning, control, and evaluation had great effect on the successful implementation of clinical governance. Conclusion: Due to the important role of accurate, reliable, and up-to-date information and information management system in the successful implementation of clinical governance, hospital managers should provide necessary facilities for collection, analysis, and use of hospital information. Hospital staff should be trained in data documentation. Key¬words: Clinical Governance, Information Management, Hospital, Quality Management Citation: Mosadeghrad AM, Sadoughi F, Ghorbani M. The Role of Information Management in the Successful Implementation of Clinical Governance. Journal of Health Based Research 2016; 2(3): 207-221

The barriers of clinical governance implementation in Khozestan province hospitals

زمینه و اهداف: شناسایی موانع اجرای حاکمیت بالینی و اقدام برای رفع آنها به اجرای موفق حاکمیت بالینی کمک می‌کند. این پژوهش با هدف شناسایی موانع اجرای حاکمیت بالینی در بیمارستان‌های استان خوزستان در سال 1393 انجام شد. مواد و روش‌ها: برای انجام این پژوهش بنیادی از یک پرسشنامه با روایی و پایایی بالا استفاده شد که موانع اجرایی حاکمیت بالینی در بیمارستان‌ها را در 5 محور موانع مدیریتی، فرهنگی، انسانی، فرایندی و ساختاری می‌سنجید. پرسشنامه‌ها توسط کارشناسان مسئول حاکمیت بالینی 40 بیمارستان استان خوزستان تکمیل شد. تحلیل داده‌ها، در دو سطح آمار توصیفی و استنباطی انجام شد. ملاحظات اخلاقی نظیر جلب رضایت آگاهانه، محرمانه تلقی کردن اطلاعات شخصی شرکت کنندگان در پژوهش و بی‌طرفی پژوهشگر در این پژوهش رعایت شد. یافته‌ها: میانگین موانع اجرایی حاکمیت بالینی در بیمارستان‌های استان خوزستان برابر با 2/92از 5 امتیاز بوده است. موانع ساختاری و موانع مدیریتی به ترتیب بیشترین و کمترین موانع را در اجرای حاکمیت بالینی ایجاد کردند. عدم مشارکت پزشکان در حاکمیت بالینی، کمبود منابع مالی برای اجرای حاکمیت بالینی و بروکراسی همراه با حاکمیت بالینی بیشترین مانع را در اجرای حاکمیت بالینی ایجاد کردند. نتیجه‌گیری: مدیران بیمارستان‌ها قبل از اجرای تکنیک‌های مدیریت کیفیت مانند حاکمیت بالینی باید موانع موجود را برطرف کنند و ساختار و فرهنگ سازمانی مناسبی را برای تسهیل اجرای موفقیت‌آمیز حاکمیت بالینی ایجاد کنند. سیاستگذاران بهداشت و درمان باید با در نظر گرفتن ساختار و فرهنگ سازمانی و میزان بلوغ سازمانی کارکنان، مدل مناسب حاکمیت بالینی را برای این سازمان‌ها توسعه و برای اجرا پیشنهاد کنند.  Background and Aim: Identification and removal of the barriers of putting clinical governance into practice facilitate its successful implementation. This study aimed to identify the barriers of clinical governance implementation in Khozestan province hospitals in 2014.Materials and Methods: A valid and reliable questionnaire was used for conducting this descriptive cross-sectional study. The questionnaire assessed five issues including managerial, cultural, human resource, procedural, and structural barriers of clinical governance. Questionnaires were completed by clinical governance officers in 40 hospitals of Khuzestan province. All statistical analyses (descriptive and analytical) were done using SPSS. Ethical issues such as informed consent, confidentiality of information and researchers’ objectivity were all considered.Results: The mean score of clinical governance implementation barriers in studied hospitals was 2.92 out of 5. Structural and managerial barriers were respectively the most and least barriers of clinical governance implementation.Lack of doctors’ involvement in clinical governance, insufficient financial resources for implementing clinical governance and the bureaucracy involved in clinical governance had created the greatest obstacle in implementing clinical governance.Conclusion: Hospital managers should overcome the barriers of quality management techniques such as clinical governance before implementing these techniques. In addition, they have to create an appropriate structure and organizational culture in order to facilitate the successful implementation of clinical governance. Besides, health policy makers should develop an appropriate clinical governance model considering the structure and organizational culture of the hospitals

Teachers and student nurses’ attitudes towards caring for older adults in Arak, 2012

Background and aim: Nurses are an important part of the care team that in the care of the elderly plays a major role that their attitudes towards working with older people have an impact on the quality of care. This study was aimed to determine the attitude of teachers and nursing students towards the nursing care of the elderly. Methods: In this descriptive analytical study, all of 116 nursing students of third and fourth year and 22 clinical instructors in Arak University of Medical Sciences participated in this study in 2012. Samples were selected with census method. Data collection instrument was an investigator- made questionnaire that its validity and reliability was established. Scores of attitudes were arranged to three levels of weak, average and good after recoded in terms of accepted scores. Results: In terms of attitudes toward care of older people, findings showed that teachers (3.69±0.42) have more positive attitude toward caring for the elderly compared to students with an average of 3.45±0.32. This difference was significant (P=0.01). The majority of nursing students (83.6%) and teachers (72.7%) had moderate attitude towards the care of elderly patients. Conclusion: Although obvious weakness of this approach was less visible teachers can be a suitable model by knowledge and a change in their attitude for their students and try for induction understanding of health value for all members of society, and create better living conditions for them

بررسی میزان موفقیت حاکمیت بالینی در بیمارستان‌های استان خوزستان

Background and Aims: Clinical Governance (CG) is a strategy for providing responsive, accountable, patient-centered, high quality, safe and effective healthcare services through creating an appropriate organizational structure and culture. Development, implementation and monitoring clinical standards are also included in CG. This study aimed to assess the success of clinical governance implementation in hospitals in Khuzestan province, Iran. Materials and Methods: This descriptive questionnaire survey was conducted in 2014 in 40 hospitals using a valid and reliable questionnaire covering seven dimensions of CG (i.e., management and leadership, employees’ education and management, clinical effectiveness, clinical audit, risk management, patient involvement, and information management). All clinical governance officers of hospitals were asked to complete the questionnaires. Overall, 40 questionnaires were returned. Data analysis was done using SPSS software.  Ethical issues such as informed consent, voluntary participation, participants’ anonymity, information confidentiality and researchers’ objectivity in data collection, analysis and reporting were all considered. Results: The mean score of CG implementation success was 65.6 percent in Khuzestan province hospitals. About half of the hospitals were moderately successful in CG implementation. Hospitals achieved more success in employees’ education and management and less success in clinical effectiveness dimensions of clinical governance. Top managers’ and employees’ commitment and involvement in CG activities was critical for CG successful implementation. Conclusion: Clinical governance was slightly successful in Khuzestan hospitals. However, strong management and leadership, managers’, employees’ and physicians’ participation, education and training, patient centeredness, evidence based practice, and clinical audits are necessary for successful implementation of CG in hospitals.زمینه و اهداف: حاکمیت بالینی یک استراتژی سازمانی برای ارائه خدمات بهداشتی و درمانی بیمار محور، با کیفیت، ایمن و اثربخش از طریق توسعه ساختار و فرهنگ سازمانی مناسب و تدوین، اجرا و پایش منظم استانداردهای بالینی است. این پژوهش با هدف تعیین میزان موفقیت اجرای حاکمیت بالینی در بیمارستان‌های استان خوزستان انجام شد.  مواد و روش‌ها: این پژوهش توصیفی و مقطعی با استفاده از یک پرسشنامه محقق ساخته در 40 بیمارستان‌ استان خورستان انجام شد. پرسشنامه‌ها به صورت سرشماری در اختیار کارشناسان مسئول حاکمیت بالینی بیمارستان‌ها قرار گرفت. تحلیل داده‌ها با استفاده از   نرم افزار  SPSSدر دو سطح آمار توصیفی و تحلیلی انجام شد. ملاحظات اخلاقی نظیر رضایت آگاهانه شرکت کنندگان در پژوهش، حفظ محرمانگی اطلاعات و بی‌طرفی پژوهشگران در این پژوهش رعایت شد.  یافته‌ها: میزان موفقیت حاکمیت بالینی در بیمارستان‌های استان خوزستان 6/65 درصد و در حد متوسط بوده است. بیشترین میزان موفقیت در محور آموزش و مدیریت کارکنان و کمترین موفقیت در محور اثربخشی بالینی گزارش شده است. عواملی مانند تعهد مدیریت و کارکنان بر اجرای موفقیت­آمیز حاکمیت بالینی تأثیرگذار بود. بیمارستان‌هایی که از مشارکت و تعهد بالای مدیران برخوردار بودند، موفقیت بیشتری در اجرای حاکمیت بالینی بدست آوردند.  نتیجه‌گیری: اجرای حاکمیت بالینی در بیمارستان‌های استان خوزستان تا حدودی موفق بود. مدیریت و رهبری قوی، مشارکت مدیران و کارکنان در اجرای حاکمیت بالینی، آموزش و توانمندسازی کارکنان، بیمار محوری، طبابت و مراقبت مبتنی بر شواهد، ممیزی‌های بالینی و انجام اقدامات اصلاحی، منجر به موفقیت حاکمیت بالینی می‌شود

The role of information management in successful implementation of clinical governance

Introduction: The ability of managers to use accurate, reliable, and up-to-date information is an important factor for organizational success. The aim of this study was to investigate the role of information management in the successful implementation of clinical governance in the hospitals of Khuzestan province, Iran. Methods: This descriptive-analytical study was conducted in 40 hospitals of Khuzestan province in 2014, using a valid and reliable researcher-made questionnaire included 35 questions about 7 dimensions of clinical governance. All clinical governance managers of the hospitals were asked to complete the questionnaire. Data were analyzed using descriptive statistics and inferential statistics (such as correlation coefficient and logistic regression) by SPSS 19. Results: The mean success rate of clinical governance in the hospitals of Khuzestan was 65.6 percent. The mean score of information management of clinical governance was 62.4 percent. There was statistically significant relationship between information management and successful implementation of clinical governance (P=0.01). Appropriate use of health technology and information systems by the staff, staff training in data documentation, and using hospital information in decision-making process, planning, control, and evaluation had great effect on the successful implementation of clinical governance. Conclusion: Due to the important role of accurate, reliable, and up-to-date information and information management system in the successful implementation of clinical governance, hospital managers should provide necessary facilities for collection, analysis, and use of hospital information. Hospital staff should be trained in data documentation. Key­words: Clinical Governance, Information Management, Hospital, Quality Managemen

The impact of Multimedia Software Support on the Knowledge and Self-Care Behaviors of Patients with Type 2 Diabetes: a Randomized Clinical Trial

Introduction: Education is the most effective and economical part of diabetes treatment. The purpose of this study was to investigate the effect of a training program with multimedia software on the knowledge and self-care behaviors of patients with type 2 diabetes. Methods: This study was a randomized controlled clinical trial in which 60 patients referred to diabetes clinic at Arak city were divided randomly into experimental (n=30) and control (n=30) groups. The instruments for collecting data were "Summary of Diabetes self-care activities questionnaire" and "knowledge of self-care in patients with diabetes". Data were collected before and 2 months after the intervention in the both groups. Educational program with equal content was applied for both experimental group (self-care program with multimedia software support) & control group (lecture and presentation with PowerPoint). Data analysis was done using SPSS Ver.13. Results: Implementation of the self-care program with multimedia software support resulted in improvements in patients’ self-care behaviors in the experimental group, whereas these behaviors had not significant changes in the control group after eight weeks. There was a significant difference in the mean score of knowledge in both the experiment and control groups before and after the intervention. Conclusion: Considering beneficial effects of training program with multimedia software support on the knowledge and self-care behaviors and the importance of this issue, suggested that the patients preferably provide terms of use of educational software for themselves

The Effect of Using Feedback Strategies with an Emphasis on Pharmaceutical Care standards on Nursing Students’ Knowledge and their Medication Errors

Introduction: Medication administration process is a critical aspect of professional nursing care. Prevention from medical errors needs awareness and appropriate decision-making and performance. The aim of this study is to evaluate the effect of using feedback strategies with an emphasis on medication care standards on knowledge of nursing students and their medication errors. Methods: During two semesters of 2011-2012 academic year, a quasi-experimental study was conducted on 59 nursing students of Arak nursing school, who were passing training course in cardiopulmonary ward. Students were divided into 2 groups of intervention and control. Data-gathering tool was a researcher-made observation checklist about the types and frequency of medication errors which was completed by an observer. In order to evaluate pharmaceutical knowledge, a questionnaire of 26 items was developed by the researcher. The data was analyzed using descriptive statistics (mean and standard deviation) and Wilcoxon and Mann Whitney statistical tests. Results: There was a significant difference between mean scores of medication errors in both groups before and after intervention. After intervention, the mean score of knowledge was higher in intervention group (19.86±2.43) compared to that of control group (13.70±2.92). In addition, a statistically significant difference was observed in mean of medication errors between experiment (0.48±0.63) and control group (1.23±1.04) after intervention (P=0.001 and Z=3.20). Conclusion: There was an enhancement in the students’ awareness of medication care and a reduction in their medication errors. This reveals the positive outcome of giving feedback along with an emphasis on medication care standards and its helpful effects on students’ knowledge and their failures. Therefore, in order to enhance the efficacy of education and to reduce medication errors as well, clinical instructors can enrich the clinical training practices by choosing proper programs designed in accordance with objectives and educational contents