The Status of Outsourcing Services in a Specialized Tehran Hospital Using SWOT

Background: Outsourcing in healthcare is a cost-effective strategy that reduces costs and increases service quality. Managers must attempt to outsource healthcare services using scientific methods. Objective: This study is a strategic analysis of the outsourcing of health services in one specialty and subspecialty hospital in Tehran. Methods: This mixed method study (quantitative-qualitative) was performed in 2014 at one of the biggest specialty hospitals in Tehran. Data was collected through interviews, focus discussion groups (FDG), and the internal and external factors evaluation matrix. The study population comprised managers and directors of the hospital. Data was analyzed using Excel 2010 software and SWOT analysis. Results: The final scores for internal and external factors were 2.16 and 2.68, respectively, indicating the hospital had a conservative strategic position for choosing outsourcing strategies. Conclusion: Since this hospital had a conservative strategic position in outsourcing, managers were able to change their outsourcing strategy while considering its advantages and disadvantages and determining the type of services to be outsourced

Effect of Reengineering on the Information and Statistics Process in the Iran University of Medical Sciences

Introduction: Nowadays, organizations working in dynamic and competitive environments have to change their processes from both the inside and outside of the organization. One of the most effective strategies for monitoring and controlling these changes is re-engineering. This study aimed to refine the collection and classification process of data through re-engineering. Methods: This study was done with an analytical-descriptive approach in 2012, in the Planning and Budget department of the Iran University of Medical Sciences. Data were collected by documents, interviews and observations. Three main process indicators include: number of activities, time, and costs of human resource. These were calculated and compared before and after the implementation of the reengineering. Data were analyzed using Microsoft Excel 2007. Results: The current status of the process included 53 activities that reduced to 27 after reengineering. Total process time was reduced from 79 to 38 days and direct human costs decreased to about 15 million Rls. Thus, by the implementation of reengineering, the number of activities, time and costs were decreased to 49%, 52% and 54% respectively. Conclusion: Based on the findings, re-engineering led to improvements of performance and saved resources. Therefore the use of this technique is recommended in order to have an improvement in different performances, increases satisfaction and saves resources

Health Technology Assessment of the Psychotherapy Effect on Prevention of Suicide and Self-Harm: A Rapid Review of Secondary Studies

Introduction: According to the World Health Organization (WHO) report, acute depression disorders are the second largest health problem in the world which can cause disability and imposes huge costs on individuals and societies. This study aims to investigate the effectiveness and cost-effectiveness of using psychotherapy in patients with depression for prevention of suicide and self harm commitment. Methods: Cochrane library (Issue 10, 2012) and CRD (Centre for Review and Dissemination) were searched using Mesh. Studies that compared psychotherapy with different alternative methods such as antidepressant drugs and used outcomes such as self-harm or suicide rates were included. Results: Eighteen articles were included in this review. Most of them showed that using psychotherapy as only suicide preventive method cannot be sufficiently effective, so that in the one of the included meta-analysis was shown that the effect of psychotherapy on suicide imagination and the risk of suicide were small. In terms of cost-effectiveness, it seems that MACT (Manual-assisted cognitive behavior therapy) is a cost-effective method in prevention of self-harm. Conclusion: Generally, it seems that using combination of therapeutic methods will increase the effectiveness of suicide and self-harm prevention methods

Comparação da precisão de medições lineares em imagens CBCT com diferentes campos de visão

This study sought to investigate the effect of the field of view (FOV) on linear measurements of cone beam computed tomography (CBCT) images. Methods: In this in vitro study, five dry human skulls were used. After using red wax to simulate soft tissue, the skulls were scanned using Galileos CBCT scanner (Sirona, Bensheim, Germany) with exposure parameters of 85 kVp and 21 mAs and voxel size of 0.280 mm; once with FOV of 15 cm × 8 cm and once again with 15 cm × 15 cm. The measured distances were the distance between the center of the bilateral mental foramen in the axial view (MM), the distance between the alveolar crest and the mandibular inferior border in the sagittal view on the midline (CB), and the depth of the socket of the left mandibular central incisor (L1). Descriptive statistics as well as Pearson’s correlation coefficient were used for statistical analysis (α = 0.05) using SPSS software (v. 25, IBM, NY, USA). Results: The measurements obtained with small and large FOV and with the dry skull were not significantly different (p > 0.05). The measurements obtained in small FOV had excellent correlation coefficient when compared with those obtained with the dry skull, with values of 0.890 for MM, 0.954 for CB, and 0.921 for L1 (p < 0.001). The measurements in large FOV also had excellent correlation coefficient when compared with those on the dry skull, with values of 0.894 for MM, 0.949 for CB, and 0.902 for L1 (p < 0.001). Conclusion: According to our findings, linear measurements obtained by CBCT scans in small and large FOVs were not significantly different than those on dry skulls. Since the linear measurements are accurate regardless of FOV size, selection of FOV must be based on patient factors, such as area of interest and radiation dose.O objetivo do presente estudo é investigar o efeito do campo de visão (field of view – FOV) em imagens de tomografia computadorizada de feixe cônico (CBCT) na medida linear. Métodos: Neste estudo in vitro, foram utilizados cinco crânios humanos secos. Depois de usar cera vermelha para simular tecidos moles, os crânios foram escaneados usando o scanner GALILEOS CBCT (Sirona, Bensheim, Alemanha) usando parâmetros de exposição de 85 kVp e 21 mAs e o tamanho de voxel de 0,280 mm; uma vez com FOV de 15 cm × 8 cm e outra com 15 cm × 15 cm. As medidas usadas foram as distâncias entre o centro dos forames mentuais bilaterais, na visão axial (MM): a distância entre a crista alveolar e a borda inferior da mandíbula, na visão sagital na linha média (CB); e a profundidade do soquete do incisivo central da mandíbula esquerda (L1). Estatística descritiva e o coeficiente de correlação de Pearson foram utilizados para análise estatística (α = 0,05) usando o software SPSS (v. 25, IBM, NY, EUA). Resultado: As medidas obtidas com FOV pequeno e grande e com o crânio seco não foram significativamente diferentes (p > 0,05). As medidas feitas com FOV pequeno apresentaram excelente coeficiente de correlação em relação ao crânio seco, com valores de 0,890 para MM, 0,954 para CB e 0,921 para L1 (p < 0,001). As medidas feitas no FOV grande também apresentaram excelente coeficiente de correlação em relação ao crânio seco, sendo 0,894 para MM, 0,949 para CB e 0,902 para L1 (p < 0,001). Conclusão: De acordo com nossos resultados, as medidas lineares obtidas por CBCT em FOV pequenos e grandes não foram significativamente diferentes das medidas obtidas com crânios secos. Como as medições lineares são precisas, independentemente do tamanho do FOV, a seleção do FOV deve ser baseada de acordo com os fatores do paciente, como área de interesse e dose de radiação

Prevalência de osteosclerose idiopática em ossos da mandíbula: estudo de tomografia computadorizada de feixe cônico

Objective: The aim of this study is to determine the prevalence of idiopathic osteosclerosis (IO) in the mandible in an Iranian subpopulation using cone beam computed tomography (CBCT). Methods: This cross-sectional study was performed on all CBCT images obtained in 2010-2014 from the archive of Oral and Maxillofacial Radiology Department at Isfahan Dental School. Images were evaluated by two observers in identical room and monitoring conditions. IO was defined as homogenous radiopacities with no particular etiology, ranging from 2 mm to 2 cm in size. Demographic information of all patients, as well as the lesion’s number, location, border, shape, and association with adjacent teeth were recorded. Results: From 377 CBCT images, 43 images (11.4%) had at least one IO lesion. Two separate IO lesions were detected in six patients; therefore, 49 IO lesions were found in total. No gender differences were observed in IO prevalence (P = 0.806). Although most common in patients who were in their 30s, IO prevalence was not statistically different among age groups (P = 0.369). IO was most frequent in the molar region, with 63.2% of lesions. Conclusion: IO prevalence was 11.4% in the studied population and was not statistically different between age groups or sexes. Most lesions were found in the mandibular molar region.Objetivo: Este estudo busca determinar a prevalência de osteosclerose idiopática (OI) na mandíbula em uma subpopulação iraniana usando tomografia computadorizada de feixe cônico (TCFC). Métodos: Este estudo transversal foi conduzido em todas as imagens de TCFC obtidas entre 2010 e 2014 do arquivo do Departamento de Radiologia Oral e Maxilo-facial da Isfahan Dental School. As imagens foram avaliadas por dois observadores em condições iguais de ambiente e monitoramento. A OI foi definida como radiopacidades homogêneas sem causa específica, de tamanho entre 2 mm e 2 cm. As informações demográficas de todos os pacientes foram registradas, assim como o número, localização, borda e formato da lesão e sua relação com dentes adjacentes. Resultados: De 377 imagens de TCFC, 43 imagens (11,4%) tiveram pelo menos uma lesão de OI. Duas lesões individuais de OI foram detectadas em seis pacientes; assim, houve 49 lesões no total. A prevalência de OI não demonstrou preferência por gênero (P = 0,806). A OI foi mais comum em pacientes na faixa dos 30 anos de idade, mas sua prevalência não diferiu estatisticamente entre faixas etárias (P = 0,369). A região mais comum para OI foi a do molar, onde ocorreram 63,2% das lesões. Conclusão: A prevalência de OI foi de 11,4% na população estudada e não diferiu estatisticamente entre faixas etárias e sexos. A maioria das lesões foi encontrada na região do molar mandibular

Assessment and reduction of human error using SHERPA technique in chemotherapy department of a large military hospital

Background: Medical errors are numerous in medical activities. Considering the sensitivity and importance of the medical group's professions, the emergence of an apparently simple error can cause the death of an individual or even a group of individuals. The present study aims the evaluation and reduction of human error using a system human error reduction and prediction approach System Human Error Reduction and Prediction Approach (SHERPA) in the nurses of Baqiyatallah hospital's chemotherapy ward in 2019. Materials and Methods: A cross-sectional study was conducted in the chemotherapy ward using the SHERPA technique. Then, the duties were determined in detail using Hierarchical Task Analysis (HTA). The errors were identified using the SHERPA checklist, and the risk outcomes and intensities were finally evaluated. Results: Based on the study findings, there are 109 possible errors for 48 sub-duties. The most frequent errors fall in the functional area (54%) and the least frequent errors pertain to the area of selection (3%). Conclusions: In order to reduce the errors and increase the quality of the services and safety of the patients, errors can be identified by using the SHERPA technique; after identifying these errors, using this technique, it is possible to prevent the recurrence of the identified errors by careful planning. Considering the fact that the most frequent error was found in the functional domain, modern protocols can be codified in this area, and standards can be observed for putting the problems of this section atop of the priority list and reducing the errors and increasing safety of the patients

Providing a model for financing the treatment costs during biological crises using the fiscal space development approach

Abstract Background Expanding fiscal space for health can be defined as providing additional budgetary resources for health, which is highly important during biological crises. This study aimed to provide a model for financing the treatment costs during biological crises using the development of the fiscal space approach. Methods This study employed a descriptive mixed-method design, consisting of three stages. In the first stage, a systematic review of relevant literature was conducted using multiple databases, including Scopus, PubMed, and Google Scholar. A total of 45 studies that met the inclusion criteria were selected. In the second stage, a panel of 14 experts identified five primary and 32 secondary strategies using an open questionnaire. Any additional strategies not identified during the literature review were added if a consensus was reached by experts. In the final stage, the Best Worst Method (BWM) was used to prioritize the identified strategies and sub-strategies based on their feasibility, effectiveness, quick yield, and fairness. Results Five strategies and fifty sub-strategies were identified. The most important strategies were the increase in health sector-specific resources (0.3889), increase in efficiency of health expenditures (0.2778), structural reforms (0.1111), health sector-specific grants and foreign aid (0.1667), and conducive macroeconomic conditions (0.05556). The most important sub-strategies were establishing and increasing earmarked taxes for the health sector (0.0140), expanding Universal Health Coverage (UHC) plans (0.0103), attracting the participation of non-governmental organizations (NGOs) and charitable organizations in the health sector (0.0096), integrating basic social insurance funds (0.0934), and tax exemptions for economic activists in the health sector (0.009303) during the crisis. Conclusion This study identified five main strategies and 50 sub-strategies for financing the treatment costs during biological crises. The most important strategies were increasing health sector-specific resources, improving efficiency of health expenditures, and implementing structural reforms. To finance health expenditures, harmful and luxury goods taxes can be increased and allocated to the health sector during crises. UHC plans should be improved and expanded, and the capacity of NGOs and charitable organizations should be better utilized during crises

The Dilemma of Irrational Antibiotic and Corticosteroid Prescription in Iran: How Much It Can Affect the Medicine Expenditures?

In recent years the high cost of medicines and the lack of it were one of the major problems in developing countries that despite numerous efforts to solve the root causes of this problem, the issue remains, unfortunately. Therefore, this study aimed to assess the impact of antibiotics and corticosteroids prescription on the medicines expenditures. This was descriptive-analytical study that conducted to assess the function of medical expenditures through prescription letters and analysis the factors affecting medicine expenditures. We used the data of 91,994,667 selected prescription letters that were collected by the Ministry of the Health and Medical Education (MOHME) throughout the country in the year 2011 which was analyzed through a logarithmic regression model and OLS estimator. The average number of prescription items in each prescription letter were varied from 2.7 to 3.6, and the average price of each letter was varied from 30223 to 69986 Rials. Between 39 to 61 percent of prescription letters containing antibiotic items and between 15 and 35% of them contain corticosteroids. Also, the impact of antibiotic and corticosteroid prescriptions on the average expenditure of prescription letters were -1.4 and 0.032 respectively. Excessive and irrational prescribing had the greatest impact on medicine expenditures. On the other hand, the expenditure of prescription letters had the negative elasticity to antibiotics prescription and relatively inelastic for corticosteroids. So, raising the price of medications to reduce the use of them could not play a successful role in a control policy

Assessing the quality of dental services using SERVQUAL model

Background: The measurement of service quality had an important role in managing service provided, diagnosing the problem, and assessing service performance. Patient satisfaction is one of the key indicators of quality in health-care organizations. This study aimed to measure the service quality gap of patients' perceptions and expectations in five dimensions at a military Specialized Dental Clinic in Iran using SERVQUAL tool. Materials and Methods: This was a cross-sectional and descriptive-analytical study conducted at a Specialized Dental Clinic affiliated to the Armed Forces of Islamic Republic of Iran in Tehran in 2013. All 385 patients referring to the studied clinic during two working shifts of morning and evening in one month, August, were selected. The required data were collected using the modified SERVQUAL questionnaire. The collected data were analyzed using SPSS 20.0 through statistical tests including Mann–Whitney and Kruskal–Wallis tests. P < 0.05 was considered statistically significant. Results: The results showed that the quality of services provided to patients was significantly lower than their expectations and the quality gaps were statistically significant in all studied dimensions (P < 0.001). Furthermore, the highest and lowest quality gap was related to empathy (−1.16) and reliability (−0.61), respectively. Conclusion: According to the results, the managers of this clinic should take steps toward improving the quality of services in all dimensions, especially responsiveness and empathy, through planning properly, prioritizing services, and reviewing processes with regard to the patients' expectations