Patient absconding from emergency department and its financial burden: a study in a large public hospital, Tehran

Background and Aims: Patient absconding is a major health issue with economic, social, and health costs and consequences. The present study aimed to investigate the absconding rate from a emergency department and its financial burden in a public hospital in Tehran, IRAN.Materials and Methods: This retrospective and descriptive study was carried out in the emergency department of a large public and teaching hospital in Tehran. Data were collected using the absconded patient records from 23 September 2013 to 22 September 2014. Data were analyzed using descriptive statistics.Concerns about medical ethics, including patient’s confidentiality and hospital name were observed at all stages of study.Results: The results of this study indicate that 774 patients had left the hospital without permission or a notice to staff, so the absconding rate in this study was about 2.4 percent. Young, male, married and uninsured patients were more absconded. Average billing per absconded patient was 1,449,738 Iranian Rials (IRR). The hospital was consequently incurred financial losses amounted to 1,122,097,212 IRR as a result of patientabsconding.Conclusion: In order to preventing and reducing the abscond rate, the following strategies are recommended: the identification of high-risk patients for further care, regular monitoring of emergency departments, good communication and interaction with the patient and his family, introducing the discharge against medical advice (DAMA) policy to patients, accurate recording of patient information to reduce the risk of abscond oraccess to him/her after the absconding.Key words: Patient Absconding, Emergency Department, Retrospective Study*Correspondin

The effect of job-stress on patient-safety in hospitals affiliated to Alborz University of Medical Sciences, Iran

BACKGROUND: Patient-safety is one of the main pillars of healthcare. Given that nurses are the largest group associated with patients, so with safety harms, job-stress among then can reduce patient-safety in hospitals. The aim of this article was to investigate the effects of job-stress on patient-safety in hospitals affiliated to Alborz University of Medical Sciences, Karaj, Iran.METHODS: In this cross-sectional study, data gathering tools consisted of a reliable researcher-made job-stress questionnaire, and a patient-safety checklist. 320 nurses in hospitals affiliated to Alborz University of Medical Sciences, who were selected using simple randomized sampling method, completed the questionnaire, and the checklist was filled by the researcher. Data were analyzed at two levels of inferential and descriptive statistics.RESULTS: Job-stress and also patient-safety were at average levels in studied hospitals. Among the demographic factors, only the relationship between job-stress and marital status was statistically significant (P < 0.050). There were no significant relationships between different aspects of job-stress among nurses and patient-safety.CONCLUSION: According to average level of job-stress among studied nurses, the quality of offered services would decrease and patient-safety would become undermined, if no action take place to reduce the job-stress among them. Therefore, it is necessary to increase nurses’ physical, psychological, and social health to increase patient-safety

Application of Balanced Scorecard (BSC) in Evaluating the Performance of Health Care Providers: A Review

Background: As a comprehensive approach to assessing the performance of hospitals, Balanced Scorecard methodology is a tool to transform the organization's mission into concrete measurable objectives, activities and performance. Methodology: The present study is a systematic review conducted via searching in different sites, such as: Magiran, Irandoc, Google Scholar, Iranmedex. Several studies on the balanced scorecard have been done in different organization. In this study, we chose the articles aiming to assess the health care and hospital using BSC. Then their subjects were compared with the present study, and then the related studies were briefly mentioned. Finding: Based on the results of studies in this area, the main purpose of using the balanced scorecard can be used in studies such as the ability to update the strategy, the establishment of the strategy throughout the organization, coordination unit and individual goals of the strategy, linking strategic objectives to long-term goals and annual budget through performance measures, assessment of performance for learning and improvement strategies. Results: The results of this study showed that combining models is a way for assessing function and increasing the satisfaction and commitment. And the balanced scorecard is recommended as a model that can help increase efficiency and better evaluation of the performance

The relationship between working life quality and turnover intention among hospital staff

Background and Aims: Staff turnover is one of the key managerial issues in the health sector. Health managers may prevent staff turnover and job displacement using quality of working life. This study was aimed to develop a relationship between the quality of working life and turnover intention among a hospital staff under the auspices of Tehran University of Medical Sciences.Materials and Methods: The present cross-sectional study was conducted in 2014. The study population included all staff members in the hospital, and a total of 126 subjects were selected through stratified random sampling. Data were collected using the Walton’s quality of working life questionnaire consisting of 32 questions as well as 3 questions about staff turnover. Data analysis was carried out using descriptive statistics,correlation coefficients and multiple regressions.Results: Based on the findings of this study, a significant relationship between quality of working life and staff turnover. Constitutionalism and integrity were significant predictors of staff willing to leave.Conclusion: Quality of working life can significantly affect employee turnover. Therefore, in order to maintain and retain qualified and skilled workforce, hospital management should prioritize supportive management and supervision, justice and fairness in the organization. Trying to make the fairly payment system, consistency and balance between work and other aspects of life could also improve the quality of working life for hospital staff.Key words: Turnover intention, Quality of working life, Health workers, Teaching Hospita

Evaluation of Discharge Against Medical Advice in Victims of Traffic Accidents at the Emergency Department: A Case study

Background: Annually in the world 2.1 million people are killed and more than 50 million people are either injured or disabled in road accidents. Discharge against medical advice (DAMA) has increased risk of morbidity and mortality. This study aimed to evaluate the rate and reasons for DAMA in the traffic accident victims at the emergency department (ED) to provide solutions in reducing its complications. Methods: This is a descriptive and cross-sectional study. The population in this study consisted of the victims of traffic accidents referred to the ED of Imam Khomeini Hospital affiliated by Tehran University of Medical Sciences. The  random sampling method was usedand by Cochran formula 147 people were selected and examined for two months. In order to evaluate the validity of checklists, 10 patients were randomly assigned to call and the cause of discharge was requested. Data collection was done through DAMA checklist in the patients’ documents. The finding were entered into spss16 for descriptive statistics and analysis. Results: Most of traffic accident victims (79.6%) discharged with physicians’ recommendations. The DAMA was 17.7% and 2.7% escaped from hospital. In all of patients’ DAMA (26), 46.15 percentage was about all four reasons, 23.08 percentage was treatment reason, and the last reason was due to hospitalized issues (3.85%). Conclusion: Among the four causes of DAMA, treatment problems was higher than others. Patients’ participation in the selection of treatment and focusing on medical equipment are recommended. It is a challenge to the quality of health care services when patients do not adhere to their physicians’ recommendations for treatment

Effect of workload on quality of work life among staff of the teaching hospitals of Shahid Beheshti University of Medical Sciences (2014)

Background: Quality of work life is the reaction of employees to their work specially the individual results at work and mental health that affects their personal experience and work results. Objective: The aim of this study was to determine the effect of workload on quality of work life in staff of the teaching hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran. Methods: This analytical study was conducted in 530 staff of four hospitals affiliated to the Shahid Beheshti University of Medical Sciences that were selected by Cochrane sampling method during 2014. The measurement tools were demographic questionnaire, Walton's quality of work life questionnaire (including 32 questions and eight dimensions), and the NASA TLX workload scale. Data were analyzed using Pearson’s correlation coefficient. Findings: The mean scores of quality of work life and workload were 48.21±13.34 and 64.70±11.44, respectively. There was negative significant correlation between workload and quality of work life (r= -0.0161). Conclusion: With regards to the results, it seems that high workload is one of the most important factors of reduced quality of work life that can be reduced through proper organization and planning. Keywords: Quality of life, Workload, Hospital

Determinants of job motivation among frontline employees at hospitals in Tehran

Introduction: Human resources are the most strategic resource and the most significant input for health systems. Their behavior and motivation can strongly affect the overall performance of the health systems. The aim of this study was to determine the factors that affect motivation in frontline employees at teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBMU) in Tehran, Iran. Methods: This cross-sectional study was conducted in 2015. The participants (nurses, physiotherapists, radiology and laboratory technicians, operating room and pharmacy staff) were 300 employees selected by the stratified random sampling method from two general and teaching hospitals. The data collection instrument was a questionnaire that consisted of 42 questions in the 7 domains of motivational factors. Data analysis was performed using descriptive statistics and independent samples t-test by SPSS software, version 23. Results: The findings indicated that working relationships (mean of 3.95) were the main determinant of job motivation of frontline employees. Job content (3.76) career development (3.75), social respect (3.75), and autonomy (3.30) were the next four affective factors. Recognition and remuneration had the least influence on the job motivation of frontline employees. The results of the Friedman test indicated that the difference between the mean scores of different dimensions was significant (χ 2 (6) = 607.00, p < 0.001). Conclusion: A hospital that seeks to engender increased motivation of its frontline employees should have in place a human resources strategy that includes facilitating communication between personnel and management, supporting employees in the community, and promoting social respect for health professions, providing educational opportunities and career development, development of appropriate promotional policies, employee participation in goal setting, facilitating a good working environment and job security, job enrichment, and delegation

Evaluation of the Quality of Health Service Providers: The Iranian People Perspective 2014

Introduction: Quality is the center of attention in all service providing organizations that are effective in promoting satisfaction of patients who are referred to medical centers. The aim of this study was to investigate the quality of health service providers in a case study of Qazvin, Iran, in 2014. Methods: This descriptive study was conducted on 1,002 people who were residents of Qazvin Province (Iran) in 2014. The people were selected randomly from the population of the study area. The main variables studied were education, perceptions, expectations, and gaps in service quality. The data collection tool was the standard Servequal questionnaire. To determine the reliability of the research tool, we used Cronbach’s Alpha coefficient and the test-retest method. Statistical analyses were conducted using SPSS and the ANOVA test. Results: The mean age of people included in the study was 32 ± 9.9 years, and the average waiting time to receive services was 73 ± 47 minutes. Hospitals and doctors' offices had the highest quality gap of -1.420 ± 0.82 and -1.01 ± 0.75, respectively. The service quality gaps in medical centers, health providers of rural area, and health providers of urban area were -0.883 ± 0.67, -0.882 ± 0.83, and -0.804 ± 0.62, respectively. There was a significant relationship between peoples' perceptions and expectations concerning the quality of health services and their educational levels. Conclusion: The higher gaps in quality in hospitals and in doctors' offices require more attention. Managers and policy makers should consider developing and implementing plans to reduce these gaps in quality and to promote better health services in these two sectors

Preparedness of Iranian Hospitals Against Disasters

Context: Over the past decade the number of accidents and disasters has been growing around the world. In addition to damaging communities and infrastructures, unexpected disasters also affect service providers. This study aimed to evaluate the readiness of hospitals when confronted with unexpected disasters. Evidence Acquisition: The present study was a simple review article, which was conducted via searching different sites, such as:Web of Science, Scopus, Science Direct and PubMed, using different key words such as: Disasters, Crisis, Hospital and preparedness.The relationship between the articles found in relation to our subject was investigated through the title and abstract of articles. The relationship between the articles, which were found in relation to our subject, was investigated through the title and abstract of the articles. Our search included papers published during the period between 2007 and 2015 and we only considered studies that measured the preparedness of hospitals in critical conditions. Among the 30 articles, which were found, 17 were excluded from the study due to lack of relevant data. Hence, 15 papers, which were of proper design and robust data analysis, were included in the current study. Results: Hospital preparedness in disaster was evaluated in three dimensions: structural, non-structural factors and vulnerability management performance. A total of readiness of hospitals in three dimensions was mediocre. Conclusions: Overall, the results derived from these studies indicated that hospital safety levels in most of the surveyed hospitals were moderate. Although the situation in hospitals is not critical, there is a need to plan and take appropriate measures to improve the safety level of the hospitals. Keywords: Disasters, Risk Assessment, Hospital Preparedness, Iranian Hospital

The Assessment of Inequality in the Geographical Distribution of Burn Beds in Iran

Introduction: In recent years, the World Health Organization (WHO) has emphasized the importance of determining the equality of the distribution of healthcare resources. Inequalities in the healthcare system are one of the world’s most important developmental challenges, and the inefficiencies that exist in healthcare systems are the most important reason for these challenges. Thermal burns are one of the common injuries worldwide, and their effects are a significant reason for the mortality and morbidity rates throughout the world. Considering the importance of burns as one of the 30 leading causes of death in Iran, this study was aimed to compare the distribution of burn beds with its disability-adjusted life years (DALY) in Iran. Methods: This applied analytic-descriptive study was conducted in order to determine the distribution of burn beds in Iran using the Lorenz curve. In this way, the distribution of burn beds was analyzed in relation to the population of each province and lost DALY caused by burns in Iran. For each province, the number of burn beds in 2012 was collected from credible and authoritative sources at the Ministry of Health, and the population of each province was obtained using data from the National Center of Statistics. The data were analyzed and presented using Microsoft Office Excel. Results: Isfahan and Khorasan Razavi Provinces had approximately 11 and 10.4% of the country’s burn beds, respectively. The Provinces that had the most DALY were Sistan Baluchestan, Fars, and Kerman with 10.75%, 10.34%, and 9.54%, respectively. The Gini coefficients of burn beds in relation to population and DALY were calculated as 0.09 and 0.16, respectively. Conclusion: The Gini coefficients in relation to population and DALY were less than 0.2. Although the Gini coefficient of the burn beds in relation to DALY was more than that for the population, the difference was not significant, and the distributions of beds regarding the two calculated coefficients were equal. It is recommended that healthcare policymakers distribute burn beds in proportion to the populations of the provinces