Organizational culture of selected teaching hospitals of Tehran

Background: Organizational culture affects hospital performance. This study aimed to assess organizational culture of selected teaching hospitals of Tehran in 2014.Material and methods: This descriptive and cross sectional study was carried out in 7 teaching hospitals. Hospitals were selected out of 43 teaching hospitals using quota- randomized sampling method. A questionnaire with 32 questions was used to measure organizational culture of hospitals in 8 domains including attention to details, customer-oriented, team working, creativity and innovation, risk taking,integration (Coherence), power distance and short/long- oriented. About 308 employees working in clinical, diagnostic, administrative, and logistic departments participated in this study. Data were analyzed using SPSS software (version 20) through U Man- Whitney and Kruskal- Wallis statistical tests. Ethical issuessuch as informed consent, confidentiality of information and researchers’ objectivity were all considered.Results: The mean score of organizational culture was 3.57 out of 6 (moderate). The most and least scores were observed in attention to details (4.48) and risk taking (3.18) dimensions of organizational culture, respectively. The highest score of organizational culture was related to administrative units. Curative wardsin hospitals got the lowest scores. There was a significant relationship between organizational culture and the type of hospital (p<0.05).Conclusion: The findings of this study indicate a moderate organizational culture in selected hospitals.Given the importance of corporate culture in the success of the hospitals and improving patient outcomes, hospital managers should take appropriate actions to improve organizational culture, especially in termsof team-working, innovation, risk-taking and coherence

Relationship between managers’ leadership style and organisational structure and culture of Qazvin hospitals

Background and Aims: Organizational structure and culture influence the performance of an organization. Various factors, on the other hand, affect the structure and culture of an organization. This study aimed to examine the relationship between managers’ leadership style and organizational structure as well as culture in Qazvin hospitals, Qazvin, Iran.Materials and Methods: The present descriptive and cross-sectional study was conducted through the use of leadership (including transformational, transactional and laissez-fair dimensions), organizational structure (including mechanistic and organic dimensions) and organizational culture (including attention to details, creativity, risk taking, stability, team- working and power distance dimensions) questionnaires. The questionnaires were distributed among hospital employees and managers using stratified random issues such as informed consent, sampling method. Data were analyzed using SPSS software. Ethical confidentiality of information and researchers’ objectivity were all considered.Results: Qazvin hospitals mainly had a mechanic and bureaucratic structure. The hospitals also revealed to have a moderate organizational culture. Stability and paying attention to details dimensions of organizational culture achieved higher scores. On the other hand, power distance, team working, risk taking and creativity achieved moderate scores. The prevalent leadership style of managers was  transformational. There was a meaningful statistical relationship between managers’ leadership styles and organizational structure and culture of Qazvin hospitals. Transformational leadership had the most impact on power distance and creativity dimensions of organizational culture.Conclusion: Identifying organizational structure and culture types as well as using an appropriate leadership style could improve hospitals’ productivity.Keywords: Organizational structure, organizational culture, leadership style, employee, manager, hospita

The impact of quality management on reducing canceled elective operations: a participatory action research

Background and Aims: Surgery operations cancellation causes problems in operation theatre planning and results in hospital inefficiency as well as resource wastage. In addition, it causes stress for both patients and their relatives.This study aimed to examine the impact of quality management on surgery operations cancellation in Vali-e-asr hospital’s operating theatre department (Tehran) in 2014-2015.Materials and Methods: In this participatory action research, the reasons for surgery operations cancellation were identified using a checklist. These reasons were assessed and an action plan was developed for cancellation reduction. The plan was implemented using the action research cycle. SPSS software (version 22) was used for data analysis. Ethical issues such as respect for patients and staff and the confidentiality of information were all considered.Results: Patients failing to turn up, lack of ICU beds availability, and prolonged previous surgeries were the most common causes of surgery operations cancellation. Surgery operations were increased by 15 percent and surgery operations cancellation was reduced by 14.6 percent through the implementation of quality management strategy. Standardization of processes, proper planning, using HIS based operation list, recruiting more staff and giving more information to patients helped reducing the surgery operations cancellation.Conclusion: Formation of quality improvement team, using an appropriate quality management model and its appropriate implementation can help enhance hospital departments’ productivity and reduce surgery operations cancellation.Keywords: Quality management, surgery operations cancellation, hospital, action researc

Factors influencing healthcare service quality

Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality

Verification of a Quality Management Theory: Using a Delphi Study

Background: A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify th e SCQM model. Methods: The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement. Results: The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation. Conclusion: A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellenc

A Survey of Clinical Governance Success in University Hospitals in Tehran

Background & Objectives: Clinical Governance (CG) is an organizational strategy for maintaining and improving the quality and safety of patient care and increasing employees’ and managers’ responsiveness and accountability through developing an appropriate organizational structure and culture as well as developing, implementing and monitoring clinical guidelines, pathways and standards. This study aimed to examine the success of CG implementation in university hospitals, in Tehran, Iran. Methods: In this descriptive analytic study, a researcher-made questionnaire was filled out by managers and CG executive managers of 39 university hospitals in Tehran/ Iran. Data analysis was done through SPSS software and using Pearson, Spearman and logistic regression. Results: Clinical Governance was moderately successful in Tehran university hospitals (58%). The most success was achieved in patient involvement and risk management dimensions and the least success was observed in clinical effectiveness and clinical audit dimensions. Management and leadership and clinical audit had the most effect on CG success. The involvement and commitment of managers and employees in implementing CG were moderate and physicians’ involvement and commitment was poor. The length of CG implementation time had significant relationship with managers’ and employees’ commitment and CG success. Conclusion: Clinical governance was not successful in Tehran university hospitals. Active involvement and commitment of top managers, staff empowering, patient centeredness, evidence-based practice, and clinical audit are necessary for successful CG implementation. Key­words: Quality management, Clinical governance, Hospital, Critical success factors ­Citation: Mosadeghrad AM, Arab M, Shahidi Sadeghi N. A Survey of Clinical Governance Success in University Hospitals in Tehran. Journal of Health Based Research 2019; 5(1): 101-16. [In Persian

Study of Conflict Management Styles in Tehran University Affiliated Hospitals

Study of Conflict Management Styles in Tehran University Affiliated Hospitals Mosadeghrad Ali Mohammad1, Arab Mohammad2, Mojbafan Arezoo3* Received: 10. 02. 2016 Revised: 25. 05. 2016 Accepted: 31. 05. 2016 Abstract Introduction:Conflicts in hospitals, in addition to reducing Employee’s productivity and satisfaction, and also increasing hospital’s costs, has a negative effect on the treatment process. Therefore, acquiring necessary knowledge and skills for conflict management are essential for hospital managers. The present study aimed to investigate the conflict management strategies used by managers of hospitals affiliated with Tehran University of Medical Sciences (TUMS). Method:This is a descriptive – analytic study conducted as a cross-sectional one in 2015. The sample consisted of 563 managers of three levels of management including senior, middle, and executive managers in hospitals affiliated with TUMS. Using a high valid and reliable self-made questionnaire based on Thomas and Kilman’s model, the data was collected. Data analysis was performed by SPSS software 19, and using descriptive (Mean, Standard Deviation, Frequency and Percentage) and inferential statistics (Regression, Spearman and ANOVA). Results:The results show that collaborating style was the dominant style used by hospital managers. Compromising and accommodating styles were the next management strategies in order. There were significant statistical relationship between management style and management level (P=-0.038), age (P=0.016), manager’s work experience (P=0.019), management experience (P= 0.021) and conflict management training courses (P=0.001). Conclusion:The nature of healthcare organizations requires that managers use collaborating, compromising and accommodating styles in order to interact with various stakeholders. Holding suitable training course in the field of conflict management has a significant role in reducing devastate effects of conflict in the hospitals. Key¬words:Conflict Management, Senior Managers, Middle Managers, Executives, Teaching Hospitals Citation:Mosadeghrad AM, Arab M, Mojbafan A.Study of Conflict Management Styles in Tehran University Affiliated Hospitals. Journal of Health Based Research 2016; 2(1):1-13. 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 Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 3. MSc, Department of Health Management and Economics, School of Public Health, Tehran 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]

The Impact of Strategic Planning on Job Satisfaction among Hospital Staff: a case study

Background & Objectives: Hospital staff's job satisfaction has a significant role in improving the quality of hospital productivity. This study aimed to examine the impact of strategic planning on hospital staff's job satisfaction. Methods: This participatory action research was carried out in a selected private hospital in Isfahan/ Iran during 2012-2014. The hospital strategic plan, with a goal for improving job satisfaction was designed and implemented. Employees’ job satisfaction was measured before and after implementing the strategic plan through 9-item Job Satisfaction Questionnaire. Data were analyzed through SPSS22 software package. Results: The rate of subjects' job satisfaction in 2012 was approximately 58.6%. The highest satisfaction rate was found for the nature of job and job and coworkers' needs and the lowest was obtained for salary, job promotion, work conditions and job security. Employees’ job satisfaction increased to 64.7% in 2014 (10.1% improvement). Employees’ tendency for job quit decreased by 61.4% (from 42.2% in 2012 to 16.3% in 2014). Strategic plan had the most impact on dimensions of job promotion, management and supervision, coworkers and salary. Conclusion: Adequate designing and implementation of a strategic plan can improve job satisfaction of employees and reduces their tendency for job quit. Key¬words: Strategic planning, Employees, Job satisfaction, Hospital, Case study ¬Citation: Mosadeghrad AM, Ebneshahidi A, Abdolmohammadi N. The Impact of Strategic Planning on Job Satisfaction among Hospital Staff: a case study. Journal of Health Based Research 2017; 3(2): 99-114

Equity in Geographical Distribution of Medical Specialists in Iran

Background & Objectives: Fair distribution of healthcare personnel improves the society healthcare indicators. The aim of this study was to investigate the geographical distribution of medical specialists, based on their field of specialty, in Iran. Methods: The present research was a descriptive and cross- sectional study. Data related to the country population and the number of medical specialists working in hospitals affiliated to the Ministry of Health and Medical Education in each province were gathered from the reports of 2011 national census population and housing performed by Iran national statistics center. Data was analyzed through Excel software. Lorenz curve was drawn and Gini index was calculated. Results: There were 21.45 medical specialists per 100,000 population in Iran in 2011. Semnan had the highest (40.23) and North Khorasan had the lowest (11.7) medical specialists in the country. Gini index for medical specialists was calculated as 0.043. The greatest Gini index was observed for Neuropsychologists (0.080) and the smallest was seen for dermatologists (0.001). Conclusion: Although the ratio of medical specialists to the population differed in provinces of Iran, medical specialists were distributed fairly among provinces. It is recommended that in addition to distribution equity, policy makers pay more attention to the population medical needs in each region. Key¬words: Distribution equity, Gini index, Medical specialists, Lorenz curve ¬Citation: Mosadeghrad AM, Hashempour R, Veisy M. Equity in Geographical Distribution of Medical Specialists in Iran. Journal of Health Based Research 2017; 3(1): 25-37

Reducing chronic medical complications due to failure of patient safety using Standardized Plant Analysis Risk-Human Reliability Analysis (SPAR-H) method

BACKGROUND: Human errors in the medical profession can lead to irreparable errors in people's lives, damage, and heavy costs. Among health care workers, nurses spend more time with patients compared to other personnel; hence, they are more prone to human error. Therefore, the purpose of this study was to identify and evaluate human errors using the Standardized Plant Analysis Risk-Human Reliability Analysis (SPAR-H) method in nursing staff of a general hospital in Qazvin Province, Iran.METHODS: This cross-sectional study was conducted in a general hospital in Qazvin during last 6 months of 2016 and first 6 months of 2017. The target population in the present study was nursing groups based on their highest work experience, from each section in hospital. The SPAR-H method was used to investigate human error in the population and the collected data were analyzed using SPSS software.RESULTS: The highest error related to inappropriate venipuncture with probability of 0.7, and the least probable error related to error in entering the numbers of vital signs with the probability of 0.0045.CONCLUSION: Due to the sensitivity of the role of nurses in hospitals, the need for increased workforce, the use of people with higher work experience in sensitive sectors, reducing overtime even for those who volunteered to work overtime, scientific scheduling of the personnel’s work shifts, and providing practical training such as stress control methods in case of emergencies can be effective in reducing the probability of an error