Research code: مقاله مستخرج از رساله است
Ethics code: IR.iau.semnan.rec.13970004
Clinical trials code: مقاله مستخرج از رساله است
Department of Industrial Engineering, Islamic Azad University, Semnan Branch, Semnan, Iran , alijahan@yahoo.com
Abstract: (26 Views)
Background and Purpose: Hospitals are the most important elements of the care and treatment system. They attract a large part of financial, human, and capital resources, and are at the forefront of public health. Hospitals and medical centers are sectors that have shown rapid growth in the economy in recent decades, and this growth is higher in developing countries than in other countries because health services follow the global trend of moving from the public to the private sector. The main mission of hospitals is to provide high-quality care for patients and fulfill their needs and expectations. The hospitals must provide appropriate and high-quality services to meet the patients' needs. To his end, attention has been paid to the service quality at hospitals under the law and it is the main duty of the Ministry of Health and Medical Education. The provision of health services for the general public is an important criterion for social development and perhaps emergency care is the most important pillar of medical care at universities of medical sciences. The emergency department has a sensitive and exceptional position in the hospitals and the health care system of any country due to the need to perform fast, high-quality, and effective various and complex processes The emergency department of hospitals is significantly important due to the reception of the largest, most diverse, most affected, and most sensitive group of patients . Patients, who visit this department, are in critical conditions in terms of physical condition, and taking care of them as soon as possible and with the highest quality is a duty of the medical and nursing staff who work in this department. In terms of structure, this department should be properly organized and the service delivery processes of this department should be regularly considered and reviewed so that applying efficient management can cause a proper performance in improving service capacity or providing desirable services for patients in need. It should be noted that measuring the quality of health services from the patients' perspective has become increasingly important in recent years because it is the patients' right to comment on the services they receive. Therefore, service quality is defined as the customer's demand, perceptions, and expectations as the main determinants of quality. The more appropriate, correct, and faster these services are, the more the public trust in the health system will increase.One of these important and sensitive departments of hospitals is the emergency department. In this research, by examining the research background, the key indicators of improving the quality of services in hospitals and emergency departments have been studied, and then using fuzzy TOPSIS method, we have prioritized them and then proposed optimal methods in this field.
Method: This is a descriptive survey study and applied in terms of purpose. The statistical population including 125 patients who referred to 15 selected emergency departments in Hamadan hospitals were selected by random sampling method. The required data were collected using a researcher-made pairwise comparison questionnaire and analyzed using one of the most well-known multi-criteria decision-making methods, namely the fuzzy TOPSIS method.
Results: After collecting the answers to the questions, we classified them into 6 indices and 26 sub-indices according to the experts' opinion in the emergency department at this stage. Using the opinion of professors and experienced experts and according to the extracted data, and the relationships between indices and sub-indices of multifunctional decision-making methods, fuzzy TOPSIS method as well as ANP and DEMETAL techniques, we outlined the importance of the relationships of indices indicators and sub-indices. The phases are described as follows.
4. Phase 1: Extracting the concept of emergency service capacity
5. Phase 2: After examining the concept of emergency service, we obtained the nurses, physicians, and paramedics' answers to a list of problems in the emergency department of certain hospitals in Hamadan during the design of an open questionnaire, including 6 application fields mentioned in the third chapter.
6. Phase 3: Identification of indices and sub-indices by summarizing the comments provided in the questionnaire: According to the answers to 6 open-ended questions (by taking into account the current status of Coronavirus) as mentioned in the third chapter.
7. Phase 4: The phase included designing importance matrices and relationships between indices and sub-indices, and completing matrices of the experts' opinion in addition to analyses of statistical methods such as Delphi methods, questionnaire design, and SPSS to analyze data. In the present study, we utilized multi-criteria decision-making to qualitatively examine the identification of relationships and the interaction of indices and sub-indices in this field. We then pointed out their weighting by the APN method.The results indicate that, the criterion of reliability with a weight of 0.205 is the most important effective factor in the process of quality of medical service in the emergency department, after that the criterion of responsiveness with a weight of 0.0199 is among the effective criteria of service quality in the emergency department. Professionalism with a weight of 0.139 has gained the last rank among the criteria related to the quality of medical services.
Conclusion: It is noteworthy that we could extract issues and problems through an open questionnaire by applying the researcher in different shifts and investigating and identifying the current status using the views of all representatives of the service groups in the sector. Thereafter, the brainstorming improved the service capacity according to the issues extracted in the emergency department and determined the indices and sub-indices. We first prioritized 26 indices identified in the section using the ANP and DEMATEL techniques. Due to the time constraints, sensitivity, and stressful emergency spaces, especially emergency department, the present study sought to extract qualitative indices as much as possible with the cooperation of medical staff (doctors, head nurses, nurses, residents, etc.) to be more effective in improving patient service capacity than other studies that were often quantitative.The ANP and DEMATEL techniques were first used to prioritize the indices and sub-indices in emergency departments. The techniques were able to measure the interaction and impact of indices and sub-indices and express the importance of the criteria and their subsets. The integration of both quantitative and qualitative methods in the fourth chapter was another innovation of the present research.
Method: This is a descriptive survey study and applied in terms of purpose. The statistical population including 125 patients who referred to 15 selected emergency departments in Hamadan hospitals were selected by random sampling method. The required data were collected using a researcher-made pairwise comparison questionnaire and analyzed using one of the most well-known multi-criteria decision-making methods, namely the fuzzy TOPSIS method.
Results: After collecting the answers to the questions, we classified them into 6 indices and 26 sub-indices according to the experts' opinion in the emergency department at this stage. Using the opinion of professors and experienced experts and according to the extracted data, and the relationships between indices and sub-indices of multifunctional decision-making methods, fuzzy TOPSIS method as well as ANP and DEMETAL techniques, we outlined the importance of the relationships of indices indicators and sub-indices. The phases are described as follows.
4. Phase 1: Extracting the concept of emergency service capacity
5. Phase 2: After examining the concept of emergency service, we obtained the nurses, physicians, and paramedics' answers to a list of problems in the emergency department of certain hospitals in Hamadan during the design of an open questionnaire, including 6 application fields mentioned in the third chapter.
6. Phase 3: Identification of indices and sub-indices by summarizing the comments provided in the questionnaire: According to the answers to 6 open-ended questions (by taking into account the current status of Coronavirus) as mentioned in the third chapter.
7. Phase 4: The phase included designing importance matrices and relationships between indices and sub-indices, and completing matrices of the experts' opinion in addition to analyses of statistical methods such as Delphi methods, questionnaire design, and SPSS to analyze data. In the present study, we utilized multi-criteria decision-making to qualitatively examine the identification of relationships and the interaction of indices and sub-indices in this field. We then pointed out their weighting by the APN method.The results indicate that, the criterion of reliability with a weight of 0.205 is the most important effective factor in the process of quality of medical service in the emergency department, after that the criterion of responsiveness with a weight of 0.0199 is among the effective criteria of service quality in the emergency department. Professionalism with a weight of 0.139 has gained the last rank among the criteria related to the quality of medical services.
Conclusion: It is noteworthy that we could extract issues and problems through an open questionnaire by applying the researcher in different shifts and investigating and identifying the current status using the views of all representatives of the service groups in the sector. Thereafter, the brainstorming improved the service capacity according to the issues extracted in the emergency department and determined the indices and sub-indices. We first prioritized 26 indices identified in the section using the ANP and DEMATEL techniques. Due to the time constraints, sensitivity, and stressful emergency spaces, especially emergency department, the present study sought to extract qualitative indices as much as possible with the cooperation of medical staff (doctors, head nurses, nurses, residents, etc.) to be more effective in improving patient service capacity than other studies that were often quantitative.The ANP and DEMATEL techniques were first used to prioritize the indices and sub-indices in emergency departments. The techniques were able to measure the interaction and impact of indices and sub-indices and express the importance of the criteria and their subsets. The integration of both quantitative and qualitative methods in the fourth chapter was another innovation of the present research.
Keywords: Quality improvement, Medical services, Emergency, Hospital, Fuzzy TOPSIS method, Optimization solutions
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