Search published articles
Showing 3 results for Quality Improvement
K Kabir, M Nojomi, M Motafaker, A Jamali, M Sadr Bafghi,
Volume 13, Issue 50 (4-2006)
Volume 13, Issue 50 (4-2006)
Abstract
Background & Aim: AMI is a major coronary disease that causes a high degree of death and disability. Worldwide death rate from AMI is declining and a significant cause of this decline is due to diagnosis and treatment. However, results indicate that many patients are deprived of proper treatment. In the present study AMI quality improvement program in Yazd Afshar Hospital was implemented to improve the quality of in-hospital AMI care. Patients & Methods: This study had 3 stages: 1- baseline assessment, 2-feedback and intervention and 3-remeasurement. To quantify baseline situation, 143 AMI patients who were admitted to Afshar Hospital during one year(2003) were studied. Later, a group discussion and baseline results feedback were arranged and then the group selected an educational plan to improve the quality. Booklets and posters were prepared based on hospital AMI guidelines and then distributed. After intervention, AMI patients admitted to hospital were assessed for 4 months(during 2004) again. Results: In baseline assessment, aspirin and b-blocker administration at admission for eligible patients was 86.1% and 79% respectively. Among patients who received thrombolytic, only 50.5% received it in less than 30 minutes from hospital arrival and mean time to thrombolysis was 44.38 minutes. No patient during hospital stay took advice/counseling for smoke cessation and echocardiography was performed for 44.3% of patients. Aspirin and b-blocker in discharge were administred for 41.9% and 36.6% eligible patients respectively and 20% of heart failure patients were administerd ACE(inh) at discharge. In-hospital deaths were a little more than expected(relative hospital mortality=1.12). Remeasuring and comparing the results showed significant improvements in smoke cessation advice/counseling, performing echocardiography during hospital stay and in administration of aspirin, b-blocker, and ACE(inh) at discharge. Improvement caused by aspirin and b-blocker at hospital admission was not statistically significant. Conclusion: There are many opportunities for care improvement in this hospital and quality improvement program can be effective. In short, continuation and development of this program in Afshar Hospital and the initiation of such programs in other hospitals are suggested.
Mohammad Ali Makhani, Seyyedah Zahra Hosseini Daron Kolai, Babak Hosseinzadeh,
Volume 31, Issue 1 (3-2024)
Volume 31, Issue 1 (3-2024)
Abstract
Background & Aims: Scientific and technological advances in the field of medicine and treatment have increased the complexity and rapid changes in care methods and standards. Therefore, the need to provide high-quality and evidence-based training for assistants and nurses is felt more than before. As one of the main pillars in providing health care, this group has heavy responsibilities and must have the ability to face complex and variable clinical conditions. Therefore, continuous updating of their knowledge and skills is necessary to maintain and improve the quality of care provided to patients. In this regard, traditional educational methods alone may not be able to meet today's complex needs. Assistants and nurses need knowledge that is not only based on basic scientific principles but also following the latest research evidence and clinical experience. For this reason, evidence-based learning (EBL: Evidence-Based Learning) has been proposed as a new approach to medical education. This educational approach allows students and medical staff to make decisions based on the latest scientific findings and the best available evidence and improve their clinical practice. In general, evidence-based learning means the integration of research evidence, clinical experiences, and patient values in the process of teaching and clinical decision-making. This approach not only helps to improve educational quality but can also lead to increasing the self-efficacy of assistants and nurses, so the aim of this study was to the effect of evidence-based learning on improving the educational quality and self-efficacy of assistants and nurses of Babol University of Medical Sciences.
Methods: The present research was conducted with a mixed approach (qualitative and quantitative) with an exploratory design. The statistical population in the qualitative section includes senior managers and professors of Babol University of Medical Sciences, who were identified as 20 people and their opinions were used. The statistical population in the quantitative section included 774 assistants and nurses of Babol University of Medical Sciences. In the qualitative section, 10 people were selected as a statistical sample using the purposeful sampling method and considering the saturation law. In the quantitative part, according to Cochran's formula, 247 people were selected by stratified random sampling method. In order to collect qualitative data, semi-structured interviews and the quantitative part based on the evidence-based learning questionnaire, Sadeghi et al.'s educational quality questionnaire (2016) and Sherer et al.'s self-efficacy (1982) became. For data analysis, exploratory factor analysis, confirmatory factor analysis, and structural equation tests were used.
Results: The results show that the relationship between evidence-based learning and improving educational quality, as well as the relationship between evidence-based learning and self-efficacy, is statistically significant. According to graphs 1 and 2 and the results of the path analysis in Table 1, between the exogenous latent variable (evidence-based learning) and the endogenous latent variable (self-efficacy), based on the path coefficients, there is a factor loading of 0.224. Also because the t-value (3.602) is outside the range (2.58 and -2.58). Because the t-value is outside the critical range (-2.58 and 2.58), it means that the relationship between evidence-based learning and self-efficacy is statistically significant. A very high t-value (3.602) indicates that the probability of this relationship is very low by chance and it can be said with more confidence that evidence-based learning significantly affects self-efficacy. In other words, increasing the quality and effectiveness of evidence-based learning leads to improved self-efficacy. Self-efficacy, which refers to a person's confidence in his abilities to perform various tasks, plays an important role in increasing performance and personal development. In this way, paying attention to evidence-based learning as an educational strategy not only improves the quality of learning but also helps to develop the self-efficacy of people, which in turn can lead to personal and professional improvements.
Conclusion: In general, it can be stated that the application of evidence-based learning in educational environments not only helps to improve the quality of education, but also strengthens the self-confidence and self-efficacy of students and makes them more ready to face more complex challenges in their careers. Therefore, it is recommended that evidence-based learning be considered as an effective approach in educational programs. This relationship shows that evidence-based learning is not only effective in strengthening the knowledge and skills of students or medical personnel, but also helps to improve the overall structure of education. As an educational approach based on research and scientific data, evidence-based learning increases the quality of education by creating opportunities for deeper and more applied learning. In other words, strengthening this type of learning allows teachers and students to make better educational decisions by relying on valid evidence and scientific research, and thus the education process goes beyond the mere transfer of knowledge and leads to the development of critical thinking skills and detailed analysis. to be These results suggest that investment in strengthening evidence-based learning can directly affect the improvement of the overall quality of education. Therefore, it is recommended that universities and educational institutions actively implement this approach in their educational programs to improve both the quality of learning and educational outcomes. One of the main reasons for this meaningful relationship is that evidence-based learning creates an active and analytical approach in the educational process. This type of learning emphasizes the use of research and scientific evidence to solve problems and make educational and clinical decisions. Rather than merely conveying information, evidence-based learning encourages students and assistants to approach issues in a critical and action-oriented manner. This helps them not only to deepen their theoretical knowledge, but also to strengthen their practical and practical abilities in real situations. Improving educational quality through evidence-based learning occurs in several ways. First, this type of learning ensures that the educational content is always up-to-date and based on the best available scientific evidence. This matter is of great importance in areas such as medical sciences and nursing, where new scientific methods and findings are constantly changing.
Mansor Bakhtiar, Ali Jahan, Lila Najafi,
Volume 31, Issue 1 (3-2024)
Volume 31, Issue 1 (3-2024)
Abstract
Bakcground & Aims: 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. In this regard, obtaining customer feedback is a basic step to provide and improve quality and its review and prioritization can improve service and optimization methods in treatment.
The emergency department of medical sciences hospitals is an essential and crucial component in the treatment of emergency patients so that the health care systems usually first face emergency patients. 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.
Methods: The method used in this research is descriptive survey and practical in terms of purpose, the statistical population of this research included the emergency rooms of 16 selected hospitals in Hamadan province which have been a case study. The purpose of this research was to investigate the factors for improving medical services in the emergency department, which includes a combined approach and a network analysis process approach for prioritizing SERVQUAL and FUZZY TOPSIS criteria for prioritizing effective factors.
This is a descriptive survey study and applied in terms of purpose. The statistical population including 400 patients who referred to 16 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
In this model, closed answer questions were used in the preparation of the researcher-made questionnaire of the network analysis process. For this purpose, nine options of "same importance", "slightly more important", "more important", "very important" and "definitely more important" were used to evaluate the criteria affecting the quality of services in the emergency department. In the researcher-made questionnaire related to TOPSIS, closed-ended questions of very poor, poor, average, good and very good were used, so that the respondent can easily determine the degree of fulfillment of the desired sub-criterion after reading the relevant explanations. In this research, the Analytic Network Process method was used to determine the weight of the criteria and indicators of the model. First, the main criteria are prioritized based on the goal. Then, the internal relationships between the main criteria have been identified. Each of the sub-criteria has been compared and prioritized in its respective cluster. Finally, by calculating the initial super matrix the weighted super matrix and the limit super matrix, the final priority of the indicators have been determined.
Results: According to the above table, the criterion of reliability with a weight of 0.205 is the most important effective factor in the process of quality of medical care in the special care department, after that the criterion of responsiveness with a weight of 0.0199 among the effective criteria of service quality in It has dedicated the special care department. Professionalism, with a weight of 0.139, has won the last rank among the criteria related to the quality of medical services. Among the sub-criteria, behavior has been assigned the first rank among them, and the mental image sub-criterion was ranked second, and the timing sub-criterion was ranked third, and the security sub-criterion was ranked among the 19 sub-criteria. It was placed last.
TOPSIS method was used to prioritize the factors obtained from Delphi technique. In this question, the main indicator was the improvement of service ability, which had 6 factors affecting it. Decision matrix for lack of personnel (0.12), delay in transfer of patients (0.19), lack of drugs and equipment (0.13), weakness in the decision-making system (0.16), delay in paraclinical measures (0.9) 0) and inappropriate space (0.08) was obtained. Then the normalized matrix was formed and after that the balanced matrix was formed. Weighted matrix for the factors of lack of personnel (0.35), delay in transfer of patients (0.35), lack of medicine and equipment (0.24), weakness in the decision-making system (0.29), delay in paraclinical measures (16. 0) and inappropriate space (0.15) were obtained. Then the positive and negative ideals were formed, and the positive ideal was 0.35 and the negative ideal was 0.15. Based on this, the positive and negative ideal distances were determined. Finally, the factors were ranked. Based on this, lack of personnel, delay in transferring patients, weakness in decision-making speed, lack of medicine and equipment, delay in paraclinical procedures and inappropriate space have an effect on the ability to serve, respectively.
Conclusion: This study was conducted with the aim of investigating the factors affecting the improvement of service quality in the emergency department and providing solutions for its optimization. The results showed that the criteria of reliability, responsiveness and professionalism are three important factors in improving service quality. According to the obtained results, 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, followed by the criterion of responsiveness with a weight of 0.0199 among the effective criteria of service quality in the emergency department. has assigned Professionalism, with a weight of 0.139, has won the last rank among the criteria related to the quality of medical services. Among the sub-criteria, the way of behavior has been assigned the first rank among them, and the mental image sub-criterion was ranked second, and the time sub-criterion was ranked third.
According to the results obtained from the scoring of the optimization methods, and determining the information registration system, the specialization of the nurses' performance and the implementation of the guidelines for the maintenance and transfer of patients hospitalized in the emergency department were known as the most optimal methods. Therefore, the framework presented in this research can be used as a criterion to evaluate the performance and improve the quality of services in the emergency department of hospitals.
The emergency department of medical sciences hospitals is an essential and crucial component in the treatment of emergency patients so that the health care systems usually first face emergency patients. 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.
Methods: The method used in this research is descriptive survey and practical in terms of purpose, the statistical population of this research included the emergency rooms of 16 selected hospitals in Hamadan province which have been a case study. The purpose of this research was to investigate the factors for improving medical services in the emergency department, which includes a combined approach and a network analysis process approach for prioritizing SERVQUAL and FUZZY TOPSIS criteria for prioritizing effective factors.
This is a descriptive survey study and applied in terms of purpose. The statistical population including 400 patients who referred to 16 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
In this model, closed answer questions were used in the preparation of the researcher-made questionnaire of the network analysis process. For this purpose, nine options of "same importance", "slightly more important", "more important", "very important" and "definitely more important" were used to evaluate the criteria affecting the quality of services in the emergency department. In the researcher-made questionnaire related to TOPSIS, closed-ended questions of very poor, poor, average, good and very good were used, so that the respondent can easily determine the degree of fulfillment of the desired sub-criterion after reading the relevant explanations. In this research, the Analytic Network Process method was used to determine the weight of the criteria and indicators of the model. First, the main criteria are prioritized based on the goal. Then, the internal relationships between the main criteria have been identified. Each of the sub-criteria has been compared and prioritized in its respective cluster. Finally, by calculating the initial super matrix the weighted super matrix and the limit super matrix, the final priority of the indicators have been determined.
Results: According to the above table, the criterion of reliability with a weight of 0.205 is the most important effective factor in the process of quality of medical care in the special care department, after that the criterion of responsiveness with a weight of 0.0199 among the effective criteria of service quality in It has dedicated the special care department. Professionalism, with a weight of 0.139, has won the last rank among the criteria related to the quality of medical services. Among the sub-criteria, behavior has been assigned the first rank among them, and the mental image sub-criterion was ranked second, and the timing sub-criterion was ranked third, and the security sub-criterion was ranked among the 19 sub-criteria. It was placed last.
TOPSIS method was used to prioritize the factors obtained from Delphi technique. In this question, the main indicator was the improvement of service ability, which had 6 factors affecting it. Decision matrix for lack of personnel (0.12), delay in transfer of patients (0.19), lack of drugs and equipment (0.13), weakness in the decision-making system (0.16), delay in paraclinical measures (0.9) 0) and inappropriate space (0.08) was obtained. Then the normalized matrix was formed and after that the balanced matrix was formed. Weighted matrix for the factors of lack of personnel (0.35), delay in transfer of patients (0.35), lack of medicine and equipment (0.24), weakness in the decision-making system (0.29), delay in paraclinical measures (16. 0) and inappropriate space (0.15) were obtained. Then the positive and negative ideals were formed, and the positive ideal was 0.35 and the negative ideal was 0.15. Based on this, the positive and negative ideal distances were determined. Finally, the factors were ranked. Based on this, lack of personnel, delay in transferring patients, weakness in decision-making speed, lack of medicine and equipment, delay in paraclinical procedures and inappropriate space have an effect on the ability to serve, respectively.
Conclusion: This study was conducted with the aim of investigating the factors affecting the improvement of service quality in the emergency department and providing solutions for its optimization. The results showed that the criteria of reliability, responsiveness and professionalism are three important factors in improving service quality. According to the obtained results, 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, followed by the criterion of responsiveness with a weight of 0.0199 among the effective criteria of service quality in the emergency department. has assigned Professionalism, with a weight of 0.139, has won the last rank among the criteria related to the quality of medical services. Among the sub-criteria, the way of behavior has been assigned the first rank among them, and the mental image sub-criterion was ranked second, and the time sub-criterion was ranked third.
According to the results obtained from the scoring of the optimization methods, and determining the information registration system, the specialization of the nurses' performance and the implementation of the guidelines for the maintenance and transfer of patients hospitalized in the emergency department were known as the most optimal methods. Therefore, the framework presented in this research can be used as a criterion to evaluate the performance and improve the quality of services in the emergency department of hospitals.
| Page 1 from 1 |
© 2025 CC BY-NC-SA 4.0 | Razi Journal of Medical Sciences
Designed & Developed by : Yektaweb