Elahe Khorasani

The relationship between health literacy with health status and healthcare utilization in 18-64 years old people in Isfahan.

Background: Today, much attention has been paid to the patient role as the central factor in the management of their own health. It is focused on the issue that the patient has a more critical role compared with the health-care provider in controlling the patient own health. defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Objective: The objective of this study was to determine health literacy, health status, healthcare utilization and the relationship between them in 18 - 64 years old people in Isfahan. Structure and Design: This study was a descriptive analytical survey, which was conducted on 300 subjects of 18-64 years old in Isfahan with Multi-stage sampling method proportional to selected sample size. Materials and Methods: For collecting the data, questionnaire adapted from CHAP (Consumer Assessment of Healthcare Providers and Systems) health literacy questionnaire was used. Health status was measured based on an assessment of the physical and mental health over the past 6 months by 5° Likert scale. Data analysis was performed by using SPSS 18, descriptive statistics, Chi-square test and multivariate analysis of variance. Results: There was no significant correlation between health literacy, health status and healthcare utilization. Utilization was less in the urban area No. 6 of the city. In the bachelors degree group, the health status was lower than the other groups in these cases: Older ages, married, women, large family size, undergraduates, and urban area No. 14. Conclusions: Due to the average prevalence of health literacy in 18-64 years old individuals in Isfahan and low- healthcare utilization, the followings are recommended: Necessity of more attention to the issue of health literacy, improving the physician-patient relationship and community awareness, whether through health promotion programs or media for the optimum use of available resources.

Experts' perceptions of the concept of induced demand in healthcare: A qualitative study in Isfahan, Iran.

Context: One of the most important subjects in health economics and healthcare management is the theory of induced demand. There are different views about the concept of induced demand. Extensive texts have been presented on induced demand, however a compatible concept has not necessarily been provided for this phenomenon and it has not been defined explicitly. Aims: The main aim of this article is to understand the concept of induced demand with the use of experts’ perceptions of Isfahan University of Medical Sciences. Settings and Design: The research was done using a qualitative method. Semi-structured interview was used for data generation. Participants in this study were people who had been informed in this regard and had to be experienced and were known as experts. Purposive sampling was done for data saturation. Materials and Methods: Seventeen people were interviewed and criteria such as “reliability of information” and “stability” of the data were considered. The anonymity of the interviewees was preserved. Statistical Analysis Used: The data are transcribed, categorized and then the thematic analysis was used. Results: In this study, 21 sub-categories and three main categories were derived. Three main subjects were included: Induced demand definition, induced demand elements, and induced demand methods. Each of these issues contained some sub-subjects. Conclusion: The result of this study provides a framework for examining the concept of induced demand. The most notable findings include the definition of induced demand, induced demand elements, and method of induced demand. In induced demand definition, an important issue that is often overlooked is that inducing regarding to the effectiveness of clinical services and medical values can lead to better or worse outcomes for patients. These findings help the health policy makers study the phenomenon of induced demand with clear-sighted approach.

Electronic health indicators in the selected countries: Are these indicators the best?

Background: Many changes have been made in different sciences by developing and advancing information and communication technology in last two decades. E-health is a very broad term that includes many different activities related to the use of electronic devices, software as well as hardware in health organizations. Aims: The aim of this study is comparing electronic health indicators in the selected countries and discussion on the best indicators. Settings and Design: This study has chosen 12 countries randomly based on the regional division of the WHO. The relevant numbers of health indicators and general indicators and information technology indicators are extracted of these countries. We use data from the Bitarfs comparative study, which is conducted by the Iranian Supreme Council of Information Technology in 2007. Materials and Methods: By using Pearson correlation test, the relations between health general indicators and IT indicators are studied. Statistical Analysis Used: Data was analyzed based on the research objectives using SPSS software and in accordance with research questions Pearson correlation test were used. Results: The findings show that there is a positive relation between indicators related to IT and “Total per capita health, healthy life expectancy, percent literacy”. Furthermore, there is a mutual relation between IT indicators and “mortality indicator”. Conclusion: This study showed differences between selective indicators among different countries. The modern world, with its technological advances, is not powerless in the face of these geographic and health disparity challenges. Researchers must not rely on the available indicators. They must consider indicators like e-business companies, electronic data internet, medical supplies, health electronic record, health information system, etc., In future, continuous studies in this field, to provide the exact and regular reports of amount of using of these indicators through different countries must be necessary.

The impact of implementing operational crisis management plan in educational hospital.

Dear Editor, Hospitals constitute the most important centers which accept people during disasters such as earthquakes, wars and flood. Hospitals have sophisticated organizations due to their direct contact with human health and diseases, therefore the level of service quality in such organizations is of utmost importance (1, 2). The critical conditions resulting from disasters pose great problems for hospitals. In order to enhance efficiency in critical conditions of disaster, hospitals need to have a pre-organized operational plan, lack of which will cause chaos and confusion at the time of crisis (3). The current study was conducted in order to implement the operational plan of crisis management in Imam Reza educational hospital, and also to evaluate its effect on preparation of hospital for encountering crisis in 2009. The data collection tool was a checklist with 5 dimensions and 147 questions. Validity of the questionnaire was confirmed with the viewpoints of university professors, managers of hospitals who involved in crisis, experts in crisis management of the Red Crescent organization of Kermanshah Province. The reliability was calculated Cronbachs α = 0.800. Initially, training classes of crisis management were held for all managers, authorities and personnel. Subsequently, the organizational chart of hospital crisis management was designed and implemented, the human resources were organized according to the chart, and ultimately, maneuvers and drills of crisis preparation were conducted. The findings indicate that the level of preparation of the information system for encountering crisis improved from 61.8% before intervention to 90.9% after. The level of preparation of the command center for encountering crisis in Imam Reza hospital improved from 74.1% to 90.3% following the intervention. Training for encountering crisis improved from 58.3% before intervention to 91.8% after intervention. The intervention improved the organization of personnel for encountering crisis from 75% to 93.5%. Prior to intervention, no maneuvers had been conducted in the hospital in the case of crisis; the intervention improved this figure from 0% to 93.3%. As a result, general preparation of the hospital for a coming crisis improved from 53.8% to 92%. The intervention improved the information system of Imam Reza Hospital from 61.7% to 90.9%. A study conducted by Mosadegh Rad et al. in Isfahan reported the status of information and communicative system of hospitals to be 32% (4). The crisis command center vigilance of hospital improved from 61.7% before intervention to 90.3% after intervention. Nowadays, command center constitutes the most common system of crisis management worldwide, and its acceptance is increasing due to its successful results. A study by Mahbubi reported that the crisis command centers were feeble which is similar to our pre-intervention findings (5). The level of preparation of organization in Imam Reza hospital improved from 75% before intervention to 93.5% after. One study concerning the same issue in educational hospitals of Isfahan reported that the level of preparation was 54% (6) while another finding was not in accordance with Imam Reza hospital and showed greater preparation for organization. In fact, it is essential to organize a crisis management system in hospitals consisting of specified posts in organizational chart, in which each post will accomplish a certain mission under critical conditions. Such a system requires a logical structure of management, clarifying the responsibilities and creating canals for unambiguous reports. In general, the level of preparation for crisis in Imam Reza educational hospital in Kermanshah was 53% before intervention and improved to 92%. Crisis management has been implemented in Amir-ol-Momenin hospital in Tehran with a command center-based organizational chart determining the responsibilities of respective individuals, which is similar to our study (7). The findings indicate that the implementation of hospital crisis management system in Imam Reza hospital of Kermanshah university of medical sciences improved its preparation to an acceptable level. In conclusion, we recommend organizing crisis management centers in Iranian hospitals in order to prepare operational plans for encountering crises based on the unique features of each respective hospital. Such plans need to be organized in manuals and executive instructions.

Evaluating the application of failure mode and effects analysis technique in hospital wards: a systematic review

Abstract: Background: Medical errors are one of the greatest problems in any healthcare systems. The best way to prevent such problems is errors identification and their roots. Failure Mode and Effects Analysis (FMEA) technique is a prospective risk analysis method. This study is a review of risk analysis using FMEA technique in different hospital wards and departments. Methods: This paper has systematically investigated the available databases. After selecting inclusion and exclusion criteria, the related studies were found. This selection was made in two steps. First, the abstracts and titles were investigated by the researchers and, after omitting papers which did not meet the inclusion criteria, 22 papers were finally selected and the text was thoroughly examined. At the end, the results were obtained. Results: The examined papers had focused mostly on the process and had been conducted in the pediatric wards and radiology departments, and most participants were nursing staffs. Many of these papers attempted to express almost all the steps of model implementation; and after implementing the strategies and interventions, the Risk Priority Number (RPN) was calculated to determine the degree of the technique’s effect. However, these papers have paid less attention to the identification of risk effects. Conclusions: The study revealed that a small number of studies had failed to show the FMEA technique effects. In general, however, most of the studies recommended this technique and had considered it a useful and efficient method in reducing the number of risks and improving service quality.

Investigating the relationship of mental health with job stress and burnout in workers of metal industries

Introduction: Since job stress and burnout are considered as basic factors in reducing efficacy and engendering physical and mental side effects, the present study was conducted with the aim of determining the mental health state and its relationship with job stress and burnout. Methods: The present study is a descriptive-analytical one which uses a cross-sectional design. In line with the research objectives, 125 workers of the metal industry were randomly selected. To collect data, the Demographic Characteristics Questionnaire, the Goldberg General Health Questionnaire, the US Institute of Mental Health Job Stress Questionnaire, and Maslach Job Burnout Inventory (with Chronbachs alpha coefficients of 0.89, 0.92, and 0.86, respectively) were used. Data analysis was conducted using SPSS-20. Results: The mean scores of mental health, job stress, and burnout are 47.97 ± 10.8, 147.54 ± 17.8, and 54.69 ± 13.94, respectively. According to Pearson correlation coefficient, mental health has a direct correlation with job stress and burnout. It means that by increasing the degree of job stress and burnout, the mental health state was unfavorable. Conclusions: Regarding the results of the present study in which there is a direct correlation between mental stress on job stress and burnout. If job stress and burnout in workplaces are not identified and controlled, they have negative effects on general health. Therefore, by identifying the resources and reasons of occurring job stress and burnout, and presenting practical and applied strategies for coping with and preventing the occurrence of job stress and burnout can supply and retain general health of the workers in workplaces.

Job characteristic perception in medical record staff of training hospitals

Introduction: Motivating human resources is one of paramount objectives in realizing the importance of an organization. Every job containing some specific characteristics can be motivating. Thus, by identifying characteristics of each job as well as job enrichment as an organizational interference planned, steps can be taken toward rebuilding the jobs aiming at making them challenging, motivating, and satisfying. The present study aimed to determine job characteristic perception mean in medical record staff of training hospitals in Isfahan in 2012. Methods: The type of the study is descriptive survey. The population includes all the medical record staff working in medical record departments in the training hospitals of Isfahan. One hundred twenty seven subjects were selected by conducting a census. Data collected by using questionnaire of job characteristics devised by Hackman and Oldeham. Content validity was confirmed by experts and its reliability was calculated through the coefficient of Cronbachs alpha (r1 = 0.84). The completed questionnaires were entered into SPSS (18) software; furthermore, statistical analysis was performed descriptively and inferentially (MANOVA, least significant difference). Results: Job characteristics scores mean and its elements (variety of skills, job identity, job significance, independence, and feedback) were higher than the average level. No significant difference was noticed among mean amounts of job characteristic perception according to age, gender, education, and type of educational degree in hospitals. However, there was a significant difference among mean amounts of job characteristic perception according to unit of service and years of service in hospitals. Conclusion: Findings show that all job characteristic aspects score was higher than average level and job significance perception score was higher than other aspects. As job characteristics have a great role in changing intrinsic motivation level in staff, it is suggested that different jobs in medical record department be devised in a way that staff, with intrinsic motivation and enthusiasm, step toward achieving job objectives and main goals of health system.