Relationships Between Lifestyle, Quality of Life, Organizational Culture and Job Satisfaction Among Nurses Related to Health Promoting Hospital (HPH) Standards

Providing quality healthcare services through health promotion activities to patients, hospital-based professionals and the wider community is the goal of the health promoting hospital (HPH). There is, however, no formal structured pathway for "universally" providing health promotion services in hospitals. Accordingly, this study was conducted with the aim of presenting a model designed to promote and increase health-related satisfaction of hospital-professionals in health-promoting hospitals (HPHs) in Iran-as a potential tool to guide international HPH standards. Lifestyle, quality of life, organizational culture, and job satisfaction were measured using standardized questionnaires in specialized hospitals in Hamadan, Iran. A structural equation model (SEM) using partial least squares (PLS) software (version 2) was used to determine the validity and fit of the conceptual framework/model. The study revealed that several factors were identified as strong predictors of job satisfaction and wellbeing, including various dimensions of lifestyle such as spiritual health, physical activity, stress management, and interpersonal communication, dimensions of quality of life including physical and mental aspects, and organizational culture. The values of predictive relevance (Q2) for physical and psychological dimension of life quality, organizational culture, and job satisfaction were estimated to be 0.101, 0.250, and 0.040 and 0.251, respectively. Conclusively, the study found a goodness of fit (GOF) value of 0.415, indicating that the model had a high predictive power and fit well. Based on these results, it is suggested that implementing HPH interventions that focus on the outcomes of this model could lead to increased job satisfaction and wellbeing in hospitals. Additionally, the model could serve as a useful indicator of HPHs.

[Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]

INTRODUCTION

Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years.

METHOD

This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid.

RESULTS

Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]).

CONCLUSION

This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.

Which patients bring the most costs for hospital? A study on the cost determinants among COVID-19 patients in Iran

Background

Accurate information on the cost determinants in the COVID-19 patients could provide policymakers a valuable planning tool for dealing with the future COVID-19 crises especially in the health systems with limited resources.

Objectives

This study aimed to determine the factors affecting direct medical cost of COVID-19 patients in Hamadan, the west of Iran.

Methods

This study considered 909 confirmed COVID-19 patients with positive real-time reverse-transcriptase polymerase-chain-reaction test which were hospitalized from 1 March to 31 January 2021 in Farshchian (Sina) hospital in Hamadan, Iran. A checklist was utilized to assess the relationship of demographic characteristics, clinical presentation, medical laboratory findings and the length of hospitalization to the direct hospitalization costs in two groups of patients (patients with hospitalization ≤ 9 days and > 9 days). Statistical analysis was performed using chi-square, median test and multivariable quantile regression model at 0.05 significance levels with Stata 14 software program.

Results

The median cost of hospitalization in patients was totally 134.48 dollars (Range: 19.19–2397.54) and respectively 95.87 (Range: 19.19–856.63) and 507.30 dollars (Range: 68.94–2397.54) in patients with hospitalization ≤ 9 days and > 9 days. The adjusted estimates presented that in patients with 9 or less hospitalization days history of cardiovascular disease, wheezing pulmonary lung, SPO2 lower than 90%, positive CRP, LDH higher than 942 U/L, NA lower than 136 mEq/L, lymphosite lower than 20% and patients with ICU experience had significantly positive relationship to the median of cost. Moreover, in patients with more than 9 hospitalization days, history of cardiovascular disease and ICU experience was statistically positive association and age older than 60 years and WBC lower than 4.5 mg/dL had statistically negative relationship to the median of hospitalization cost.

Conclusion

As the length of hospital stay, which can be associated with the severity of the disease, increases, health systems become more vulnerable in terms of resource utilization, which in turn can challenge their responsiveness and readiness to meet the specialized treatment needs of individuals.

Hospital efficiency measurement in the west of Iran: data envelopment analysis and econometric approach

Objective

Measuring hospital efficiency is one of the way how to use resources.The optimal hospital performance is the goals of healthcare policymakers. This study aimed to the current study was conducted to evaluate the efficiency the current study was conducted to evaluate the efficiency and assess the association between hospital size and hospital area population with technical efficiency in public hospitals.

Methods

In this descriptive-analytical study, the statistical population consisted of 15 public hospitals in the west of Iran. First, the data envelopment analysis (DEA) method was used to evaluate technical efficiency. inputs included staff and beds, and outputs consisted of the number of surgeries, the number of patients, and the average length of stay. Then, according to the public ownership of all hospitals, their educational and therapeutic activities, as well as their size and population were considered as the environmental factor affecting efficiency. Thus, regression was applied to measure their effects on efficiency.

Results

The average technical efficiency of the studied hospitals, the average management efficiency, and the average efficiency of the scale were 0.935, 0.961, and 0.987, respectively. Out of the total evaluated hospitals, six and nine hospitals had an efficiency of less than one and one, respectively. Moreover, the size of the hospital and the population as the environment variable were significant in the Tobit model. Our regression demonstrated that although the size of the hospital is positively associated with its technical efficiency, the hospital population negatively affects hospital efficiency.

Conclusion

According to the size and area population of the hospitals, they decrease their inputs to maximize their efficacy by optimizing their surplus amounts. Tobit regression analysis concludes that hospital size and population covered by the hospital significant effect on hospitals' efficiency.

Effect of TQM educational interventions on the management policy standard of health promoting hospitals

The purpose of this study was to manage total quality management (TQM) to increase the standard of management policy and contribute to achieve the standards for health promotion hospitals (HPHs). This was a quasi-experimental intervention study. A total of 35 managers participated in this study were selected in the census. Based on the TQM components, educational items were provided as lectures, posters and pamphlets. The TQM questionnaire and HPHs checklist used to collect data in three different periods: before the interventions, immediately after the interventions and 3 months after the interventions (follow-up). The data analysis was done by means of SPSS software (version 23). The results showed that the average difference of the components of the qualitative groups (p < 0.001), education (p = 0.004), evaluation and feedback (p < 0.001), customer-orientation (p < 0.001), suggestion system (p = 0.024), leadership commitment (p < 0.001) was significant over the three periods. Excluding the employment status before the educational intervention (p = 0.002), there was no significant relationship between the demographic characteristics and mean score of TQM (p > 0.05). Based on the findings of this study, the educational interventions had a positive effect on quality management and management policy. Therefore, educational interventions should be accompanied by changes in the culture and management policies of the hospital to meet HPH standards.

The Effect of Health Evolution Plan on Health System Responsiveness: An Experience of Health System Reform from Iran

The purpose of this study was to investigate the effect of the Health Evolution Plan (HEP) on Health System Responsiveness (HSR) in hospitals of Hamadan, Iran. Data were collected before and after the implementation of the HEP by interviewing hospital inpatient referrals about factors relating to responsiveness. The difference between the mean responsiveness scores before (2014) and after (2018) implementation of the HEP was not significant. The study findings demonstrate that, even though one of the most important goals of the HEP was the improvement of HSR, the responsiveness of hospitals was unchanged.

Indirect estimation of student marijuana consumers population in Hamadan using PRM and NSU methods

Background: Finding social causes of a particular disease or specific health problem in groups or hidden illnesses, such as drug misuse is difficult. To estimate the population size, it should be taken into account that under enumeration usually occurs in direct estimation of population of certain high-risk groups. The present study used indirect methods to accurately estimate the population of students who have once experienced marijuana abuse. Methods: This cross sectional research was conducted on 461 students in Hamadan. Two indirect methods, the Network Scale-up (NSU) and proxy respondent method (PRM), were used. Data were analyzed by statistical tests and SPSS version 16 and Excel. Results: The mean age (standard deviation) was 22.51 (4.19 years), and the prevalence of marijuana misuse was 1.94%, 4.12%, and 2.6%, respectively, in girls and 14.57%, 12.58%, and 10.4% in boys using NSU, PRM, and direct method. Conclusion: Direct and NSU methods had higher bias than PRM, the frequency of PRM was closer to reality, and the once use prevalence of marijuana was higher in the young male population than in the female.

Association of smoking and drug abuse with treatment failure in individuals with tuberculosis: a case-control study

INTRODUCTION

Treatment failure in tuberculosis (defined as a positive sputum smear 5 months after the initiation of anti-TB treat-ment) is a major threat to the control over TB. This study aimed to investigate the association of smoking and drug abuse with treatment failure among individuals with TB.

MATERIAL AND METHODS

Out of 286 TB patients with available data registered by the health system of Hamadan Provinces in western Iran, 24 TB patients with treatment failure (positive sputum smear, 5 months after initiation of anti-TB treatment) and 262 patients without treatment failure (negative sputum smear, five months after initiation of anti-TB treatment) were selected as case and control groups, respectively. These two groups were compared to each other in terms of demographic status which include age, sex, job, residence, and risk factors such as smoking and drug abuse status. An odds ratio (OR) with a 95% confidence interval was used as a measure of association. The Bonferroni correction was used to counteract multiple comparisons, therefore, a p-value of less than 0.004 was statistically significant.

RESULTS

No significant association was found between treatment failure and age, residence, comorbidity, education level, job status, sex, smoking, and method of drug abuse (P > 0.004). However, a significant association was found between duration of smoking, number of cigarettes per day, and drug abuse with treatment failure in univariate analysis (P < 0.004). In multivariate analysis, only an association with drug abuse was significantly associated with treatment failure (P = 0.047).

CONCLUSION

Drug abuse substantially increases the risk of treatment failure. Therefore, in order to control TB, it is suggested that preventive programs are designed in order to decrease drug abuse among TB patients before starting treatment.

Exploring the views of medical staff in transforming a hospital into a health promoting hospital in Iran: a qualitative research

Objectives: One of the current concerns of hospitals is how to become a health promoting hospital (HPH). This qualitative research aimed at exploring the views of members of the medical staff in two Iran hospitals about the defined standards to transform the hospitals into a health promoting one.Methods: The research reported in this paper was a content analysis qualitative study. The license numbered (IR.UMSHA.REC.1395.388) was obtained from the ethics committee of Hamadan Medical Science University. Sampling was carried out through the snowballing method. Also, 55 interviews were conducted with the members of the medical staff. To collect data, the semi-structured interview guide was used based on the standards of HPHs. The framework analysis method was used to analyze the data qualitatively.Results: From three central questions on the basis of the main study question, nine themes were earned. Policies governing the hospitals were in the direction of converting them to health promoting organizations including the creation of a health promoting work environment, empowering personnel and health promoting corporate culture. Also, suggestions to create a HPH included improving management, paying attention to patients and their satisfaction, as well as increasing effective interpersonal relationships in the hospital.Conclusion: The findings showed that it can be a key strategy in this field to use staff's solutions for the existing problems and their opinions on the challenges against establishing the standards for HPHs. People usually accept more comfortable and easy changes in decision-making and implementing processes of which they are involved.

Health promoting hospitals in Iran: A review of the current status, challenges, and future prospects

Background: Health promoting hospitals (HPHs), in addition to their routine diagnosis and treatment services, concentrate on health enhancement and disease prevention. This study was conducted to systematically review studies conducted in the field of health promoting hospitals (HPH) in Iran to achieve HPH standards.

Methods: Electronic search was conducted from October to February 2016 in Persian and English databases. Search was done IranMedex, SID, ISI Web of Knowledge, ScienceDirect, PubMed, and Google Scholar with the following keywords: Health promotion hospital (s), health promoting hospital (s), health promotion hospitals, HPH, and Iran. Based on inclusion and exclusion criteria and the aim of the study, 10 studies were selected to be reviewed.

Results: The results showed that HPH standards in studied hospitals were very poor in overall standard and that the standard of management policy had the lowest mean. Studies conducted in the order modeling HPH in Iran showed that factors of patient empowerment and society had the greatest impact and needs assessment had the lowest impact. The results of interventional studies were reviewed in this study and it was found that implementing standards of HPH and educational interventions increase the standard of HPH.

Conclusion: The review of the HPH studied indicated that the most important challenge in achieving the standards of health promotion hospitals is Iran’s hospital policy, which is more treatment-oriented.

Interventions on reducing burnout in physicians and nurses: A systematic review

Background: Burnout is one of the main factors in reducing the performance quality among hospital staff. Appropriate interventions can reduce burnout among physicians and nurses and result in promotion of the quality of services provided at hospitals. The present study aimed to provide a more comprehensive understanding of the interventions on burnout reduction among hospital physicians and nurses.

Methods: Studies were searched from January 2000 to June 2017 in PubMed, Embase, Scopus, Cochrane, and Web of Science. Randomized clinical trials (RCTs) and pretest-posttest studies that had interventions to reduce the burnout of physicians and nurses were included. However, studies conducted on medical and nursing students and nonmedical providers or beyond hospitals were excluded.

Results: Based on the study inclusion criteria, 12 RCTs and 6 pretest-posttest studies were included in the review. Most of the included studies were from Netherlands, the United States, and England. The interventions included team-based program, EMH-approach, and coping and communication skills training. Most of the interventions had a positive effect on burnout reduction. Nevertheless, some studies had no significant impact.

Conclusion: The results showed that the most interventions used to improve burnout were improving communication skills, teamwork, participatory programs, and psychological interventions (Yoga, meditation, and mindfulness). The impact of these interventions can increase mental health in the long term. Burnout is a complicated problem and should be treated by combining interventions.

Investigation of health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences: health-promoting hospitals

OBJECTIVES

The prophecy of health promoting hospitals (HPH) is bringing about a change and transition from treatment-oriented to health-oriented attitudes. In Iran, hospitals usually play the traditional roles. The present study was aimed at the evaluation of the health promotion status in specialized hospitals associated with Hamadan University of Medical Sciences (HUMS).

METHODS

This applied study was conducted in two Hamadan specialized hospitals in the Hamadan city. The health promotion status was evaluated using a self-assessment checklist designed by the World Health Organization's HPH. The evaluation was done in five standards including management policy, patient assessment, patient information and intervention, promotion of a healthy workplace and continuity and cooperation.

RESULTS

The results showed that both the hospitals studied had a poor status in terms of promoting a healthy workplace (average = 31.24%) and management policy standards (average = 35.29%) in comparison with the other relevant standards: patient assessment (53.12%), patient information and intervention (62.5%), continuity and cooperation (65.78%)). The results of the standards and sub-standards status displayed better performance in the cardiovascular hospital (53.67%) compared to the women and parturition hospital (42.64%).

CONCLUSION

The findings indicated that HPH standards are very low in the studied hospitals. The reason behind this wide gap might be due to the fact that hospitals in Iran are more treatment-oriented and patient-oriented and they do not play an active part in health promoting. It was found that management policy and promoting healthy workplace standards had the worst status and must be improved.

Relationship between organizational culture and commitment of employees in health care centers in west of Iran

Introduction

Presence of committed personnel in each organization not only reduces their absenteeism, delays, and displacements but also leads to a dramatic increase in performance and efficiency of an organization, mental freshness of employees, better manifestation of noble objectives, and organizational mission as well as fulfillment of personal goals. Therefore, the purpose of this study was to determine the relationship between organizational culture and organizational commitment of employees in administrative units of health care centers in the cities of Hamedan Province based on the Denison model in 2015.

Methods

In this cross-sectional study, 177 employees in administrative units of health care centers in the cities of Hamedan Province were selected by a multistage stratified sampling method. The data collection instruments included the standardized Denison organizational culture survey and organizational commitment questionnaire by Meyer and Allen. Data were analyzed by IBM-SPSS version 21 using descriptive statistics and Pearson product-moment coefficient.

Results

Among the 12 indicators of organizational culture, the highest mean scores were assigned to empowerment (16.74), organizational learning (16.41), vision (16.4), and strategic direction (16.35); respectively. Furthermore, the indicators of capability development (14.2), core values (15.31), team orientation (15.45), and goals (15.46) received the lowest mean scores in this respect. Among the four dimensions of organizational culture, the highest mean score was related to “mission” in organizational culture and the lowest score was associated with “involvement.” Meyer and Allen’s organizational commitment model also had three components in which affective commitment in this study obtained the highest score (26.63) and continuance commitment received the lowest score (24.73). In this study, there was a significant correlation between all the components of organizational culture and organizational commitment of employees in administrative units of health care centers (p < 0.05).

Conclusion

Reflecting on all the dimensions and indicators of organizational culture can lead to an escalation of organizational commitment among employees. Furthermore, focus on factors affecting the improvement of continuance commitment can promote organizational commitment of employees in administrative units of health care centers.

Evaluation of the Quality of Occupational Health and Safety Management Systems Based on Key Performance Indicators in Certified Organizations

BACKGROUND

Occupational Health and Safety Management Systems are becoming more widespread in organizations. Consequently, their effectiveness has become a core topic for researchers. This paper evaluates the performance of the Occupational Health and Safety Assessment Series 18001 specification in certified companies in Iran.

METHODS

The evaluation is based on a comparison of specific criteria and indictors related to occupational health and safety management practices in three certified and three noncertified companies.

RESULTS

Findings indicate that the performance of certified companies with respect to occupational health and safety management practices is significantly better than that of noncertified companies.

CONCLUSION

Occupational Health and Safety Assessment Series 18001-certified companies have a better level of occupational health and safety; this supports the argument that Occupational Health and Safety Management Systems play an important strategic role in health and safety in the workplace.

Relationship between managerial skills and employees job stress in health centers

BACKGROUND

Job stress is one of the important issues in the health sector and its high effect on workers' productivity. Managerial skills can help organizations to improve employees' effectiveness and reduce job stress. The present study investigated the relationship between employees' job stress and managers' professional skills.

METHODS

This cross-sectional and correlation study was conducted in 2010.We selected 90 health workers of 13 Health and Treatment Centers in Razan Health Center, western Iran. All data were gathered using self-administered questionnaires. Employees' job stress levels were measured using the Eliot Stress Questionnaire and managers' professional skills were assessed using the standard Questionnaire with 40- items in Likert format. Data were analyzed u SPSS software and Pearson correlation coefficient and Kendall correlation tests.

RESULTS

87.7% of employees had mid- level of job stress. The professional skills level was high in 36.7% of health managers; moderate in 56.6%, and low in 6.7%. In addition the human skill was highest level among all managers' professional skills. A significant and negative correlation was found between job stress and managers' human, conceptual and design skills (P <0.005).

CONCLUSION

The level of managers' professional skills was significantly related with employees' job stress, thus training and developing managerial skills especially human, conceptual and design skills in supervisors and managers of health centers can reduce job stress and enhance effective performance.

Communication skills of heads of departments: verbal, listening, and feedback skills

BACKGROUND

Managers' communication skills are one of the most important topics in educational sector of universities of medical sciences and may have considerable effect on faculty members and employees. This study was per-formed to determine the level of communication skills (verbal, listening, feed-back) of the heads of department of faculties and its relation with some demo-graphic variables.

METHODS

This cross-sectional study was conducted from June 2009 to January 2010. We enrolled all of the heads of departments (N=60) in Hamadan University of Medical Sciences, western Iran. The participants received a self-administered 24-item questionnaire in Likert format (six general items and 18 items related to communication skills). Data were analyzed with SPSS software using Chi-square and Fisher's exact tests.

RESULTS

The average scores of verbal, listening and feedback communication were 22.5, 16.1 and 21.1, respectively. Accordingly, 78.3% of participants in verbal communication, 16.7% in listening communication and 73.3% in feedback communication had high status. There were significant differences between the average score of listening skills and age (P=0.013) as well as gender (P=0.042). In addition, there was a significant statistical difference between verbal skills and gender (P=0.021).

CONCLUSION

The overall communication skills of more than half of the heads of departments were moderate. This needs designing some programs for improving department managers' communication skills.

The Relationships Among Employees' Job Stress, Job Satisfaction, and the Organizational Performance of Hamadan Urban Health Centers

The purpose in this study was to determine the levels of employees' job stress and job satisfaction in urban health centers in Hamadan, Iran, and the relationship of these levels to the organizational performance. Employees' stress levels were assessed using the Eliot Stress Questionnaire (Eliot, 1994), and job satisfaction levels were measured using the Robbins Job Satisfaction Questionnaire (Robbins, 1991). The performance of the centers was evaluated by using a series of outcome indicators. On average, the employees in all of the health centers reported a moderate level of stress. A positive correlation was found between performance and the midlevel of employees' stress was found (r = 0.69, α < 0.05).

Quality Management in Health Systems of Developed and Developing Countries: Which Approaches and Models are Appropriate?

BACKGROUND

Quality Management is one of the most effective strategies for improving the health systems performance in developed and developing countries. The main goal of this study was identifying the most important aspects of quality management and preparing an appropriate model for health system.

METHOD

This research was a comparative study on quality management models in the health systems of different countries. We have selected, as a sample, different countries in Asia, Africa, North America, Europe, and South America having a background in using various samples of total quality models in their health units. The studies also included the experiences of World Health Organization in different countries.

RESULTS

The main goals for promoting quality in the countries are being studied includes service efficiency increase, promoting services delivery, promoting quality of working life, and changing organizational culture. Total approaches used for the countries studied include quality Assurance, Cultural change, ISO 9001, TQM and improving services quality. There are not generally outcomes criteria in 22 cases of the studies done in the developing countries. The most important problems revealed in establishing the quality management, organizational resistance against the change, lack of senior management commitments, lack of strategic planning and lack of required resources.

CONCLUSION

The models for quality management should pay attention to the cultural change strategies, staff participation, strategic vision and Strategic planning. Strategic total quality management is the appropriate model in this regard.

An Integrated and Multivariate Model along with Designing Experiments Approach for Assessment of Micro- and Macro- Ergonomic Factors: The Case of a Gas Refinery

BACKGROUND

The objectives of this paper are three folds. First, an integrated framework for designing and development of the integrated health, safety and environment (HSE) model is presented. Second, it is implemented and tested for a large gas refinery in Iran. Third, it is shown whether the total ergonomics model is superior to the conventional ergonomics approach. This study is among the first to examine total ergonomics components in a manufacturing system.

METHODS

This study was conducted in Sarkhoon & Qeshm Gas refinery- Iran in 2006. To achieve the above objectives, an integrated approach based on total ergonomics factors was developed. Second, it is applied to the refinery and the advantages of total ergonomics approach are discussed. Third, the impacts of total ergonomics factors on local factors are examined through non-parametric statistical analysis.

RESULTS

It was shown that total ergonomics model is much more beneficial than conventional approach. It should be noted that the traditional ergonomics methodology is not capable of locating the findings of total ergonomics model.

CONCLUSION

The distinguished aspect of this study is the employment of a total system approach based on integration of the conventional ergonomics factors with HSE factors.