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Defensive medicine (DM) is the deviation of a physician from normal behavior or what is a good practice and is aimed at reducing or avoiding the risk of legal litigation from patients or their families. Therefore, this study aimed to determine DM-related behaviors and associated risk factors among Iranian surgeons. In this cross-sectional study, 235 surgeons were selected using convenience sampling. The data gathering tool was a researcher-made questionnaire confirmed as a reliable and valid tool. Factors associated with DM-related behaviors were identified using logistic regression analysis. DM-related behaviors ranged from 14.9% to 88.9%. The most common positive DM-related behaviors, including unnecessary biopsy (78.7%), imaging and laboratory tests (72.4% and 70.6%), and refusing high-risk patients (61.7%), was the most common negative DM-related behavior. The likelihood of DM-related behaviors was more in younger and less experienced surgeons. Other variables, such as gender, specialty, and lawsuit history, positively affected some DM-related behaviors (p < 0.05). This study showed that the proportion of surgeons who frequently performed DM-related behaviors was higher than those who rarely performed it. Therefore, strategies including reforming the rules and regulations for medical errors and litigations, developing and implementing medical guidelines and evidence-based medicine, and improving the medical liability insurance system can reduce DM-related behaviors.

Introduction: Fair and effective performance appraisal can improve employee performance and healthcare quality. We aimed to examine the perspectives of health workers on the annual performance appr...

Background: Following the implementation of the health transformation plan in Iran and the significant increase in medical tariffs, it seems there is still a considerable gap between the actual cost of the Global Surgical procedures (GSPs) and the approved tariffs. The aim of this study was to compare the actual costs of GSPs with approved tariffs in hospitals affiliated to Qazvin University of Medical Sciences in 2016. Methods: In this cross-sectional study, data of 6,126 GSPs performed in three hospitals were extracted from Hospital Information System and approved tariffs were also obtained from the Supreme Council of Health Insurance. The difference between the average actual costs of a GSP and its tariff was considered as the tariff-actual cost gap. Regression test was used to determine the factors affecting the tariff-actual cost gap using SPSS.21. Results: The average actual cost of GPSs was 503 USD while the average tariff was 361 USD, indicating a significant negative gap between the approved tariffs and the actual cost of GPSs. In fact, for each procedure, the hospital suffered an average of 142 USD losses. In 54 of 63 GSPs, the average actual cost was 0.3% to 307.4% higher than the tariff. The highest negative gap was related to the “femoral fracture fixation" with -307.4%. The gap was higher in older patients, females, and patients with a longer stay, orthopedic specialty, and full-time surgeons (p

Responsiveness refers to the fulfilment of patient’s rational expectations in terms of non-medical healthcare aspects. This study aimed to assess and compare the responsiveness levels of private an...

Purpose Hospital responsiveness to the patient expectations of non-medical aspect of care can lead to patient satisfaction. The purpose of this paper is to investigate the relationship between the eight dimensions of responsiveness and overall patient satisfaction in public and private hospitals in Tehran, Iran. Design/methodology/approach This cross-sectional study was conducted in 2015. In all, 500 patients were selected by the convenient sampling method from two public and three private hospitals. All data were collected using a valid and reliable questionnaire consisted of 32 items to assess the responsiveness of hospitals across eight dimensions and four items to assess the level of overall patient satisfaction. Data analysis was performed using descriptive statistics and multivariate regression was performed by SPSS 18. Findings The mean score of hospital responsiveness and patient satisfaction was 3.48±0.69 and 3.54±0.97 out of 5, respectively. Based on the regression analysis, around 65 percent of the variance in overall satisfaction can be explained by dimensions of responsiveness. Seven independent variables had a positive impact on patient satisfaction; the quality of basic amenities and respect for human dignity were the most powerful factors influencing overall patient satisfaction. Originality/value Hospital responsiveness had a strong effect on overall patient satisfaction. Health care facilities should consider including efforts to responsiveness improvement in their strategic plans. It is recommended that patients should be involved in their treatment processes and have the right to choose their physician.

Introduction Defensive medicine (DM) is defined as the deviation of a physician from normal behavior or what is good practice aimed at decreasing or preventing from the complaints and criticism by the patients or their families. The current study aimed at examining DM behaviors in a sample of Iranian surgeons. Methods In this cross-sectional study, 235 surgeons were selected by systematic random sampling method. The data gathering tool was a researcher-made questionnaire which its validity and reliability were confirmed. For data analysis, Fisher's exact test, Kruskal-Wallis test, Chi-square and logistic regression tests were used in SPSS 21 software. Results The most common positive DM behaviors including unnecessary biopsy (78.7%), imaging and laboratory tests (72.3% and 70.6%), and refusing to accept high-risk patients (61.7%) was also the most common negative DM behavior among surgeons. The likelihood of DM behaviors was more in young and less experienced surgeons. Other variables such as gender, specialty and complaint history also had a positive effect on some DM behaviors (p

Objective: Human resources are the most vital resource of any organizations which determine how other resources are used to accomplish organizational goals. This research aimed to identity factors affecting health workers’ motivation in Shahid Beheshti University of Medical Sciences (SBUMS). Method: This is a cross-sectional survey conducted with participation of 212 health workers of Tehran health centers in November and December 2011. The data collection tool was a researcher-developed questionnaire that included 17 motivating factors and 6 demotivating factors and 8 questions to assess the current status of some factors. Validity and reliability of the tool were confirmed. Data were analyzed with descriptive and analytical statistical tests. Results: The main motivating factors for health workers were good management, supervisors and managers’ support and good working relationship with colleagues. On the other hand, unfair treatment, poor management and lack of appreciation were the main demotivating factors. Furthermore, 47.2% of health workers believed that existing schemes for supervision were unhelpful in improving their performance. Conclusion: Strengthening management capacities in health services can increase job motivation and improve health workers’ performance. The findings suggests that special attention should be paid to some aspects such as management competencies, social support in the workplace, treating employees fairly and performance management practices, especially supervision and performance appraisal.

Objective: Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran. Method: This cross-sectional study was conducted in the year 2010. The study’s sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression. Result: this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction. Conclusions: Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers.

Background: The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient’s trust is the service quality. Objectives: This study aimed to examine the effect of quality of services provided in private hospitals on the patient’s trust. Patients and Methods: In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. Results: The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P < 0.001) were the strongest factors in predicting patient’s trust, but the quality of the environment had no significant effect on the patients' degree of trust. Conclusions: The interaction quality and process quality were the key determinants of patient’s trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff.

Introduction: The accreditation process is conducted to enhance the organizational quality and outcomes based on the localized standards. The objective of the study was to compare quality indices in hospitals of Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran with different accreditation degrees. Materials and Methods: Ten indices, representing the quality measures of inpatient cares, were selected among accredited hospitals based on importance and patient influences. In this applied descriptive study, data of 11 teaching hospitals of SBUMS were studied and analyzed by SPSS 21 using descriptive statistics and ANOVA in 2015. Data were collected from hospital records. Results: The most favorable indices - patients' satisfaction with emergency and hospitalization services, mean duration of triage (levels 2, 3, 4, and 5), and unsuccessful cardiopulmonary resuscitation (CPR) - were in the lowest ranking hospitals. Six of 10 indices, including cesarean, the death level, the discharge rate of admitted patients in the emergency department and hospital wards by personal consent, the patients' satisfaction with the hospitalization and emergency services, mean duration of triage (levels 2, 3, 4, and 5), and unsuccessful CPR were the most unfavorable in hospitals with the highest ranking, i.e., the first excellent degree. Conclusion: There was no significant difference in the indices of hospital care processes with different accreditation degrees. There were also reverse correlations between the direction of outcome changes and the accreditation level in some domains, which might require reassessment of the conduction of the program.

Background: Every year in the world 2.1 million people are killed in road accidents, and more than 50 million are either injured or disabled. The way to enter the hospital for the Victims of traffic accidents in order to receive treatment in Emergency Department (ED). The low quality of the offered services in this ward leads to a decrease in the patient’s satisfaction, an increase in the number of deaths and handicaps. So we decided to evaluate the quality of the procedure of the offered treatments to the Victims of traffic accidents based on indicators derived from the indicators of quality evaluation of AHRQ services of ED in Imam Khomeini hospital complex. Methods: The statistical society in this study consists of those who were injured in traffic indicators and brought to the emergency section of Imam Khomeini hospital. The indicators in mind were taken from the repertoire of AHRQ indicators which evaluate quality aspects (effectiveness, timeliness, safety, efficiency, patient-centeredness), and whose validity and reliability have been proven in Romano’s study, albeit with minute alterations. The findings were given to SPSS18 software and were analyzed using descriptive statistics and statistical tests. Results: According to the findings of this study, 42% of the injured experienced hemorrhage which were controlled successfully, and the average time for controlling it found to be about 3 minutes. The starting time for preliminary examinations was reported at 3.37 minutes. Immediate sonography was done for 100% of the patients with abdominal problems. 100% of the intubation operations on patients were done correctly. 96.49% of the patients were prescribed sedatives. Conclusions: The indicators under study show an appropriate state in the processes of ED of the hospital investigated. Regarding the importance of managing and controlling pain in urgent patients, the hospital needs to compile processes for measuring and controlling pain. The investigation of the processes of ED is recommended to be done with the indicators of structure and the results. Keywords: Emergency Services, Quality process indicators, Quality, Victims of traffic accidents