Mousavi Seyed Mohammad Hadi, Dargahi Hossein, Mohammadi Sara
Health Information Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Health Care Management, Health Information Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Health Care Management, School of Allied Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2016 Oct;54(10):667-677.
Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.
创建一个安全的医疗保健系统需要建立高可靠性组织（HROs），这可以减少错误，并提高医院的安全水平。该模式侧重于通过更高的流程设计、营造认证文化以及利用人为因素来提高可靠性。本研究旨在从这些医院管理者的角度确定德黑兰医科大学附属医院建立HROs模式的准备情况。这是一项在2013 - 2014年进行的描述性分析研究。研究对象包括德黑兰医科大学15所附属医院的105名高级和中级管理人员。数据收集工具是一份由研究者编制的包含55个问题的问卷，涵盖HROs的六个要素，用于从管理者的角度评估建立HROS模式的准备水平。问卷的效度通过内容效度法由10位医院认证领域的专家计算得出，其信度通过重测法计算，相关系数为0.90。回复率为90%。问题采用李克特量表，数据分析通过SPSS 21版进行。描述性统计通过表格呈现数据的正态分布和均值。分析方法包括t检验、曼 - 惠特尼检验、斯皮尔曼检验和克鲁斯卡尔 - 沃利斯检验，用于呈现推断性统计。研究表明，从本研究中所考虑医院的高级和中级管理人员的角度来看，这些医院确实准备好接受和建立HROs模式。HROs模式及其要素与管理者的人口统计学细节（如年龄、工作经验、管理经验和管理级别）之间存在显著关系。尽管从管理者的角度来看，所研究的医院有能力实现HROs的目标，但在这方面似乎存在很多挑战。因此，建议针对医院在HROs不同特征方面的现状进行详细审计，并为医院的医疗和非医疗员工以及管理者举办作为影响因素的研讨会；随后进行重新评估过程，有助于推动医院从当前状态迈向HROs文化。
