Beyranvand Tina, Aryankhesal Aidin, Hashjin Asgar Aghaei
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Educ Health Promot. 2020 Nov 26;9:298. doi: 10.4103/jehp.jehp_117_20. eCollection 2020.
There is a growing global movement toward quality and safety in healthcare and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the challenges and barriers to achieve such goals and then to define appropriate actions. This study aims to provide an overview of the QI challenges in Iranian hospitals' surgery-related processes and suggest applied solutions accordingly.
This is a sequential (qual-quant) mixed-method study from November 2019 to January 2020, involving 21 face-to-face interviews with hospital managers, quality officers, and surgery-related clinicians and staff, followed by a Delphi consensus-seeking stage to finalize solutions. MAXQDA software was applied for organizing the concepts, and thematic content analysis was used for analyzing the data as an inductive approach to extract the emerging themes and sub-themes.
The managerial problems were classified into four groups of (I) defects and delays in completing patient medical records, (II) irregularity and the lack of transparency in the direction of processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor safety considerations. The proposed solutions included imposing stricter regulations for competing for medical records, such as reduction of payments, development of guiding brochures or protocols for patients on their arrival, assigning a certain number of experienced nurses and surgeons for schedule management, rewarding the report of medical and surgical error cases, and developing a regular monitoring program for the proper implementation of surgical safety guidelines.
There are various managerial barriers that hamper QI in hospitals' surgery-related processes. Implementing simple but agreed solutions can lead to saving patients' lives, reduction of the unnecessary use of resources, and enhance of patient and staff satisfaction.
全球范围内，医疗保健领域朝着质量与安全以及普通外科质量改进的方向发展的趋势日益增强。任何质量改进举措的第一步都是识别实现这些目标的挑战和障碍，然后确定适当的行动。本研究旨在概述伊朗医院手术相关流程中的质量改进挑战，并据此提出应用解决方案。
这是一项于2019年11月至2020年1月进行的序贯（定性-定量）混合方法研究，包括对医院管理人员、质量管理人员以及与手术相关的临床医生和工作人员进行21次面对面访谈，随后进入德尔菲共识寻求阶段以确定最终解决方案。使用MAXQDA软件来组织概念，并采用主题内容分析法作为一种归纳方法来分析数据，以提取新出现的主题和子主题。
管理问题分为四类：（I）患者病历完成过程中的缺陷和延误；（II）医院流程方向的不规范和缺乏透明度；（III）不适当和不切实际的手术安排；（IV）安全考虑不足。提出的解决方案包括对病历管理实施更严格的规定，如减少支付、为患者制定到达时的指导手册或方案、分配一定数量有经验的护士和外科医生进行日程管理、奖励医疗和手术差错案例报告，以及制定定期监测计划以确保手术安全指南的正确实施。
存在各种管理障碍阻碍医院手术相关流程中的质量改进。实施简单但已达成共识的解决方案可挽救患者生命、减少资源的不必要使用，并提高患者和工作人员的满意度。
