At first glance, informal payments experience on track: why accept or refuse? Patients' perceive in cardiac surgery department of public hospitals, northeast of Iran 2013.

BACKGROUND: Patient's Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013. METHODS: In this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level. RESULTS: Sixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: "gratitude" (43.75%), satisfaction with health services provided" (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were "no request for informal payments" (98.14%), "not affording to pay for informal payments" (73.33%) and "paying the hospital expenses by taking out a loan" (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient's health priority, 40.71% would also "search for other alternative solutions" and 27.33% "accepted the demand as a kind of gratitude culture". Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05). CONCLUSION: Despite the widespread prevalent belief about informal payments in public hospitals -particularly to the well-known physicians - such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.

A roadmap for implementing general policies of resistance economy in the Isfahan Universities of Medical Sciences.

CONTEXT AND AIMS: The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences. MATERIALS AND METHODS: This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively. RESULTS: Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people-centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health. CONCLUSION: The implementation of resistance economy policies entails planning in the long run, culture-building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

Designing a safety management system for higher education centers.

INTRODUCTION: The system of safety management in higher education centers can prevent the complications caused by harmful issues to students and bring their potential talents closer to perfection. Therefore, this study aimed to design a safety management system (SMS) in higher education centers of Iran in 2016. MATERIALS AND METHODS: This study was a descriptive study of qualitative type. This study was conducted in three independent phases, including (1) evaluating theoretical concepts, (2) developing an initial system by determining the points of sharing and differentiation of the evaluated systems, and (3) validating the SMS using the Delphi technique. Consensus on opinions and identifying similarities and differences of reviewed studies have been used for qualitative data analysis, and the descriptive statistics (sum of scores and mean) by means of SPSS version 21 has been used for quantitative data analysis. RESULTS: In the first stage, 108 indexes were identified by reviewing the studies and evaluating the SMS in the world's educational and noneducational organizations for the 12 main categories of SMS. In the Delphi phase, 83 components were identified as a key index of the SMS in higher education centers of Iran. Furthermore, the average mean of participants' views on the dimensions of the SMS for higher education centers has been 4.32, with the highest average mean of 4.59 related to the dimension of the facility and the firefighting department and the lowest mean of 4.10 for the student dimension. CONCLUSION: The indexes presented in this study will provide a fairly complete tool for designing SMS in higher education centers, which by applying it will provide a good opportunity to improve the performance of these systems over time.

Risk assessment of the emergency processes: Healthcare failure mode and effect analysis.

BACKGROUND: Ensuring about the patient's safety is the first vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care. METHODS: In this study, in combination (qualitative action research and quantitative cross-sectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used. RESULTS: In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identified by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy. CONCLUSION: "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.

Risk Assessment of Using Entonox for the Relief of Labor Pain: A Healthcare Failure Modes and Effects Analysis Approach.

INTRODUCTION: In order to prevent medical errors, it is important to know why they occur and to identify their causes. Healthcare failure modes and effects analysis (HFMEA) is a type of qualitative descriptive that is used to evaluate the risk. The aim of this study was to assess the risks of using Entonox for labor pain by HFMEA. METHODS: A mixed-methods design (qualitative action research and quantitative cross-sectional research) was used. The modes and effects of failures in the process of using Entonox were detected and analyzed during 2013-2014 at Hefdahe Shahrivar Hospital, Mashhad, Iran. Overall, 52 failure modes were identified, with 25 being recognized as high-risk modes. RESULTS: The results revealed that 48.5% of these errors fall into the care process type, 22.05% belong to the communicative type, 19.1% fall into the administrative type, and 10.2% are of the knowledge and skills type. Strategies were presented in the forms of acceptance (3.2%), control (90.3%), and elimination (6.4%). CONCLUSION: The following actions are suggested for improving the process of using Entonox: Close supervision by the midwife, precise recording of all the stages of the process in the woman's medical record, the necessity of the presence of the anesthesiologist at the woman's bedside during labor, confirming the indications for use of Entonox, and close monitoring to ensure the safety of the gas cylinder guards.