Hospital performance evaluation indicators: a scoping review.

BACKGROUND: Hospitals are the biggest consumers of health system budgets and hence measuring hospital performance by quantitative or qualitative accessible and reliable indicators is crucial. This review aimed to categorize and present a set of indicators for evaluating overall hospital performance. METHODS: We conducted a literature search across three databases, i.e., PubMed, Scopus, and Web of Science, using possible keyword combinations. We included studies that explored hospital performance evaluation indicators from different dimensions. RESULTS: We included 91 English language studies published in the past 10 years. In total, 1161 indicators were extracted from the included studies. We classified the extracted indicators into 3 categories, 14 subcategories, 21 performance dimensions, and 110 main indicators. Finally, we presented a comprehensive set of indicators with regard to different performance dimensions and classified them based on what they indicate in the production process, i.e., input, process, output, outcome and impact. CONCLUSION: The findings provide a comprehensive set of indicators at different levels that can be used for hospital performance evaluation. Future studies can be conducted to validate and apply these indicators in different contexts. It seems that, depending on the specific conditions of each country, an appropriate set of indicators can be selected from this comprehensive list of indicators for use in the performance evaluation of hospitals in different settings.

A novel mathematical model to generate semi-automated optimal IMRT treatment plan based on predicted 3D dose distribution and prescribed dose.

BACKGROUND: In recent years, with the development of artificial intelligence and deep learning techniques, it has become possible to predict the three-dimensional distribution dose (3D3 ) of a new patient based on the treatment plans of similar recent patients. Therefore, some new questions have arisen for the above issue: how to make use of the predicted 3D3 obtained from deep learning, to facilitate treatment planning? How to convert the predicted 3D3 to a clinical deliverable Pareto optimal plan? Little research has been done and limited software has been developed in this regard. PURPOSE: In the current research, an attempt was made to contribute the knowledge-based planning by presenting a new mathematical model, and to take a novel step towards optimizing the treatment plan derived from both predicted 3D3 as well as dose prescription to generate a semi-automated clinically applicable optimal IMRT treatment plan. METHODS: The presented model has benefited from both prescribed dose as well as predicted dose and its objective function includes both quadratic and linear phrases, so it was called the QuadLin model. The model has been run on the data of 30 patients with head and neck cancer randomly selected from the Open-KBP dataset. There are 19 sets of dose prediction data for each patient in this database. Therefore, a total of 570 problems have been solved in the CVX framework with commercial solver Mosek and the results have been evaluated by two plan quality approaches (1) DVH points differences, and (2) satisfied clinical criteria. RESULTS: The results of the current study indicate a strong significant improvement in almost all plan evaluation indicators compared to the reference plan of the dataset, 3D3 predictions, as well as the results of previous research, based on the Wilcoxon signed ranks test with a significance level of 0.01. Accordingly, for all regions of interest (ROIs) (or structures) of all 570 problems total clinical indicators have improved by more than 21%, 15%, and at least13%, on average, compared to the predicted dose, the reference plan, and previous research, respectively, with 341 s as the average of solving time. CONCLUSIONS: Evaluation of the research results indicates the significant effect of the QuadLin model on improving the dose delivery to the target volumes while reducing the dose and preserving organs at risk. Based on the literature, the proposed model has generated the best-known treatment plan from the predicted 3D3 so far.

Improving the medical records department processes by lean management.

BACKGROUND: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. AIMS: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. MATERIALS AND METHODS: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. STATISTICAL ANALYSIS USED: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. RESULTS: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. CONCLUSION: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. ORIGINALITY/VALUE: The study represents one of the few attempts trying to eliminate wastes in the MRD.

A Review on influencing criteria for selecting supplier of information technology services in the hospital.

Organizations try to outsource their activities as much as possible in order to prevent the problems and use organizational capabilities in Information Technology (IT) field. The purpose of this paper was first, to express the effective criteria for selecting suppliers of IT services, second, to explain the advantages and disadvantages of outsourcing IT in hospitals. This study was narrative review, which search was conducted with the help of libraries, books, conference proceedings, and databases of Science Direct, PubMed, Proquest, Springer, and SID (Scientific Information Database). In our searches, we employed the following keywords and their combinations: Outsourcing, information technology, hospital, decision making, and criteria. The preliminary search resulted in 120 articles, which were published between 2000 and 2013 during July 2013. After a careful analysis of the content of each paper, a total of 46 papers were selected based on their relevancy. The criteria and sub-criteria influencing outsourcing decisions in Iranian hospitals were identified in six major categories including administrative issues, issues related to the service/product, technology factors, environmental factors, risks, and economic factors associated with 15 sub-criteria containing business integration, dependence on suppliers, human resources, focus on core competencies, facilities and physical capital, innovation, quality, speed of service delivery, flexibility, market capabilities, geographical location, security, management control, cost, and financial capability. Identify the advantages and disadvantages of outsourcing and effective criteria in IT services supplier selection causes the managers be able to take the most appropriate decision to select supplier of IT services. This is a general review on influencing criteria for electing of supplier of information technology services in hospitals.

Wait time in emergency department (ED) processes.

INTRODUCTION: Emergency Department (ED) provides urgency clinical and Para clinical care for patients who injured in accidents and incidents. Simulation is one of the decision supporting techniques that analyze risk factors and strategies in decision-making. GOAL: The aim of this study was to determine the waiting time in emergency department services at Ayatolahkashani Hospital to propose scenarios for reducing waiting time. METHODS: This study was an analytical and cross-sectional in which data collected by forms and observations. Population included waiting and service time in all stations related to ED's treatment processes along with diagnostic departments (e.g. Laboratory, Radiology, Ultrasonography, and C-T Scan) over a two-week period for 663 patients. For data analysis, SPSS software and simulation technique were used. RESULTS: Results show that add one intern to the Ear Nose Throat (ENT) service makes the most reduction on the waiting time from 112.19 to 99.24 minutes. In this option the mean of ENT services time will be reduced to 26.54 minutes, neurology services time will be reduced to 6.58 minutes and the mean of orthopedic services time were reduced to 5.98 minutes. CONCLUSION: Health care managers, in the ED are usually physicians who are not familiar with principals of management. Hence, they need simple tools for logical decision-making. Operation research methods such as simulation should be suitable for them.

Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

Waiting time in emergency department by simulation.

The aim of research was to reduce waiting time at ED. Population includes the patients who received services in ED. The arrival and service times in different stations were collected for 663 patients. For data analysis, SPSS and simulation technique were used. Results shows that add one intern to the Ear Nose Throat (ENT) service makes the most reduction on the waiting time from 112.19 to 99.24 minutes. Health care managers, in the ED are usually physicians who are not familiar with principals of management.

Efficiency measurement of cardiac care units of isfahan hospitals in iran.

The purpose of this study is to evaluate the performance of the Cardiac Care Units (CCU) of hospitals in Isfahan, Iran. The multi-criteria comparison between the wards of different hospitals is not only useful for the patients but also important for the hospitals management to improve their performance and for the medical policy makers to plan strategic decisions. In this paper, it is intended to consider the aspects of efficiency beyond the traditional evaluation of check list. There are some measures which are used in the existing health audit system and several quantified ratios. Among them the most important ones, based on the patient satisfaction and resource efficiency, have been selected using the weights obtained from their paired comparisons. The factors which have been chosen are divided into two subsets: first, input factors consisting of average number of active beds, medical equipment, personnel (such as doctors, nurses and technicians), and technological capabilities, and second, output factors including bed occupancy percentage, average length of stay, total percentage of survival and performance ratio. The input oriented and variable returns to scale model of Data envelopment analysis (DEA) technique is used to evaluate the efficiency of each CCU ward. The model can be used to find out the causes of inefficiency and how to improve the performance. The method has been applied to evaluate and compare 23 CCUs of hospitals in Isfahan. Although the current health audit system, which uses a check list, has reported 21 of them as first class CCU, DEA model reveals that 11 of them are inefficient. The results may be then used to suggest the improvement strategies based on the output factors.

Readiness assessment of electronic health records implementation.

INTRODUCTION: During the past 20 years, with huge advances in information technology and particularly, in the areas of health, various forms of electronic records have been discussed, designed or implemented. Although making health records automatically has many advantages but unfortunately in some cases, creation of an Electronic Health Record (EHR) system seems to be complicated. E-health (Electronic health) readiness assessment, as a part of the assessment before implementation is considered essential and prior to implementation. Readiness assessment aims to evaluate preparedness of each organizational component. This process can lead to the correct decision making. Therefore, identifying areas and requirements for such an assessment is so essential. Using the results of this assessment can identify deficiencies in the existing electronic health records to plan their strategies. The aim of this study was first; to show the situation of readiness assessment in EHR implementation roadmap, second, to recognize requirements associated with electronic readiness assessment and main areas of EHR readiness assessment. RESULTS AND DISCUSSION: This study reviewed the literature on EHR readiness assessment with the help of library and also searches engines available at Google. For our searches, we employed the following keywords and their combinations: readiness, assessment, implementation, Electronic Health Record (EHR), Information Technology, road map in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 45 of them were selected based on their relevancy.