ابعاد موثر بر موفقیت حاکمیت بالینی (محرک‌ها، توانمندسازها و چالش‌ها) در یک بیمارستان خصوصی با رویکرد دلفی فازی
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانیزینب محمدی 1 , حسین دیده خانی 2
1 - داﻧﺸﺠﻮی دکتری، دانشکده ﻣﺪﯾﺮﯾﺖ، واحد علی‌آبادکتول، داﻧﺸﮕﺎه آزاد اﺳﻼﻣﯽ، ﻋﻠﯽآﺑﺎدﮐﺘﻮل، ایران
2 - استادیار، گروه مهندسی صنایع، واحد علی‌آبادکتول، داﻧﺸﮕﺎه آزاد اﺳﻼﻣﯽ، ﻋﻠﯽآﺑﺎدﮐﺘﻮل، ایران
کلید واژه: توانمند سازی کارکنان, حاکمیت بالینی, رقابت در بخش خدمات, سیستم اطلاعات, بازاریابی داخلی,
چکیده مقاله :
مقدمه: در کشورهای مختلف تا به امروز روش‌ها و ابزار متنوعی جهت ارتقا مراقبت‌های سلامت به کارگرفته شده است که یکی از این شیوه‌ها حاکمیت بالینی است. در این مطالعه ابعاد موثر بر اجرای موفق حاکمیت بالینی از نگاه مدیران سلامت بررسی گردید.روش پژوهش: در این مطالعه کیفی، الگوی جامع عوامل اثرگذار بر حاکمیت بالینی با روش دلفی فازی ارائه گردید. با استفاده از بررسی متون و نظرات 30 نفر از خبرگان و مدیران حوزه سلامت دانشگاه علوم پزشکی گلستان، گرگان، و بیمارستان خصوصی فلسفی موارد موثر بر ابعاد هشت گانه حاکمیت بالینی در بیمارستان فلسفی انتخاب و به صورت یک مدل طراحی و سپس با روش آنالیز فازی مورد سنجش قرار گرفتند.یافته‌ها: ابعاد و متغیرهای موثر مدل پیشنهادی در سه گروه محرک‌ها، توانمندسازها و چالش‌ها قرار گرفتند. مقدار سطح معناداری بر اساس میانگین ستون مقدار معناداری 8/31 به دست آمد. بر این اساس بعد بازاریابی داخلی با دارا بودن بیشترین سطح معناداری(10/88) و پس از آن ابعاد آموزش (تحقیق و توسعه) و توانمندسازی کارکنان با سطح معناداری به ترتیب 10/54 و 10/48 بیشترین تاثیر را در اجرای حاکمیت بالینی داشته اند. کمترین اثر در اجرای موفق حاکمیت بالینی را بعد آموزش با سطح معناداری 2/95 دارا بود.نتیجه‌گیری: یافته‌های پژوهش پیشنهاد می‌کند که استقرار حاکمیت بالینی در بیمارستان مورد مطالعه به طور ویژه نیازمند تقویت بازاریابی داخلی، آموزش (تحقیق و توسعه) و توانمندسازی کارکنان است و می‌توان از حاکمیت بالینی در بهبود عملکرد مراکز درمانی استفاده نمود.
Introduction: Different countries have used methods and tools for promotion of health care to date. One of these methods is clinical governance. In this study, effective dimensions on clinical governance were evaluated in the point of view of health managers.Methods: In this qualitative study, a comprehensive model of effective agents on clinical governance was presented by Delphi Fuzzy method. Using literature review and opinion of 30 experts and health managers of Golestan University of Medical Sciences, Goragn, and Phalsaphi privet hospital, impaired items on eight dimensions of clinical governance in Phalsaphi hospital were selected, designed as a model and assessed by Fuzzy analysis.Results: According to suggested model, effective dimensions and variables were in three groups including stimuluses, enablers and challenges. The significance level was 8.31 based on the mean of significance level column. According to it, the internal marketing dimension with the highest significance level (10.88) and after that dimensions including education (research and development) and empowering employees with the significance level 10.54 and 10.48, respectively, had the highest effect on clinical governance implementation. The lowest effect on successful implementation of clinical governance was belong to the education dimension with the significance level 2.95. Conclusion: The findings suggest that establishment of clinical governance in studied hospital specially needs strengthen internal marketing, education (research and development) and empowering employees and clinical governance can be used to improve the performance of the treatment centers.
1- Behzadifar M, Bragazzi NL, Arab-Zozani M, Bakhtiari A, Behzadifar M, Beyranvand T, et al. The challenges of implementation of clinical governance in Iran: a metasynthesis of qualitative studies. Health Research Policy and Systems, 2019; 17(1): 1-14.
2- Nasiripour AA, Zarei Z, Zaheri MM, Zarei MR. Evaluation of the Effect of Applying Three Dimensions of Clinical Governance on Hospital Performance: A Quasi-Experimental Study. Qom University of Medical Sciences Journal, 2015; 9(6):46-52. [In Persian]
3- Kahouei M, Salari F, Arghandi Pour S, Akhbari R, Gholi Zadeh S. Hospital staff’s expectations of information in promoting clinical governance. Health Information Management, 2014; 11(2):149-57. [In Persian]
4- Azimian moghadam F, Hozni A, Yeganeh M, Ghorbani R. [Nurses' attitude about human and organizational factors affecting clinical governance in Rasht family hospital]. Health and treatment management, 2014; 5 (2): 67-75. [In Persian]
5- Ataollahi F, Bahrami MA, Atashbahar O, Rejalian F, Gharaie H, Homayooni A, et al. Clinical Governance Implementation Challenges in Teaching Hospitals Affiliated to Yazd University of Medical Sciences, Iran, Based on the Experts' Viewpoint. Journal of Management and Medical Informatics School, 2013; 1(2):110-02. [In Persian]
6- Ziari A, Rassouli M, Mirbaha-Hashemi F, Heidarnia MA, Abachizadeh K. Prioritizing barriers to implement clinical governance in teaching hospitals of Iran: A mixed method study. Medical Journal of the Islamic Republic of Iran, 2019; 33:140. [In Persian]
7- Ghalehei AR, Shohoudi M. Modeling the relations between cultural intelligence and clinical governance: Perspective of nurses of public hospitals in Kermanshah. Research in Medical Science Education, 2014; 6 (1): 39-48. [In Persian]
8- Hojjat M, Mosalanejad L, Charkhandaz M, Pabarja E, Ehsani M, Mohammadi S. Barriers to clinical governance administration from point of view of managers and nurses. Comprehensive Nursing and Midwifery, 2016; 25 (78): 45-52. [In Persian]
9- Kuo YF, Chen PC. Constructing performance appraisal indicators for mobility of the service industries using Fuzzy Delphi Method. Expert Systems with Applications, 2008; 35 (4):1930-9.
10- Lee AHI, Wang W, Lin T. An evaluation framework for technology transfer of new equipment in high technology industry. Technological Forecasting and Social Change, 2010; 77 (1), 135–150.
11- Hsiao TY. Establish standards of standard costingwith the application of convergent gray zone test. European Journal of Operational Research, 2006; 168 (2), 593–611.
12- Ishikawa A, Amagasa M, Shiga T, Tomizawa G, Tatsuta R, Mieno H. The max–min Delphi method and fuzzy Delphi method via fuzzy integration. Fuzzy Sets and Systems. 1993; 55, 241–253.
13- Mosadeghrad AM, Arab M, Shahidi Sadeghi N. A survey of clinical governance success in University hospitals in Tehran. Journal of Health Based Research, 2019; 5(1):101-16. [In Persian]
14- Younesifar SM, Sanaei A, Shahin A. [The degree of dominance of internal marketing components and its effect on the development of service quality in Afshar Hospital, Yazd]. Journl of Marketing Management, 2012; 16: 99-108. [In Persian]
15- Atashbahar A, Rejalian F, Bahrami MA, Gharaei H, Homaioni A, Ataollahi F, et al. [Educational needs of the staff of teaching hospitals in Yazd city for the establishment of clinical governance]. Health and Treatment Management, 2014; 5 (1): 69-78. [In Persian]
16- Mosadeghrad AM, Sadoughi F, Ghorbani M. A survey of clinical governance success in Khozestan province. Journal of Health in the Field, 2019; 7 (3): 48-63. [In Persian]
17- Gauld R, Horsburgh S, Brown J. The clinical governance development index: Results from a New Zealand study. BMJ Quality and Safety. 2011; 20 (11):947-952.
18- Scally G, Donaldson L. Clinical Governance and Drive for Quality Improvement. BMJ, 1998; 317: 61-65.
19- Mirkamali SM, Javanak Liavali M, Yeganeh MR. Correlation between Organizational Culture with Clinical Governance in Public Hospitals in Rasht. Journal of Hayat, 2014; 20 (1): 15-25. [In Persian]
20- Amerion A, Shahabi Nejad M. Assessing the barriers of strategic plan implementation from hospital managers' perspective in Kerman city. Journal of Hospital, 2015; 14 (4): 95-102. [In Persian]
21- Mosadeghrad AM, Sadoughi F, Ghorbani M. The role of information management in the successful implementation of clinical governance. Journal of Health-Based Research, 2016; 3: 207-21. [In Persian]
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1- Behzadifar M, Bragazzi NL, Arab-Zozani M, Bakhtiari A, Behzadifar M, Beyranvand T, et al. The challenges of implementation of clinical governance in Iran: a metasynthesis of qualitative studies. Health Research Policy and Systems, 2019; 17(1): 1-14.
2- Nasiripour AA, Zarei Z, Zaheri MM, Zarei MR. Evaluation of the Effect of Applying Three Dimensions of Clinical Governance on Hospital Performance: A Quasi-Experimental Study. Qom University of Medical Sciences Journal, 2015; 9(6):46-52. [In Persian]
3- Kahouei M, Salari F, Arghandi Pour S, Akhbari R, Gholi Zadeh S. Hospital staff’s expectations of information in promoting clinical governance. Health Information Management, 2014; 11(2):149-57. [In Persian]
4- Azimian moghadam F, Hozni A, Yeganeh M, Ghorbani R. [Nurses' attitude about human and organizational factors affecting clinical governance in Rasht family hospital]. Health and treatment management, 2014; 5 (2): 67-75. [In Persian]
5- Ataollahi F, Bahrami MA, Atashbahar O, Rejalian F, Gharaie H, Homayooni A, et al. Clinical Governance Implementation Challenges in Teaching Hospitals Affiliated to Yazd University of Medical Sciences, Iran, Based on the Experts' Viewpoint. Journal of Management and Medical Informatics School, 2013; 1(2):110-02. [In Persian]
6- Ziari A, Rassouli M, Mirbaha-Hashemi F, Heidarnia MA, Abachizadeh K. Prioritizing barriers to implement clinical governance in teaching hospitals of Iran: A mixed method study. Medical Journal of the Islamic Republic of Iran, 2019; 33:140. [In Persian]
7- Ghalehei AR, Shohoudi M. Modeling the relations between cultural intelligence and clinical governance: Perspective of nurses of public hospitals in Kermanshah. Research in Medical Science Education, 2014; 6 (1): 39-48. [In Persian]
8- Hojjat M, Mosalanejad L, Charkhandaz M, Pabarja E, Ehsani M, Mohammadi S. Barriers to clinical governance administration from point of view of managers and nurses. Comprehensive Nursing and Midwifery, 2016; 25 (78): 45-52. [In Persian]
9- Kuo YF, Chen PC. Constructing performance appraisal indicators for mobility of the service industries using Fuzzy Delphi Method. Expert Systems with Applications, 2008; 35 (4):1930-9.
10- Lee AHI, Wang W, Lin T. An evaluation framework for technology transfer of new equipment in high technology industry. Technological Forecasting and Social Change, 2010; 77 (1), 135–150.
11- Hsiao TY. Establish standards of standard costingwith the application of convergent gray zone test. European Journal of Operational Research, 2006; 168 (2), 593–611.
12- Ishikawa A, Amagasa M, Shiga T, Tomizawa G, Tatsuta R, Mieno H. The max–min Delphi method and fuzzy Delphi method via fuzzy integration. Fuzzy Sets and Systems. 1993; 55, 241–253.
13- Mosadeghrad AM, Arab M, Shahidi Sadeghi N. A survey of clinical governance success in University hospitals in Tehran. Journal of Health Based Research, 2019; 5(1):101-16. [In Persian]
14- Younesifar SM, Sanaei A, Shahin A. [The degree of dominance of internal marketing components and its effect on the development of service quality in Afshar Hospital, Yazd]. Journl of Marketing Management, 2012; 16: 99-108. [In Persian]
15- Atashbahar A, Rejalian F, Bahrami MA, Gharaei H, Homaioni A, Ataollahi F, et al. [Educational needs of the staff of teaching hospitals in Yazd city for the establishment of clinical governance]. Health and Treatment Management, 2014; 5 (1): 69-78. [In Persian]
16- Mosadeghrad AM, Sadoughi F, Ghorbani M. A survey of clinical governance success in Khozestan province. Journal of Health in the Field, 2019; 7 (3): 48-63. [In Persian]
17- Gauld R, Horsburgh S, Brown J. The clinical governance development index: Results from a New Zealand study. BMJ Quality and Safety. 2011; 20 (11):947-952.
18- Scally G, Donaldson L. Clinical Governance and Drive for Quality Improvement. BMJ, 1998; 317: 61-65.
19- Mirkamali SM, Javanak Liavali M, Yeganeh MR. Correlation between Organizational Culture with Clinical Governance in Public Hospitals in Rasht. Journal of Hayat, 2014; 20 (1): 15-25. [In Persian]
20- Amerion A, Shahabi Nejad M. Assessing the barriers of strategic plan implementation from hospital managers' perspective in Kerman city. Journal of Hospital, 2015; 14 (4): 95-102. [In Persian]
21- Mosadeghrad AM, Sadoughi F, Ghorbani M. The role of information management in the successful implementation of clinical governance. Journal of Health-Based Research, 2016; 3: 207-21. [In Persian]