بررسی عوامل اثرگذار بر روش امتیازدهی اعتباربخشی بیمارستانی در ایران
محورهای موضوعی : -مدارک پزشکیلادن قدمی 1 , ایروان مسعودی اصل 2 , سمیه حسام 3 , محمود مدیری 4
1 - دانشجوی دکتری رشته مدیریت خدمات بهداشتی و درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران
2 - دانشیار گروه مدیریت خدمات بهداشتی و درمانی، دانشکده مدیریت و اطلاعرسانی، دانشگاه علوم پزشکی ایران، تهران، ایران
3 - استادیار گروه مدیریت خدمات بهداشتی و درمانی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران
4 - استادیارگروه مدیریت صنعتی، واحد تهران جنوب، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: اعتباربخشی, مطالعه کیفی., بیمارستان, روش امتیازدهی,
چکیده مقاله :
مقدمه: اعتباربخشی یک مدل حمایتی و جامع جهت بررسی عملکرد بیمارستان است. پژوهش حاضر مطالعه کیفی با هدف بررسی روش امتیازدهی استانداردهای اعتباربخشی بیمارستانی در ایران انجام گردیده است. روش پژوهش: این پژوهش یک مطالعه کیفی در سال 96 می‌باشد. هدف ما مصاحبه با خبرگان در حیطه سیاست‌گذاری و صاحب‌نظران اعتباربخشی بیمارستانی در ایران بود. بر این اساس با 25 نفر از خبرگان و ارزیابان اعتباربخشی بیمارستانی مصاحبه نیمه ساختار یافته انجام شد. از روش تحلیل چارچوبی برای آنالیز داده‌های کیفی استفاده شد. یافته‌ها: در مطالعه حاضر، شش موضوع به عنوان عوامل کلیدی اثرگذار بر روش اعتباربخشی بیمارستانی شناسایی شدند. دسته‌بندی استانداردها، نمره‌دهی،وزندهی، رتبه‌بندی نمره کلی، نقش ارزیابان، روش ارزیابی بود. در روش فعلی نمره کلی تفاوت بیمارستان‌ها را مشخص نمی‌نمود وزندهی بصورت شفاف مشخص نبود .گام‌های اجرایی سنجه‌ها که راهنمای اجرا می‌باشند نمره‌دهی شده و مدل تصمیم‌گیری ارزیابان یکسان نبود و ارزیابی‌ها اجباری بوده و توسط سازمان مستقل انجام نمی‌گردید. نتیجه‌گیری: در حیطه دسته‌بندی استانداردها و نحوه نمره‌دهی و وزندهی درارزیابی اعتباربخشی تغییراتی لازم است. سنجه‌های الزامی‌در استانداردهای اعتباربخشی حذف شود. پیش شرط ورود به فرآیند اعتباربخشی کسب مجوزهای لازم قبل از اعتباربخشی خواهد بود. پیشنهاد می‌گردد از مقیاس لیکرت برای نمره‌دهی سنجه‌ها استفاده شود. برای استانداردهای ایمنی بیمار وزن بیشتری در نظر گرفته شود.
Introduction: Accreditation is a comprehensive and supportive model for assessing hospital performance. The present study aimed to assess the methodology of scoring hospital accreditation standards in Iran. Method: This research is a qualitative study in 2017. The main scope was to interview the experts in the area of policy and accreditation of hospitals in Iran. Accordingly, semi-structured interviews were conducted with 25 experts and hospital accreditation assessors. A framework analysis was used to analyze qualitative data. Results: In this study, six subjects were identified as the key factors influencing the hospital accreditation method. Standards Classification, Scoring, Weighting, Overall Score Ranking, Role of Assessors, Evaluation Method. In the current method, the overall score did not determine the difference between hospitals. Weighting was not clearly specified. The executive steps which were guidelines of implementation were scored. The decision making methods of the assessors were not the same, and the assessments were mandatory and not carried out by an independent organization. Conclusion: In the area of classification of standards and the method of scoring and weighting in the current accreditation evaluation, there needs to be changes. Required measurable elements in the accreditation standards will be eliminated. The precondition for entering the accreditation process will be to obtain the necessary permits before accreditation. It is suggested that the Likert scale be used for scoring. It’s recommended that the weight of patient safety standards must be considered more.
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2- Veillard J, Champagne F, Klazinga N, Kazandjian V, Arah O, Guisset A-L. A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. International journal for quality in Health Care, 2005; 17(6): 487-96.
3- International standards in medical education: assessment and accreditation of medical schools'--educational programmes. A WFME position paper. The Executive Council, The World Federation for Medical Education. Medical education, 1998; 32(5): 549-58.
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8- Asadi P, Marjani K. Presentation of Validation Model for Auditing National Accreditation Standards of Iranian Hospitals. First Clinical Audit Contest and Quality Improvement; Tabriz University of Medical Sciences, 2012.
9- Ariankhesal A, Sheldon T. The dysfunctional concept of a performance measurement system: the case of the Iranian hospital program. Journal of health services research & policy, 2015; 20(3): 138-45.
10- Tabrizi J, Gharibi F, Ramezani M. Designing a National Available: Accreditation Model for the Specialized Clinics Department of Hakim Hospital. First Clinical Audit Contest and Quality Improvement; University of Medical Sciences, Tabriz, Iran, 2012.
11- Mosadeghrad M, Akbari-sari A, Yousefinezhadi T. Evaluation of hospital accreditation standards. Razi Journal of Medical Sciences, 2017; 153(23): 50-61.
12- Arredondo A, Orozco E. Equity, governance and financing after health care reform: lessons from Mexico. The International journal of health planning and management, 2008; 23(1): 37-49.
13- Barrowman L. Review of the implementation of the nurse prescribing role. On behalf for the Trust Nurses Association in Northern Ireland Belfast, Ireland: Northern Ireland Practice and Education Council for Nursing and midwifery (NIPEC); 2007 [Available from: http://www.nipec.hscni.net/pub/NursePrescribingFinalRpt.pdf.
14- Lacey A, Luff D. Qualitative data analysis: Trent Focus Sheffield; 2001.
15- Rashidian A, Eccles M, Russell I. Falling on stony ground? A qualitative study of implementation of clinical guidelines’ prescribing recommendations in primary care. Health policy, 2008; 85(2): 148-61.
16- Bryman A, Burgess B. Analyzing qualitative data: Routledge; 2002.
17- Fortune T, Connor EO, Donaldson B. Guidance on Designing Healthcare External Evaluation Programmers Including Accreditation: International Society for Quality in Health Care-Accreditation; 2015 [Available from: http://www.isqua.org/accreditation/reference-materials-2015.
18- National Accreditation Standards of Iran: Ministry of Health and Medical Education; 2016 [Available from: http://accreditation.behdasht.gov.ir.
19- A Self-Assessment Guide for Health Care Organizations: World Bank organization; 2018 [Available from: https://www.ifc.org/wps/wcm/connect/509355004970c21ca215f2336b93d75f/IFCSelfAssessGuide.pdf?MOD=AJPERES; 2010.
20- The Thailand Board of Investment: Thailand: Medical Hub of Asia; 2009 [Available from: http://www.thinkasiainvestthailand.com/download/Medical.pdf.
21- Boyd L, Sheen J. The national safety and quality health service standards requirements for orientation and induction within Australian Healthcare: A review of the literature. Asia Pacific journal of health management, 2014; 9(3): 31-7.
22- Aryankhesal A, Sheldon T, Mannion R. Impact of the Iranian hospital grading system on hospitals’ adherence to audited standards: An examination of possible mechanisms. Health policy, 2014; 115(2): 206-14.
23- Shaw CD. Accreditation in European Health Care. Joint Commission Journal on Quality and Patient Safety, 2006; 32(5): 266-75.
24- Mosadeghrad A, Shakibaei E. Hospital Accreditation Implementation Prerequisites. Journal of Hospital, 2017; 16(3): 43-56.
25- Sadaghiani I, Zare H. The system of evaluation and accreditation of medical institutions of the Institute for Social Security Research; 2005.
26- Vision 2030 Saudi Central Board for Accreditation for Hospital Institution2017 [Available from: http://cbahi.securehostsite.biz/Library/Assets/CBAHI%20Corporate%20Profile-041915.pdf.
27- Joint Commission International Survey Process Guide for Hospitals 2017 [Sisth edition:[Available from: https://www.jointcommissioninternational.org/assets/3/7/JCI_Publications_Services_Brochure_2.17.pdf.
28- Accreditation Standards for hospitals Danish Institute for Quality and Accreditation in Health care2012 [Second edition:[Available from: https://www.ikas.dk/FTP/PDF/D12-10072.pdf.
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1- Organization WH. The health for all policy framework for the WHO European Region: 2005 Update, 2005.
2- Veillard J, Champagne F, Klazinga N, Kazandjian V, Arah O, Guisset A-L. A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. International journal for quality in Health Care, 2005; 17(6): 487-96.
3- International standards in medical education: assessment and accreditation of medical schools'--educational programmes. A WFME position paper. The Executive Council, The World Federation for Medical Education. Medical education, 1998; 32(5): 549-58.
4- Scrivens E. A taxonomy of the dimensions of accreditation systems. Social Policy & Administration, 1996; 30(2): 114-24.
5- Shirdel A. Accreditation is a way to ensure the quality of services in the hospital. First Clinical Audit and Quality Improvement Conference,; University of Medical Sciences, Tabriz, Iran, 2015.
6- Yosefinejad T. Analysis of evaluation and accreditation policies of Iranian hospitals: Tehran university of medical sciences, 2017.
7- Tofighi S, Delgoshae B. Comparison of Hospital Standards with ISO Principles and Providing Appropriate Model for Hospital Standardization. Quarterly Journal of Lorestan University of Medical Sciences, 2004; 23: 22-9.
8- Asadi P, Marjani K. Presentation of Validation Model for Auditing National Accreditation Standards of Iranian Hospitals. First Clinical Audit Contest and Quality Improvement; Tabriz University of Medical Sciences, 2012.
9- Ariankhesal A, Sheldon T. The dysfunctional concept of a performance measurement system: the case of the Iranian hospital program. Journal of health services research & policy, 2015; 20(3): 138-45.
10- Tabrizi J, Gharibi F, Ramezani M. Designing a National Available: Accreditation Model for the Specialized Clinics Department of Hakim Hospital. First Clinical Audit Contest and Quality Improvement; University of Medical Sciences, Tabriz, Iran, 2012.
11- Mosadeghrad M, Akbari-sari A, Yousefinezhadi T. Evaluation of hospital accreditation standards. Razi Journal of Medical Sciences, 2017; 153(23): 50-61.
12- Arredondo A, Orozco E. Equity, governance and financing after health care reform: lessons from Mexico. The International journal of health planning and management, 2008; 23(1): 37-49.
13- Barrowman L. Review of the implementation of the nurse prescribing role. On behalf for the Trust Nurses Association in Northern Ireland Belfast, Ireland: Northern Ireland Practice and Education Council for Nursing and midwifery (NIPEC); 2007 [Available from: http://www.nipec.hscni.net/pub/NursePrescribingFinalRpt.pdf.
14- Lacey A, Luff D. Qualitative data analysis: Trent Focus Sheffield; 2001.
15- Rashidian A, Eccles M, Russell I. Falling on stony ground? A qualitative study of implementation of clinical guidelines’ prescribing recommendations in primary care. Health policy, 2008; 85(2): 148-61.
16- Bryman A, Burgess B. Analyzing qualitative data: Routledge; 2002.
17- Fortune T, Connor EO, Donaldson B. Guidance on Designing Healthcare External Evaluation Programmers Including Accreditation: International Society for Quality in Health Care-Accreditation; 2015 [Available from: http://www.isqua.org/accreditation/reference-materials-2015.
18- National Accreditation Standards of Iran: Ministry of Health and Medical Education; 2016 [Available from: http://accreditation.behdasht.gov.ir.
19- A Self-Assessment Guide for Health Care Organizations: World Bank organization; 2018 [Available from: https://www.ifc.org/wps/wcm/connect/509355004970c21ca215f2336b93d75f/IFCSelfAssessGuide.pdf?MOD=AJPERES; 2010.
20- The Thailand Board of Investment: Thailand: Medical Hub of Asia; 2009 [Available from: http://www.thinkasiainvestthailand.com/download/Medical.pdf.
21- Boyd L, Sheen J. The national safety and quality health service standards requirements for orientation and induction within Australian Healthcare: A review of the literature. Asia Pacific journal of health management, 2014; 9(3): 31-7.
22- Aryankhesal A, Sheldon T, Mannion R. Impact of the Iranian hospital grading system on hospitals’ adherence to audited standards: An examination of possible mechanisms. Health policy, 2014; 115(2): 206-14.
23- Shaw CD. Accreditation in European Health Care. Joint Commission Journal on Quality and Patient Safety, 2006; 32(5): 266-75.
24- Mosadeghrad A, Shakibaei E. Hospital Accreditation Implementation Prerequisites. Journal of Hospital, 2017; 16(3): 43-56.
25- Sadaghiani I, Zare H. The system of evaluation and accreditation of medical institutions of the Institute for Social Security Research; 2005.
26- Vision 2030 Saudi Central Board for Accreditation for Hospital Institution2017 [Available from: http://cbahi.securehostsite.biz/Library/Assets/CBAHI%20Corporate%20Profile-041915.pdf.
27- Joint Commission International Survey Process Guide for Hospitals 2017 [Sisth edition:[Available from: https://www.jointcommissioninternational.org/assets/3/7/JCI_Publications_Services_Brochure_2.17.pdf.
28- Accreditation Standards for hospitals Danish Institute for Quality and Accreditation in Health care2012 [Second edition:[Available from: https://www.ikas.dk/FTP/PDF/D12-10072.pdf.