شناسایی عوامل موثر بر کیفیت خدمات ارائه شده به بیماران همودیالیزی در بیمارستان‌های ایران
محورهای موضوعی : -مدارک پزشکی
فاطمه پائین رسکتی
1
(کارشناسی ارشد مدیریت خدمات بهداشتی درمانی، واحد مرودشت، دانشگاه ازاد اسلامی، مرودشت، ایران)
شقایق وحدت
2
(استادیار، گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه ازاد اسلامی، تهران، ایران)
سمیه حسام
3
(استادیار، گروه مدیریت خدمات بهداشتی درمانی، واحد تهران جنوب، دانشگاه ازاد اسلامی، تهران، ایران)
کلید واژه: کیفیت خدمات, بخش همودیالیز, بیماران همودیالیزی,
چکیده مقاله :
مقدمه: با توجه به اهمیت تاثیر نارسایی مزمن کلیه بر جنبه‌های مختلف زندگی بیماران، هدف تحقیق، تعیین عوامل موثر بر کیفیت خدمات ارائه شده به بیماران همودیالیزی بود. روش پژوهش: پژوهش به روش آمیخته انجام، نمونه‌ها در مرحله کیفی بصورت هدفمند و شامل 24 نفر از خبرگان بخش‌های همودیالیز از 6 استان کشور بودند. در مرحله کمی، 150 نفر از شاغلان بخش همودیالیز مورد بررسی قرار گرفتند. ابزار گردآوری اطلاعات در گام اول، کتابخانه‌ای و در گام دوم پرسشنامه‌ای بود. پرسشنامه‌ای محقق‌ساخته با 6 مولفه طراحی، روایی و پایایی پرسشنامه نیز با استفاده از نیکویی برازش مورد بررسی قرار گرفت. تجزیه و تحلیل در بخش آمار توصیفی شامل فراوانی، درصد، میانگین و انحراف معیار و در بخش آمار استنباطی تحلیل عاملی اکتشافی و تاییدی مورد استفاده قرار گرفت. تحلیل عاملی اکتشافی با استفاده از نرم‌افزار آماری SPSS 21 و تحلیل عاملی تاییدی از طریق نرم‌افزار لیزرل صورت گرفت. یافته‌ها: شش عامل موثر بر کیفیت خدمات همودیالیز شناسایی شد که براساس ضریب اهمیت عبارت بودند از نیروی انسانی (0/866)، مدیریت (0/784)، فناوری اطلاعات (0/749)، تجهیزات (0/731)، امکانات و تسهیلات (0/683) و فضای فیزیکی (0/628). مجموعه شاخص‌های برازش نیز نشان داد که عوامل موثر برازش مناسبی را داشته و می‌توان از عوامل فوق به عنوان عوامل موثر بر کیفیت خدمات بخش همودیالیز در ایران نام برد. نتیجه‌گیری: با توجه به پایین بودن کیفیت زندگی بیماران همودیالیزی بایستی راهکارهای مناسب جهت جلوگیری از هدر رفت منابع و افزایش کیفیت زندگی بیماران با استفاده از نتایج حاصله؛ اخذ گردد.
Introduction: Considering the importance of the effect of chronic renal failure on various aspects of patients' life, the purpose of the study was to determine the factors affecting the quality of services provided to hemodialysis patients. Methods: The research was carried out using a mixed method. Samples were targeted at the qualitative stage and included 24 experts from hemodialysis section from 6 provinces of the country. In the quantitative phase, 150 employees in the hemodialysis department were examined. The information gathering tool in the first step was a library and in the second step was a questionnaire. The researcher-made questionnaire was designed with 6 elements; validity and reliability of the questionnaire were also evaluated using goodness of fit. The analysis in the descriptive statistics section included frequency, percentage, mean and standard deviation, and was used in the inferential statistics of exploratory and confirmatory factor analysis. Exploratory factor analysis was performed using SPSS 21 software and confirmatory factor analysis through Laser Level software. Results: Six factors influencing the quality of hemodialysis services were identified, and based on the importance were: human resources (0.866), management (0.874), information technology (0.749), equipment (0.731), facilities (0.683) and physical space (0.628). The fittest indices also showed that effective factors have suitable fit and can be mentioned as factors affecting the quality of hemodialysis services in Iran. Conclusion: Due to the low quality of life in hemodialysis patients, appropriate strategies should be taken to prevent the loss of resources and improve the patients' life quality by using the result.
1- Mosadeghrad AM. A conceptual framework for quality of care. Mat Soc Med. 2012;24:251–61. doi: 10.5455/msm, 2012.; 24: 251-261.
2- Yousapronpaiboon K, Johnson WC. Out-patient Service Quality Perceptions in Private Thai Hospitals. International Journal of Business and Social Science., 2013; 4(2): 57–66.
3- Sodani P. Managing quality in health care. WHO South East Asia J Public Health, 2012; 1(1): 119–120.
4- Pai YP, Chary ST. Dimensions of hospital service quality: A critical review: Perspective of patients from global studies. International journal of health care quality assurance, 2013; 26(4): 308–40.
5- Mosadeghrad AM. Towards a theory of quality management: an integration of strategic management, quality management and project management. International Journal of Modelling in Operations Management. 2012;2:89–118. doi: 10.1504/ijmom, 2012; 043962.
6- Nekoei-Moghadam M., Amiresmaili M. Hospital services quality assessment: Hospitals of Kerman University of Medical Sciences, as a tangible example of a developing country. Int J Health Care Qual Assur, 2011; 24(1): 57–66.
7- Nayar P, Ozcan YA, Yu F, et al. Benchmarking urban acute care hospitals: efficiency and quality perspectives. Health Care Manage Rev, 2013; 38: 137–45. doi: 10.1097/HMR.0b013e3182527a4c.
8- Mosadeghrad AM. Essentials of Total Quality Management in Healthcare: A systematic review. Int J Health Care Qual Assur, 2014; 27: 544–58. doi: 10.1108/ijhcqa-07-2013-0082.
9- Mosadeghrad AM. Why TQM programs fail? A pathology approach. The TQM Journal, 2014; 26: 160–87. doi: 10.1108/tqm-12-2010-0041.
10- Mosadeghrad AM, Ferdosi M, Afshar H, Hosseini-Nejhad M. The impact of top management turnover on quality management implementation. Med Arch, 2013; 67: 134–40. doi: 10.5455/medarh, 2013; 67: 134-140.
11- Mosadeghrad AM. Sokhanvar M. An evaluation of quality of services in Tehran Hospitals using the HEALTHQUAL model. Journal of Medical Council of Iran, 2017; 25(1): 9-19. URL: http://jmciri.ir/article-1-2692-fa.html.
12- Kim J, Han W. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions. Osong Public Health Res Perspect, 2012; 3(2): 94–99. doi: 10.1016/j.phrp.2012.04.005
13- Ramezanian M R, Gheibdoust H. Prioritization of the Influential Factors on Health Care Services Quality Using a Hybrid Approach Based on Analytic Network Process (ANP) and Fuzzy TOPSIS in Public Hospitals. Jhosp, 2016; 15 (4) :79-93. URL: http://jhosp.tums.ac.ir/article-1-5566-fa.html
14- Kliger Alan S. Quality Measures for Dialysis: Time for a Balanced Scorecard. Clin J Am Soc Nephrol,. 2016; 11(2): 363–368. doi: 10.2215/CJN.06010615.
15- Tabibi S.J., Gohari M.R., Shahri S. Assessment of health care services in outpatient clinics based on SERVQUAL model in hospitals of Tehran. Payavard Salamat, 2012; 5(4): 49–56.
16- Wu HY, Fukuma S, Shimizu S, Norton EC, Tu YK, Hung KY, Chen MR, Chien KL, Fukuhara S. Effects of Higher Quality of Care on Initiation of Long-term Dialysis in Patients With CKD and Diabetes. Am J Kidney Dis, 2017; 70(5): 666-674. doi: 10.1053/j.ajkd.2017.05.020.
17- Plantinga Laura C., Pastan Stephen O., Wilk Adam S. Referral for Kidney Transplantation and Indicators of Quality of Dialysis Care: A Cross-sectional Study. Am J Kidney Dis, 2017; 69(2): 257–265. doi: 10.1053/j.ajkd.2016.08.038.
18- Joshi U, Subedi R, Poudel P, Ram Ghimire P, Panta S, Raj Sigdel M. Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study. Int J Nephrol Renovasc Dis, 2017; 10: 195–203. doi: 10.2147/IJNRD.S136522
19- Havas Beigi F, Ahmadi A, Yas Bolaghi B, Sharahi M. A Survey of the Quality of the Provided Services by Public Hospitals of Ilam and Kermanshah city to the Out-Patients on the Basis of SERVQUAL Model (Text in Persian) Ilam University of Medical Science, 2013; 21(4): 207–14.
20- Teerawattananon Y, Luz A, Pilasant S, Tangsathitkulchai S.How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings? Health Res Policy Syst, 2016; 14: 21. doi: 10.1186/s12961-016-0090-7.
21- Niihata K, Fukuma S, Akizawa T, Fukuhara S. Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study. PLoS One, 2017; 12(7): e0180498. doi: 10.1371/journal. pone. 018049
22- Ajam M, Sadeghifar J, Anjomshoa M, Mahmoudi S, Honarvar H, Mousavi S M. Assessing Quality of Healthcare Service by the SERVQUAL Model: A Case Study of a Field Hospital. J Mil Med, 2014; 15(4): 273-279. URL: http://militarymedj.ir/article-1-1088-fa.html.
23- Bakhteari Z, Hanifi N, Amini K, Jafari Varjoshani N. Quality of Nursing Services in Dialysis Center of Valiasr Hospital in Zanjan from Nurses and Patients' Viewpoint Using the SERVQUAL Model. IJN, 2018; 31(113): 18-29.URL: http://ijn.iums.ac.ir/article-1-2696-fa.htm.
24- Nadi A, Shojaee J, Abedi G, Siamian H, Abedini E, Rostami F. Patients’ Expectations and Perceptions of Service Quality in the Selected Hospitals. Med Arch, 2016; 70(2): 135–139. doi: 10.5455/medarh, 2016; 70: 135-139.
25- Mohebifar R, Hasani H, Barikani A, Rafiei S. Evaluating Service Quality from Patients' Perceptions: Application of Importance–performance Analysis Method. Osong Public Health Res Perspect, 2016; 7(4): 233–238. doi: 10.1016/j.phrp.2016.05.002.
26- Shafiee M, Ghafoori M H, Aboee F, Forootan S, Arab M. Evaluation of Delivered Services among Selected Hospital Wards: A Case Study Using Multiple Criteria Decision Making Methods (MCDM) . jhosp, 2016; 15(4): 95-102. URL: http://jhosp.tums.ac.ir/article-1-5389-fa.html
27- Mosadeghrad AM. Factors influencing healthcare service quality. Int J Health Policy Manag, 2014; 3: 77–89. doi: 10.15171/ijhpm.2014.65.
28- Nooronessa R, Rezaeeian S, Saghaayee A, Assessing the quality of health care services in the emergency ward of the hospital based on patients' rights (a cross-sectional study), Journal of Medical Ethics, 2013, 7(23): 161-185.[Persian]
29- Sohn M, Choi M. Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study. Osong Public Health Res Perspect, 2017; 8(5): 332–341. doi: 10.24171/j.phrp.2017.8.5.07.
30- Weisbord SD. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life. Semin Dial, 2016; 29(2): 158-64. doi: 10.1111/sdi.12464.
31- Bobocea L, Gheorghe IR, Spiridon St, Gheorghe CM, Purcarea VL. The management of health care service quality. A physician perspective. J Med Life, 2016; 9(2): 149–152.
32- Bakarman MA, Alghamdi HA, Alraddadi RM. Quality of healthcare for hemodialysis patients in various health sectors in Jeddah, Saudi Arabia. Ann Saudi Med, 2015; 35(4): 288-92. doi: 10.5144/0256-4947.2015.288.
33- Papanikolaou V, Zygiaris S. Service quality perceptions in primary health care centres in Greece. Health Expect, 2014; 17(2): 197-207. doi: 10.1111/j.1369-7625.2011.00747.x.
34- Chakravarty A. Evaluation of service quality of hospital outpatient department services. Med J Armed Forces India, 2011; 67(3): 221–224. doi: 10.1016/S0377-1237(11)60045-2.
35- Grangé S, Hanoy M, Le Roy F, Guerrot F, Godin M. Monitoring of hemodialysis quality-of-care indicators: why is it important? BMC Nephrol, 2013; 14: 109. doi: 10.1186/1471-2369.
36- Estaki R, Atafar A, Quality of nursing services (status and expected status) using SERVQUAL model from nurses' point of view in al-Zahra hospital in Isfahan (2010), Modern Care Journal, 2012, 9(2): 72-79. [Persian]
37- Amini M, Farjam S, Survey on Quality of Services in the Public Sector (Case Study: Isfahan University of Medical Sciences affiliated hospitals), Sterategic Management Thought, 2009, 3(1): 165-189. [Persian]
_||_1- Mosadeghrad AM. A conceptual framework for quality of care. Mat Soc Med. 2012;24:251–61. doi: 10.5455/msm, 2012.; 24: 251-261.
2- Yousapronpaiboon K, Johnson WC. Out-patient Service Quality Perceptions in Private Thai Hospitals. International Journal of Business and Social Science., 2013; 4(2): 57–66.
3- Sodani P. Managing quality in health care. WHO South East Asia J Public Health, 2012; 1(1): 119–120.
4- Pai YP, Chary ST. Dimensions of hospital service quality: A critical review: Perspective of patients from global studies. International journal of health care quality assurance, 2013; 26(4): 308–40.
5- Mosadeghrad AM. Towards a theory of quality management: an integration of strategic management, quality management and project management. International Journal of Modelling in Operations Management. 2012;2:89–118. doi: 10.1504/ijmom, 2012; 043962.
6- Nekoei-Moghadam M., Amiresmaili M. Hospital services quality assessment: Hospitals of Kerman University of Medical Sciences, as a tangible example of a developing country. Int J Health Care Qual Assur, 2011; 24(1): 57–66.
7- Nayar P, Ozcan YA, Yu F, et al. Benchmarking urban acute care hospitals: efficiency and quality perspectives. Health Care Manage Rev, 2013; 38: 137–45. doi: 10.1097/HMR.0b013e3182527a4c.
8- Mosadeghrad AM. Essentials of Total Quality Management in Healthcare: A systematic review. Int J Health Care Qual Assur, 2014; 27: 544–58. doi: 10.1108/ijhcqa-07-2013-0082.
9- Mosadeghrad AM. Why TQM programs fail? A pathology approach. The TQM Journal, 2014; 26: 160–87. doi: 10.1108/tqm-12-2010-0041.
10- Mosadeghrad AM, Ferdosi M, Afshar H, Hosseini-Nejhad M. The impact of top management turnover on quality management implementation. Med Arch, 2013; 67: 134–40. doi: 10.5455/medarh, 2013; 67: 134-140.
11- Mosadeghrad AM. Sokhanvar M. An evaluation of quality of services in Tehran Hospitals using the HEALTHQUAL model. Journal of Medical Council of Iran, 2017; 25(1): 9-19. URL: http://jmciri.ir/article-1-2692-fa.html.
12- Kim J, Han W. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions. Osong Public Health Res Perspect, 2012; 3(2): 94–99. doi: 10.1016/j.phrp.2012.04.005
13- Ramezanian M R, Gheibdoust H. Prioritization of the Influential Factors on Health Care Services Quality Using a Hybrid Approach Based on Analytic Network Process (ANP) and Fuzzy TOPSIS in Public Hospitals. Jhosp, 2016; 15 (4) :79-93. URL: http://jhosp.tums.ac.ir/article-1-5566-fa.html
14- Kliger Alan S. Quality Measures for Dialysis: Time for a Balanced Scorecard. Clin J Am Soc Nephrol,. 2016; 11(2): 363–368. doi: 10.2215/CJN.06010615.
15- Tabibi S.J., Gohari M.R., Shahri S. Assessment of health care services in outpatient clinics based on SERVQUAL model in hospitals of Tehran. Payavard Salamat, 2012; 5(4): 49–56.
16- Wu HY, Fukuma S, Shimizu S, Norton EC, Tu YK, Hung KY, Chen MR, Chien KL, Fukuhara S. Effects of Higher Quality of Care on Initiation of Long-term Dialysis in Patients With CKD and Diabetes. Am J Kidney Dis, 2017; 70(5): 666-674. doi: 10.1053/j.ajkd.2017.05.020.
17- Plantinga Laura C., Pastan Stephen O., Wilk Adam S. Referral for Kidney Transplantation and Indicators of Quality of Dialysis Care: A Cross-sectional Study. Am J Kidney Dis, 2017; 69(2): 257–265. doi: 10.1053/j.ajkd.2016.08.038.
18- Joshi U, Subedi R, Poudel P, Ram Ghimire P, Panta S, Raj Sigdel M. Assessment of quality of life in patients undergoing hemodialysis using WHOQOL-BREF questionnaire: a multicenter study. Int J Nephrol Renovasc Dis, 2017; 10: 195–203. doi: 10.2147/IJNRD.S136522
19- Havas Beigi F, Ahmadi A, Yas Bolaghi B, Sharahi M. A Survey of the Quality of the Provided Services by Public Hospitals of Ilam and Kermanshah city to the Out-Patients on the Basis of SERVQUAL Model (Text in Persian) Ilam University of Medical Science, 2013; 21(4): 207–14.
20- Teerawattananon Y, Luz A, Pilasant S, Tangsathitkulchai S.How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings? Health Res Policy Syst, 2016; 14: 21. doi: 10.1186/s12961-016-0090-7.
21- Niihata K, Fukuma S, Akizawa T, Fukuhara S. Association of coping strategies with mortality and health-related quality of life in hemodialysis patients: The Japan Dialysis Outcomes and Practice Patterns Study. PLoS One, 2017; 12(7): e0180498. doi: 10.1371/journal. pone. 018049
22- Ajam M, Sadeghifar J, Anjomshoa M, Mahmoudi S, Honarvar H, Mousavi S M. Assessing Quality of Healthcare Service by the SERVQUAL Model: A Case Study of a Field Hospital. J Mil Med, 2014; 15(4): 273-279. URL: http://militarymedj.ir/article-1-1088-fa.html.
23- Bakhteari Z, Hanifi N, Amini K, Jafari Varjoshani N. Quality of Nursing Services in Dialysis Center of Valiasr Hospital in Zanjan from Nurses and Patients' Viewpoint Using the SERVQUAL Model. IJN, 2018; 31(113): 18-29.URL: http://ijn.iums.ac.ir/article-1-2696-fa.htm.
24- Nadi A, Shojaee J, Abedi G, Siamian H, Abedini E, Rostami F. Patients’ Expectations and Perceptions of Service Quality in the Selected Hospitals. Med Arch, 2016; 70(2): 135–139. doi: 10.5455/medarh, 2016; 70: 135-139.
25- Mohebifar R, Hasani H, Barikani A, Rafiei S. Evaluating Service Quality from Patients' Perceptions: Application of Importance–performance Analysis Method. Osong Public Health Res Perspect, 2016; 7(4): 233–238. doi: 10.1016/j.phrp.2016.05.002.
26- Shafiee M, Ghafoori M H, Aboee F, Forootan S, Arab M. Evaluation of Delivered Services among Selected Hospital Wards: A Case Study Using Multiple Criteria Decision Making Methods (MCDM) . jhosp, 2016; 15(4): 95-102. URL: http://jhosp.tums.ac.ir/article-1-5389-fa.html
27- Mosadeghrad AM. Factors influencing healthcare service quality. Int J Health Policy Manag, 2014; 3: 77–89. doi: 10.15171/ijhpm.2014.65.
28- Nooronessa R, Rezaeeian S, Saghaayee A, Assessing the quality of health care services in the emergency ward of the hospital based on patients' rights (a cross-sectional study), Journal of Medical Ethics, 2013, 7(23): 161-185.[Persian]
29- Sohn M, Choi M. Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study. Osong Public Health Res Perspect, 2017; 8(5): 332–341. doi: 10.24171/j.phrp.2017.8.5.07.
30- Weisbord SD. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life. Semin Dial, 2016; 29(2): 158-64. doi: 10.1111/sdi.12464.
31- Bobocea L, Gheorghe IR, Spiridon St, Gheorghe CM, Purcarea VL. The management of health care service quality. A physician perspective. J Med Life, 2016; 9(2): 149–152.
32- Bakarman MA, Alghamdi HA, Alraddadi RM. Quality of healthcare for hemodialysis patients in various health sectors in Jeddah, Saudi Arabia. Ann Saudi Med, 2015; 35(4): 288-92. doi: 10.5144/0256-4947.2015.288.
33- Papanikolaou V, Zygiaris S. Service quality perceptions in primary health care centres in Greece. Health Expect, 2014; 17(2): 197-207. doi: 10.1111/j.1369-7625.2011.00747.x.
34- Chakravarty A. Evaluation of service quality of hospital outpatient department services. Med J Armed Forces India, 2011; 67(3): 221–224. doi: 10.1016/S0377-1237(11)60045-2.
35- Grangé S, Hanoy M, Le Roy F, Guerrot F, Godin M. Monitoring of hemodialysis quality-of-care indicators: why is it important? BMC Nephrol, 2013; 14: 109. doi: 10.1186/1471-2369.
36- Estaki R, Atafar A, Quality of nursing services (status and expected status) using SERVQUAL model from nurses' point of view in al-Zahra hospital in Isfahan (2010), Modern Care Journal, 2012, 9(2): 72-79. [Persian]
37- Amini M, Farjam S, Survey on Quality of Services in the Public Sector (Case Study: Isfahan University of Medical Sciences affiliated hospitals), Sterategic Management Thought, 2009, 3(1): 165-189. [Persian]