Quality improvement in the surgery‑related processes: Managerial challenges and solutions from hospitals of Iran
نویسندگان
1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
2 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
3 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
doi
چکیده
BACKGROUND: There is a growing global movement toward quality and safety in healthcareand quality improvement (QI) in general surgery. The first step in any QI initiative is identifying thechallenges and barriers to achieve such goals and then to define appropriate actions. This studyaims to provide an overview of the QI challenges in Iranian hospitals’ surgery‑related processes andsuggest applied solutions accordingly.METHODS: This is a sequential (qual‑quant) mixed‑method study from November 2019 to January2020, involving 21 face‑to‑face interviews with hospital managers, quality officers, and surgery‑relatedclinicians and staff, followed by a Delphi consensus‑seeking stage to finalize solutions. MAXQDAsoftware was applied for organizing the concepts, and thematic content analysis was used foranalyzing the data as an inductive approach to extract the emerging themes and sub‑themes.RESULTS: The managerial problems were classified into four groups of (I) defects and delays incompleting patient medical records, (II) irregularity and the lack of transparency in the direction ofprocesses in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poorsafety considerations. The proposed solutions included imposing stricter regulations for competingfor medical records, such as reduction of payments, development of guiding brochures or protocolsfor patients on their arrival, assigning a certain number of experienced nurses and surgeons forschedule management, rewarding the report of medical and surgical error cases, and developing aregular monitoring program for the proper implementation of surgical safety guidelines.CONCLUSION: There are various managerial barriers that hamper QI in hospitals’ surgery‑relatedprocesses. Implementing simple but agreed solutions can lead to saving patients’ lives, reduction ofthe unnecessary use of resources, and enhance of patient and staff satisfaction.
