| Přispěvatelé: |
Klazinga, N.S., Kringos, D.S., Faculteit der Geneeskunde, Klazinga, Nicolaas S., Kringos, Dionne S., Public and occupational health |
| Popis: |
This thesis concentrates on the subject of quality assurance strategies in hospitals; exploring the development, implementation and impact of quality assurance (QA) methods in Iranian hospitals. A series of descriptive and analytical studies using qualitative and quantitative data were performed. The results show that the cycle of QA policies forms a tight QA system using a combination of mandatory and voluntary methods, however, their effectiveness, impact and maturity need to be improved. The analysis of the performance of 850 Iranian hospitals over seven successive years (2002-2008) showed that the Iranian hospital performance measurement program has had a positive impact on the performance of both general and specialized hospitals, however, the impact in the general hospitals was stronger than specialized hospitals. On average, 69% of hospital frontline staff reported using quality indicators in practice. They varied significantly in their reported use of organizational, clinical process and outcome quality indicators. The implementation of patient safety and patient-centeredness strategies reported 84% and 72% respectively by hospitals. The average reported application rate for the QA strategies in the Diagnostic and Clinical Support Services units ranged from 57-94% by the responsible persons for QA activities at these units. Despite a relatively widespread implementation of the majority of QA strategies for summative external accountability purposes in Iranian hospitals, there is still room for further improvement towards their formative internal quality and impact in practice. This may achieve by further maturing of the QA strategies and legally embedding them, strengthening standard setting, involvement of hospital staff in the development and implementation process of quality measures, and creating a feeling of shared ownership and an organizational culture of responsiveness to demands of patients. |
