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Additional file of Nurses’ perception of patient safety culture and its relationship with adverse events: a national questionnaire survey in Iran

Edris Kakemam,1 Mohammad Reza Rajabi,2 Pouran Raeissi,3 Lars Holger Ehlers4 1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Cardiology, Faculty of Medicine, Shahed University, Tehran, Iran; 3Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran; 4Danish Center for Healthcare Improvements, Institute of Business and Management, Faculty of Social Sciences, Aalborg University, Aalborg, DenmarkCorrespondence: Edris Kakemam Department of Health Management and Economics, School of Public HealthTehran University of Medical Sciences, Tehran, IranEmail edriskakemam@gmail.comPurpose: The hospital accreditation system in Iran is relatively young, having been introduced in 2012. Therefore, there is a real need for research on the status and impact of hospital accreditation in Iran. The purpose of this study was to evaluate and compare attitudes towards accreditation and quality improvement activities among hospital employees, specifically the attitudes towards the impact of accreditation on the quality of healthcare and its benefits in Iran.Materials and Methods: A cross-sectional survey was carried out at 23 teaching hospitals in three metropolises in Iran, all of which successfully passed national accreditation surveys. Some 1213 hospital managers, administrative staff, nurses, and para-clinical staff participated in the survey. The main outcome measures were quality results, and the activities related to quality improvement include senior managers’ commitment and support, strategic quality planning, education and training, rewards and recognition, quality management, use of data, the involvement of professionals in accreditation, and accreditation benefits. The questionnaire was applied using a 5-point Likert scale ranging from 1 “strongly disagree” to 5 “strongly agree”. One-way analysis of variance (ANOVA) was used to compare mean values between respondent groups.Results: Among nurses and managers, there was low support for accreditation and even less among para-clinical staff who fail to see accreditation having a positive impact on healthcare quality. Also, nurses’ attitudes toward the accreditation benefits were more positive compared with the two other groups. Staff stated that the main reasons for low support were a lack of education and training to act upon the accreditation survey results and a lack of management visibility and support for quality improvement.Conclusion: Improving quality through means of hospital accreditation is a complex process with high demands for management and employees. Questionnaires on employees’ attitudes and perceptions of the impact of accreditation and quality improvement-related activities in the hospitals can provide valuable information on the current problems of a hospital accreditation program.Keywords: accreditation, quality improvement, employees, surveys, Iran

Palliative care and terminal patients care centers have an important role in improving the physical and psychological state of the patient and their families and increasing their satisfaction and care providers. A literature search of online databases (PubMed, Scopus, Web of science, Cochrane library, and Google Scholar) was searched from January 1, 2000, to the end of April 2019, by using the appropriate English keywords. Furthermore, IranMedex, Barkat, and Magiran databases were searched for the Persian articles. We used Standards for Reporting Qualitative Research checklist to evaluate the articles quality. From 1328 articles, 166 were reviewed in depth with 13 satisfying our inclusion criteria. The findings of this study revealed a wide range of barriers and challenges to palliative care delivery. The identified barriers were: Cultural, social and organizational barriers, lack of resources, equipment and financing, attitudes and cultures, barriers related to the patient and the patient's family, related barriers providers, time and money, education, communication challenges, policies, insurance problems, safety, and crisis management. The results of the studies showed that there are various barriers and challenges such as economic, cultural, social, organizational, and communication related to palliative care. Given the identified barriers and challenges, it is suggested that to improve the delivery of palliative care, the health system policy-makers and planners consider a resource-appropriate and culturally appropriate framework for palliative care delivery.

INTRODUCTION: In the development perspective of each country, it is important to pay attention to the health sector and improve health indicators; therefore, planning in training and distribution of human resources in the health sector is an important factor to achieve the health system goals. The aim of this study was to investigate the effect of changes in health sector human resources on infant mortality rate (IMR), maternal mortality rate (MMR), and under-five mortality rate (U5MR) in Iran. METHODS: This was an econometric study (data panel) that conducted retrospectively and used data from the period 2006 to 2017 among Iranian provinces. Three regression models were used to determine the effect of health sector human resources (physicians, nurses, and paramedical staff) on the IMR, MMR, and U5MR. The random-effects model was selected over the fixed-effects model to assess the effect of health sector human resources on health outcomes. RESULTS: Results showed that the number of physicians in different models has a stronger impact on these mortality rates than those of nurses and paramedics, so that a 1% increase in the number of physicians leads to 2.1%, 3.8%, and 2.2% decrease in IMR, MMR, and U5MR, respectively. Furthermore, per capita income has a bigger impact on these mortality rates than human health resources. CONCLUSION: Increasing the number of human resources in the health sector, especially the number of physicians, by investing in these resources by providing educational facilities, plays an important role in improving the mothers’ and infants’ health indicators.