Journal of Education and Health Promotion

Quality improvement in the surgery‑related processes: Managerial challenges and solutions from hospitals of Iran

Document Type : Original Article

Authors

. Tina Beyranvand 1
. Aidin Aryankhesal 2
. Asgar Aghaei Hashjin 3

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

Abstract
BACKGROUND: There is a growing global movement toward quality and safety in healthcare
and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the
challenges and barriers to achieve such goals and then to define appropriate actions. This study
aims to provide an overview of the QI challenges in Iranian hospitals’ surgery‑related processes and
suggest applied solutions accordingly.
METHODS: This is a sequential (qual‑quant) mixed‑method study from November 2019 to January
2020, involving 21 face‑to‑face interviews with hospital managers, quality officers, and surgery‑related
clinicians and staff, followed by a Delphi consensus‑seeking stage to finalize solutions. MAXQDA
software was applied for organizing the concepts, and thematic content analysis was used for
analyzing 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 in
completing patient medical records, (II) irregularity and the lack of transparency in the direction of
processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor
safety considerations. The proposed solutions included imposing stricter regulations for competing
for medical records, such as reduction of payments, development of guiding brochures or protocols
for patients on their arrival, assigning a certain number of experienced nurses and surgeons for
schedule management, rewarding the report of medical and surgical error cases, and developing a
regular monitoring program for the proper implementation of surgical safety guidelines.
CONCLUSION: There are various managerial barriers that hamper QI in hospitals’ surgery‑related
processes. Implementing simple but agreed solutions can lead to saving patients’ lives, reduction of
the unnecessary use of resources, and enhance of patient and staff satisfaction.

Keywords

Barriers and solutions
general surgery
hospital
operating rooms
operation room
quality improvement
surgical procedures
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Journal of Education and Health Promotion
Volume 10, Issue 11
November 2020
Pages 1-8

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