نشریه علمی پژوهشی طب انتظامی Journal of Police Medicine
Volume 12, Issue 1 (2023)
J Police Med 2023, 12(1) |
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Adish M A, Alikhan Gorgani R, KiaKojouri K. Organizational Excellence Status of Iranian Hospitals with Emphasis on EFQM Model: A Meta-Analysis Study. J Police Med 2023; 12 (1) : e6
URL: http://jpmed.ir/article-1-1155-en.html
URL: http://jpmed.ir/article-1-1155-en.html
1- Department of Public Administration, Rasht Branch, Islamic Azad University, Rasht, Iran
2- Department of Public Administration, Rasht Branch, Islamic Azad University, Rasht, Iran , aruhollah@yahoo.com
3- Department of Public Administration, Bandar Anzali Branch, Islamic Azad University, Bandar Anzali, Iran
2- Department of Public Administration, Rasht Branch, Islamic Azad University, Rasht, Iran , aruhollah@yahoo.com
3- Department of Public Administration, Bandar Anzali Branch, Islamic Azad University, Bandar Anzali, Iran
English Extended Abstract: (1173 Views)
Aims: Monitoring the performance of health care systems is a vital requirement for improving the quality of health care services. This review research was conducted on the results of recent studies in the field of organizational excellence in Iranian hospitals that were conducted with the EFQM model.
Materials and Methods: The current research was conducted in 2022 to review the articles published in Persian and English journals available in SID, Google Scholar, ProQuest, PubMed, Elsevier, ISI, Scopus, IranMedex, Science Direct, Spring, and CIVILICA related to the last 15 years. Articles were searched using the keywords of organizational excellence, performance assessment or evaluation, EFQM, hospital, and health system or their Persian equivalent. Information sources were analyzed based on qualitative analysis and meta-analysis using "Metafor version 3.8-1" and "Meta version 6.1-0" packages in the R programming language.
FINDINGS: In general, in the investigated period, 14 studies dealt with organizational excellence in hospitals, one of which was devoted to the qualitative study of organizational excellence and 13 to the quantitative evaluation of organizational excellence. Out of 13 studies, two studies were only limited to the evaluation of enablers. The articles' specifications and the quantitative results of organizational excellence components were presented (2006 to 2021) in Tables 2 and 3. Examining the time trend of studies shows that organizational excellence has not been a topic of interest to researchers in recent years, and no growing trend was observed in relation to the number of articles. Figure 2 is the forest diagram for the meta-analysis results of organizational excellence values on 13 studies. The overall estimate of the organizational excellence index for the mentioned studies was equal to 533 in the 95% confidence interval (464-602). In addition, the weight of each of the mentioned studies in the overall estimate of the analysis was reported as a percentage, and the two studies by Malekzadeh et al. [19] and Motaghi et al. [20] had the highest weight in the final result of this analysis with weights of 12.48 and 11.84, respectively (the large and bold square shape inside the confidence interval lines indicates the greater weight of that study). The index of organizational excellence in these studies varied between 367 and 700, and the range of changes based on random effects in the meta-analysis was estimated at 63%, indicating relatively significant changes among studies. This heterogeneity was also statistically significant (Q=37.5, P-value<0.001, I²=62.6%).
The funnel diagram was used to check the publication bias in the meta-analysis in Figure 3. This graph shows that 3 of the 13 analyzed studies showed publication bias with 95% confidence and Egger's test (p-values <0.05). Notably, all three mentioned studies had a higher sample size than others, and the estimated effect in the two cases was lower and in one case was higher than the overall effect estimated in the meta-analysis. The score of the enablers dimension was equal to 500, therefore the index obtained for this dimension of organizational excellence in different studies was divided by 500 to obtain the desired effect size of the analysis as a ratio of the total score. Sixteen studies reported the enablers index score that was used for analysis. The total estimated value for enablers was equal to 276. Also, the amount of heterogeneity in the report of this index was estimated to be equal to 78%, which showed a statistically significant heterogeneity (p<0.001). Therefore, this heterogeneity in the report of the enablers index was evaluated as very severe (Figure 4). The score of the dimension of the results was equal to 500, therefore the index obtained for this dimension of organizational excellence in different studies was divided by 500 to obtain the desired effect size of the analysis as a ratio of the total score. Thirteen studies reported results index scores that were used for analysis. The total estimated value for the results was equal to 246. Also, the amount of heterogeneity in the report of this index was estimated to be 59%, which shows a statistically significant heterogeneity (p=0.001). Therefore, this heterogeneity in the results index report in different studies was evaluated at an average level (Figure 5). To investigate the publication bias in the enablers dimension report, according to the respective Funnel charts, the reports of 6 studies were beyond the range of 95% changes, which exactly the same 3 of the studies that showed the publication bias of the total organizational excellence index (Figure 4) were repeated in this list (Figure 6). To check the publication bias in the results dimension report, according to the relevant Funnel charts, only 3 studies were out of this range, which were exactly the same studies that had publication bias in the total organizational excellence index (Figure 7).
Conclusion: The state of organizational excellence in hospitals indicates the need to review the requirements for establishing clinical governance and accreditation systems, focusing on the dimensions of organizational excellence to improve the quality of healthcare services.
Clinical & Practical Tips in POLICE MEDICINE: The results of the current research indicated that the level of service quality of hospitals in the country is not in a favorable condition. In addition, the lack of studies in the field of performance evaluation of the police hospitals was evident. Therefore, studies based on the evaluation of the level of service quality of the police hospitals should be carried out in order to achieve organizational excellence with the aim of improving employee motivation, increasing patient satisfaction, and ultimately improving the level of physical and mental health of the police personnel.
Acknowledgments: The present study is obtained from the doctoral thesis of the first author. The article's authors sincerely thank all those who have cooperated in the implementation of the research.
Conflict of Interest: The article's authors stated that there is no conflict of interest in the present study.
Authors Contribution: Mohammad Ali Adish, presentation of the idea and design of the study, data collection, data analysis; Ruhollah Alikhan Gorgani, presentation of the idea and design of the study, data analysis; Karim Kiakajuri, presentation of the idea and design of the study. All authors have participated in the initial writing of the article and its revision, and all of them accept the responsibility for the accuracy and correctness of the article's contents with the final approval of this article.
Funding Sources: This article was written without any financial support.
Table 1) An example of the search algorithm used in the Scopus database
Figure 1) Steps of selecting articles
Table 3) Quantitative evaluation results of organizational excellence components in studies
Figure 2) Forest diagram of values of organizational excellence in Iranian hospitals
Figure 3) Funnel diagram of bias in the publication of organizational excellence studies in Iranian hospitals
Figure 4) Forest diagram of values of organizational excellence in the dimension of enablers in Iranian hospitals
Figure 5) Forest diagram of values of organizational excellence in the dimension of results in Iranian hospitals
Figure 6) funnel diagram of bias in the dimension of enablers in organizational excellence studies of Iranian hospitals
Figure 7) Bias funnel diagram in the dimension of results in organizational excellence studies of Iranian hospitals
Materials and Methods: The current research was conducted in 2022 to review the articles published in Persian and English journals available in SID, Google Scholar, ProQuest, PubMed, Elsevier, ISI, Scopus, IranMedex, Science Direct, Spring, and CIVILICA related to the last 15 years. Articles were searched using the keywords of organizational excellence, performance assessment or evaluation, EFQM, hospital, and health system or their Persian equivalent. Information sources were analyzed based on qualitative analysis and meta-analysis using "Metafor version 3.8-1" and "Meta version 6.1-0" packages in the R programming language.
FINDINGS: In general, in the investigated period, 14 studies dealt with organizational excellence in hospitals, one of which was devoted to the qualitative study of organizational excellence and 13 to the quantitative evaluation of organizational excellence. Out of 13 studies, two studies were only limited to the evaluation of enablers. The articles' specifications and the quantitative results of organizational excellence components were presented (2006 to 2021) in Tables 2 and 3. Examining the time trend of studies shows that organizational excellence has not been a topic of interest to researchers in recent years, and no growing trend was observed in relation to the number of articles. Figure 2 is the forest diagram for the meta-analysis results of organizational excellence values on 13 studies. The overall estimate of the organizational excellence index for the mentioned studies was equal to 533 in the 95% confidence interval (464-602). In addition, the weight of each of the mentioned studies in the overall estimate of the analysis was reported as a percentage, and the two studies by Malekzadeh et al. [19] and Motaghi et al. [20] had the highest weight in the final result of this analysis with weights of 12.48 and 11.84, respectively (the large and bold square shape inside the confidence interval lines indicates the greater weight of that study). The index of organizational excellence in these studies varied between 367 and 700, and the range of changes based on random effects in the meta-analysis was estimated at 63%, indicating relatively significant changes among studies. This heterogeneity was also statistically significant (Q=37.5, P-value<0.001, I²=62.6%).
The funnel diagram was used to check the publication bias in the meta-analysis in Figure 3. This graph shows that 3 of the 13 analyzed studies showed publication bias with 95% confidence and Egger's test (p-values <0.05). Notably, all three mentioned studies had a higher sample size than others, and the estimated effect in the two cases was lower and in one case was higher than the overall effect estimated in the meta-analysis. The score of the enablers dimension was equal to 500, therefore the index obtained for this dimension of organizational excellence in different studies was divided by 500 to obtain the desired effect size of the analysis as a ratio of the total score. Sixteen studies reported the enablers index score that was used for analysis. The total estimated value for enablers was equal to 276. Also, the amount of heterogeneity in the report of this index was estimated to be equal to 78%, which showed a statistically significant heterogeneity (p<0.001). Therefore, this heterogeneity in the report of the enablers index was evaluated as very severe (Figure 4). The score of the dimension of the results was equal to 500, therefore the index obtained for this dimension of organizational excellence in different studies was divided by 500 to obtain the desired effect size of the analysis as a ratio of the total score. Thirteen studies reported results index scores that were used for analysis. The total estimated value for the results was equal to 246. Also, the amount of heterogeneity in the report of this index was estimated to be 59%, which shows a statistically significant heterogeneity (p=0.001). Therefore, this heterogeneity in the results index report in different studies was evaluated at an average level (Figure 5). To investigate the publication bias in the enablers dimension report, according to the respective Funnel charts, the reports of 6 studies were beyond the range of 95% changes, which exactly the same 3 of the studies that showed the publication bias of the total organizational excellence index (Figure 4) were repeated in this list (Figure 6). To check the publication bias in the results dimension report, according to the relevant Funnel charts, only 3 studies were out of this range, which were exactly the same studies that had publication bias in the total organizational excellence index (Figure 7).
Conclusion: The state of organizational excellence in hospitals indicates the need to review the requirements for establishing clinical governance and accreditation systems, focusing on the dimensions of organizational excellence to improve the quality of healthcare services.
Clinical & Practical Tips in POLICE MEDICINE: The results of the current research indicated that the level of service quality of hospitals in the country is not in a favorable condition. In addition, the lack of studies in the field of performance evaluation of the police hospitals was evident. Therefore, studies based on the evaluation of the level of service quality of the police hospitals should be carried out in order to achieve organizational excellence with the aim of improving employee motivation, increasing patient satisfaction, and ultimately improving the level of physical and mental health of the police personnel.
Acknowledgments: The present study is obtained from the doctoral thesis of the first author. The article's authors sincerely thank all those who have cooperated in the implementation of the research.
Conflict of Interest: The article's authors stated that there is no conflict of interest in the present study.
Authors Contribution: Mohammad Ali Adish, presentation of the idea and design of the study, data collection, data analysis; Ruhollah Alikhan Gorgani, presentation of the idea and design of the study, data analysis; Karim Kiakajuri, presentation of the idea and design of the study. All authors have participated in the initial writing of the article and its revision, and all of them accept the responsibility for the accuracy and correctness of the article's contents with the final approval of this article.
Funding Sources: This article was written without any financial support.
Table 1) An example of the search algorithm used in the Scopus database
| TITLE-ABS-KEY(“organizational excellence”) OR TITLEABS-KEY(“performance evaluation”) OR TITLEABS-KEY(“EFQM”) AND TITLE-ABS-KEY(“hospital”) AND TITLEABS-KEY(“health system”) AND PUBYEAR > 2006 AND (LIMIT-TO (DOCTYPE, “ar”) OR LIMIT-TO (DOCTYPE, “re”)) AND (LIMIT-TO (LANGUAGE, “English”)) AND (LIMIT-TO (SRCTYPE, “j”)). |
Figure 1) Steps of selecting articles
Table 2) A summary of the final reviewed studies
| Row | Authors/year/reference | Type of study | Title | Number and statistical population | Data collection tool |
| 1 | Hashemi et al./2016/[30] | qualitative | Examining the explanation of the model of human resource empowerment and organizational excellence among the emergency workers of Gilan, Iran universities hospitals | 195 people from emergency units of Rasht University hospitals | EFQM Organizational Excellence Standard Questionnaire |
| 2 | Maleki and Izadi/2007/[41] | quantitative | The status of enablers in Tehran's social security hospitals based on the model of organizational excellence | 15 managers and experts in each hospital | EFQM Organizational Excellence Standard Questionnaire |
| 3 | Kalhor et al./2010/[24] | quantitative | Performance evaluation of Qazvin Shahid Rajaei Hospital based on EFQM organizational excellence model EFQM | 60 hospital managers | EFQM Organizational Excellence Standard Questionnaire |
| 4 | Tabatabai et al./2011/[42] | quantitative | Performance evaluation of Mehr hospital in Mashhad based on EFQM organizational excellence model | 48 hospital managers | EFQM Organizational Excellence Standard Questionnaire |
| 5 | Torabipour and Rekab Islamizadeh / 2011/ [25] | quantitative | Self-evaluation of EFQM organizational excellence model in selected hospitals of Ahvaz city in Iran | 50 managers in each hospital (including senior managers and their deputies, matrons and heads of units and departments) | Standard and valid self-assessment questionnaire of the European Quality Management Federation |
| 6 | Sadeghi and Hejazi/2012/[26] | quantitative | Self-evaluation of the performance of educational hospitals in Bojnord based on the EFQM model of organizational excellence | 18 members of the quality improvement committee in Imam Ali hospital and 8 members of the quality improvement committee in Imam Reza hospital in Bojnord city. | Standard performance evaluation questionnaire based on organization excellence model |
| 7 | Shahin and Sanayei/2012/[27] | quantitative | Evaluation of the performance of Shahid Sadouqi Hospital in Yazd based on the EFQM model of organizational excellence | A sample of 302 employees working in different departments of Shahid Sadoughi Hospital in Yazd | EFQM Organizational Excellence Standard Questionnaire |
| 8 | Parham et al./2012/[43] | quantitative | Performance evaluation of Shahid Beheshti Hospital in Qom based on EFQM organizational excellence model | 10 hospital managers | EFQM Organizational Excellence Standard Questionnaire |
| 9 | Eghbal et al./2013/[28] | quantitative | Areas of improvement based on the model of excellence in Imam Musa Kazem hospital. | 15 experts and senior managers of the hospital | EFQM Organizational Excellence Standard Questionnaire |
| 10 | Rahimi et al./2015/[29] | quantitative | Evaluation of Shahid Rahimi Khorramabad Hospital based on EFQM Organizational Excellence Model | 26 senior, middle, and basic managers of the hospital, including the hospital manager, hospital deputies according to the organizational chart, and managers of nursing units, human resources, financial affairs, performance evaluation, and IT | EFQM Organizational Excellence Standard Questionnaire |
| 11 | Asadi et al./2018/[44] | quantitative | Applying the EFQM model for performance evaluation (a case study in a public hospital) | 18 hospital employees | EFQM Organizational Excellence Standard Questionnaire |
| 12 | Malekzadeh et al./2019/[31] | quantitative | Performance evaluation of Imam Khomeini (RA) Hospital in Sari with organizational excellence model and operational planning approach | 33 people from the managers and supervisors of the hospital | EFQM Organizational Excellence Standard Questionnaire |
| 13 | Malekzadeh, et al./2020/[19] | quantitative | Examining and comparing hospital performance using "accreditation model", "organizational excellence model" and "program chain model" | 180 senior, middle and operational managers of five medical training centers under Mazandaran University of Medical Sciences | Iran Hospital Accreditation Questionnaire, EFQM Organizational Excellence Questionnaire, and Program Chain Model Questionnaire |
| 14 | Motaghi et al./2020/[20] | quantitative | Performance evaluation of the model of the European Foundation for Quality Management of Organizational Excellence of Shahid Beheshti Yasouj Hospital in Iran | 126 hospital employees |
| EFQM Organizational Excellence Standard Questionnaire |
Table 3) Quantitative evaluation results of organizational excellence components in studies
| Row | Authors/references | place of study |
توانمندسازها (۵۰۰) | نتایج (۵۰۰) | |||||||
| leadership (100) | Employees (90) | Policy and strategy (80) | process (140) | Partners and sources (90) | Employee results (90) | Customer results (200) | Community results (60) | performance results (150) | |||
| 1 | Maleki and Izadi/ [41] | Alborz Karaj Social Security Hospital | 41.6 | 40.75 | 40.5 | 85.5 | 41.5 | Not evaluated | |||
| Panzdah Khordad Varamin Hospital | 38.1 | 42.65 | 40.16 | 70 | 44.55 | ||||||
| 2 | Kalhor et al./[24] | Qazvin Shahid Rajaei Hospital | 35.08 | 30.69 | 27.17 | 50.52 | 40.53 | 22.48 | 75.64 | 21.14 | 64.45 |
| 3 | Tabatabai et al./[42] | Mehrshahr hospital of Mashhad | 40.7 | 47.2 | 32.3 | 54.2 | 54.8 | 43.5 | 81 | 25.1 | 90.01 |
| 4 | Torabipour and Rakab Islamizadeh/[25] |
Imam Ahvaz Hospital | 66.8 | 65.5 | 66 | 63.9 | 70.4 | 60.6 | 62.3 | 53.6 | 68.6 |
| Ahvaz Oil Hospital | 72.44 | 66.4 | 67.4 | 65.07 | 63.4 | 54.4 | 62.84 | 59.45 | 45.94 | ||
| 5 | Sadeghi and Hejazi/[26] |
Imam Ali Bojnord Hospital | 71 | 84 | 80 | 79 | 77 | 60 | 61.9 | 54.3 | 53 |
| Imam Reza Bojnord Hospital | 61 | 52 | 63 | 70 | 75 | 47 | 68 | 57 | 70 | ||
| 6 | Shahin and Sanayeei/[27] | Shahid Sadoughi Hospital, Yazd | 34.86 | 31.25 | 31.13 | 51.95 | 35.86 | Not evaluated | |||
| 7 | Parham et al./[43] | Shahid Beheshti Hospital, Qom | 48.4 | 43.8 | 35.9 | 65 | 44.6 | 34.8 | 84.3 | 26.4 | 67.3 |
| 8 | Eghbal et al | Imam Musa Kazem Hospital, Isfahan | 60 | 61 | 47 | 78 | 54 | 54 | 116 | 38 | 91 |
| 9 | Rahimi et al./[29] | Shahid Rahimi Hospital, Khorramabad | 78.69 | 64.22 | 61.53 | 93.9 | 65.62 | 54.78 | 141.1 | 35.2 | 105.1 |
| 10 | Asadi et al./[44] | One of Tabriz government hospitals | 73.6 | 54.1 | 46.8 | 59.8 | 41.9 | 23.76 | 66 | 40.2 | 71.35 |
| 11 | Malekzadeh et al./[31] | Imam Khomeini Hospital, Sari | 65.2 | 54.18 | 49.4 | 92.68 | 58.32 | 58.8 | 132 | 35.28 | 90.3 |
| 12 | Malekzadeh et al./[31] | 5 educational-therapeutic centers covered by Mazandaran University of Medical Sciences | 64.8 | 57.33 | 51.84 | 97.16 | 55.17 | 56.2 | 131.1 | 33.82 | 87.4 |
| 13 | Motaghi et al./[20] | Shahid Beheshti Yasouj Hospital | 35.08 | 30.69 | 27.17 | 50.52 | 40.53 | 22.48 | 75.64 | 21.14 | 64.45 |
Figure 2) Forest diagram of values of organizational excellence in Iranian hospitals
Figure 3) Funnel diagram of bias in the publication of organizational excellence studies in Iranian hospitals
Figure 4) Forest diagram of values of organizational excellence in the dimension of enablers in Iranian hospitals
Figure 5) Forest diagram of values of organizational excellence in the dimension of results in Iranian hospitals
Figure 6) funnel diagram of bias in the dimension of enablers in organizational excellence studies of Iranian hospitals
Figure 7) Bias funnel diagram in the dimension of results in organizational excellence studies of Iranian hospitals
Article number: e6
Article Type: Systematic Review |
Subject:
Police Medicine Management
Received: 2022/12/10 | Accepted: 2023/01/23 | Published: 2023/03/11
Received: 2022/12/10 | Accepted: 2023/01/23 | Published: 2023/03/11
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