After the implementation of Common Assessment Framework (CAF) – a useful quality tool – in the ICU of General Hospital of Trikala from 2012 up to 2015, we integrated the first cycle of self assessment and we present our results and conclusions of the past 3-year-period (2012- 2013 -2014). We analyzed CAF, FS- ICU 24, TISS-28 and Burn out syndrome questionnaires and medical indicators as Standardized mortality rate (SMR), Length of Stay (LOS), Standardized Resource Use (SRU), SMR/SRU, Therapeutic intervention scoring system (TISS-28), TISS-28/days of hospitalization, Nurse/Patient ratio, cost indicators and mortality. Analyzing the CAF questionnaire the score was 2.5-3.5, counting the indicator TISS-28 we found an average value higher than 50, concerning the burn-out syndrome questionnaire it was found that 58.82% of the respondent employees working in the ICU had mild symptoms of the syndrome. We analyzed the true Level of ICU (TISS-28/days of hospitalization) with the Level of ICU (nurse /patient ratio) and we found that they were not alike. We found an increase of mortality rate and LOS (length of stay) during the period of 2011 –2015 but a gradual reduction of the SMR/SRU indicator (the whole period ≤ 1) and a decline of the average cost/ patient and the average cost/ day of hospitalization.

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At 2012 the ICU of General Hospital of Trikala has registered as CAF user in the CAF database. With this quality management instrument, public sector organizations improve their performance by recognizing weaknesses and by promoting strong points. The purpose of using CAF protocols is to improve the quality of provided Health services. For the implementation of CAF we used specialized questionnaires such as: CAF questionnaire, family satisfaction (FS- ICU 24), questionnaire concerning nursing care (TISS - 28) and about fatique of personnel (Burn-out questionnaire). Also, indicators such as observations of mortality in relationship with the cost (SMR/SRU), Bacteraemias, V.A.P (Ventillation associated pneumonia), and the effectiveness of nurse project (Level of ICU) have been used. The design of CAF protocol implementation was adjusted, as structure, according to the data of our ICU. General Indicators concerning Public sector administration have been used but also specialized indicators concerning ICU output, mortality rate, infections and cost. Undergoing this project by using the CAF quality instrument the target is to identify fields were effective functioning was observed (strong points) and fields that need improvement (weak points). The purpose is, throughout self assesment evaluation but also with Bench-marking with other ICUs, to improve the provided health services from the ICU of General Hospital of Trikala.

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Access to appropriate and high quality health care is one of the most important ways to reduce maternal and infant mortality. This study evaluates the quality of care during childbirth, the effective factors, and promoting strategies in Lorestan province, Iran. This research is a mixed explanatory study (i.e., quantitative and qualitative). The quantitative part is descriptive-analytic. The quality of 200 care processes during childbirth was assessed in the health centers of the province. The data were gathered through the checklists prepared according to the guidelines of the Iranian Ministry of Health. Statistical analysis was performed using SPSS software. In the qualitative part, the strategies for solving the problem were assessed through interviews with service providers, maternity administrators, and senior decision-making university officials. According to our results, the levels of care quality during childbirth were intermediate in all four phases. The lowest levels of quality in the first, second and third stages were associated with Leopold's maneuver, hand washing and pulse control, respectively. Based on the interviews, the main reasons for the reduction of care quality include lack of staff’s motivation, overcrowding and shortage of nursing workforce, low attention of officials to the Department of Midwifery, and the high burden of writing in the maternity. To improve the quality of services, the authorities in Lorestan University of Medical Sciences propose strategies such as making some incentives for care promotion. Considering the quality of care during childbirth as intermediate in all four stages in the province and investigation of the reasons indicating the lack of sufficient incentive in midwives, it is recommended that strategies such as financial incentives, greater use of private sector to reduce public sector workload, quality increase and further use of in-service training to improve the quality of services be adopted.

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