الفهرس 
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Abstract
The performance of most organizations in developing countries is characterized by declining productivity, tensed medical staff, and dissatisfied patients. Improving the performance and the quality is therefore unquestionably, among the most important priorities of healthcare organizations and is an essential step towards achieving a better healthcare system. By improving the quality of care and performance, these healthcare organizations can continue improving the health status of people while not sacrificing too much of their material well-being in the process. The extent to which a healthcare organization tries to achieve higher standards in its practices reflects upon the quality of its services.
Hospital performance is a complex issue affected by the interaction of many factors. This concept includes some dimensions such as effectiveness, efficiency, safety, patient-centeredness, management practices, and human resources. Sub-dimensions and indicators for each dimension are determined from the literature. For that, (Nikjoo et al., 2013) reported that in an organization, a lack of a multidimensional assessment system is considered a disease.
The issues of performance and factors affecting it are not adequately addressed in Egypt. Therefore, it is necessary to generate relevant evidence through a detailed case study examining the performance of one of the government hospitals in the Cairo governorate and evaluate it after the effect of some corrective interventions to guide the studied hospital managers to continue developing strategies for improving hospital performance. This research argues that hospital performance can be measured by measuring both patient’s and health care workers’ (HCWs) perceptions because the delivery of services is mainly dependent on the patients and the employees. The evidence from this study could also feed into developing a new performance appraisal system.
The specific objectives of the current study were: to measure the Mabra Misr Al-Qadima hospital performance based on the opinion of a group of patients and a group of its health care workers before the correction interventions, to measure the patients’ and HCWs’ satisfaction before the correction intervention, to implement quality improvement interventions, and to measure the effectiveness of these interventions by re-evaluation of both the hospital performance and the satisfaction from the perspective of both patients and hospital health care workers.
This study used the case study methodology which followed a quasi - experimental design on two separate samples of patients to achieve the objectives among them and a pre-post follow up design among the HCWs group. Patients with acute illnesses, difficult physical or mental communication, and those refusing to give consent were excluded from the study and also the HCWs employed for less than one year. A convenient non-random sample technique was used to select participants of both populations; patients (n=422) and HCWs (n=204). Two structured Arabic questionnaires were used by the researcher to collect the data ; one for the hospital performance assessment and the second for the participants’ satisfaction. Responses of both questionnaires were ranged from “ strongly agree” to “ strongly disagree” in a 5 a five-point Likert scale with weights of the responses ranged from 5-1 respectively. Questionnaires for the patients group were applied through interviews, while that for HCWs were self administered. After analysis of the pre-intervention data, a correction team including the hospital quality personnel, the hospital manager, the researcher, and the heads of the departments was performed. They met several times to put a group of improvement interventions. The project was funded by the Cairo Curative Organization (a non-profit organization). The team assumed 18 correction interventions. At the post-intervention data collection phase, only nine interventions were implemented and the others were started to implement. Suitable statistical analyses were used to describe and analyze the data using SPSS statistical package-version 24.
The results of the current thesis are present in three parts: Part I: Patients results; Pre intervention and Post intervention. Part II: Hospital Health Care Workers (HCWs) results; Pre intervention and Post intervention. Part III: Comparison between patients and health care workers results. As regard the patients’ group opinion before the intervention, the mean % from the maximum score of most dimensions and the total performance was around 25%. The mean percentages ranged from 15.8% for information management to 25.7% for drug management dimensions. The total performance was improved to 52.4% after the corrective interventions with the highest mean percent was for drug management dimension (64.6%) followed by the environmental safety measures (61.9%). Also, there was statistically significant improvement of the patients’ satisfaction with clear increase in the good level after the intervention in the expense of decreasing in both the poor and moderate levels. As regard the HCWs’ group opinion before the intervention, the total performance mean percent was 30.6% (significantly higher than that of the patients group), which was improved to 48.9% (insignificantly lower than the patients group) after the correction interventions. from the HCWs’ opinion, all the dimensions were improved except the organization management dimension. Similar to the patients group, the HCWs’ satisfaction score was significantly improved after the interventions. There was significant correlation between the total performance score and the satisfaction score in both groups at the pre and post intervention phases.
The study concluded that in the pre-intervention stage, the hospital performance was poorly perceived by both the patients and the health care workers which improved in most of the dimensions after the corrective interventions. Considering patients’ and physician’s perceptions of these dimensions provide an integrative overview of where improvements may be needed in the hospital. Among the dimensions which still needs much work are the patients’ rights , information management, health education, and organization management.
The researcher recommended the application of the other proposed corrective interventions in order to more improvement of the hospital performance and to design a performance measurement system aiming to improve the hospital performance, rather than to identify individual failures. This system should not rely on single sources of data but should use a range of information. Patients should be prominently involved, and the results of assessments should be transparent and freely accessible to the public.