مدل مفهومی عامل بنیان برای سیستم ارزشیابی و اعتباربخشی بیمارستانی

هدف این مطالعه، ارایه مدل مفهومی عامل‌بنیان در سیستم اعتباربخشی بیمارستانی ایران از طریق پژوهش های کیفی می‌باشد. برای تدوین مدل مفهومی عامل‌بنیان از مدل داده‌بنیاد استفاده شد. از طریق رویکرد ترتیبی و سیستماتیک، مدل داده‌بنیاد ایجاد و سپس به کمک آن، نمودار حالت بدست آمد. با استفاده از نمودار حالت، نمونه‌گیری‌های اولیه، مرور سیستماتیک منابع و مصاحبه‌ها، 9 عامل مفهومی «سازمان‌های حاکمیتی، مدیریت و رهبری، پرسنل بالینی، پرسنل پشتیبان، زیرساخت‌های بیمارستان، ارزیابان، استانداردها، روش ارزیابی و گیرنده خدمت» شناسایی شدند. سپس مدل مفهومی عامل‌بنیان، محیط، قوانین رفتاری عامل‌ها و تعاملات ورودی و خروجی آنها، ارایه گردید. جهت اعتبارسنجی مدل مفهومی عامل‌بنیان، عامل‌ها و تعامل‌های آنها، از روش دلفی‌فازی با اعداد فازی مثلثی استفاده شد. مدل مفهومی عامل‌بنیان حاصل این پژوهش، می‌تواند زیربنای مطالعاتی مناسبی را برای روندهای شبیه‌سازی محیط و ایجاد سیستم هوشمند و چندعاملی اعتباربخشی بیمارستانی در جهت ارایه رهنمودهای بهره‌ورانه به کارگزاران مربوطه ایجاد نماید. مربوطه ایجاد نماید.

providing agent based conceptual model for the hospital evaluation and accreditation system

the aims of this study is to provide a conceptual model of hospital accreditation in iran through qualitative research. the grounded theory model was compiled using the results of the analysis of the interviews. then, with the help of the grounded theory model and the results of qualitative analysis, a state diagram was obtained. using the state diagram, initial sampling, systematic review of sources and results of interviews, 9 conceptual agents &governance organizations, management and leadership, clinical personnel, support personnel, hospital infrastructure, assessor, standards, assessment method and service recipient& were identified. finally, the conceptual model of agent based, environment, behavioral rules of agents and their input and output interactions was presented. in future researches, reinforcement learning models can be designed according to the conceptual model of this study, so that by using it, software developers can develop a suitable framework for solving complex problems in the field of hospital accreditation. because the field of hospital management systems is one of the desirable types of socio technical systems that have high capacities.introductionthe ecosystem of hospital accreditation is a triangle with “standard, accreditation method, and accreditation assessors” sides (mosadeghrad et al.,2017). hospital accreditation in iran has faced challenges, the most important of which are: “a large number of standards and measures, lack of transparency and ambiguity in the measures, incompleteness and defects in the standards and high emphasis on structure and documentation, lack of systemic thinking and following that, a lot of focus on the sectoral approach” (mosadeghrad ghazanfari, 2020). the results of a systematic review of sources and documents indicate that as a result of the lack of new approaches to solving “social technical” problems such as “use of agent based systems”, the above mentioned challenges have become more prominent and ultimately cause the credibility and ranking of hospitals to become unrealistic (ghazanfari et al., 2021). this study aims to present new models such as the agent based conceptual model in iran’s hospital accreditation system. this model will create a study foundation for the environmental simulation process and the creation of a multi agent hospital accreditation system to provide useful guidelines to the relevant policymakers.therefore, it seems that the result of the current research covers the research gap in this field to some extent. also, this study aims to answer the main research question; “what are the rules, position, behavior, and relationships of each of the agents in the multi agent hospital accreditation system and how are they formulated?” it has started working.literature reviewhospital accreditationhospital accreditation is the process of systematic evaluation and determination of hospital credit by an external organization using the desired structural, process, and outcome standards (chehrzad et al., 2019).figure 1. the main elements of the hospital accreditation system, source: (mosadeghrad ghazanfari, 2021) figure 1 shows the main elements of the hospital accreditation system. the hospital accreditation system is a triangle that includes the sides of “standard, accreditation method, and accreditation assessors”. the governance element is the regulator and controller of the sides of this triangle.agent based systemsthe agent based system can be used to solve problems that are difficult or impossible to solve for a “single agent” or an integrated system. agent based systems provide new methods for solving complex computing problems and implementing social technical software projects (dorri et al.., 2018). the elements of agent based systems are: “environment, objects, a set of agents, a set of relationships, and a set of agent behaviors” (bonabeau, 2002).research backgroundtable 1 shows the summary report of the background of the most important research conducted in the fields of hospital accreditation and agent based models.table 1. summary report of the background of the researchsummary of study resultsresearchera comprehensive hospital accreditation model was developed and validated. paying attention to structures, processes, outcomes, and systemic thinking during model development is one of the advantages of this study.(mosadeghrad ghazanfari, 2021)the challenges of hospital accreditation standards were categorized into two groups: standards development process and standards content.(ghazanfari et al., 2021)the identified agents describe the consumer’s impulse buying behavior as an economic analysis based on the relationship between the customer and the product.(abbasi siar et al., 2022)the multi agent model and process simulations provide useful information for generating strategies to reduce the risks of covid 19 transmission inside the facility.(cuevas, 2020)the results of the agent based simulation show the advantages of the proposed model for reducing the response time to requests compared to the current maintenance system.(yousefli et al., 2020)the proposed model of pre hospital management operation was presented. the identified agents are: “management center, ambulance, traffic station, medical service provider, patient, counseling center, national medical record system, and service quality monitoring”.(safdari et al., 2017)methodologyto collect data, library and field methods have been used. using qualitative analysis and obtained results, conceptual models were created. therefore, the approach of this research is of a hybrid type. also, the snowball sampling method was used to collect the required information. by using primary sampling, agents, the environment, and their relationships were extracted. by conducting six interviews, theoretical saturation was achieved regarding the conceptual model. to collect the information needed to know the elements and processes, a systematic review of sources and semi structured interviews were used. the interviewees were selected from among the professors, managers, and employees of the hospitals. finally, the interviews were summarized using grounded theory based methods, approaches, and systematic approaches. to calculate the reliability of the interviews, the method of two inter coder agreements was used. finally, the fuzzy delphi method with triangular fuzzy numbers was used to validate the extracted conceptual model.