title: Application of Quality Assurance Strategies in Diagnostics and Clinical Support Services in Iranian Hospitals.
abstract: BACKGROUND
  Iran has a widespread diagnostics and clinical support services (DCSS) network that plays a crucial role in providing diagnostic and clinical support services to both inpatient and outpatient care. However, very little is known on the application of quality assurance (QA) policies in DCSS units. This study explores the extent of application of eleven QA strategies in DCSS units within Iranian hospitals and its association with hospital characteristics.
  
  
  METHODS
  A descriptive cross-sectional study was conducted in 2009/2010. Data were collected from 554 DCSS units among 84 hospitals.
  
  
  RESULTS
  The average reported application rate for the QA strategies ranged from 57%-94% in the DCSS units. Most frequently reported were checking drugs expiration dates (94%), pharmacopoeia availability (92%), equipment calibration (87%) and identifying responsibilities (86%). Least reported was external auditing of the DCSS (57%). The clinical chemistry and microbiology laboratories (84%), pharmacies, blood bank services (83%) reported highest average application rates across all questioned QA strategies. Lowest application rates were reported in human tissue banks (50%). There was no significant difference between the reported application rates in DCSS in the general/specialized, teaching/research, nonteaching/research hospitals with the exception of pharmacies and radiology departments. They reported availability of a written QA plan significantly more often in research hospitals. Nearly all QA strategies were reported to be applied significantly more often in the DCSS of Social Security Organization (SSO) and private-for-profit hospitals than in governmental hospitals.
  
  
  CONCLUSIONS
  There is still room for strengthening the managerial cycle of QA systems and accountability in the DCSS in Iranian hospitals. Getting feedback, change and learning through application of specific QA strategies (eg, external/internal audits) can be improved. Both the effectiveness of QA strategies in practice, and the application of these strategies in outpatient DCSS units require further policy attention.
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.|Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Asgar
authors.initials: A
authors.lastname: Aghaei Hashjin
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.
authors.forename: Dionne
authors.initials: D
authors.lastname: Kringos
authors.affiliation: Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ravaghi
authors.affiliation: Department of Quality Improvement, Tehran Heart Center Hospital, Tehran, Iran.
authors.forename: Jila
authors.initials: J
authors.lastname: Manoochehri
authors.affiliation: Department of Health Services Management, School of Health Services Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Hassan Abolghasem
authors.initials: HA
authors.lastname: Gorji
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.
authors.forename: Niek S
authors.initials: NS
authors.lastname: Klazinga
mesh_terms: D003430:Cross-Sectional Studies; D006302:Health Services Research; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007492:Iran; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards*
keywords: Diagnostics and Clinical Support Services (DCSS); Hospital; Iran; Quality Assurance (QA) Strategy; Quality Improvement