الفهرس 
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Abstract
Summary br “Performance” could be defined in relation to explicit goals reflecting the values of various stakeholders (such as patients, professions, insurers, regulators). In reality, very few performance measurement systems focused on health outcomes valued by customers. “Measurement” implied objective assessment but does not itself included judgement of values or quality; these may be added by those who later presented and interpreted the data. At the system level, improvement in such areas as health priority setting, system planning, financing and resource allocation, professional recognition and overall quality management often became important aims of health reforms (Healy J- McKee M., 2002). br At the national level, many countries, such as Ireland (Dublin., 2001), Denmark (Copenhagen., 2002), the United Kingdom (NHS, 2002), developed frameworks for performance assessment and improvement. br At the European level much work had been done to summarize data on hospital performance and quality assurance policies in the European Union (Federal Ministry of Labour, Health and Social Affairs. 1998), accession states (Federal Ministry of Social Security and Generations. 2001) and other WHO Member States. General recommendations on the development and implementation of quality improvement systems in health care were made to health ministers by the Council of Europe in 1997 (Council of Europe. 1997), and best practices in the efficient and effective delivery of services were published by the European Commission in 1999 (Luxembourg: Office for Official Publications, 1999). br At the global level, findings concerning health systems performance measurement in 192 Member States were summarized in the WHO World Health Report 2000 (WHO. 2000). br Hospital performance may be defined according to the achievement of specified targets, either clinical or administrative (WHO. 1994). Ultimately, the goal of health care is better health, but there are many intermediate measures of both process and outcome. Objectives may be related to traditional hospital functions, such as diagnosis, treatment, care and rehabilitation as well as to teaching and research. However, both the definition and the functions of hospitals were changed, as emphasis shifted -#102;-#114;-#111;-#109; inpatient care to ambulatory care, community outreach programs and health care networks (Healy J- McKee M., 2002). br Hospital performance may thus be expected to include elements of community care and public health, as well as social and employment functions. These dimensions of hospital performance had been analyzed in the European context (Onyebuchi A et al., 2003). br Patient satisfaction defined as a person’s feeling of pleasure or disappointment resulting for comparing product service’s perceived performance or outcome in relation to his or her expectations. As this definition makes clear, satisfaction is a function of perceived performance and expectations. If the performance falls short of expectations, the patient is dissatisfied. If the performance matches the expectations, the patient is satisfied. If the performance exceeds expectations, the patient is highly satisfied or delighted. (Astrachan, 1991; Bryant et al, 1998; Sinay, 2002). br To achieve patient satisfaction, medical service providers should realize the importance of healthcare marketing. Therefore, Hospitals, clinics and medical service providers should make effort to develop relationship marketing with their patients, determining their needs, and tailoring their services to meet those needs. br This study aimed at Assessment of the physical facility infrastructure of the Internal Medicine, General Surgery, Gynacology and Pediatric departments in Sohag University Hospital and man power resources. Assessment of the work performance of health care providers (Residents, Assistant lecturers, Lecturers, Assistant professors and Professors). Evaluation of patients and health care provider’s satisfaction with health services provided in the chosen departments of Sohag University Hospital. Identification of their suggestions for improving the services. br This study was carried out in: inpatient sectors of Internal medicine, General surgery, Gynecology and Pediatric departments as they are the major operating departments of Sohag University Hospital br Total coverage of health care providers (Residents, Assistant lecturers, Lecturers, Assistant professors and Professors) of the Internal medicine, General surgery, Gynecology and Pediatric departments of Sohag University Hospital was done. br Also, total coverage of the patients admitted to the chosen departments over a period of eight months br The study consisted of three main parts: br First part: Assessing the Internal medicine, General surgery, Gynecology and Pediatric department of Sohag University Hospital infrastructure by using the Joint Commission check list (Joint commission for accreditation. 2011). br Second part: Assessing the health care providers (Residents, Assistant lecturers, Lecturers, Assistant professors and Professors) work performance by using an observation checklist (American Academy of Physician Assistants.2014). br Third part: for Evaluation of patients and healthcare providers satisfaction -#102;-#114;-#111;-#109; services provided in these inpatient departments by well-structured questionnaires (Grant N. and Marshall- Ron D. Hays., 1994) (Chickasaw Nation Health System., 2005). br This study revealed that the overall satisfaction was low (156.74) compared to maximum score. As regard subscales of satisfaction, the highest satisfaction was with the time spent with doctors (6.05) compared to maximum score followed by general satisfaction with services (22.35), technical quality of doctors (35.64) then communication with doctors (14.67). While the lowest mean satisfaction score was reported as regard the financial aspects (24.27) compared to maximum score. As regard the satisfaction with technical quality, this study revealed that most of the studied inpatients (94.5%) were agreeing with that doctors were very competent and well trained and careful to check everything during treating and examining them. Majority of them (87.4%) were disagreeing with that doctors sometimes make them wonder if their diagnosis was correct. More than two third of them (66.4%) were disagreeing with that doctors rarely give them advices to avoid illness. As regard the satisfaction of the studied inpatients with the communication and time spent with doctors, this study revealed that near three fourth of the studied inpatients (74.5%) were agreeing with that during their medical visits, they were always allowed to say everything that they think was very important. Majority of patients (87.4%) were agreeing with that if they have medical question, they could get doctor for help without any problems. More than three fourth of the studied inpatients (77.7%) were agreeing that doctors were good about explaining the reason for medical tests. Considerable number of them (82.2%) were satisfied as regard the time spent with doctors. As regard satisfaction of the studied inpatients with the financial aspects of the offered health services, this study found that three fourth of the studied inpatients (75.5%) expressed worry about having to pay large medical bills. Near half of them (49.4%) were agreeing and (25.7%) of them were strongly agreeing with that it was a problem to cover cost of medical. As regard the satisfaction of the studied inpatients with accessibility and convenience of the offered health services, this study revealed that most of the studied inpatients (91.6%) were agreeing with that if they were needing hospital they could get admitted without troubles. Considerable number of them (83.9%) were agreeing with that it was easy for them to get medical care in emergency. Majority of the patients (85.4%) were agreeing with having easy access to the medical specialist they need. One fourth of the studied inpatients (25.8%) were disagreeing with the convenience of locations -#119;-#104;-#101;-#114;-#101; they get medical care. More than two thirds of patients (64.2%) were disagreeing with that peoples have to wait too long time for emergency treatment. As regard physicians satisfaction with recruitments this study revealed that (55.5%) of the studied physicians were having good understanding of what was expected of them both by peers within the service, other medical staff and administration. On the other hand, (43.3%) of them didn’t feel welcome and free to ask questions when they interviewed for employment and had an opportunity to visit their work location. Also, (43.3%) of them were not agreeing that the tribal orientation was appropriate and important for me to understand the organization and structure of the Sohag university hospital More than half of them (52.7%) were disagreeing with that the lifestyle they found after employment was what they had hoped for. More than two third of them (62.7%) were disagreeing with that their compensation was competitive with the current market for their specialty and type of practice. As regard physicians job satisfaction, this study revealed that (66.7%) of the studied physicians were unsatisfied as regard feeling that they were provided an opportunity for adequate input into decision-making and policy formation. Also (75.3%) of them were not satisfied with equality of patients load hospital admissions and on-call responsibilities. As regard the overall job satisfaction, (37.4%) of them were satisfied. Half of the studied physicians (52%) were not satisfied the quality of care provided by their service was good. Half of the studied physicians (52%) didn’t receive both formal and informal support and recognition -#102;-#114;-#111;-#109; their peers and administration. Considerable number of the physicians (72.6%) said that it was important for them to have outside interaction with their medical staff colleagues and also during the work day. As regard physicians satisfaction with community participation, this study revealed that (76.7%) of the studied physicians were satisfied with feeling accepted and appreciated by the patient population they serve and the community. Considerable number of the studied physicians (76.7%) welcomed the opportunity to participate in a professional student rotation opportunity in their service. As regard physicians satisfaction with quality of services provided to the patients this study revealed that (55.3%) of them were un satisfied with equipment inside the patients’ rooms. As regard doctor’s number compared to the patients’ number, (62%) of the studied physicians were not satisfied. As regard patient care that provided by physicians this study revealed that (98.2%) of the studied physicians were satisfactory (satisfactory to excellent) as regard accurate and complete history taking. Concerning the physical examination of the patients, (95.4%) of them were satisfactory. Regarding provision of quality patient education, all of them were satisfactory performing. Concerning the medical knowledge of the studied physicians all of them (ranged -#102;-#114;-#111;-#109; satisfactory to excellent) were competent as regard the following issues; appropriate selec-#116;ion of diagnostic tests and interpretation of its results, integration of history, physical findings and diagnostic studies to formulate differential diagnosis, overall integration of clinical information into treatment plan and the Pharmacological knowledge and appropriate ordering of therapeutics. As regard practicing based learning. This study revealed that near to two thirds of the studied physicians (59.1%) were aware by evidence based medicine and (61.8%) were applying it in their clinical practice. As regard professionalism and interpersonal communication skills of the studied physicians, this study revealed that all of the studied physicians were competent (ranging -#102;-#114;-#111;-#109; satisfactory to excellent) as regard displaying sensitivity and responsiveness to patients’ culture, age, gender and disabilities. Almost all of them (94.6%) had effective communications and behaviors with patients and (98.1%) of them had effective and appropriate communication and behavior with their supervisors. Majority of them (94.6%) demonstrated emotional resilience and stability, adaptability, flexibility, tolerance of ambiguity and anxiety. Nearly all of them (99.1%) used effective listening, nonverbal, explanatory, interviewing and writing skills to elicit and provide information. br As regard the building, environmental infection control and utilities of the studied departments; this study revealed that the rooms well ventilated and allowing adequate natural light, corridors and doors allowing free movement of wheelchairs and trolleys, emergency services were in the ground floor, Signage for directions is in place - for all services were offered (Lab, OPD, Ward, etc..) and the four departments were not in clean conditions. There were accessible not clean toilets but sewage was discharged properly, there was functional incinerator, placenta pits was applied only in the Gyn- Obstetric departments, there was adequate waste management (Segregation of waste in clinical and non-clinical refuse; biological waste in adequate containers both red for highly infectious and black for general waste) in all departments with safe disposal of sharps, There were available safe running water - tap or container, sufficient and stable electrical power supply, backup electrical system. Regarding the general management and recording all items as Vision/Mission/Objectives, Certifications/accreditations- e.g. NHIF,ISO, Safe care or JCI (joint commission international, Approved Organization -#99;-#104;-#97;-#114;t ) were not available. There were available files for every patient; these files were kept, registered with availability of electronic records, daily records of performed procedure and qualified record officer. Regarding the items of equipment management as (preventative maintenance of equipment as per manufactures instructions was documented, checked on scheduled basis and dates for maintenance were completed and documented and results documented) were not fulfilled in all departments but the refrigerators/freezers/incubators, etc were temperature monitored. Regarding the consultation- examination rooms, there were minimal equipment as BP machine, stethoscope, thermometer, weighing machine, gloves). As regard the operating theatre which applied only in the General Surgery and Gyne- Obstetric departments, all items were fulfilled except adequate lay out for infection control. Regarding the sterilization process in the previous two departments, all items also were fulfilled. Regarding the pharmacy and laboratory, all items were fulfilled except availability of policy and procedure, documentation of medication error and reference material. As regard the radiology and imaging services, all items were fulfilled except radiation safety program, radiation badges uses and control and standard operating procedure.