Document Type : Research Paper

Authors

• Javad Keshvari Kamran ¹
• Mohammad ali Keramati ²
• Abbas Toloie Eshlaghy ³
• Seyed Abdollah Amin Mousavi ⁴

¹ Department of IT Management, Faculty of Management, Tehran Center Branch, Islamic Azad University, Tehran, Iran

² Ph,D in Faculty of Management Islamic Azad University. Central Tehran Branch.Iran Corresponding Author: pe.ghafari@iau.ac.ir

³ Professor, Department of Industrial Management, Sciences and Research Branch, Islamic Azad University, Tehran, Iran

⁴ Assistant Professor, Department of Information Technology Management, Central Tehran Branch, Islamic Azad University, Tehran, Iran

Abstract

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.

Introduction

The 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 Review

Hospital accreditation
Hospital 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 systems
The 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 background
Table 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 research




Summary of study results


Researcher






A 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)





Methodology

To 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.
 
 

Results

Conceptual model of the agent-based
Using the results obtained from qualitative data analysis and the grounded theory model, examples and independent agents of each agent group were identified. All the interactions of the agents are included in the final model in the form of input and output. Figure 2 shows the agent-based conceptual model of the hospital accreditation system.
Figure 2. Conceptual model of the agent-based hospital accreditation system (source: findings of the present research)
 

Discussion

This study aimed to provide a conceptual model of the agent-based system in Iran's hospital accreditation system. Also, agents, the environment, general behavioral rules, and their interactions with the environment were obtained. Because, so far, a lot of research has been conducted to provide an optimal model in the hospital accreditation ecosystem, there have been no studies that have new methods such as agent-based design. Therefore, it seems that the findings of the current research have covered some research gaps in this field because agent-based design is one of the newest and most efficient solutions available for solving distributed problems and complex human processes and environments. The agent-based conceptual model of the current research can create a suitable study base for the environmental simulation process and the creation of a multi-agent hospital accreditation system. Also, future researchers are suggested to carry out relevant research in this field, considering the wide application of agent-based modeling in the field of social-technical hospital systems and the importance of using reinforcement learning algorithms in them.

Conclusion

The background analysis of the research was done with the method of systematic review of sources. Using experts' opinions, broad and general questions were asked about the results of the research, and then their description and analysis were addressed through grounded theory-based tools (MAXQDA), and a conceptual model of the grounded theory was obtained. Then, to 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?” The appropriate answer was given so that by using qualitative analysis, the dimensions of the problem were fully understood and the obtained results were converted into the final conceptual model. Also, agents, the environment, and their relationships were obtained. Then their general rules of conduct were compiled. All interactions of the agents with the environment were included in the model as input and output.
Keywords: Agent-Based Conceptual Model, Hospital Accreditation, Multi-Agent System, Simulation.
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.

Introduction

The 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 Review

Hospital accreditation
Hospital 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 systems
The 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 background
Table 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 research




Summary of study results


Researcher






A 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)





Methodology

To 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.
 
 

Results

Conceptual model of the agent-based
Using the results obtained from qualitative data analysis and the grounded theory model, examples and independent agents of each agent group were identified. All the interactions of the agents are included in the final model in the form of input and output. Figure 2 shows the agent-based conceptual model of the hospital accreditation system.
Figure 2. Conceptual model of the agent-based hospital accreditation system (source: findings of the present research)
 

Discussion

This study aimed to provide a conceptual model of the agent-based system in Iran's hospital accreditation system. Also, agents, the environment, general behavioral rules, and their interactions with the environment were obtained. Because, so far, a lot of research has been conducted to provide an optimal model in the hospital accreditation ecosystem, there have been no studies that have new methods such as agent-based design. Therefore, it seems that the findings of the current research have covered some research gaps in this field because agent-based design is one of the newest and most efficient solutions available for solving distributed problems and complex human processes and environments. The agent-based conceptual model of the current research can create a suitable study base for the environmental simulation process and the creation of a multi-agent hospital accreditation system. Also, future researchers are suggested to carry out relevant research in this field, considering the wide application of agent-based modeling in the field of social-technical hospital systems and the importance of using reinforcement learning algorithms in them.

Conclusion

The background analysis of the research was done with the method of systematic review of sources. Using experts' opinions, broad and general questions were asked about the results of the research, and then their description and analysis were addressed through grounded theory-based tools (MAXQDA), and a conceptual model of the grounded theory was obtained. Then, to 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?” The appropriate answer was given so that by using qualitative analysis, the dimensions of the problem were fully understood and the obtained results were converted into the final conceptual model. Also, agents, the environment, and their relationships were obtained. Then their general rules of conduct were compiled. All interactions of the agents with the environment were included in the model as input and output.
Keywords: Agent-Based Conceptual Model, Hospital Accreditation, Multi-Agent System, Simulation.vv

Keywords

• Agent-based Conceptual Model
• Hospital Accreditation
• Hospital Evaluation
• Intelligent Multi-Agent System
• Simulation

Main Subjects

• Management approaches in the field of smart