Hospital

The effect of dimensions of organizational commitment on nurses' job attachment in clinical education environments

Sajjad Bahariniya

Background and Purpose: Organizational commitment among nurses, a critical aspect of hospital workforce management, is influenced by various factors, including job attachment. This attachment fosters motivation and commitment, which ultimately enhances the quality of healthcare services. This study investigates the relationship between organizational commitment and job attachment among nurses working in selected teaching hospitals affiliated with Shahid Sadoughi University of Medical Sciences in Yazd in 2022.
Methods: This descriptive-analytical study involved all nurses at Shahid Sadoughi Hospital in Yazd. A sample size of 298 nurses was determined using Cochran's formula. Data collection was conducted using the Job Descriptive Index (JDI) by Edwards and Kilpatrick (1984) and the Organizational Commitment Questionnaire (OCQ) by Allen and Meyer (1990). The data were analyzed using the Chi-square test with SPSS version 21 software and structural equation modeling via LISREL software.
Results: Among the nurses surveyed, 43.17% reported being satisfied with their jobs, while 40.17% exhibited organizational commitment. The findings revealed a significant relationship between job attachment and organizational commitment (P<0.001). The average scores were 3.75 ± 0.76 for the affective dimension, 3.97 ± 0.26 for the continuance dimension, 3.65 ± 0.36 for the normative dimension, and 3.74 ± 0.93 for overall job attachment.
Conclusion: The significant direct relationship between job satisfaction and organizational commitment highlights the importance of managerial focus on enhancing job satisfaction to increase employee responsibility and commitment. Managers should prioritize factors that improve job satisfaction as a means to strengthen organizational commitment.

Validity And Reliability Of The Persian Version Of Spector's Job Satisfaction Questionnaire (A Study Among Employees Of Emergency Medical Centers In One Of Iran's Cities)

Ahmad Tahmasebi ghorrabi

Background and purpose: Assessing job satisfaction within any organization is essential due to its impact on productivity and overall effectiveness. This study aimed to evaluate the validity and reliability of the Persian version of Spector's Job Satisfaction Questionnaire among employees of emergency medical centers.
Methods: This descriptive-analytical study was conducted among 270 employees of emergency medical centers in Ahvaz between February 2021 and June 2021. Data collection was performed using a census method and Spector's Job Satisfaction Questionnaire. Face validity, content validity, and translation accuracy of the questionnaire were reviewed by experts. Convergent and divergent validity and reliability were assessed using factor loadings, average variance extracted (AVE), reciprocal factor loadings, Cronbach's alpha, and composite reliability in SMART-PLS 3 software.
Results: The face validity, content validity, and translation accuracy of the questionnaire were confirmed by experts to suit the Iranian context. All item factor loadings and the AVE index for all constructs exceeded 0.4. The AVE index for the entire questionnaire was 0.523. Examination of reciprocal factor loadings confirmed divergent validity. Cronbach's alpha and composite reliability indices for all constructs were above 0.7. The Cronbach's alpha coefficient and composite reliability for the entire questionnaire were 0.83 and 0.88, respectively.
Conclusion: The validity and reliability of this questionnaire, as adjusted for the Iranian population, were confirmed to be high. Therefore, this questionnaire can be effectively used to evaluate job satisfaction among employees in various organizations, particularly in healthcare organizations and centers.

Assessing handwashing rate among health care workers in Intensive Care Units of Modares hospital in 2018-2019

SHahnaz SHarifi

Background and Purpose: Infections related to inadequate healthcare practices can have adverse effects on healthcare systems. This study aims to identify the gap between the current handwashing practices and standard levels by determining the frequency of handwashing among staff at Shahid Modares Hospital in Tehran.
Methods: This descriptive cross-sectional study was conducted in the wards of Shahid Modares Hospital between 2018 and 2019. The tool comprised two parts: job information and hand hygiene practices at different times and specific actions. Observers directly monitored all staff in each shift using a headcount method. Each column represented the hand hygiene compliance score of a specific professional group, allowing simultaneous performance evaluation.
Results: Out of 640 observed instances, 202 involved the use of disinfectants, 255 involved handwashing, 111 involved glove use, and in 71 instances, hand hygiene was not observed. The highest compliance occurred when staff intended to contact the patient's body, while the lowest compliance was observed after performing surgery on the patient.
Conclusion: Given the significant role of nurses in therapeutic interventions, multifaceted training interventions, the drafting of hand hygiene policies, and increasing awareness among department officials should prioritize this group of employees. These measures aim to bring practices closer to desired standards and prevent unwanted consequences.

The utilization of healthcare services by refugees and migrants during the COVID-19 epidemic from health centers affiliated with Iran University of Medical Sciences

Pouria Farrokhi

Background and purpose: Iran is ranked among the top ten nations in the world for hosting a large number of migrants and refugees. During the COVID-19 outbreak, refugees and migrants were among the most vulnerable groups. This study aimed to investigate the extent of healthcare service utilization by refugees and migrants during the COVID-19 pandemic in healthcare centers affiliated with Iran University of Medical Sciences
Methods: This quasi-experimental study was conducted in 2021 in Tehran. The research environment included all healthcare networks and general and specialized hospitals. Data were collected through document review and registered information in the Sina system. All provided services were categorized into four groups: primary care, outpatient, emergency, and inpatient services. Data analysis was performed using the Chow test and Interrupted Time Series model with the Wats and Sctest software packages in R version 4.3.0.
Results: The decrease in utilization of outpatient, emergency, and inpatient services by refugees and migrants was significant (P-value < 0.001), whereas the decrease in primary care services was not significant. Additionally, after the onset of COVID-19, only the utilization of inpatient services showed a significant increasing trend (P-value < 0.013).
Conclusion: During the COVID-19 pandemic, the utilization of all healthcare services by refugees and migrants, including primary, outpatient, emergency, and inpatient care, decreased. It is recommended to provide complete insurance coverage for refugees, offer free treatment for impoverished refugees, increase awareness among refugees to encourage greater use of health services, reduce existing social and economic barriers, and facilitate interaction between healthcare providers and refugees.

Analyzing and comparing the results of meta-synthesis and thematic analysis in identifying supply chain risks in the pharmaceutical industry

Mohammad Rahim Ramazanian

Background and Purpose: Health status is undeniably one of the most critical indicators of social development and progress. Providing healthcare poses a significant challenge for human life, and managing the healthcare supply chain is of strategic importance. The aim of this research is to analyze and compare the results of meta-synthesis with thematic analysis in identifying the risks of the pharmaceutical industry's supply chain.
Methods: This research follows a qualitative approach, utilizing both meta-synthesis and thematic analysis to identify supply chain risks in the pharmaceutical industry. In the first step, a meta-synthesis and systematic review of related studies over the past twenty-three years were conducted, identifying one hundred articles, which were refined to twenty-six key articles for the research. In the next step, risks specific to Iran's pharmaceutical supply chain were identified through thematic analysis and semi-structured interviews with experts, using targeted sampling. Finally, the results from these two approaches were compared and analyzed.
Results: The meta-synthesis approach identified ten general supply chain risks in the global pharmaceutical industry. Similarly, the thematic analysis approach identified ten specific supply chain risks in Iran's pharmaceutical industry. Six risks were common to both approaches: low quality of raw materials, complexity and incompatibility of information systems, supply of foreign currency and financial payments, transportation and insurance issues, increase in the price of raw materials, and unavailability of medicines. These common risks are critical for both the global and Iranian pharmaceutical supply chains.
Conclusion: Stakeholders in Iran's pharmaceutical supply chain (including hospitals) should prioritize managing these six common risks to improve supply chain performance. Additionally, they should focus on the four unique risks identified through thematic analysis specific to Iran's pharmaceutical supply chain, applying appropriate control measures and activities.

Identifying and Ranking the Risks of Using Artificial Intelligence Systems in Hospital Waste Management Using a Multi-Criteria Decision-Making Approach A Case Study of Hospitals Affiliated with Zahedan University of Medical Sciences

Mohammadreza Shahraki

Background and Purpose: Artificial intelligence (AI) plays a crucial role in the optimal management of hospital waste, particularly in predicting the volume and type of waste generated. This study aims to identify and rank the risks associated with the use of AI systems in hospital waste management by employing a multi-criteria decision-making approach.
Methods: This descriptive, cross-sectional study was conducted in 2023 (1402 in the Iranian calendar) at two hospitals, Ali Ibn Abitaleb and Khatam al-Anbiah, in Zahedan. Ten hospital staff members were selected as expert participants for the Delphi panel. The Shannon entropy method was utilized for risk weighting, and the TOPSIS method was applied to rank the identified risks.
Results: Kendall's coordination coefficient was used to assess the level of consensus among the Delphi panel members, with the coefficient values for the first, second, and third Delphi rounds being 6.3, 7.1, and 7.3, respectively. The indicators were weighted using the Shannon entropy method, based on three criteria: impact intensity (0.3), probability of occurrence (0.4), and detection probability (0.32). The TOPSIS method was then employed to rank the identified risks, with the most significant risks being the need for necessary infrastructure (0.847), the requirement for accurate and complete data (0.751), and budget constraints (0.749).
Conclusion: By applying multi-criteria decision-making methods, healthcare managers can effectively identify and prioritize the risks associated with using AI systems in hospital waste management, enabling them to focus on strengthening waste management practices based on these priorities.

Investigating factors affecting unreasonable use of costly imaging services in general hospitals of Iran

Soad Mahfoozpour

Background and purpose: As health resources face increasing constraints, the use of medical imaging services has risen significantly. On average, diagnostic services account for approximately 10% of total healthcare expenditures, and this figure is steadily increasing. This study aims to identify the causes of irrational utilization of medical imaging services and propose corrective measures.
Methods: This descriptive-survey research was conducted in two phases. In the first phase, a comprehensive literature review was performed using both international and national databases, covering the period from 1990 to November 2021. Relevant studies were identified using specific keywords. In the second phase, a semi-structured questionnaire was developed, and a series of in-depth interviews with experts and professionals were conducted. Data were analyzed using the six-step thematic approach by Braun and Clarke, utilizing MAXQDA software.
Results: A total of 605 studies were initially identified, of which seven met the inclusion criteria after rigorous screening. In the second phase, 12 in-depth interviews were conducted, yielding 65 codes, which were organized into 12 themes. The identified themes included legal issues, conflict of interest, monitoring challenges, poor governance and stewardship, inappropriate policymaking and planning, financial incentives, inadequate service provision infrastructure, health culture, education and continuous training systems, financing and purchasing services, political factors, and inadequate insurance systems. Various strategies for controlling the inappropriate use of diagnostic and therapeutic services were proposed, including policy interventions, monitoring and evaluation, and training.
Conclusion: The irrational use of healthcare services is a significant challenge in many countries. Key contributing factors include incomplete insurance coverage, out-of-pocket payments by patients, defensive medical practices, and gaps in knowledge. Addressing these issues requires targeted interventions and reforms.

Withdrawal Article Investigating The Factors Affecting Succession Planning In The Leadership Of Healthcare Organizations In Iran: A Stakeholder Perspective

SHaghayegh Vahdat

Background and purpose: In today’s competitive organizational landscape, the significance of recruiting and developing competent human resources has become paramount. Organizations not only aim to select and attract capable and efficient personnel but also seek to enhance and expand their capabilities. Consequently, the concept of meritocracy has become a key concern for modern organizations. This study aims to investigate the factors influencing succession planning in the leadership of healthcare organizations in Iran.
Methods: This qualitative study was conducted using content analysis in 2020. The statistical population comprised key decision-makers and policymakers in successful and prominent Iranian organizations known for effective succession planning, such as the Islamic Revolutionary Guard Corps (IRGC) and the public banking system. A total of 15 experts were selected through purposive and snowball sampling, with data collection continuing until theoretical saturation was achieved. Data were gathered through structured interviews, and the analysis and coding were performed using MAXQDA 11 software.
Results: The study identified five main themes: alignment of strategic goals and needs analysis, strategic communication and organizational structure, talent identification and empowerment, development and excellence of qualified individuals, and monitoring of succession planning programs. These were further divided into 13 sub-themes.
Conclusion: Organizations and managers should provide comprehensive support and demonstrate commitment to the effective implementation of succession planning programs. This will lead to improved organizational decisions and policies, ensuring that competent and qualified individuals are placed in key positions. Additionally, this approach will enhance work quality, boost employee motivation, reduce resource wastage, and improve career advancement opportunities for staff.