Hospital

Exploring Challenges in Electronic Health Prescriptions: A Qualitative Study

Maryam RadinManesh

Background and purpose: Given the interdisciplinary nature and multiple stakeholders involved in electronic prescribing systems, their implementation process encounters numerous complexities. This qualitative study aimed to explore and clarify the challenges associated with electronic prescribing and prescription dispensing systems.
Methods: A qualitative content analysis was conducted in 2021 (Iranian calendar: 1400). Data were collected through semi-structured interviews with 25 key informants from the treatment management sector and affiliated hospitals of Tehran University of Medical Sciences. The collected data were analyzed using conventional content analysis methodology facilitated by MAXQDA 10 software.
Results: Approximately 350 initial codes were identified, which were categorized into four main themes with eight sub-themes: policy preparation (establishing a policy secretariat and achieving political consensus), policy formulation (developing policy content and advocacy), policy implementation (planning and executing policies), and policy evaluation (monitoring and evaluating policies).
Conclusion: Ensuring public health remains the ultimate goal of the healthcare system. Electronic transformation, particularly in establishing electronic health records, can significantly improve healthcare service quality. Integrated policymaking among the various institutions involved, enhancing technical and procedural infrastructure, human resource training, and societal cultural readiness are essential factors for the effective implementation of electronic prescription systems and the enhancement of healthcare quality.

Identification and Prioritization of Strategies for Removing Pharmaceutical Contaminants from Hospital Wastewater in Selected Hospitals of Markazi Province Using the Analytic Hierarchy Process (AHP)

Abbas Jahangiri

Background and purpose: Pharmaceutical pollutants in hospital wastewater pose significant environmental and public health risks. This study aimed to identify and prioritize effective strategies for removing these contaminants from the wastewater of selected hospitals in Markazi Province, Iran.
Methods: This descriptive-analytical study employed a multi-criteria decision-making (MCDM) approach. Initially, a comprehensive review of scientific literature, expert interviews, and consultation with professionals in environmental health and wastewater treatment was conducted. Relevant strategies and prioritization criteria were identified using MAXQDA 2022. Subsequently, the Analytic Hierarchy Process (AHP) method was applied using Expert Choice version 11 software to assign weights to criteria and rank the identified strategies.
Results: Five key treatment strategies were identified: (1) integrated biological, physical, and chemical treatment methods (hybrid systems), (2) advanced oxidation processes (AOPs), (3) aerobic and anaerobic biological reactors, (4) membrane filtration, and (5) activated carbon adsorption. The prioritization was based on five criteria: (1) pollutant removal efficiency (0.357), (2) environmental compatibility (0.241), (3) implementation and operational costs (0.198), (4) technology durability and sustainability (0.123), and (5) implementation complexity and feasibility (0.081). The final priority scores of the strategies were 0.312, 0.256, 0.211, 0.134, and 0.087, respectively.
Conclusion: The findings indicate that hybrid treatment systems combining biological, chemical, and physical processes offer the most effective strategy for eliminating pharmaceutical pollutants in hospital wastewater. These insights can guide healthcare policymakers and hospital administrators in selecting optimal wastewater treatment methods, contributing to environmental protection and water quality improvement.

Modeling the Impact of Financial Variables on Hospital Service Performance: An Integrated Structural Equation Approach

Amirhossein Abdolalipour

Background and purpose: This study proposes an integrated model to explore the mediating role of financial performance in the relationship between quality indicators, learning and growth, and the overall performance of hospital facility management services.
Methods: The statistical population included hospital managers across West Azerbaijan Province, Iran. Based on Cochran’s formula, 147 participants were selected using a simple random sampling method. Data were analyzed using Structural Equation Modeling (SEM) via SmartPLS software. Standardized factor loadings were used to assess model fit, and the Z-test was applied to evaluate the statistical significance of the relationships. Predictive power was assessed using the adjusted R² and Stone-Geisser Q² criteria.
Results: The indirect effects of quality indicators (t = 2.41), learning and growth indicators (t = 2.20), and internal process indicators (t = 2.39) on hospital service performance—mediated by financial performance—were all statistically significant (t > 1.96). Standardized path coefficients of 0.201, 0.344, 0.359, and 0.805 further confirmed the model's empirical robustness and goodness of fit.
Conclusion :The findings suggest that improvements in internal processes, service quality, and organizational learning and growth significantly enhance financial performance, which in turn improves the effectiveness of hospital facility management services. These enhancements contribute to increased patient satisfaction, strengthened hospital reputation, reduced operational costs, and ultimately improved revenue and financial efficiency.

Determining the Criteria of Digital Medical Marketing and Investigating Their Association with the Admission of Foreign Patients in Selected Hospitals of Tehran in 1401

Amin Qasem Beglou

Background and purpose: Developing countries strive for solutions to attract medical tourists. Digital marketing is explored here. The aim is to assess digital medical marketing criteria and their relation to health tourist acceptance in selected Tehran hospitals in 2022.
Methods: A descriptive-analytical approach using mixed methods. Qualitatively, through text review, digital medical marketing criteria were identified using fuzzy Delphi, resulting in 5 factors and 61 concepts. Quantitatively, after distributing questionnaires among 30 experts, 25 valid questions were retained. The sample included 125 experts from health tourism units and hospital staff. Kendall's correlation and Chi-square tests were run via SPSS 18.
Results: Identified criteria encompassed multilingual websites, content, digital systems, human resources, and health tourist attraction. Kendall's correlation indicated significant relations with human resource performance (r=0.413), website content (r=0.247), and digital systems (r=0.235) significantly influencing tourist attraction (p<0.01). Chi-square tests revealed significant differences in multilingual websites, website content, digital systems, and human resource performance impacting health tourist attraction (p<0.01).
Conclusion: Iran's medical tourism benefits from enhancing service quality, website content, human resource performance, and digital systems, leading to increased health tourist attraction.

Investigating Behavioral Barriers to the Adoption of Digital Technologies in Healthcare

Mehdi Hosseini

Background and purpose: The integration of digital technologies—computer-based systems, devices, and methods—is transforming organizational activities within the healthcare sector. However, research on the adoption of these technologies in healthcare remains limited, with a predominant focus on structural rather than behavioral factors. As the successful implementation of technology ultimately depends on the workforce, behavioral aspects play a decisive role. Therefore, this study aims to identify the principal behavioral barriers to the adoption of digital technologies in the healthcare sector.
Methods: This applied research utilized a three-stage survey methodology. The stages included: (1) identifying the most significant behavioral barriers to digital technology adoption through a literature review and expert opinions; (2) developing a hierarchical model of these barriers using Interpretive Structural Modeling (ISM); and (3) testing the hypotheses derived from the model with a sample of 302 healthcare professionals.
Results: The ISM model identified a hierarchy of six key behavioral barriers: lack of digital literacy, low perceived value, high perceived risk, negative attitude, resistance to change, and ultimately, non-adoption of digital technology. Based on this model, six research hypotheses were formulated. Regression analysis was conducted to test these hypotheses, and the results indicated that all six were statistically supported.
Conclusion: The findings establish that a lack of digital literacy is the most fundamental barrier to digital technology adoption in the healthcare sector. To address this primary obstacle, the study recommends targeted interventions, such as conducting national assessments of digital literacy levels among healthcare staff and implementing tailored training programs to enhance their technological competencies.

Examining the Share of Pharmaceutical and Medical Consumable Costs in Total Health System Expenditure: A National Study in Iran

Hossein Dargahi

Background and purpose: The healthcare sector is undergoing a profound transformation driven by rapid scientific, economic, and social advancements. The World Health Organization (WHO) emphasizes the necessity of medical equipment and supplies for reducing health disparities and achieving strategic health system objectives. However, there is a notable gap in the literature regarding this cost component within the Iranian health system. This study, therefore, aims to quantify the share of pharmaceutical and medical consumable costs in Iran's total health system expenditure.
Methods: This retrospective, cross-sectional study analyzed outpatient and inpatient medical records from 2018 to 2020. Data on the costs of pharmaceuticals and medical consumables were extracted from Iran's National Health Accounts (NHA) and the SPAS dashboard. The collected data were statistically analyzed to determine the proportional costs of these items relative to total national health expenditure.
Results: Between 2018 and 2020, inpatient pharmaceutical and medical consumable costs constituted 12% of the total health expenditure, demonstrating an annual decrease of 1.8%. In contrast, outpatient costs accounted for 19.5% of the total, with an annual increase of 0.7%. Basic health insurance allocated approximately 10.3% of its budget to cover these items, which corresponds to 31.5% of the nation's total healthcare spending.
Conclusion: The findings highlight the critical need for strategic interventions within Iran's health system. Key implications include the necessity for effective supply chain management, strategic planning to reduce import dependency, and robust mechanisms for monitoring prices. Mitigating the adverse effects of inflation and sanctions is paramount. Furthermore, increasing the healthcare budget's share of the Gross Domestic Product (GDP) and expanding insurance coverage are essential for ensuring financial protection for the population and advancing towards Universal Health Coverage (UHC).

Causes of the Tendency to Migrate and Strategies to Reduce it among Paramedics at Tehran University of Medical Sciences: A Mixed-Methods Study

Hojjat Rahmani

Background and purpose: The migration of healthcare workers from developing countries to more developed nations is a long-standing and ongoing trend. The loss of personnel due to migration can negatively impact healthcare systems. Therefore, this study aimed to identify the causes of the tendency to migrate and strategies to reduce it among paramedics at Tehran University of Medical Sciences.
Methods: The present study is an applied research conducted using a mixed-methods approach in three phases: literature review, Delphi method, and expert panel. It was carried out at Tehran University of Medical Sciences in 2024. Based on the literature review, a questionnaire on the causes of and solutions for reducing paramedical staff migration was developed. After confirming its validity and reliability, the questionnaire was distributed among students. The most important strategies for reducing migration were identified through the expert panel. Quantitative data were analyzed using SPSS version 22, while qualitative content analysis was used for the literature review and expert panel data.
Results: The main causes of paramedics’ migration included contextual factors, work-related factors, health system-related factors, individual-related factors, and factors related to the destination countries. According to the findings, increasing salaries and benefits, improving welfare facilities, and enhancing economic conditions were the most important strategies for reducing migration from the perspective of students and experts.
Conclusion: Although some actions, such as raising awareness about the hardships of migration, may influence individuals’ decisions, more fundamental measures—such as improving economic conditions, reforming the healthcare system structure, creating equal job opportunities, and enhancing the social status of paramedics—are essential to control and reduce the migration trend.

Competency Mapping Framework for Frontline and Middle Managers at Tehran University of Medical Sciences

Farin Razaghi Kashani

Background and purpose: In Iran’s health system, the lack of a systematic process for selecting managers based on the specific competencies required in medical universities and the health sector has long been a challenge. To address this gap, Tehran University of Medical Sciences took the lead as the first institution to design a competency mapping framework for frontline and middle managers, aiming to align managerial selection with the strategic goals of the health system.
Methods: Firstly, a succession planning committee was formed in the university’s Vice-Chancellor for Management Development and Resource Planning. Following an extensive review of relevant models and strategies by several expert panels, this committee proposed guidelines for selecting selecting managers based on merit and developed a competency mapping process.
Results: The competency mapping process was structured into eight steps, including: candidate eligibility screening, assessment of general and technical competencies, 360-degree performance evaluation, review of prior experience, and participation in a mentoring-based empowerment program.
Conclusion: Using this merit-based selection model, top-performing candidates could be successfully appointed to managerial roles. A key achievement of this process is fostering a culture of meritocracy and advancing the organizational maturity of the university. Competency and talent mapping can serve as a robust framework for succession planning and managerial development in medical universities and the broader health system. This approach might significantly contribute to optimizing the selection and development of future leaders for critical positions via identifying skill gaps, assessing development needs, evaluating performance, and enhancing talent identification.