Hospital

Identifying and Analyzing Investment Risks in Hospital Wastewater Infrastructure Using the FMEA Method

Abbas Jahangiri

Background and purpose: Hospital wastewater infrastructure is critical for safeguarding public health and protecting the environment. Deficiencies in the management of these systems can precipitate severe public health and environmental crises. This study aimed to identify and prioritize investment risks associated with hospital wastewater infrastructure.
Methods: This applied case study was conducted in a general hospital in Arak, Iran, during April 2025. Initial risk identification involved a comprehensive literature review and semi-structured interviews with 14 experts, with data analysis facilitated by MAXQDA 2022 software. Subsequently, a Failure Mode and Effects Analysis (FMEA) approach, utilizing a customized checklist, was employed to score each identified risk based on its severity, probability of occurrence, and detectability. The Risk Priority Number (RPN) for each risk was then calculated using Microsoft Excel. Finally, risks were ranked in descending order according to their RPN values.
Results: A total of 23 key risks were identified and categorized into five principal areas: design, technical, environmental, operational, and managerial. The highest RPNs were attributed to "lack of pre-treatment systems," "insufficient capacity planning," and "wastewater leakage into surrounding soil". Additionally, managerial and operational risks, such as "insufficient budget for maintenance" and "shortage of skilled personnel," were recognized as significant aggravating factors for other risks.
Conclusion: The findings underscore that many critical risks within hospital wastewater infrastructure originate from fundamental weaknesses in initial design and ongoing management. The FMEA method proved to be an effective and systematic tool for identifying and prioritizing these risks, thereby facilitating improved engineering and managerial decision-making and enhancing the overall effectiveness of investments in this vital infrastructure.

The Effect of Ambient Light Intensity and Correlated Color Temperature on the Thermal Comfort of Nurses in Clinical Settings

Karen Fatahi

Background and purpose: Nurse's thermal comfort in a clinical setting directly impacts their performance and the quality of patient care. This study investigates how two key environmental factors—ambient light intensity and Correlated Color Temperature (CCT)—influence this perception of thermal comfort.
Methods: This experimental study was conducted in a controlled laboratory setting with 60 healthy female nurses over four months (December 2024–March 2025). We assessed the effects of light intensity (at two levels: 300 and 750 lux) and CCT (at three levels: 2700 K, 4000 K, and 7800 K) on perceived thermal comfort. Data were analyzed using a two-way Analysis of Variance (ANOVA).
Results: Light intensity, CCT, and their interaction all had a statistically significant effect on nurses' perceived thermal comfort (p < .05). Optimal thermal comfort was reported at a CCT of 4000 K under both 300 and 750 lux intensities. At a warm CCT (2700 K), comfort was maintained at 300 lux but not at 750 lux. Conversely, at a cool CCT (7800 K), the 300 lux condition was perceived as uncomfortable, while the 750 lux condition was reported as comfortable.
Conclusion: This study demonstrates a significant interaction between light intensity and CCT in shaping thermal perception in a clinical context. The findings suggest that lighting design in healthcare facilities must consider both metrics simultaneously to optimize the work environment. A neutral CCT of 4000 K appears to be the most robust for maintaining thermal comfort across different light levels, highlighting its potential as a design standard for healthcare settings.

Efficiency and Performance Analysis of Tehran University of Medical Sciences Hospitals in Response to the COVID-19 Crisis (2019–2022)

Sara Emamgholipour

Background and purpose: Evaluating hospital efficiency serves as a critical tool for assessing the preparedness and responsiveness of health systems in times of crisis. Accordingly, this study examines the performance of hospitals affiliated with Tehran University of Medical Sciences in response to the COVID-19 pandemic during the years 2019 to 2022.
Methods: This analytical study assessed hospital efficiency using the Pabon Lasso model over the period 2019–2022. Additionally, statistical correlation analysis was employed to explore the relationship between changes in COVID-19 admissions and variations in hospital expenditures, revenues, average length of stay, and bed occupancy rates.
Results: The outbreak of COVID-19 led to a temporary improvement in performance indicators and more optimal utilization of hospital resources. However, following the subsidence of the crisis, hospitals reverted to their previous inefficient structures. In 2022, the operational structure of hospitals returned to pre-pandemic conditions, with only 14% of hospitals falling within the efficient zone. Compared to 2019, a 33% increase in hospitals located in Zone 1 and a 17% decrease in those in Zone 4 indicated a lack of progress in enhancing systemic efficiency. Moreover, the rise in COVID-19 admissions was associated with increased expenditures and subsidies, yet had no significant impact on hospitals’ direct income from patients. Functional effects were limited to a slight reduction in average length of stay and a modest increase in bed occupancy rates.
Conclusion: The findings highlight the absence of mechanisms necessary to sustain crisis management achievements and promote long-term efficiency. Health system preparedness for future crises requires continuous integration of crisis experiences, proactive planning, resource allocation, and the establishment of frameworks to maintain and enhance productivity under all conditions. Therefore, crisis management should not be viewed as a temporary response but rather as an integral component of the strategic and permanent structure of healthcare organizations.

A Realistic Evaluation Pattern of Co-Production Principles in Healthcare Programs

Fateme Tavallaei

Background and purpose: Non-communicable diseases (NCDs) account for 76% of mortality in Iran, where effective management hinges on community empowerment and integrated service delivery. Co-production, an innovative strategy involving shared power between service users and providers, is a promising approach for addressing the multifaceted needs of patients with chronic conditions. This study aimed to develop a context-sensitive framework for implementing and evaluating co-produced NCD management programs. We achieved this by integrating the core principles of co-production with a realist evaluation lens, drawing on the perspectives of senior healthcare managers.
Methods: Employing a qualitative methodology, this study conducted a thematic analysis of data derived from a comprehensive literature review and semi-structured interviews. A cohort of 17 senior healthcare managers, selected via purposive sampling in 2025, participated as key informants.
Results: The analysis yielded a hierarchical thematic structure comprising 71 basic themes, 20 organizing themes, and 6 overarching global themes. These global themes, which form the core of the proposed framework, are: (1) Developing Participatory Clinical Processes, (2) Establishing Equity-Oriented Support Services, (3) Recognizing Diverse User Groups, (4) Enhancing Provider Capabilities, (5) Understanding User Responses, and (6) Fostering Mutual Benefits among Stakeholders. The dynamic interplay of these themes is crucial for operationalizing effective NCD co-production.
Conclusion: By innovatively integrating co-production principles with a realist evaluation framework, this study offers a context-sensitive model that clarifies theoretical concepts for practical application in NCD management. A key implication is the necessity for monitoring systems that track both clinical and well-being outcomes, supported by multi-level incentive structures. This research provides a foundational model for policymakers to develop, implement, and evaluate more effective and equitable co-produced healthcare programs. Further longitudinal research is recommended to assess long-term outcomes and incorporate patient perspectives.

Full Cost Analysis of the Student Loan Disbursement Process: A Case Study of the Iranian Ministry of Health's Student Welfare Fund

Zakiyeh Raeisi

Background and purpose: The Student Welfare Fund of Iran's Ministry of Health is a public institution tasked with providing financial aid to medical students. Amid growing demand for these services and constrained government resources, a comprehensive analysis of the full cost of loan disbursement is crucial for ensuring operational efficiency and financial sustainability.
Methods: This applied, descriptive study conducted a retrospective cost analysis from the perspective of the Student Welfare Fund. The study population comprised all student loan records processed during the 2024 fiscal year. A hybrid top-down and bottom-up costing methodology was employed to determine the full cost of the loan disbursement process. Data were extracted from the Fund's internal financial records, annual reports, and publicly available price lists for equipment and consumables, and subsequently analyzed using Microsoft Excel.
Results: The full cost per loan processed was lowest for single-student academic and essential-needs loans, at IRR 33,538,137, and highest for housing deposit loans, at IRR 56,743,475. The total cost for all student loans disbursed during the 2024 fiscal year amounted to IRR 124,222,283,295.
Conclusion: Processing times were shortest for academic loans and longest for housing deposit loans. Human resources constituted the largest cost component in the disbursement process. Despite the significant personnel costs, a comparison between the full costs and the service fees collected suggests that the Fund's operational processes and staff performance are acceptably efficient.

The Role of Aesthetics in Organizational Documents and Artifacts: A Qualitative Study from the Perspective of Nursing Leaders

Mohammad Ali Cheraghi

Background and purpose: A key aesthetic dimension of nursing leadership involves embedding aesthetic principles into the formulation of organizational documents and artifacts. These elements embody beauty in both visual design and semantic content within the healthcare environment, created by providers and perceived by all stakeholders. This study aimed to explore the role and manifestation of aesthetics in such organizational materials from the perspective of nursing leaders at Tehran University of Medical Sciences.
Methods: This qualitative study, conducted in 2023, utilized a conventional content analysis methodology guided by the Graneheim and Lundman approach. The participants were nursing managers and leaders from hospitals affiliated with Tehran University of Medical Sciences. A total of 28 participants were recruited via purposive and snowball sampling. Data were collected through in-depth, semi-structured interviews, supplemented by photovoice and field observations, to explore the guiding principles and prevailing atmosphere shaping organizational aesthetics.
Results: The analysis of the data yielded 191 initial codes, which were abstracted into six main themes: (1) Preservation and Maintenance, (2) Standardization, (3) Cleanliness and Beautification, (4) Order and Arrangement, (5) Organization, and (6) The Sublime.
Conclusion: The study concludes that the aesthetic vision championed by nursing leaders—as manifested in organizational documents and the workplace environment—is palpable to all stakeholders. This perceived aesthetic fosters a sense of grace and compassion in the thoughts, speech, and actions of both care providers and recipients. Ultimately, it facilitates a more holistic form of "aesthetic nursing care" and helps to create a comforting, home-like atmosphere for patients.

Mental Health Services for Children and Adolescents in Iran: A Scoping Review

Fatemeh zahra Ahmadi

Background and purpose: The prevalence of mental health disorders among children and adolescents is on the rise, exerting profound effects on individual development, academic performance, and social well-being. This study aims to map the current landscape of mental health services for this demographic in Iran, identify existing challenges, and propose strategies to enhance service accessibility and quality.
Methods: This scoping review was conducted in 2025 using the six-stage framework developed by Arksey and O’Malley. A comprehensive search was performed across international databases (Scopus, Web of Science, PubMed) and national databases (MagIran, SID), as well as Google Scholar and relevant organizational websites (e.g., WHO, Ministry of Health and Medical Education). Data were extracted using a narrative approach and analyzed thematically.
Results: Nineteen studies met the inclusion criteria. The review identified a multi-level service delivery system encompassing primary care, specialized care, school-based, community-based, family-based, and national-level interventions. These services utilized diverse modalities, including education, screening, and therapeutic interventions. Key barriers to effective service delivery included structural constraints (e.g., inefficient referral systems, resource scarcity), socio-cultural challenges (e.g., stigma, low public awareness), and human resource shortages (e.g., lack of specialists).
Conclusion: Leveraging the capacities of the primary healthcare network and the educational system, alongside workforce capacity building and public awareness initiatives, is essential for expanding access to and improving the quality of mental health services in Iran.

A Comparative Review of Financing Family Physician Programs and Referral Systems in Selected Countries and Iran

abasat mirzaei

Background and purpose: One of the health system reform programs is the Family Physician and Referral System Program. Therefore, the purpose of this study is to review how family physicians and referral systems are financed in selected countries and Iran.
Methods: This study was conducted as a comparative review in 1403. Information was extracted using related keywords and their English equivalents based on specific subject headings (Mesh) in various databases. In addition, data from the World Health Organization and health system reports of selected countries were also reviewed. Information was extracted based on a data extraction form (researcher-made). Finally, the information was categorized and analyzed by subject.
Results: The study results showed that the main source of financial resources was through the budget and public taxes, and the payment system in the family physician program in the majority of the countries studied was based on performance-based per capita payments. Finally, in addition to the weaknesses and challenges of the countries studied in implementing The family physician program, in Iran, lack of public awareness, poor supervision and management, incorrect policymaking, and challenges in implementing electronic health records were also identified as weaknesses of the family physician program.
Conclusion: Despite the many similarities in the implementation of the family physician program among the selected countries, there are differences in terms of policymaking, implementation methods, and funding methods. Based on the research findings, it is suggested that in order to successfully implement the family physician program, the successful experiences of other countries at the international level, as well as evidence and information in implementing this program, be used.