Journal of

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Background: The aim of this research was to measure and compare relative efficiency of general hospitals under supervision of Mashhad University of Medical Sciences (MUMS). The study also seek to investigate the likely relationship between the official evaluating scores reported by MUMS with findings of this study.
Materials & Methods: Data Envelopment Analysis (DEA) is utilized to determine relative efficiency of individual decision making units (DMUs). From state-run general hospitals in this study, 17 were selected based on the criteria suggested by the model. To distinguish efficient hospitals from inefficient ones, revised input-based BCC model was used incorporating ‘number of physicians' and ‘number of nurses' as inputs. Outputs were set as ‘the rate of inpatient days to staffed beds', ‘outpatient visits' and ‘number of surgeries' reported both at emergency and wards.
Results: The findings based on both CRS and VRS simulations indicate that the mean of technical efficiency was 0.823, mean managerial efficiency was 0.931 and subsequently mean scale efficiency was 0.881. It was further noticed that, there was no significant relationship between the performance appraisal outcomes from DEA model, and scores allocated to each hospital through official evaluation system.
Conclusion: Current official appraisal system based on pre-defined checklists may not be a reliable mean for evaluating and ranking efficiency of general hospitals.

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Background: Organizational commitment among nurses as care providers provided the quality of patient care by their conservation. Therefore, nurses are committed to the investment and the competitive advantage of clinics and hospitals which have a significant impact on increasing the quality of services. In this study, the effect of psychological contracts and organizational trust studied
as an organizational commitment of Ghaem hospital nurses in Mashhad province.
Materials and methods: Strategy survey - analysis of data obtained for the study of 193 Ghaem hospital nurses in the city of Mashhad through distributed questionnaires by the structural equations and partial the least squares method to seek the help of software were analyzed.
Results: The results indicated that the first, model of the material used has a strong theoretical model that is to predict nurses' organizational commitment. Secondly, all direct and indirect relationships between variables in the model were significant. But the relationship between organizational trust and nurses' continuous commitment was not confirmed.
Conclusion: This study indicates not only depends on nurses' organizational commitment to creating positive psychological space, but also they are in the reliability of this space gives rise to the obligation. On the other hand, the quality of the organizational commitment for nurses could be effective and efficient in use of available resources. Therefore, hospital administrators need to be more attention to an effective component of organizational commitment as supply facilities, participate in decision making, good communication, and job enrichment.

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Abstract: Background: Recently, hospitals in order to improve strategic and operational work have been under a lot of pressure Nonetheless, lack of taxonomy researches have been noticed in Health care. The purpose is to present taxonomy of health care operational systems and strategies of Mashhad hospitals sections in correct order in the base of their aims and operational decisions and afterwards assign Proportionate strategies and systems with each other. Materials and Methods: Considering its objective, this study is applied. It is exploratory and based on survey regarding its method. 84 samples of remedial hospitals sections in Mashhad have been chosen by chance and after final survey and justifiability implement research to analysis data using from k-means cluster analysis and in order to assess the validity of this analysis, the multiple discriminant analysis has been used. The test of independence was used to assess the correlation between strategies and recognized systems. Results: for each strategies and operational systems 3 clusters have reconnoitered that each of them in a correct order is emphasizing on goals and different decisions. Also the results of performing independence test is expressive the proportion between Leaders of service- centric strategy with operation leading system and cost- based follower strategy with creative cautious system. Conclusion: This study dose not only provides a useful description of the operational situation and operational position of a hospital, but also provides a necessary setting for more professional studies and theorizing.

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Background: In service organizations such as hospitals, human resources (HR) play a key role in the quality of service delivery. Lack of a systemic attitude in terms of system dynamics, HR planning have been somewhat distant from reality. In order to solve such a problem, this study aimed to modeling the dynamics of human resources capacity management system in healthcare services.
 
Materials and Methods: This case study is one of the cases at a clinic of Khatam -al-Anbia Eye Hospital of Mashhad which was used to simulate the system dynamics approach. In the implementation process, after modeling and formulating in Vensim software, the model was validated and appropriate policies were identified based on simulation results.
 
Results: The simulation results revealed a gap existence between service capacity and desired capacity led to a work pressure. Consequently, time per service relative to the standard time per service (0.333 hours equivalent to 20 minutes) as the core of service quality has been reduced (cutting corners of time).  To counteract such a situation, appropriate policies were identified during the time in a dynamic manner using sensitivity analysis based on changing patient acceptance rates and human resource changes.
 
Conclusion: The proposed model provides the status for hospital managers which allows them to manage appropriate human resources in the same conditions with a viewpoint of causal relationships with respect to system dynamics.
 

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Background: Assessing and improving the quality of services in hospitals because deal with the health of humans is very important. The purpose of this study is to identify and weigh quality criteria and ranking of four hospitals in Mashhad.
 
Materials & Methods: The present study is of type  Applied Studies  that is a cross-sectional study conducted in the winter of 1396. In this study, by literature review, dimensions of service quality in the hospital was identified. Then, a paired comparison questionnaire (including 8 people) was used to conduct the survey. Then coefficients of importance of each dimension were calculated through the process of hierarchical analysis in a fuzzy environment. Decision-making matrix questionnaire was completed by a 400-person sample of patient companions in four hospitals.Then, hospitals were ranked using GRA-TOPSIS method. The validity of questionnaires were confirmed by the expert group.
 
Results:Using FAHP, knowledge and skills of medicine obtained the most important coefficient. Also, using GRA-TOPSIS, third hospital received the fourth place in the provision of services. Also in the third hospital the quality of access requires the greatest improvement.
 
Conclusion: In addition to ranking hospitals based on quality of service criteria, the GRA-TOPSIS method is able to identify each hospital's weaknesses in each criterion. As a result, the priorities for improving the quality of service in each hospital were identified, and the hospital manager could work to improve performance on the criteria that he or she achieved with lower performance than other hospitals.