Journal of

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Abstract Background: Family physician plan is a form of health care delivery system which its correct implementation results in health promotion. Being aware of family physicians’ viewpoints towards their occupation would play an important role in its better implementation. The present study aims to to investigate family physicians` attitude who are working in health centers affiliated with Tehran University of Medical Sciences towards their profession. Materials and Methods: This qualitative study was conducted in 2011. In order to reach information saturation , the data were collected by performing two singular interviews and four focus group discussions among all 33 physicians working at health care centers of Tehran University of Medical Sciences. Eventually, data were analyzed using conceptual framework method. Results: Data analysis indicated three general concepts. The first issue is the factors that encourage physicians to choose family physician profession and continue doing it (including economical, cultural and environmental factors and work conditions). The second one is the study challenges (including preparation to implement the plan, work conditions and professional limits) and the final one is the reforms needed for its correct and proper implementation ( in policy making and administrative level). Conclusion: Regarding the issue that economical, cultural and environmental factors and work atmosphere have the main role in motivating family physicians, the most important challenges the plan confronts are also related to these factors and major and minor reforms are needed to overcome these challenges. Moreover preparing society’s culture would surely result in better implementation of the plan.

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Abstract Background: Hospital managers' decision-making styles indicate the usual pattern managers use to make their decisions. This paper is aimed to determine the variety of managers' decision-making styles` in public and private hospitals in Shiraz. Materials & Methods: In this cross-sectional study, 106 administrative, financial, internal and nursing managers were selected from 28 public and private hospitals through census sampling technique to participate in this study. The data were collected by a 22-item questionnaire (α = 0.86) and analyzed using T-Test and ANOVA in significance level of 0.05. Results: Studied managers used rational decision-making style more often than avoidance of decision-making style. Older and official managers and private hospital managers used the intuitive decision-making style more often.Managers who had not attended management training courses used the intuitive and dependent decision-making styles more often. Managers who were teaching in the fields of nursing and midwifery used rational decision-making patterns more often. Conclusion: It seems necessary to provide sufficient ground for scientific and evidence-based decision making for all hospital managers. Therefore identifying present obstacles and providing an environment in which managers could improve their decision-making skills is recommended.

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Background: Managers can provide manpower motivations activity contexts and real efficiency through identifying and anticipating according to organizational goals. Since, today’s working motivations have not been realized in hospitals, this study aimed at determining and comparing the importance of hygiene-motivational factors in both Kosar and Faghihi hospitals in Shiraz. Materials and Methods: In this cross-sectional survey, study populations included all staffs of Kosar and Faghihi hospitals in Shiraz. One hundred fifty selected by stratified randomly sampling participated in the study.The study questionnaire was designed based on Herzberg theory. Questionnaire validity proved by available experts and Cronbach alpha calculated 0.95. Statistical analysis was done using SPSS software and independent t-test. Results:The most important hygiene factors were "job security" and "supervision" and the most significant motivational factors were "success" and "appreciation". Hygiene factors are more important than motivational ones in both hospitals. Hygiene and motivational factors had more mean score in Kosar hospital compare to Faghihi hospital. Conclusion: In the Kosar charity hospital hygiene-motivational factors were significant more than faghihi governmental hospital from the staff viewpoints. Hence, the directors of the hospitals should organize appropriate incentive actions owing to differences in terms of ownership toward quality improvement and efficiency of hospitals.

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Background: Depression is a common disorder with incremental trend among patients with hemodialysis. This study conducted in order to determine correlation between social support and depression among patients undergoing hemodialysis of Kerman city.

Materials and Methods:  This study was a cross-sectional one. 182 hemodialysis patients referred to health centers of Kerman were selected by census sampling method. data was collected Using questionnaires  including demographic information, Beck's Depression Questionnaire (BDI) and Social Support Questionnaire (ESSI: Enriched Social Support Instrument) and analyzed  by SPSS  software version 17 utilizing descriptive statistics (mean and standard deviation) and Pearson Correlation Coefficient test.

Results: 68.1% of the subjects had some degree of depression. Also, 83% of participants reported good social support. Furthermore, Assessing the relation between depression and social support revealed an inverse relationship between depression and social support (P =0.005), increasing social support occurred decreasing depression as well. 

Conclusion: Study results indicated high prevalence of depression among the patients. It seems special attention in should be paid to psychological issues in hemodialysis wards. Nurses can prevent depression incidence by recognizing high risk individuals in term of perceiving social support among these patients. 

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Background: One of the key duties of family physician is to form health records and provided recording services. This study conducted to form health records and aevaluate health records in family physician program in Northern Province of Iran.

Materials and Methods: This cross-sectional study was carried out in second half  2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected using systematic random sampling, and assessed performance recording of all family physicians. A self- designed questionnaire was used which the validity and reliability of were confirmed. Data were analyzed by SPSS₁₈ at the significant level of p<0.05.

Results: Out of the 189 assessed family physicians, the profile of patients referred to the second level and its results were recorded in referral record forms by 43 physicians. Out of 1890 studied families, 1559 families had health record which had filled 892(57%) health record completely. Out of 5869 assessed family members, 4229 patients were examined periodically by their family physician at least once and 1919(46%) results filled entirely. during 559 were reported with health records, among which 892 were filled out completely. There was a significant difference between referral record rates to registered specialist between the Northern Province of Iran (P=0.001).

Conclusion: The quantity and quality of health record formation was not in the expectation level as well and appropriate interventions are needed. 

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Background:Nosocomial infections due to mortality and economic costs are one of the main challenges in current century. Gram-negative bacilli infections acquired in hospitals and hospital environment is one of the most important places of residence and publication of these types of bacteria. This study aimed to investigate the prevalence of gram-negative bacilli from the equipment of hospital in Western region of Golestan province in 2015.
Materials and Methods: During this descriptive study, 1210 devices were examined with sterile swab of environment and equipments which used in various wards of seven teaching hospitals of Golestan province using census sampling. After identification of the isolated colonies based on biochemical standard tests, results analyzed using SPSS version 22.
Results:Based of isolated samples, 352 positive microbial cultures (29.1%) contaminated with gram-negative bacilli which the highest bacterial contamination was related to Enterobacter (10.7%). among different hospital wards the highest bacterial contamination observed in ICU_s (19.32%) and among assessed equipment, the highest contamination was related to laryngoscope blades (10.51%), phone (7.1%) , ECG sensor device and  monitoring interface (6.25%).
Conclusion:The study findings confirmed that microbial contamination with gram-negative bacilli of hospitals equipment is highly considerable in West of Golestan province. Periodic assessments can be effective in nosocomial infections prevention.

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Background and purpose: With the establishment of a comprehensive health information system (SIB system) in the health department of Iran's health system, one of the important programs of this country to improve health care through the integration of health information was keyed. This study analyzed the performance of this program from the point of view of the end users of the system in the health centers of Boyar Ahmad city.
Materials and Methods: This study was a qualitative research that was conducted using semi-structured interviews and focus group meetings with 25 system users, support officials and staff experts at different levels, reviewing relevant documents and also observing users' performance. The snowball sampling method was carried out in a targeted and networked manner. Qualitative content analysis was used to analyze the data. MAXQDA10 software was used to record, organize and manage study data after collection.
Results: The findings of this study showed that the deployment of this system from the users' point of view contains many positive and negative points, which can be categorized in five general axes, data management system, caregivers' performance, care management, quality of care and infrastructure. The most important challenges of the system included technical inefficiencies, operational inefficiencies, the challenge of statistics and reporting, and technical and social infrastructure, and the most important benefits were improving the quality of care, tracking and reporting, facilitating the care process, and improving the performance of caregivers.
Conclusion: From the point of view of users, the Sib system can be considered as a positive experience in improving the quality of health care, but due to the existence of many challenges, it is far from its final goals

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Background and purpose: In response to evolving external environments, organizations must renew their valuable resources to sustain competitive advantage. Dynamic capabilities empower organizations to effectively navigate these continual changes. Essentially, dynamic capabilities foster a stable behavioral orientation within organizations, facilitating integration, reformulation, renewal, and reconstruction of resources and capabilities, particularly enhancing and revitalizing core capabilities in response to dynamic environments to achieve sustainable competitive advantage. This study explores the influence of dynamic capabilities on constructive collaboration and supply chain performance within healthcare centers. Dynamic capabilities are categorized into four perspectives: sensitivity, learning, coordination, and integration. Constructive collaboration serves as a mediating variable, while technological orientation acts as a moderating variable in the model.
Methods: This study adopts an applied purpose and descriptive-survey method. The statistical population comprises employees at Ayatollah Taleghani Gonbadkavus Hospital. Using a questionnaire adapted from Mandal's (2022) study, the research establishes relationships between variables, categorized as descriptive-analytical. The questionnaire's validity was assessed using convergence and divergence methods, and reliability was confirmed using Cronbach's alpha and composite reliability. Data analysis employed structural equation modeling and Smart-PLS software.
Results: Data analysis reveals a significant relationship between the learning, coordination, and integration perspectives of the hospital and constructive collaboration. However, no significant relationship is observed between the sensitivity perspective and constructive collaboration, nor between constructive collaboration and the performance of the healthcare system's supply chain. A significant relationship exists, and technological orientation does not moderate the relationship between the sensitivity perspective and learning with constructive collaboration, but it moderates the relationship between the coordination and integration perspective with constructive collaboration.
Conclusion: Improvements in collaborative efforts across various hospital departments, decreased risks of medical errors, enhanced service quality, and elevated professional status of staff are among the outcomes of assessing the performance of hospitals' sustainable supply chains.

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Background and purpose: As part of Iran’s Health System Transformation Plan (HSTP), the first service package aimed to reduce out-of-pocket expenses for hospitalized patients in hospitals affiliated with the Ministry of Health and Medical Education. This study evaluates the effectiveness of the policy in reducing patient payments at teaching hospitals under Golestan University of Medical Sciences.
Methods: This descriptive-analytical cross-sectional study was conducted between 2021 and 2022. A total of 384 participants—including healthcare workers, medical staff, and physicians—were randomly selected from teaching hospitals affiliated with Golestan University of Medical Sciences. Data were collected using a 35-item researcher-designed questionnaire, validated by experts, with a Cronbach's alpha reliability score of 0.83. Data analysis was performed using SPSS version 22, Kolmogorov-Smirnov tests, and a one-sample t-test.
Results: Indicate a gap of -0.11 between the current situation and the desired outcome of the HSTP’s first axis (reducing patient payments). Analysis using the gap analysis matrix revealed that the primary shortcoming is in regulatory oversight.
Conclusion: While the Health System Transformation Plan has successfully reduced out-of-pocket expenses for hospitalized patients, it has not fully met the program’s intended financial relief targets. Further policy adjustments are required, particularly in expanding universal insurance coverage and ensuring adequate financial resource allocation to improve accessibility and affordability for patients.