Journal of

---

Background: Nowadays, researchers pay special attention to patients' satisfaction with emergency care services, as the first line of hospital health care services. However, few researches have been done about its related factors in our country. The aim of this study was assessment of patients' satisfaction with emergency care services in six military hospitals in our country and its related factors.

 Material and Methods: In this cross-sectional study, Satisfaction level of 360 patients of emergency care services in six military hospitals of Iran in 2007 was assessed. After discharge from emergency ward, a checklist containing basic information and a 12-item questionnaire about their satisfaction level with emergency care services was completed for each patient. A 5-level Likert scale was used for the response of each item. 20 to 100 scores were allocated to each response (completely dissatisfied to completely satisfied), respectively.

 Results: 3559/4220 responses (82.4%) were completely satisfied or satisfied. In respect to priority "Observation of moral points", "giving information" and "behavior of reception personnel" had the highest and on the other hand, "variety of medical specialists", "emergency ward facilities" and "speed in calling doctor" had the lowest satisfaction scores. The total satisfaction score which was reported by patients older than 35 yr(p=0.022), insurance coverage(p=0.002) and with history of previous referring to that emergency ward(p=0.017) were significantly higher than others. Sex, marital status and educational level had no statistical correlation with the total satisfaction score(p>0.05).

 Conclusion: The findings of this study revealed favorable satisfaction level of patients with emergency care services in military hospitals. However, it seems that using a variety of expert physicians and more facilities and also improvement in the process of calling doctor in emergency ward are the aspects which need the most amount of concern of health care managers in emergency centers.

---

Background: However nurses are responsible for patients quality care legally and ethically, in other side, patients have rights to receive appropriate and quality care. The aim of this descriptive study was to explore SERVQUAL dimensions (Reliability, Responsiveness, Assurance and Empathy) of Nursing Service Quality (NSQ) at Tehran Social Security Organization (SSO) Hospitals.
Material and Methods: This study was carried out as an applied, descriptive and cross- sectional study during the summer and autumn of 2009 in Tehran SSO hospitals. Study tool was prepared on the basis of the standard and modified questionnaire of SERVQUAL based on Parasuraman, Zeithaml and Berry questionnaire (1988) for NSQ and consisted of 4 dimensions which were Reliability, Assurance, Empathy, and Responsiveness. The population for this study included of all inpatients of selected Tehran SSO hospitals who were selected by random sampling (N=200). For accounting Means, Standard Deviations and percents SPSS (ver. 16) have been used.
Result:The total percentage of NSQ was upper middle (66), prescriptively Reliability (74), Assurance (69) and Empathy (64) were the most ones and Responsiveness (58) was the lowest.
Conclusion: The results of this study showed that NSQ was in desired degree from patients` perspective in selected hospitals. The health care managers should have been attention to nursing as an important workforce of a hospital for raising the service quality of their organizations .Nurses are main role in quality care improvement and patients satisfaction. So, actions regarding to improve their performance are useful and necessary. Due to lowest score of Responsiveness among nursing staff, we suggest training courses for improving organizational culture on responding and effective communication to achieve high quality performance of all nursing group staff.

---

Background: The most basic financial information and data which are needed for a laboratory manager is the costs allocated to the cost unit and the cost of services. The cost prime can increase the managers function in practical beget and strategies plan and this article based on function , is don to calculate the cost prim of clinical laboratories services in VALI A SR Hospital in Tehran by using of ABC model . Material & Methods: the study is a practical research done by descriptive-analytic method in a periodical and retrospective form during Forward to Esfand of 1378. Thirty tests were chosen according to the fluency chart. Data collecting tools, information sheets, interviews and direct observations were collected and analyzed and the cost price of laboratory services calculated by the help of MY ABCM software. Results: In VALI A SR Hospital's laboratory, Findings demonstrate that, maximum and minimum costs are related to human recourses cost (44%) and energy cost (.5%) also about activities, most activities is related to expertise activates(97% of total ). these result show THE importance of human recourses especially expert human recourse in prime cost. the maximum prime cost is related to urine analysis(11%) and the minimum prime cost is related to sodium an of biochemistry's group(21%). it means more frequency of services lead to reduce of services prime cost. Finally the average of calculated prime cost was different to hygiene ministry tariff (about 63%).this difference is result of unrealistic tariffs vs. prime cost of services.
Conclusion: According to volume test operational and other conveniences in the Valia'asr hospital's laboratory, this laboratory encounter to missing budget. We can reduce the service's prime cost by improvement of performance management especially in human recourse filed and consume recourses in best way by standardization of consumption.

---

Background: the competitive of existing area in servicing organizations which are showing the desired services, the importance and satisfy customers and making content about their needs more than before.

Material & Methods: The present study descriptive survey of practical purpose and its method correlation study has been done. Statistical Society of  this research is all referred patients to outpatient clinics in private and governmental hospitals at Tehran province(N=260). The data collecting tools have included two questionnaires, so for measuring of services quality was used from servqual standard questionnaire and part of parasoraman, zitamel and berry(1996) standard questionnaire about customer's behavioral tendencies for measuring of loyalty.

Results: T-test was used  for comparing the average in private and governmental section at all the five dimentions and  pierson correlation coefficient was used for determining the relation between one by one the five dimentions of services quality with patient 's loyalty and also used regression  test. 36% of variance in patients' loyalty is due to components of service quality. A change of one unit in tangible factors, ensuring, and empathy results in 0.263, 0.285, and 0.116 change in patient 's loyalty, respectively. Regression model cannot make any prediction for other components because the significance levels of components are greater than 0.05.

Conclusion: whereas in this research there is meaningful relation between services quality and patient's loyaltyit seems that in such organizations the strategic application which cause the improving of qualitywill redound the increasing of patient'sloyalty and finally it will cause more profitability for hospitals.

---

---

---

---

---

---

Background: In the absence of medical facilities in Social Security Organization (SSO) hospitals in provinces, the patients will be dispatched to Tehran. This will dissatisfaction and intellectual and emotional tensions and imposes a lot of costs upon SSO for dispatching the patients . The objective of this study is to compare franchise elimination of medical services in hospitals in contract with social security organization in Provinces with costs of patients dispatching to Tehran .
Materials and Methods: The study was done as retrospective and analytical research. The neurosurgical patients dispatched to Tehran were selected for the study (using the census method). The data were collected in information forms. Research finding were analyzed by SPSS software.
Results: Among studied provinces, Khuzestan province ,with 233 cases, had the highest frequency of patients dispatched and Zanjan and Golestan provinces with 2 cases had the lowest frequency. There was a significant difference between average of dispatching costs paid by SSO and the average franchise paid by patients (p<0.001) such that patients dispatching cost was higher than the franchise paid by patients. There was also no significant difference between average dispatching costs and franchise margin among studied provinces.
Conclusion: Considering the fact that cost of studied dispatching patients was higher than the franchise paid by them in exchange of medical services from hospitals in contract with SSO, elimination of medical services` franchise and treatment of patients in their provinces could decrease in the SSO costs compared with dispatching them to Tehran.

---

Background:  It  is  a  long  time  that  the  matter  of  manager`s  Communication  skills  and  staff motivation  have  come  up  in  Iranian  hospitals.  This  study  determined  the  relationship  between manager`s communication skills and staff motivation to identify the present situation and provide managers with appropriate strategies to enhance the motivation level of employees in the Modares hospital.

Materials and Methods: This study was conducted using a descriptive-correlative method. The statistical society consisted of 66 individuals including 11 top and mid-level managers and 55 of their affiliated staff which were selected using a clustered model from the medical and administration sections. Data were collected using a 3- part questionnaire. Demographic data were measured in the first part while communication skills and motivation were measured in the second and third parts separately. Manager`s communication skills were measured using the Ardeshirzadeh(2005) questionnaire while Mokhbery questionnaire (2008) was used to measure staff motivation.The data were analyzed by the SPSS software using statistical indicators, relative frequency, mean and standard deviation, nonparametric tests and Pearson correlation factor.

Results: The average of the three dimensions of manager`s communication skills were (3.57± 0.57) for non-verbal skills, (3.24 ± 0.62) for the underlying communication skills and (3.23 ± 0.88) for verbal communication skills in a descending order while the average score of staff motivation was (2.57 ± 055). Meanwhile results from the Pearson correlation factor showed that there is only a significant positive relationship between the underlying communication skills and staff motivation with the correlation coefficient of r=0.25 and p-value = 0.042.

Conclusion: Since there is a significant relationship between the underlying management communication skills (empathy, effective listening and self-efflorescence) and staff motivation, improving this dimension can increase the motivation of employees.

---

Abstract Background: Several factors have an impact on hospitals` crisis preparedness including the status of “internal factor ”. This study is aimed to investigate the relationship between the status of hospitals `internal factors and their level of preparedness in crisis. Materials and Methods: This correlative, applied, and cross-sectional study was conducted in 12 hospitals of Kurdistan University of Medical Science in 2008. The data were collected using the standard Weisbord questionnaire and hospital preparedness checklist to measure the status of internal factors and the hospitals` level of crisis preparedness ,respectively. The data were analyzed using descriptive and analytical statistical methods. Results: Changing internal factors would result in 74% of the changes in level of hospital preparedness in crisis in all studied hospitals . The preparedness level and the organizational structure of the hospital had strongest relationship and preparedness level and personnel’s attitude to changes had the weakest respectively . Conclusions: Hospitals should analyze their internal factors status in order to improve their preparedness level in crisis. Concentrating on different aspects of internal factors, reviewing objectives, improving increasing teamwork, involving personnel in decision-making, using performance-based rewards, forming communication committee, improving leadership styles, training organization `s managers and leaders, and facilitating internal and external coordination could be effective .

---

Background: Increaseing efficiency and effectiveness is the ultimate goal of staff training. Determining and being aware of staff training`s results efficiency is the necessity of learning transfer process and environmental identification which can complete the training cycle and leads to more effective plans and training activities. This study is aimed to predict the relationship between the aspects of learning environment and transmission of learning in Milad Hospital from clinical staff`s viewpoints. Materials & Methods: In this study, 306 people from different hospital's wards were selected by random sampling. The data were collected using Bartram et al learning questionnaire and researcher-made questionnaire of training transmission.The data were analyzed using Pearson correlation test and regression analysis. Results: There is a significant relationship between learning environment and learning transmission with correlation coefficient of 0.604 and coefficient of determination of. 0.604 with positive direction. About 0.60% of training transfer can be clarified by learning environment. Conclusion: Identifying the elements of learning environment is essential to enhance learning transfer to workplace. Learning transfer can lead to the development of organizational learning and sharing skills in order to optimize quality of services provided for clients and patients.

---

Backgrounds: Explanation of Cognitive empowerment & Human Sources Productivity is theoretically & practically important . This research is aimed to examine the relationship between psychological empowerment of staff with human resources’ productivity. Materials & Methods: This study is applied by purpose and survey by method and correlation was used to investigate the mentioned relationship . The statistical population consist of administrative and financial stuff of Hashemi Nejad hospital. The data were collected by questionnaire and interviewing and observing. Two types of questionnaire had been distributed among statistical samples for testing survey’s hypotheses witch their questions were based on Likert scale of seven. First questionnaire’s reliability was 0.95 and second one was 0.93. Due to achieve survey’s objectives, both analytical and descriptive statistic had been used. Results: using Pearson correlation coefficient, the survey’s testing hypothesis showed a significant correlation between component of cognitive empowerment and four variables of human recourses productivity (organizational commitment, organizational participation, job creativity and job satisfaction). The relationship between the empowerment component and four other variables were 0.95, 0.90, .0.86 and 0.85 respectively. Conclusion: using effective psychological empowerment components can play a major role in stuff’s productivity.

---

Background:Hospital is the most important health care services provider center.Undoubtedly, properand effective management performance can be very important. This study aimed at assessing professional and non-professional managers’ performance among selected hospitals in Tehran. Materials and Methods: In thisdescriptive study the population was staffs of ten selected hospitals in Tehran. With the intention of performing the study, a 41-items questionnaire was used which confirmed its validity by experts and its reliability by Cronbach alpha(=90).After data entry in SPSS software,frequency distribution tables, diagrams and central tendency and dispersion were used. With the intention of measure probable correlation Contingency Correlation Coefficient - C was utilized. Results:The comparison betweenprofessional managers’ responses with non-professional ones revealed an incremental trendfrom “seldom” to “always” in all domains of management functions (including planning, organizing, coordinating and control)and Contingency Correlation Coefficient - C indicated statisticallysignificant relation between domains and types of managers (professional and non-professional)P = 0.003, P = 0.006, P = 0.001, P0.0001 respectively. Conclusion:Managers’ professional education is inevitable for hospital managing duties.

---

Background: Nowadays, quality of working life as a universal concept of human resource management and organizational development have been regarded and improving it, is key to successfully managing any organization. This study was conducted to survey   Relationship between Quality of working life and Work-family conflict among Nurses of Hospitals in Tehran.

Materials and Methods: This study is descriptive –analytic that performed cross sectional. The study population was the nurses of the hospitals of the Tehran University of Medical  sciences (N=215).The data was gathered using two questionnaires , Quality  of working life components of Casio and questionnaire of work-family conflict prepared based on Carlson. Cronbach's alpha was used to assess the reliability of the questionnaire. Spearman correlation test was used for statistical analysis.

Results: There was no significant relationship between Education and work facilities (Quality of  working  life components) with the work-family conflict (p >0.05).but  relationship between the democracy, participation in decision making, job design, workplace in organization with the work-family conflict was significant (p <0.05).finally,  between Quality of  working  life  and  work-family conflict a significant relationship was observed (p <0.001).

Conclusion: Because the significant relationship was observed between the Quality of working life and work-family conflict among the nurses, It can be concluded that Work-family conflict be reduced with improve of Quality of working life.

---

Background: Hospitals are best places to provide preventive and health promotion services along with healthcare services. These studies aimed at determine the effect of establishing health promoting hospitals’ standards on hospitals indicators in Fatemieh hospital.

Materials and Methods: This is a comparative study which was conducted in Fatemieh (case) and Khatamolanbia (control) hospitals in 2013. The standards of health promoting hospitals as an independent variable were established in Fatemieh hospital. Data related to indicators of leaving hospital with personal satisfaction, Cardio pulmonary Resuscitation (CPR) and neonatal mortality were collected in both hospitals in second half of 2012 and first half of 2013. SPSS version 16 used for data analysis and Chi-square and Fisher exact tests were utilized. The results were shown by comparative tables.

Results: The neonatal mortality rate before and after the intervention was 7.28 and 14.03 in case hospital, while this rate was 5.26 and 10.83 in control hospital respectively. The percentage of leaving hospital with personal satisfaction before and after interventions was 3.43% and 2.93% respectively in case hospital and success of cardiopulmonary resuscitation in this group was 56.1% and 61.3% correspondingly. There was no significant relation between establishing standards of health promoting hospitals and indicators of leaving hospital with personal satisfaction and neonatal mortality in Fatemieh hospital, while significant relation was obtained between promoting of cardiopulmonary resuscitation indicator and standards of health promoting hospital in mentioned hospital(P=0.001).

Conclusion: Initial results revealed that establishment of health promoting hospitals’ standards had positive effects in Fatemieh hospital and lead to improve a number of indicators. 

---

Background: The Pabon Lasso graphical Model is a method to determine hospital efficacy as one of the most important part of health system in developing countries. This study aimed  at assessing the efficacy analysis using Pabon Lasso Model and comparing with national standards of educational hospitals affiliate to Qom University of Medical Sciences.

Materials and Methods: This descriptive study conducted in educational hospitals of Qom University of Medical  Sciences in 2011 - 2013. Data collected by approved forms of Health Ministry and three indicators including bed occupancy percentage, bed turnover rate, and average length of Stay were calculated for each hospital using Pabon Lasso model. One sample t-test conducted to data analysis.

Results: The mean of bed occupancy and bed turnover was 76.9±9.8 and 100.6±35.4 respectively which were significantly higher than national standards. In addition, the average length of Stay was 3±1.1 days that were similar to standard. The Highest efficacy calculated for IZ hospital and lowest efficacy observed in KA and NE hospitals. Moreover, ZA Hospital can achieve excellent efficacy in 2013.

Conclusion: The mean of bed occupancy and bed turnover assessed  very desirable  and higher than national standards. Moreover, only IZ and ZA hospitals had excellent efficacy based on Pabon Lasso model. 

---

Background: First of all, in method of Activity Based Costing (ABC), activities identify and then direct and overhead costs associated with each activity calculate based on allocation methods. This study aimed at estimating cost of Hematology ward based on method of Activity Based Costing in Imam Reza hospital of Tehran city in 2014.

Materials and Methods: This study was an applied and cross-sectional one. Specific and overhead data cost of Hematology ward collected using activity-based costing method in Imam Reza hospital in the first semester of 2014. In order to allocate the costs of Hematology ward services, first, allocation bases were determined and then direct allocation method utilized to estimate the costs.

Results: The study findings indicated that costs of each CBC Test, Malaria slide, Cell Count of Biological Fluids and Reticulocyte count were 72673, 64678, 48509 and 48508 Rials respectively. Among the cost centers, the highest costs belonged to buildings depreciation (overhead) (714117127 Rials), Hematology personneles (4182223581 Rials (and materials and supplies costs (110635349 Rials), respectively.

Conclusions: Based on study results, estimated costs differed from tariffs and only Cell Count of Biological Fluids tariff is greater than the estimated cost, the rest of the tests had fewer tariffs than estimated cost which cause laboratory financial loss. At first, in order to control or increase productivity, it is essential to focus on building depreciation costs (e.g. increasing the number of tests) and then should be plan properly to increase manpower productivity of materials and supplies. All tariffs were estimated higher than the estimated cost without building depreciation cost.

---

Background: Emergency response of hospitals to deal with disasters is essential to success in providing qualified emergency services. The aim of current study was to evaluate emergency response of hospitals in Karaj against disasters.

Materials and Methods: This study was a cross sectional one which performed among 13 Karaj hospitals in 2013. To collect data, emergency response Checklist WHO (2011) was utilized with 90 questions prepared in 9 domains (Command and control, Communication,  Safety and security, Triage, Surge capacity, Continuity of essential services, Human resources, Logistics and supply management and Post-disaster recovery).  Data analysis carried out using SPSS version 20 with descriptive tests.

Results: mean score of emergency response was 44.17%. The most and the worst dimensions were hospital triage 70.30% and accident reconstruction after the emergency 24.84% respectively.

Conclusions: Based on WHO checklist, only 44.17% of studied hospitals were able to respond disaster events. Planning and providing a systematic framework to deal with disasters is a necessity, and the major role of hospitals should not be ignored in providing services considering its priority in plans and budgets in disasters conditions.