Journal of

Background: Achieving equitable financial contribution and removing the risk of households' exposure to catastrophic expenditures are the most important challenges for health systems all over the world. This study aimes to measure Iranian households' exposure to catastrophic health care expenditures and surveying the factors affecting this expenditure, based on the World Health Organization and the World Bank approach.
Materials & Methods: Sectional data of the World Health Survey in Iran in 2001 has been analyzed. This survey covered 10300 urban and rural households across the country. The catastrophic expenditure has been calculated based on the ability to pay in the thresholds of 40, 50, and 60 percent and the income at the threshold of 20 percent. Logistic regression model was used to examine factors influencing catastrophic health expenditures.
Results: The proportion of families confronting catastrophic health expenditures was estimated at 9-15 per cent. Facing catastrophic expenditures showed a statistically significant relationship with variables such as having a family member suffering from a chronic disease, family`s financial condition, and living in rural areas regardless of the thresholds used. The insurance coverage showed a statistically significant relationship with exposure of catastrophic health expenditure just in case it was measured using the 40% threshold.
Conclusion: Political interventions and policies of the government such as implementing fee exemptions for certain target groups, designing benefits packages, extending population coverage through prepayment mechanisms and protecting the poor and disadvantaged groups can protect households from experiencing catastrophic health expenditures.

Background: Reward system program is an investment tools in order to improve quality of services. Accordingly, this study was conducted aimed to identify the challenges of the reward system and the solutions for improving that based on the views of stakeholders in Tehran University of Medical Sciences hospitals.
Materials and Methods: This directional content analysis qualitative study was performed in Tehran University of Medical Sciences during 2014and 2015 using content analysis method. Targeted sampling was done and in-depth semi structured and face to face interviews were performed with a wide variety of experts and professionals including managers, faculties and hospital staffs. After word by word transcripting and extracting codes (meaningful phrases), these codes was reviewed again in
order to achieve subcategories. Based on subcategories, information was classified to assossiated  categories. For validity and reliability checking, stakeholders and faculties member check and peer debriefing were used.Results: Eventually, a total of 29 interviews were held. The comments were classified within 6 main categories, 19 subcategories and 1100 codes. The main categories included existing arrangements in hospitals in order to improve staff motivation; reward system challenges; derived opportunities from rewarding experiences; rewarding systematic actions; types of appropriate rewards and making
infrastructure for better rewarding system implementation.
Conclusion: Regarding multiple aspects of a reward system which could have an effective role in increasing staff motivation or a contradictory effect when it is inefficient, implementation of an effective reward system in hospitals by designing an appropriate model based on identified key factors in this study, is recommended.

Background and purpose: Considering the dimensions of organizational bullying and the context of its creation in the emergency department of the hospital, the decrease in the quality of patient care and the increase in dissatisfaction with the services received and the limited research studies in this area, the research was conducted in the emergency department of a hospital of Yazd University of Medical Sciences.
Materials and methods: To carry out this descriptive-analytical research, the interpretive structural modeling method was used. The experts included 30 doctors, nurses, and nurses who were either working in the emergency department of a Yazd University of Medical Sciences hospital or had experience of service in this department. From the extraction of these factors, they were returned to them for scoring, and the effects of these factors were measured from their point of view, and the final analysis was done by MATLAB software.
Results: The results show that the greatest effect in reducing bullying is related to "adequate training for personnel to communicate" and "proper and courteous treatment in the face of clients" (with influence power of 5) and the least effect is related to "creating a suitable comfortable environment". and "Perform appropriate triage" (with penetration power of 1).
Conclusion: Considering the destructive effects of bullying, creating appropriate mechanisms to reduce this phenomenon shown in this research and using the factors identified by the people involved in bullying can prevent this phenomenon, which occurs frequently in the emergency room of the hospital. 

Background and purpose: This research was conducted with the aim of determining the relationship between the implementation of the strategic plan and the performance of the hospital. The importance of knowing the factors affecting the implementation of the strategic plan and its identification leads to better planning and the correct implementation of the strategic planning process.

Methods: The current research is a descriptive analytical research, in terms of cross-sectional time and practical results, and it was carried out in 2018. The research population is all the people who have played a role in the drafting of the strategic plan. This research has used the census, which filled the questionnaire in a high percentage of the statistical population. After collecting the data, the information was entered into the software and SPSS version 16 software was used to analyze the data.

Findings: The relationship between the implementation of the strategic plan and the performance of the hospital is direct and strong. Among all parts of the strategic plan, customer management plays a more important role than other parts of the strategic plan in improving the performance of the hospital.

Conclusion: In order to have optimal performance in a hospital, we need detailed strategic planning, and this plan must be implemented carefully and properly monitored so that it can bring us optimal performance.