Journal of

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Background: A variety of methods are available for identifying and measuring adverse events and medical errors in healthcare. The aim of this study is to review these methods with their strengths and weaknesses.

Methods: Electronic databases including Medline, Embase, Google Scholar and Iran Medex were searched to identify and summaries relevant studies.

Results: Different methods have been used to identify adverse events and their nature, causes and consequences. Record review seems to be the most common and the best method for measuring the rate and consequences of adverse events. However, this method is relatively expensive and time consuming and still underestimates the rate of adverse events. It is also not suitable for identifying the underlying causes of adverse events. The other method commonly used is reporting system including critical incident reporting system. This method is relatively cheap and more suitable for exploring the underlying causes of adverse events, but it is not suitable for identifying the rate of adverse events as it may underestimate many adverse events. Other methods include critical incident technique, interview, questionnaire, direct observation and review of claims and none of them are suitable for identifying the rate of adverse events but they might be useful for other purposes including assessment of the causes of adverse events.

Conclusion: Several methods can be used for study of adverse events. No single method can serve all purposes. Each method has some strengths and weaknesses. Using a combination of methods is more suitable, but this approach is more expensive and time consuming. Which combination of methods are more appropriate, depends on several factors including the aim of the study and resources available.

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Background: Various studies have highlighted the importance of accreditation as a ubiquitous performance measurement system of hospitals. However, the effectiveness of this mechanism has not been addressed, as much it deserves, in developing countries. Therefore, current study intends to investigate the performance of the system using the SERVQUAL model.
Material and Methods: This research is an applied and cross-sectional survey. Decision-making Board of Hamedan Hospitals (N= 200) constitutes the target group. A self-administered questionnaire including both structured and open-ended questions has been used for data collection. Analysis of the quantitative and qualitative data was conducted using SPSS and Thematic Content Analysis (TCA), respectively.
Results: Only 39 percent of the target group had high awareness of current accreditation programme. The highest rate of gap, 55.8%, between the group's perceptions and expectations from accreditation system, belonged to the indicator of staff's satisfaction and the lowest rate, 17.3%, to structures and establishments.
Conclusion: The low score of the target group's perceptions towards the accreditation programme could be a sign of the low degree of their satisfaction, which might result in their poor cooperation. More and effective attention to hospital managers' views, recommendations and reactions might be an appropriate preventive solution.

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Objective: the aim of this study was to determine the types of relationships and problems between basic insurance organizations and university hospitals.
Methods: this is a qualitative study conducted in 2010. We interviewed revenue officials of hospital and resident representatives of insurance organizations in nine hospitals affiliated to the Tehran University of Medical Sciences using semi-structured interview techniques. Interviews focused on relationships, problems and solutions between basic insurers and hospitals. We used the framework method for the analysis of qualitative data.
Findings: six themes were identified: relationship between insurers and hospitals, supervision tasks of insurers in hospital, causes of deductions, deduction solutions, hospital problems with insurer organizations, and insurers' representatives problems with hospitals. Conclusions: Hospitals and basic insurer should establish effective communications. The results of such relationships, in addition to solve their own problems, helps the patients. Inappropriate relationship between hospital and basic insurer organizations mostly affects the patients.

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Background: The aim of this study is to explore the safety and diagnostic performance of dual-source CT scan in comparison with single source CT scan and conventional angiography in patients with coronary heart diseases.
Materials and methods: A systematic review was performed using CRD standard methods. The Cochrane Library, MEDLINE, EMBASE، Google Scholar and TRIP were searched up to April 2009. The references of the marked studies and gray literature were also searched.

Results: 17 articles were included. 9 articles reported the safety and 12 articles reported the diagnostic performance of DSCT.  Generally DSCT was a non-invasive and safe procedure.  Using DSCT the exposure of patient to X-ray was less than 64-slice single source CT (SSCT) and more than conventional angiography. For the DSCT the mean sensitivity was 90.4%, mean specificity was 82%, mean PPV was 83% and mean NPV was 96%. For the SSCT the mean sensitivity was 90.4%, mean specificity was 82%, mean PPV was 83% and mean NPV was 96%. The mean sensitivity, specificity, PPV and NPV of DSCT were slightly higher than SSCT.

Conclusion: DSCT is a noninvasive and relatively safe technology. The diagnostic performance of DSCT is higher than SSCT, but its performance is not so much high to be able to substitute the conventional invasive angiography which is still the gold standard test.

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Background: Hospital is the most expensive part of a health system. Manpower is the mainly valuable factor in productivity and service delivery. Since personnel costs make up more than 60% of hospital costs, increasing productivity and efficiency of human resources are significant. The most important ways to increase utilization of this valuable resource is to standardize the quantity and composition of the human distribution. This study determined the standardizing of nurses resources in a sample hospital.

Materials & Methods: The descriptive and cross-sectional study applied in 2008. Data of study collected by questionnaires and library studies by using descriptive statistics were analyzed. Sample of study is the private general hospital with 85 active beds, including gynecology, surgery, men and children, women, surgery, neonatal intensive care wards. Data collection tools were tables containing the number and composition of nurses and hospital performance indicators. After gathering data, it compared with the standards and recommendations were conducted. Using standard of job hours of nursing care required for each group of patients and protocols of Ministry of Health and Medical Education.

Findings: The numbers of nursing staff in the hospital were 96 people, including 38 nurses, 16 assistance nurses and 42 aid nurses. The optimum numbers based on average annual bed occupancy in different sectors were: 94 nurses, including 60 nurses, 34 assistance nurses and aid nurses.

Conclusion: A sample hospital uses healthcare workers as an aid nurses to assist in a wide range of patients' care. With regard to development of medical sciences and become more specialized nursing care industry and major changes in techniques and equipments, to move on from traditional invasive surgical procedures to non-invasive medical practices and the incidence of further complex cases, it will be effected to replace them with educated nurses to care of patients.

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Background: Focusing on making opportunities to participate of patients in all levels of health care system is important in order to develop of system capability that could make improving of patients’ safety and quality of care services. The aim of this study was to determine inpatient perceptions in general hospitals of Tehran medical university regarding patient participate in treatment decisions and safety. Material and methods: This was a cross-sectional study in 1390. First, the list of eight general hospitals affiliated to Tehran University of medical sciences and all clinical wards were obtained through the university website. Then, stratified random sampling method applied to collect 300 patients as a sample size. Data were collected by using a structured questionnaire that validity and reliability were accepted. Descriptive statistical methods, linear regression and multivariate logistic regression were applied to analyze. Results: From total of 300 patients, 60% of them were female. The level of participating by patients in cure decision making were at high level (59.7%) and 27% in low level. The range of patients’ safety was at high (60%) and low (26%). The level of participate in decision making of cure process had high rate among young people and employed participants. The patients who were unmarried, educated, and employed had lower score in patients’ safety. The participants’ perception had no effect on the patients’ safety perceptions. Conclusion: The symptoms that might be interpreted as an abnormal could be interpreted in different ways by the others. These unusual results could come from dissimilarities in demographic features

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Background: With more than 12 million new cases of cancers and nearly 7.6 million deaths all around the world in 2007, cancer currently is the third leading cause of death in the world. This study was conducted to determine medical and non-medical direct costs of cancer patients’ hospitalized in the cancer institute affiliated with Imam Khomeini hospital. Materials and Methods: This was a cross-sectional study. All patients over 18 years old with kind of head, neck, and stomach cancers that undertaken of oncology treatments in the cancer institute which affiliated ” Imam Khomeini Hospital”. Initially eligible patients invited to participate in this study. The data was collected through structured interviews with patients and or their carers. The data, then, was analyzed by SPSS software. Results: The average medical and non-medical direct out-of-pocket costs during primary treatment were 2,609,000 and 245,000 Tomans per patient, respectively. Furthermore, the direct average of medical costs for patients who lived in Tehran and other cities were 3,313,000 and 1,870,000 Tomans while the direct average of non-medical costs for patients who lived in Tehran and other cities were 136,000 and 360,000 Tomans, respectively. Conclusion: The new policies for costs coverage related to cancer patients’, particularly the medical insurance organizations, financial supports from finance intuits like as banks or charity organizations, appropriate distribution of cancer’s centers or providing accommodation to cancer patients who are referred from the remote sites in other cities, and also achieving the equities in health sectors could be reduced the financial costs of cancer patients and might be helped them to manage of cancers efficiently and effectively

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Background: The hospital is one of the main organizations which offering health care and medical services in a high level allocated sources in the health sectors. Therefore, considering to efficiency costs is great importance. This study aims in considering the efficiency of the hospitals of Medical University in Tabriz, Iran, by using Data Exhaustive Analysis Method.
Materials & Methods: The study inspected and analyzed the technical efficiency and also effective factors on it in selected hospitals by using Data Exhaustive Analysis Method during the 3 period years (1384-1387). In order to conduct this study, the comprehensive Input-oriented Form of Data Exhaustive Analysis Method assuming in the variable return compared with the scale. The variables of the inputs in this study included number of physicians, non-physician staff, and active bed and annual costs of the hospital. The variables of the outputs included the coefficient of the occupied beds, number of admitted patients, and surgeries. To data analyzing, SPSS and data envelopment analysis software were used. It is worth mention that the data in this study were accumulated by using the forms devised by the authors and standardized questionnaire via referring and going to the hospitals.
Results: The findings of data exhaustive analysis method showed that there was %5(TE=0/953) possible capacity augment in the technical efficiency. The findings also suggest that there is a potential frugality in consuming the inputs in order to produce a constant amount of the output. Meanwhile, there is a potential augment of the output by using a constant amount of the input, as well. The findings also represent the effect of the demographic factors and functional factors on the efficiency of the hospitals.
Conclusion: It is suggested that to leave out the surplus staff, decrease the surplus costs of the hospital through replacing the energy consumption and a proper management of energy and other surplus inputs, hire sophisticated managers and applying the graduated field of management in health care and medical services and also hire the managers with high quality degrees, create the data envelopment analysis of enhancing efficiency should be one of the useful way to provide qualified medical services in our society as a comprehensive programming. Based on the findings of the data Exhaustive analysis method, improving the efficiency of the hospitals, health care system and medical section are essential as well.

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Background: Patient safety is one of the most important components of health care quality. Given that assessing the current culture of patient safety is the first step in improving patient safety, we decided to translate and validate one of the most used patient safety culture assessment tool (HSOPS questionnaire) for the first time in Iran, and in this way take a step toward improving patient safety in our hospitals.
Materials & Methods: This cross sectional study was done among four general hospitals of Tehran University of Medical Sciences (TUMS), which were selected purposefully. Questionnaires randomly distributed among 420 members of the study population, and were collected after completion. Results were analyzed using Confirmatory Factor Analysis (CFA), internal Consistency and correlation.
Results: The value of Fitness function (FF) was 14.25 and according to that, the value of Goodness of Fit Index (GFI) was 0.96. Almost in all of the dimensions, the internal consistency of items in the translated Persian questionnaire was lower than the original one and ranged between 0.57 to 0.8.
Conclusion: Regarding to the findings of this study the Persian translation of the HSOPS questionnaire is a valid tool for the assessment of patient safety culture in Iran's hospitals.

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Background: People give you an idea about variety of behaviors when confronting diseases. Different factors such as age, sex, economic and social situations have effect on its. Recognition of these behaviors helps politicians to deliver better services. This study aimed to identify health seeking behaviors of Zoroastrian residing in Yazd province due to advanced number of them in comparison to the other provinces.
Materials & Methods: This study is a cross sectional. The sample size was 196 cases which selected by using simple sampling method. The data was collected via the questionnaire, then data were analyzed by spss.11 software with two test of chi square and exact test of Fisher.
Results: The findings showed that 64.3% of the population was female whereas remaining 35.7% were male. 15.58% of participants were single, 76.5% married and the rest of them (7.7%) were widow. Data indicated that 4.1% of individuals were illiterate, 17.3% were high school , 51.3% had diploma, 23.5% had Bachelors degree and 3.6% had Masters Degree or Ph.D. 43.4% of studied population were unemployed and the rest of them (46.7%) were employed. 94.4% of participants had health insurance whereas 5.6% did not had uninsured card. The results showed that the following direct variables had relation with the following mentioned indirect variables sex with the action during the period of being sick, Place of born with reasons of neglecting sickness, marital status with action during the period of being sick, educational status with action during the period of being sick and referring to practitioner in different stages if sickness and using consultation of different groups, occupational status with the first place to get medical treatment, economical status with reasons of neglecting sickness and completion of treatment period and having health insurance with action during the period of being sick and using consultation of different groups.
Conclusion: Considering the fact that educational, occupational and economic status have relation with health seeking behaviors in individuals, developed in education and occupation status could be lead a chance to choose a better health behavior in people.

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Background: Regarding to the escalating costs of health care and limited resources in this field, the appropriate identification and control of costs is inevitable. This Study aimed to determine the unit cost of radiology services, in selected hospitals of TUMS.
Materials & Methods: This was a descriptive retrospective study. At first, we selected two hospitals (Shariati and Sina) out of general - teaching hospitals of TUMS randomly. After gathering data, using activity based costing method, the unit costs of radiography services in these centers in 1389 fiscal year (2010-2011) were calculated.
Results: The unit costs of radiography services in Shariati and Sina hospitals were 251255,5 and 334996,2 respectively. Building rent and human resources costs included the most share of total costs.
Conclusion: The unit cost of radiography services in this study is very different comparing with other studies. Calculated building rent costs in this study could be one of the possible reasons of this difference (other studies did not consider this costs). The other point is that, regarding the high share of human resources and building costs from total costs, special attention to these sources of costs and appropriate and adequate use of them, can be an important step toward improving the efficiency and cost savings in our national health system.

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Background: The scarcity of resources and growing demand for health care, as well as moral, socioeconomic and political imperatives for efficient use of resources, make cost information and adoption of an accurate methodology an integral part of the modern management.
Materials & Methods: At first, a research protocol including literature review strategies, inclusion and exclusion criteria and data gathering methods, was designed. Afterwards, using an electronic search of several databases, some relevant studies were identified.
Results: In the costing literature the economic and accounting approaches are distinguishable. Two methods of marginal and average unit cost analyses are attributable to these approaches. Considering the type of the problem to be decided about and cost targets, costing methods can be different. Factors such as types of cost analyses and economic evaluation, timing overview, analysis approach and advantage or disadvantage of economy of scale have a significant role in determining the costs.
Conclusion: Having no consensus of opinion on the most appropriate principles to use in costing process is one of the main challenges of the time. There is a trade-off between the accuracy and cost of achieving cost information... Therefore, standardization of costing methodologies and adoption of comprehensive approaches for the main issues will predispose an economical international and organizational comparability.

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Background: aging is a very sensitive period of life and paying attention to the problems and requirements of this period seems to be a social necessity. Improving medication for old patients is challenging and sometimes medication`s benefits are less than its disadvantages for the patient.Because of the numerous evidences of problems caused by medication in the elderly in the recent decade, many specialists and physicians have introduced tools and techniques for identifying these problems which are caused by medication and prescription of risky medicines.
Materials and Methods: Several methods, tools and criteria for assessment of quality of medication and medicine prescription in elderly have emerged since 1990.. We found out two categories of criteria reviewing the literature which are generally named as distinct criteria (criterion based) and implicit criteria (judgement based).
Result:The distinct category including Beers, Zhan, McLeod, Laroch and STOP/START criteria are all developed by a panel of experts and consensus in several stages. The second category of criteria concentrates on evaluation of clinical information.
Conclusion: All the tools and methods described in this study are used in Europe and in the USA which have limited market similarities with our country thereforedevelopment of tools for assessing prescription quality for the elderly in Iran is absolutely necessary.

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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.

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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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Background: This study is aimed to compare organizational commitment and intention to leave among employees in Teheran`s hospitals. Materials and Methods: In this survey 3 hospitals with different ownership`s type were examined included: A public hospital, a hospital owned by Social Security Organization, and a private hospital. The data were collected by distributing 450, questionnaires among 450 employees, which were randomly chosen. Results: Among all studied subjects few employees allocated high score of organizational commitment to themselves .This average rate is nearly 20%. Committed employees were impressively low in the Social Security hospitals compared to others. Comparing intention to leave indicate revealed the Public hospital`s employees have lowest scores among all subjects. There is a statistical significant correlation between commitment`s components and intention to leave. Conclusion: Generally the majority of employees have average and low organizational commitment. Employees with high level of commitment and high level of intention to leave make a small proportion of all hospital employees. Social security hospitals must be taken into consideration due to the levels of commitment and intention to leave.

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Background: In the hospital setting, the potential for conflict is considerably high, because of the frequent and complicated interactions among nurses, physicians and other medical team staff and also the variety of their roles. With regards to the destructive conflict between physician and nurse which can negatively impact on the quality of health care delivery, this study aimed to investigate sources of conflict between physicians and nurses. Materials & Methods: The study population involved a total of physicians and nursing cadre employed in 4 hospitals affiliated to Ardebil University of Medical Sciences. 260 subjects were selected by both census and Simple random sampling methods. Data collection process was accomplished through questionnaire that its reliability and validity were confirmed. Data analysis was done using the Descriptive statistics and Mann-Whitney, Kruskal-Wallis tests. Results: Inequality in the social status between physicians and nurses from the perspective of patients and their attendants and also inequality in distribution of immaterial benefits between two forementioned groups (mean=3.23) were the most leading factors in arising conflict. The Social economic system (p<0.001), the health system (p=0.013), the hospital system (p<0.001) and interpersonal relations (p<0.001) variables had a significant relationship with the organizational position. Conclusion: creating appropriate social and cultural contexts in order to promote the social status of nursing profession as well as improving the organization and its management could be effective to prevent or at least mitigate conflict between physicians and nurses.

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Abstract Background: Accreditation is a program that is designed for evaluation of health care organizations and measured processes and structures according to predetermined standards. The purpose of this study is to survey the safety situation and quality of care in selected hospitals of Tehran University of medical sciences based on the Joint Commission International (JCI) standards and determination of their strengths and weaknesses. Materials and Method: This descriptive, analytical and cross-sectional study was carried out in 5 hospitals. Translated Joint Commission International (JCI) questionnaire checklist with 14 standards was used as the study tool. Data entry and statistical analysis were performed using the SPSS.13 and K Independent Samples tests were used to compare hospitals. Results: Highest quality and safety of care score belonged to the hospital B (84%) and then to hospitals C (83%), A (72.75%), E (72%) and D (70.5%). Central indices like patient and family rights, quality improvement and patient safety, infection prevention and control standards in the studied hospitals are completely different according to the statistical results. Conclusion: Study results show that the status of hospitals in terms of safety and quality of care are almost appropriate but in some cases there is a large distance between JCI standards and their current status and the studied hospitals have to make appropriate and related policies in order to plan and implement proper programs to improve their situation in quality and safety of care.

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Background:In recent years, clinical governance introduced as amodel to determine continuous quality improvement principals in health services. This study considers assessing the readiness of selected hospitals clinical governance programsimplementation by using CGCQ instrument. Material and Methods: The survey was conducted in 14 private and public Hospitals in order to assess hospitals’ readiness to clinical governance programs implementation in Tehrancity. In this regards, 800 health professionals including physicians and nurses were inquired. Collected data analyzed by SPSS17 using correlation coefficient, mean comparison and descriptive tests. Results:Based on study results, both private and public hospitals had readiness to implement clinical governance program. Results of field survey revealed mean score of organizational climate of clinical governance (3.14) is higher than average score (2.5) in selected Hospitals. Conclusion: This survey demonstrated the necessary readiness to implement clinical governance programs is in an acceptable rangein assessed hospitals. Moreover, there is a big effort to use a unique and comprehensive strategy with the intention ofcontinuous quality improvement in health services.

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Abstract Background: Organizational commitment is an important occupational attitude which demonstrates personnel staffs liability for their organization. This study aimed at assessing the level of nurses’ organizational commitment in selected hospitals of Tehran University of Medical Sciences in 2011. Materials and Methods: In this cross - sectional study, 363 nurses with BS and MS degree who employed in selected hospitals of TUMS were chosen using random sampling method. Data were collected using a 2-section questionnaire including demographic variables and organizational commitment. With the intention of data analysis, descriptive statistics, independent t -test, chi square, Kruskal-Wallis, Mann-Whitney tests were conducted. Significant level assumed at 0.05. Results: Study results confirmed that organizational commitment and its all dimensions (affective, continuous and normative) were in moderate level (65.87± 15.32). The Level of organizational commitment had significant relation to job position (P<0.001), ward type (P<0.001), years of experience (P=0.03), and the hospitals (P=0.004). There was no significant relationship between demographic variables and organizational commitment (P>0.05). Conclusion: Since, None of the demographic variables revealed significant association with organizational commitment and occupational and organizational factors had significant relation with organizational commitment, it seems that personal factors should not be considered as the main criteria of recruiting committed nurses