Journal of

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Background: In case of disasters hospitals as one of the first centers to admit casualties need to be well prepared. This study aimed to determine the scale of preparedness of the hospitals located in the northern areas of Iran to deal with disasters.
Materials and methods: This applied and cross-sectional study was carried out in 2011. In this study all therapeutic-educational affiliated hospitals of Universities of Semnan, Shahroud, Mazandaran, Babol, and Guilan were investigated using the census method (53 hospitals). The data were collected using instruments were a managers' awareness Questionnaire (40 items) and a 141-item checklist which were filled using the self-assessment method. The data were analyzed using SPSS statistical software and Mann-Whitney , Kruskal Wallis and Pearson correlation coefficient statistical test.
Results: The average score of managers' awareness of the disaster confronting Preparedness status was 41.89±9.12 and hospital`s preparedness to confront disasters was 56.88±5.12 which show a mediocre level in all hospitals studied. There was a significant relationship (P=0.007) between the awareness of managers and receiving training on management of disasters. The least score was related to field of planning for decreasing structural risks (40.56±29.4 ).Significant relationships were observed between preparedness of hospitals in different universities and management plans for unanticipated events (P=0.047), hospital training program (P=0.019), planning for supporting vital services (P=0.005) and environmental health measures to deal with unanticipated events (P=0.001).
Conclusion: Regarding the previous of disasters in the studied provinces and the mediocre preparedness of the hospitals, educational planning to confront disasters, strengthening the hospital buildings and organizing practical maneuvers will be effective in enhancing the preparation of the hospitals.

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Background and purpose: Hospital is the largest and most important executive unit of healthcare system therefore, full consideration of how to assess its quality is of particular importance. A question is always raised as how to evaluate the quality of the services. The current study seeks to provide a fuzzy model for assessing the service quality in this healthcare sector. Material and method: The present cross-sectional study was conducted in two hospitals in Zahedan 2012.Via reviewing the related literature, the dimensions and components of service quality assessment were identified. The SERVQUAL questionnaire for hierarchical analyses was designed and the fuzzy AHP (Analytical Hierarchy Process) model was presented. SPSS v 10.0 and Fuzzy TOPSIS Solver 2013 software were used to analyze data. Results: The findings indicated that the most important dimension for estimating the quality of healthcare services was empathy. Responsiveness, assurance, and tangible assets were the last important factors. The hospitals were compared using fuzzy AHP. According to the calculations, the ranking of the hospitals based on their performance was as follows: Imam Ali hospital with 31% compared to Social Security hospital with 29% had a better performance in service quality. Conclusion: The results revealed that hospitals needed to focus more on empathy, expertise and reliability than providing high quality and satisfactory services. By considering their weaknesses, each of these hospitals can enhance service quality and consequently, provide a better service for patients.

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Background: the using of economic tools such as production function is one of the ways to improving performance and efficient use of hospital resources. The aim of this study was the estimation of production function in educational hospitals of Kurdistan University of Medical Sciences during 2007- 2011. Material & Methods: the number of inpatient as dependent variable and the numbers of active beds, nurses, doctors and other staffs as explanatory variables was considered. These data For 12 of hospitals since 2007 to 2011 was collected by production form. Also with Eviews software version 6 and panel data, the production function of hospitals was estimated. Results: the elasticity and marginal of production for all variables explanatory was positive. The marginal of production for bed active, physician, nurse and other staff was 16.7, 54, 23.6 and 40.9 respectively. The total of input coefficient was equal 1.08 and the return to scale was increasing. Conclusion: according to the positive marginal of production for all variables explanatory, for improving of productivity and efficient use of hospital resources is suggested that the managers of hospitals in exposure to regular and irregular demand can be used elasticity of production.

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  Background : All managers want to improve their organization 's efficiency . The purpose of this paper In addition to the asses the efficiency of Hospital during the time, is trying to answer to this question that, is the recruitment of new personnel able to increase hospital efficiency?

  Materials & Methods : In this sectional study, the relative efficiency of Imam Khomeini Hospital in Arak during the thirty-one months Since April 2011 to November 2013 (16 months before and 15 months after the recruitment) by input-oriented DEA method with five inputs and five outputs and with considering each month as a decision making unit, was calculated by DEAP 2.1 software. Then, the efficiency scores during the two stages, once for sixteen months, and once for a total of thirty one month separately by Mann - Kendall test via Minitab 16 software was analyzed and the most important event in the hospital during the study period, was asked from hospital authorities.

  Results: Most inputs and outputs of hospital have increased. The efficiency of the last eight months was equal to one . In addition, the efficiency of eleventh month was lower. The value of z_s for first sixteen months and for a total of thirty-one months -0.55769 and 2.05318, respectively calculated .

Conclusion: Trend analysis of the efficiency Scores showed that simultaneously with the recruitment of new personnel without reports of other influential factors, Hospital efficiency has significantly improved.

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Background: Nowadays, it is essential to employ medical and clinical librarians to provide the required information for healthcare professionals and enhance accessibility to evidence based information in hospital libraries. Thus, this study aimed at assessing the medical librarians' employment status in hospital libraries in Tehran city in 2013.

Materials and Methods: This was a descriptive and cross-sectional study. Study population considered from all 152 hospitals in Tehran city. Data collected using a questionnaire and analyzed by SPSS version 18 using descriptive statistics.

Results: only thirteen participants had medical librarianship and information science degree. While 28 persons graduated in librarianship and information science from universities affiliated to Ministry of Science, Research and Technology and others had degree in non relevant fields. The majority of participants (51.3 %) with non-related degree were educated empirically and others had learned librarianship skills with other methods. Most of participants were employed based on hiring official process and friends and relatives recommendation.

Conclusions: There is a real lack of medical librarians in the hospital libraries in Tehran city. Thus, these libraries are not able to perform their professional duties such preparing information and omitting healthcare professionals' needs in hospitals. It is necessary that hospitals’ managers attempt to hire medical librarians' and overcome employment barriers.

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Background: Data Envelopment Analysis (DEA) is a mathematical model that evaluates the relative efficiency of Decision Making Units (DMUs) with multiple input and output. The purpose of this paper was systematic study of applying this technique in Iranian hospitals.

Materials and Methods: In this systematic review which was conducted in September 2015 and February2016, attempted to search the research which conducted in Iranian hospitals regardless of the time of publication using searching keywords in six scientific databases and with the help of Google search engine. A total of 6,613 researches found. Then, 6,566 researches removed from the study because of the irrelevant, repetitive and Inaccessibility to the full text. Then,  attempted to statistical analysis of 47 remaining researches via Excel 2010 software.

Results: 93.6 percent of the researches were published in 2009 onwards. The most research and least research have been conducted in three and eleven provinces respectively. The diversity of output indexes have been more than diversity of input indexes. In 81 percent of researches; input oriented model was used and in 74.5 percent of researches variable returns to scale is assumed. In most studies, referred to Iran's inefficient hospitals because of existence of excess resources.

Conclusions: In last seven years, the interest of Iranian researchers has increased about DEA application in hospitals especially in Tehran, Yazd and Khoozestan provinces. Scientific and rational use of resources is a proposal to the relevant authorities.

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Background: Priority setting and resource allocation are assumed to be the most important issues of health-sector and fairness thereof requires considering various criteria. This study was performed to identify the criteria used for priority setting and resource allocation in the world health systems through comprehensive review.
 
Materials and Methods: Cochrane, PubMed and SCOPUS database were searched systematically from Jan.1,2005 to Oct.10,2016. The English articles with codified and specified qualitative and quantitative criteria in the resource allocation context in health sector were included in the study. The obtained data were synthetized thematically.
 
Results: Overall, 9162 papers were extracted. At the beginning of review of the included articles, 9089 papers were removed due to duplication and also based on the title. The abstracts of the remained papers were reviewed and 17 papers were removed. Full text of 59 remained papers were reviewed and based on matching with the inclusion criteria, 34 other papers were removed, too, and ultimately 25 papers were included in the final phase of the study. Extracted criteria were categorized into four dimentions based on economic, management, structural and contextual, out of which the most frequent ones were related to cost, health system goals, local capacity and disease status, respectively.
 

Conclusion: In this study, the most important criteria used by policy makers and decision makers of health system in the world were extracted for priority setting and resource allocation. The results indicated that in the world, priority setting and resource allocation in the health system is made mainly based on criteria such as cost-effectiveness, disease status, equity/equality and the need. 

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Background: Among various emergency services, the air emergency due to access to the extreme areas, possibility to move more patients, providing higher quality treatment to the patient being carried and also access to the hospital without problems such as traffic and sudden crashes, is one of the most important types of emergencies in the health sector. So, the right location according to the scientific principles, enhances the efficiency of the aerial emergency.
Materials and Methods: This descriptive- analytical present study was conducted as an applied research in Sistan and Baluchestan province in 2016. At first, indicators affecting the location of ambulances were identified. Then, the location using deploying a Fuzzy network analysis process model next to the Fuzzy Dematel technique and the integration with geographic information system was performed.
Results: Criteria for selecting the best places for deploying air ambulances in Sistan and Baluchestan province are considered as proximity to the roads, appropriate tilt area, proximity to crowded areas, proximity to high risk passages, and the convenient distance from the medical emergencies. Output weights of the technique used for affecting on GIS software were calculated 0.244, 0.083, 0.435, 0.182 and 0.057, respectively.
Conclusion: Study results revealed that number and coverage of aerial ambulances in cities and roads of Sistan and Baluchestan province are not suitable. Therefore, the map derived from the Fuzzy integration of the information layers identified by the effective factors, illustrated that the districts of Zabol and Iranshahr cities have the best status of selected criteria to establish the air emergencies bases in the province of Sistan and Baluchestan.
 

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Background: Nursing is one of the health care base and nursing services are in effect on ill-health indicators. This study aimed to investigate the relationship between professional behavior and job well-being of nurses employed at two Shahrekord educational hospitals in 2018.
Materials and Methods: This descriptive-analytic study was performed on nurses employing at two educational hospitals in Shahrekord. A total of 269 nurses in both sexes were selected using stratified random sampling method. The Goz standard professional questionnaire for nurses and the Demo and Paschoal Survival Questionnaire were used. Data were analyzed by SPSS₂₂ software using independent t-test, ANOVA, Kolmogorov Smearnov, Pearson Correlation Coefficient and simple linear regression at a significant level of 0.05.
Results: Mean age of the respondents was 33.2 years old, 48% were aged between 31 to 40 years old while 3% were aged more than 50 years old, 58% and 42%were female and male, respectively. The average score of professional behavior and job well-being were 17.8 ± 104.5 (moderate to high) and 89.3 ± 12.9 (moderate), respectively. Regression analysis revealed that per unit increasing in the nurses professional behavior, 0.661 units were added to job well-being; and also, there was a significant correlation between "professional behavior" and "job well-being" (R²=0.328).
Conclusion: The comprehensive national plan should be designed paying more attention to creation of the necessary infrastructure to promote professional behavior which can be result in long-range consequences of job well-being improvement; also, promotion of job well-being components should be considered.

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Introduction: Intensive Care Unit (ICU) in hospitals is one of the most sensitive and costly units which is really important due to safety and health of patients during their stay in these units. Hence, considering the potential risks in this unit, treatment operations for eliminating or decreasing risks are very important. Among these intensive care units, the most important one is the open-heart surgery unit which may have irreparable damages due to vulnerability of these patients in the process of their transfer, care, and discharge. The present study aims to identify the potential risks and offer solutions for eliminating or decreasing them.
Method: In this research, we used Failure Mode and Effect Analysis (FMEA) method, which is a very useful method for evaluating and managing the risks, to prioritize risk factors. Due to some limitations of the method, fuzzy FMEA and fuzzy TOPSIS methods were also used in order to have more precise results and then the results were compared with each other.
Results: The suggested approach was implemented in ICU-OH (open-heart) unit of Kowsar hospital in Semnan. Finally, nineteen factors were recognized as major risk factors. Also, corrective actions were determined for all detected risks that can be pursued according to their priorities.
Conclusions: Factors including not observing hemodynamic signs, not considering patient safety and security, and inability to interpret arterial gas valve abnormalities are the three top risk factors that can be addressed through training and having more control on nurses.

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Background: One of the most important ways to promote the quality and attractiveness of the journal for readers is the accurate evaluation of the published articles research methodology in the journals. The purpose of this study was to investigate the research methods of the articles published in the Journal of Hospital.
 
Materials & Methods: In this descriptive study, the research methods of all articles published in the Journal of Hospital from Fall 2016 to Fall 2018 including qualitative or quantitative, field or library research , data collection methods, data analysis software, location of research, nature of the research (descriptive or analytical, etc.), topics, as well as the number of authors were investigated.
 
Results: Data of 55.29% of papers was qualitative that was turned to quantitative, 47.06% of articles had descriptive-analytical method, and 68.24% of papers had employed a field research method. In addition, 51.76% of articles had used questionnaire and the SPSS software was used in 52.08% of the articles. The location of 45.45% of researches was in Tehran province. Finally, the subject of 23.53% of papers was policy making, planning, leadership, and management in hospitals.
 
Conclusion: Most authors of the articles have followed a very similar research method during the mentioned period. So, creating diversity in the nature of the researches, using other methods of collecting information rather than questionnaires, doing more library research, and not limiting the researches to Tehran province are the most important suggestions for future researchers.
 

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Background: Iranian health system transformation plan has been implemented since 2014 with the aim of financial protection of people, equity establishment in access to health services and quality improvement of hospital services. Hospital performance evaluation is essential in order to monitor the health system transformation plan. One of the tools for evaluating hospital performance is the dynamic multi-attribute decision-making method. The purpose of this study was to use the dynamic multi-attribute decision-making method to evaluate the performance of the hospital before and after the implementation of the health system transformation plan.
Materials and Methods: In this cross-sectional study, the performance of Shariati Hospital in Tehran was evaluated for 48 consecutive months (24 months before and 24 months after the Health System Transformation plan, 2012-2016). Each month was addressed as an option in the decision-making matrix and ,with considering six important health indicators, the hospital performance was dynamically assessed  using the weighted aggregated sum product assessment and through EXCEL software 2010. 
Results: Hospital performance scores had some fluctuations over time; however, in general, it had an increasing trend over forty-eight months. The highest and lowest values were for months 42 and 13 (0.4932 and 0.9408, respectively). In addition, in the first month of the solar year, the hospital performance score declined significantly for each year.
Conclusion: Changes in hospital performance scores during the study period show improvement in hospital performance. Nevertheless, this incremental process cannot be considered as a positive outcome of the health system transformation plan. Therefore, while improving the current process, continuing the hospital performance evaluation can lead to the hospital's performance promotion.
 

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Background: According to the importance of health and treatment, it is necessary to use suitable models for planning and setting surgery time. In this study, a mathematical model is offered for operational scheduling of surgeries at surgery rooms of hospitals.
 
Material and Methods: This is an applied study and its data is related to the surgery rooms of Zahedan Al-Zahra eye hospital. Study population was the surgeries performed in March 2016. The mathematical model of scheduling surgeries at the surgery room was optimized in MATLAB₂₀₁₄.
 
Results: Due to limitations on patient admission capacity in hospital surgery ward, 79 surgeries were called off. In the proposed model, the total waiting time index for performing surgeries was 1547.29, and this index was found to be 1842 without the use of the model. Therefore, the waiting time index was improved by 16%. In accordance with the third purpose (objective) function, the tally of delays for predicted surgery ending time in one month was estimated to be 69.15 hours. The process of each surgery includes four defined activities. The end time of the activities related to each surgery has been examined and it has been optimized according to the existing limitations.
 
Conclusion: The proposed model can improve the waiting time by 16% and makes it possible to choose the surgical procedures that should be canceled and delayed according to medical priorities.
 

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Background and Aim: As difficulties increase, the level of uncertainty and risk in the supply chain increases. Medicine is a strategic product and is directly related to community health. The aim of this study is to evaluate the risk factors of pharmaceutical supply chain with artificial intelligence methods.
Materials and Methods: By reviewing the texts and interviewed 6 adept experts who had a Master’s degree and Ph.D. and had experience between 7 and 15 years in the field of risk and pharmaceutical supply chain, risk factors were identified. Finally, using multilayered perceptron neural networks and support vector machines with polynomial linear kernel functions and radial base in two low-risk and high-risk classes were classified in Python software.
Results: 22 factors were identified and classified using neural networks in 5 categories: assets, network and transportation, government and market, strategy and supplier. Shift in interest and inflation, Changes in exchange rates, Inflexibility in production and disruption of customer service are the most important risks in the pharmaceutical supply chain, respectively. The results of evaluation criteria showed that the multilayer perceptron model had better performance than the support vector machines with linear, polynomial and radial basis functions.
Conclusion: The results showed that artificial neural networks are able to classify pharmaceutical supply chain risk factors with acceptable accuracy. As a result, classification of risk factors with an accuracy of 97/07% indicates the high ability of multilayer perceptron network in risk assessment of pharmaceutical supply chain.

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Background and purpose: The organ transplant network is among the most complex and challenging systems in the healthcare sector. This study presents a three-objective hierarchical location model for kidney transplants, aiming to simultaneously minimize total time and costs while maximizing geographic equity in the supply and demand network for donated kidneys. Various transportation modes within the network are also analyzed.
Materials and Methods: This applied research was conducted over a one-year period in 2022 (1401 in the Iranian calendar) in the province of Sistan and Baluchistan. The proposed mathematical model was implemented in GAMS software and solved using the Torabi-Hosseini method and epsilon constraint technique.
Results: The model recommended establishing candidate locations for organ collection units and transplant centers without the need for air transport equipment. It suggested that only the candidate location number 2 at Zabol Hospital Transplant Center should be equipped with air transport facilities, while the other proposed locations do not require the establishment or use of air emergency services.
Conclusion: The results indicate that the designed kidney transplant network is practical and feasible. Efficient network management ensures that all organ recipients, even those far from the provincial center and in remote areas, have timely access to the necessary facilities and equipment for transplant operations.

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Background and purpose: Assessing job satisfaction within any organization is essential due to its impact on productivity and overall effectiveness. This study aimed to evaluate the validity and reliability of the Persian version of Spector's Job Satisfaction Questionnaire among employees of emergency medical centers.
Methods: This descriptive-analytical study was conducted among 270 employees of emergency medical centers in Ahvaz between February 2021 and June 2021. Data collection was performed using a census method and Spector's Job Satisfaction Questionnaire. Face validity, content validity, and translation accuracy of the questionnaire were reviewed by experts. Convergent and divergent validity and reliability were assessed using factor loadings, average variance extracted (AVE), reciprocal factor loadings, Cronbach's alpha, and composite reliability in SMART-PLS 3 software.
Results: The face validity, content validity, and translation accuracy of the questionnaire were confirmed by experts to suit the Iranian context. All item factor loadings and the AVE index for all constructs exceeded 0.4. The AVE index for the entire questionnaire was 0.523. Examination of reciprocal factor loadings confirmed divergent validity. Cronbach's alpha and composite reliability indices for all constructs were above 0.7. The Cronbach's alpha coefficient and composite reliability for the entire questionnaire were 0.83 and 0.88, respectively.
Conclusion: The validity and reliability of this questionnaire, as adjusted for the Iranian population, were confirmed to be high. Therefore, this questionnaire can be effectively used to evaluate job satisfaction among employees in various organizations, particularly in healthcare organizations and centers.