Journal of

---

Background: Medical tourism is an opportunity for hospitals to fuel growth by tapping the potential of the international patient marketing. Some countries have specifically considered the need of the 21st century that man to fully benefit from the topic of "medical tourism" to use the available opportunities in their countries. The aim of this study was to develop of medical tourism through capability of the Tehran's hospitals.

Materials & Methods: This research is a practical in the aim used of correlations as in method. In this regards 4 hospitals in Tehran city which were active in the medical tourism area with a high number of foreign patients collected. The participants were 63 doctors and nurses worked in these hospitals. The Questionnaire was researcher made including 6 Likert scale points (5 = very much, 4=much, 3=mid, 2=little, 1 = very little and 0 = none) as the data collection tool. Validity was confirmed by using the expert opinion professional and the reliability was approved by obtaining a Cronbach alpha of 0.859. SPSS software was used for statistical analysis and Spearman's correlation coefficient was used to measure the associations between variables.

Results: The results showed that medical equipments had the best status with the mean score of 3.9 and information applying and communication techniques recorded the lowest scores with the mean of 1.7. The correlation between average revenue of foreign patients and medical equipment status followed by costs of services was 1 score with a positive significant correlation (P = 0.000).

Conclusion: Using the advance of medical equipments with high international technology and standards make a clear statement in the field of medical services fees, and making the competitive costs is the great benefit to develop medical tourism.

---

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.

---

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 .

---

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: 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: Demographic prediction indicates that Iran population move towards an aged society until 2025, Hence, the need for medical care will be increased.  The study aimed at predicting geriatric specialists based on dynamic system approach for the Iranian elderly.

Materials and Methods: After an exploratory study, data gathering and building similar structured in order to determine geriatrics number prediction by considering the important factors. Causal loop diagram to show relationship between variables, stock-flow diagrams for quantitative analysis of system dynamic behavior was conducted and model equations in Vensim software version 5 used.

Results: After simulation, intake students' simulated model revealed increased trend then a sharp decline and finally the pattern had fixed trend from 2009 to 2012. Pattern of physician who was still in study and also graduated physician was in growing trend. Employed physician had growing trend and then it fixed, and retired physician had fixed trend at first and then had an incremental trend. Finally, the various behavior of workforce assessed in three level.

Conclusion: According to increasing  growth of the elderly population until 2025,  we will encounter  with shortage  more than 2500  geriatrics which can be  compensate by 50% graduated admissions of the major annually. 

---

Background: One of the fundamental changes in the health system of Iran in recent years is the "health system reform plan", that the effects of which should be examined from various dimensions. The purpose of this study is to determining the effect of health system reform plan on health indicators in population covered by Ahvaz University of Medical Sciences.
 
Materials & Methods: In this descriptive-analytical study, the data of the selected health indicators of Ahvaz University of Medical Sciences in the period before and after the health care system reform plan (from 2012 to 2018) was collected, described and analyzed with SPSS.
 
Results: The highest rate of change in mortality indices was between 2013 and 2015, orderly in U5MR, IMR & NMR, With the mean difference 13.282, 10.825 & 7.955 (P=0.001, P=0.002 & P=0.004). The highest rate of change in Care Coverage for Children Under-five, is between 2014 and 2015 with mean difference of 11.335 and about the Antenatal Care Coverage, between 2014 and 2017, with mean difference 10.050 (orderly p=0.002 & p>0.001). MMR was not significant.
 
Conclusion: The time trend analysis on health indicators confirms that the changes in the early years of the reform plan have been a lot, then it has slow down. Most of the change in health indicators is related to years of 2015 and 2016. The findings indicate that the latest health reform plan in Iran has improved the mortality indices (Reduce in NMR, IMR & U5MR), Care Coverage for Children Under-five and Antenatal Care Coverage (6+). Health reform plan has not affected on MMR.

---

Introduction:The purpose of this study is Investigating the effect of strategic planning on human performance from the perspective of the staff of Shohada Tajrish Hospital in Tehran.
Materials and Methods: This research is applied-practical in terms of purpose and correlational in terms of nature and descriptive method. The statistical population of the present study includes all permanent staff of Shohada Tajrish Hospital. Using simple random sampling method and according to Cochran's formula, 184 people were selected as a statistical sample. In this study, the Strategic Human Resources Management Questionnaire and the Performance Questionnaire were used to collect data. Experts' opinions were used to confirm the validity of the questionnaire and SPSS software was used to assess the reliability. Cronbach's alpha was 0.868 and 0.751. SPSS software and simple linear regression were used to analyze the data.
Results: The results showed that planning, supply, development, performance management, reward and employee relations have a significant effect on the performance of employees of Shohada Tajrish Hospital in Tehran.
Conclusion: Since the results of the research indicate a very strong relationship between strategic human resource management and the performance of the organization in Shohada Tajrish Hospital, it is necessary to pay sufficient attention to human resource management in health centers. It is also necessary to pay special attention to categories such as human education and development, effective interaction and communication with employees, and hiring and hiring.