Journal of

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Background: Developing countries request to alternative revenue resources. Iran as one of the developing countries with high potentiality for attracting medical tourist is seeking to enter medical tourism marketing .This study aimed to analyze the importance- performance of the Tehran as a capital city to medical tourism viewed by medical tourists and medical service providers. Materials and methods: This descriptive, cross-sectional study was carried out in Tehran selected hospitals in the 3th first months of 2011. The data were gathered by using a validated self-constructed questionnaire. The data were analyzed by descriptive statistical techniques. Results: The results indicate that the majority of the medical tourists are attracted from the United Arab Emirates (22.3%). The respondents considered medical tourism factors as an importance (M=4/40±0/61).The Tehran selected hospitals` performance is average as related to medical tourism factors (M=2/75±0/66). Conclusion: Despite the importance given to medical tourism factors by medical tourists and medical services providers, Tehran selected hospitals` performance is an average and there is no serious attempts are being made to attract medical tourists at macro levels. In spite the quality, variety and costs of the medical services and equipments in the selected hospitals are satisfactory, international accreditation of the hospitals are still in a major problems

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Abstract Background: Hand hygiene is the simplest and most effective preventive measures to reduce cross infection in hospitals. However, compliance with recommended instructions is commonly poor among healthcare workers. The present study aimed to explore potential behavioral determinants of hand hygiene compliance among healthcare workers in intensive care units. Methods and Materials: A qualitative study was conducted, consisting of 42 semi-structures interviews with physicians (attending physicians, non-attending physicians, residents), nurses, nursing students and medical students, who worked in the intensive care units. Results: Participants mentioned self protection as the main reason for the performance of hand hygiene. According to the participants, hand hygiene was often performed after direct contacts and tasks that were perceived to be dirty. Participants were most concerned about knowledge gaps in hand hygiene practice. Most participants believed that having a good theoretical knowledge of hand hygiene guideline may strengthen healthcare workers' attitudes toward hand hygiene. Junior practitioners believed that the superiors' hand hygiene practice could influence their performance both negatively and positively. Participant also believed that the lack of formal and informal control may hinder compliance among healthcare workers. High workload, interruptions, and limited access to hand hygiene products were mentioned as primary barriers to hand hygiene. Conclusion: The findings revealed that a number of factors can influence had hygiene practice. Recommendations of the current study are of value to future researches aiming to improve compliance with hand hygiene behavior among healthcare workers.

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Background: Medical errors and adverse events are the main reasons of many avoidable deaths and imposed expenditures in worldwide health systems. Hence, this study aimed to recognize some challenges, medical errors and adverse events, and to address the appropriate solutions in order to solve them in the Iranian health system.

Materials and Methods: This qualitative study had three main data resources including key informants, national documents and expert panel. Key informants (30 persons) and experts (12 persons) were selected purposefully from macro, meso and micro levels of health system and some other health related organizations. Data were interpreted and analyzed through a mixed (inductive/deductive) thematic framework.

Results: Although, most reasons of medical errors were in relation with weak patient security system and low level security culture in hospitals, other factors like manpower, physical and external agents of hospital environment induced these errors as well. The most considerable solutions to decrease the medical errors comprised identification of medical error reasons in different levels of heath system, errors documentation and generation a consolidated system for recognition and following the errors and their main causes.

Conclusion: Relieveing the reasons of medical errors and adverse events can be a great step to prevent them. In order to eliminate the medical errors and its challenges, it is necessary to develop the consonant programs in national level via conclusive will of organizations, groups and related individuals.

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Background: Clinical Governance (CG) is a framework which obligates heath care system to responsiveness regarding maintaining and improving health care services' quality. Purpose of this study was to exists challenges in Clinical Governance establishment evaluation based on national assessors' aspect.

Materials and Methods: This qualitative study was conducted with national assessors' participation of Clinical Governance plan in 2014.Data collection was carried out using face to face interviews with assessors  and analyzed  based on content analysis.

Results: Three main themes were categorized including problems related to clinical governance standards, Existing challenges in assessment process and recommendations to improve quality assessment process.

From the assessors' aspects, the main existing challenges were lack of knowledge and adequate skills in some assessors towards CG, lack of sufficient accordance among assessors team, resistance of some universities and health care systems, lack of existing comprehensive guidelines with the purpose of responsiveness in related ambiguity in assessment and direction process among assessors.

Conclusion: Reinforcement of quality improvement culture in hospitals and increasing susceptibility in plan continuation, correct assessors election and ensuring about knowledge in responsibilities, updating assessors' training and putting to use equal indices in improving clinical governance assessment can be a considerable assist to improve assessment process and resolve related problems.