Journal of

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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: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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Background: The main mission of hospital is to promote care quality for patients and to meet their needs and expectations. The present study aims at identifying and prioritizing the patients’ expectations of the hospital services quality, which is considered to be the first step toward accomplishing such an important mission. Material & Methods: The present study is descriptive and applied. The data was collected through pairwise comparisons questionnaire that was distributed among 150 patients in a public hospital in Bandar Abbas, 104 patients filled out the questionnaire. The obtained data were analyzed by the use of AHP. Results: The results show that among the different dimensions of hospital service quality investigated in the present study, the patients listed 5 main dimensions in order of priority: accessibility (0.251), medical services(0.232), environment(0.202), administration(0.160), and relation(0.155). Among different criteria, access to medicine and blood(0.054) was the first priority and attention to the patient(0.010) was the low priority. Conclusion: Due to the key role of the patients in defining and assessment of service quality, the present study presents a framework for evaluation of hospital service quality according which the priorities of patients were determined. The managers are advised to prioritize the quality improvement practices based on the patients’ priorities in order to satisfy the patients and make the processes customer-oriented.

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Background: ‌ Based on increasing the privatization in hospitals, conducting researches in various fields of private hospitals and comparison with public hospitals is greatly felt.This study aimed at investigating the relationship between job satisfaction and burnout among employed nurses in selected public and private hospitals in Shiraz city.

Materials and Methods: This was a comparative-correlational study. The study population was composed of employed nurses in public and private hospitals in Shiraz city in 2012. sample size was estimated 320 using Cochran formula. The questionnaire of Spector job satisfaction” and “Maslach burnout” were used for data collection. Study conducted in two private and two public hospitals in Shiraz and data gathered randomly among nurses. In order to analysis descriptive and interfere statistics including mean and standard error, Pearson correlation coefficient, MANOVA and independent t- test.

Results: There was a significant and negative relationship among job satisfaction and three dimensions of job burnout in both public and private sectors (p<0.001). In addition, the results revealed that there was a significant difference among the emotional exhaustion and depersonalization between private and public sectors (p<0.05).  However, there was no significant difference between job satisfaction and reduced productivity performance of these two sectors.

Conclusion: According to the findings, by increase in the nurses' job satisfaction, particularly in the public sector, the adverse effects of burnout can be prevented.

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Introduction: Medication process to patients is one of the most important tasks of nurses and doing in correct way can play a significant role in patient safety. This issue is the most significant part of quality care which consisted of patient safety as the impotant element. Medication errors are the main threatening factors of patients' safety. This study aimed at assessing the causes of medication errors from the nurses' viewpoints

Materials and Methods: This study was a descriptive-sectional-analytical one which was done in 2013. The study population consisted of 232 nursing staff of Abadan hospitals(Imam khomeini,Taleghani,Shahidbeheshti ,17shahrivar) which were covered by Ahvaz University of Medical Sciences,Oil Company and Social Security Organization ,respectively. Study instrument was a two part questionnaire including demographic - occupational information and causes of medication errors in 28 items in four fields (nurse, ward, nursing management and pharmaceutical causes).Content validity of questionnaire provided by review of related papers and experts'openion and required correction was performed.reliability of questionnaire was estimated 0.91 using Cronbach's alpha method.

Results: the most important causes of medication errors included shortage of nurses in propration to patient(%44),compression of work in ward(%36.2),fatigue due to over work(%35.8),illegible physician oder(%24.5),anxiety and stress due to work(%25),noise in ward(%22.4),nurse dissatisfaction of salary(%29.7) and similarity in medicine shape(%14.7) respectively.

Conclusion: Management causes such as nursing shortage, organizational factors such as compression of work in ward and some factors like nurses' fatigue had the most effect on occurance of medication errors among nurses. Thus, organizational processes reform and hospital organization to improve service quality and patient safety in order to resolve nurses' problems.

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Introduction: Since incorrect selection of  a manager might lead to incorrect choices of other members, organizations need to consider this important issue  and use well-sought mechanisms for managers’ selection process. Accordingly, this study aims to rank the key factors associated with the selection of operational managers in Tehran University of Medical Sciences.
 
Materials and Methods: This research employed a logical and systematic trend to develop and rank the indicators using fuzzy TOPSIS method. In order for prioritization of key indicators of qualification of operational-level;  after reviewing the literature and using experts’ viewpoints , the dimensions of performance have been selected and using, the SMART technique the key criteria were weighted. A validated and reliable questionnaire was used for data collection.
 
Results: Fifty individuals participated in this study. 37 (74%) and 13 (26%) were male and female respectively. The mean and standard deviation of age of participants were 41.68 and 7.06 years. Literature reviews and related studies indicated 48 indices  for choosing qualified managers. Among these, according to the  expert’s opinion in management science and managers, 36 indices were selected as key indicators. Based on the FTOPSIS analysis, indicators of higher education in the field of management, compliance time, power of expression, adornment and belief in law and order achieved coefficients as 0.205, 0.204, 0.203, 0.202 and 0.197, rank first to fifth.
 
Conclusion: According to the results management related education and expertise in technical aspects of organizational management control  were at the top of ranking . Results of this study can help  medical universities and health service organizations to develop guidelines for selecting their managers.

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Background: Today, the organizations have found their need to a strategic planning for valuation of knowledge management. One of the most important elements for knowledge management is organizational creativity and innovation. Therefore, this study aimed to determine the relationship between knowledge management and organizational creativity and innovation among Tehran University of Medical Sciences.
Materials and Methods: This cross-sectional study was a descriptive-analytical one which conducted in 120 employees of teaching hospital in 2015-2016. The study questionnaire included three questionnaires as Probst’s knowledge management questionnaire, researcher made questionnaire for organizational creativity, Patchen’s organizational innovation questionnaire and demographic information. SPSS software version 21 utilized to data analysis using descriptive statistics, independent t-test and Pearson correlation coefficient at the significant level of less than 0.05.
Results: The study results revealed that there was a relationship between knowledge management and creativity (r=0.661, P<0.001) and organizational innovation (r=0.325, P<0.001). Also, there was a significant association between organizational creativity with innovation (P=0.02).
Conclusion: Development of knowledge management could increase the rate of organizational creativity and innovation. Therefore, the policymakers, leaders and managers of hospitals should establish the knowledge management system to improve the organizational creativity and innovation, and finally promote the efficiency and effectiveness of hospital practice.

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Background: Femoral fracture surgery is one of the most common and expensive surgical procedures and forearm fracture surgery is common performed by Ilam Imam Khomeini Therapeutic Center. This study conducted to analyze the difference in actual cost and global surgery tariffs in this hospital.Also, the related factors acutal cost of mentioned surgery were identified.
 
Materials and Methods: This cross-sectional and descriptive study was conducted on factors related to the actual costs of femoral and forearm fractures. The Activity-Based Costing approach identifies the related cost  associated with these surgeries in through six steps. Data analysis was performed using Excel 2016 software.
 
Results: The  avarage actual cost of the femur fracturs , the code 2 forearm and  the code 1 forearm were 953 thousand and 700 tomans, 444 thousand and 400 tomans and 337 thousand and 800 tomans , respectively. The actual cost of surgery for femoral fracture per unit surgery was 406,000 and 400 tomans lower than the Ministry of Health's tariff. But ,the real cost of the code 2 forearm was 33 thousand tomans higher, as well as the code 1 forearm 20 thousand tomans higher than the global tariff.
 
Conclusion: Overall,  there are significant differences between hospital costs and the Ministry of Health's global tariff. That can be corrected by improving the hospital's performance, as well as carefully examining the cost of global surgical procedures for amending the system of tariff regulation and make the actual amount closer to the tariff level.
 

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Background: The complexity and intensity of environmental fluctuations combined with unexpected accidents and dangers have increased the probability of hospital supply chain disruptions. Supply chain resilience has been suggested as a strategy for dealing with such challenges and for continued provision of appropriate and efficient services in hospital at the time of disaster. The present study intends to identify the factors influencing hospital supply chain resilience.
Methods and Materials: This qualitative study was based on the content analysis of semi-structured interviews with 14 experts in the university hospitals in Bandar Abbas in 2018. Participants were selected through purposive and snowball sampling. The interviews continued until data saturation was reached. The obtained data from interviews were coded and analyzed using MAXQDA Software.
Results: After analyzing the data, the factors influencing hospital supply chain resilience were identified and classified into six main components and 30 themes. The main components included: staffs’ attendance, suitability, infrastructures safety, disaster management, support and capacity systems, and external factors.
Conclusion: Based on the obtained results, it can be concluded that staff training, disaster management planning, command system, and surge capacity are the key factors influencing hospital supply chain resilience. Therefore, they should be taken into consideration while planning to promote hospital supply chain resilience.
 

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Background: Scenario planning is one of the most crucial future study methods in uncertain and complex situations. Hospital supply chain resilience also requires an understanding of future events due to the complexity of relationships and exposure to unexpected circumstances. The purpose of this study is to formulate scenarios for the future development of hospital supply chain resilience.
Materials & Methods: This research is the second stage of research with a mixed approach, and it is in the category of normative scenarios based on intuitive logic. Participants in this study were purposefully selected from the experts of two hospitals. In the first phase, the impact-uncertainty questionnaire and the effect-uncertainty diagram were used to determine the critical uncertainties. After forming the scenario team, based on the impact diagram and the scenario matrix, The cause and effect relationships of the variables were determined in the second phase.
Results: Drivers of Hospital supply chain resilience were clustered into 14 main categories, and the results of the impact-uncertainty diagram showed that "people's culture" and "accident nature" play a more significant role in scenario development as critical uncertainties. Four scenarios were developed based on the opinion of experts for these two drivers.
Conclusion: four scenarios, "compatible," "turbulent," "broken," and "combative," were developed based on the critical drivers in supply chain hospital resilience. Use the inspirational feature of these scenarios can help managers in health and crisis management be more prepared to face the crisis. Scenarios based on intuitive logic can be used for futures studies in other areas of the health system.

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 Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.
Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.
Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.
Conclusion: The abuse in the health service provision is a high risk for  health care managers  in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

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Background: The aim of this study was to evaluate the effect of health sector evolution plan (HSEP) on the prevalence of cesarean section and vaginal delivery in public hospitals in Kermanshah province.

Methods: In the present study, cesarean section (C-section) and vaginal delivery data were collected and evaluated in 17 public hospitals from 2009 to 2019. The main variables of this study included the prevalence of C-section and the prevalence of vaginal delivery for 121 months, both were obtained by dividing the number of deliveries by C-section and vaginal delivery by the total number. Interrupted time series analysis was used to examine the effect of HSEP on the prevalence of cesarean and vaginal delivery rates.

Results: The prevalence of C-section before and after the HSEP was 42.5% and 43.2%, respectively. Months before the intervention, the rate of C-section was increasing by 0.13%, which was statistically significant. In the first month after the intervention, the prevalence of     C-section decreased by 3.6% that was statistically significant. The share of C-section in the months after the implementation of the HSEP showed a monthly increase of 0.12% compared to before the intervention, which was statistically significant.

Conclusions: The results of the study showed that the HSEP has led to a significant reduction in C-section in short term, but in the months after the implementation of the plan, the prevalence of C-section has increased again.

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Introduction: Health tourism is a new form of tourism industry that aims to maintain recovery and regain physical and mental health and has grown in recent years. Therefore, the present study was conducted to investigate the factors affecting the marketing of health tourism in hospitals affiliated to Iran University of Medical Sciences.
Methods: The present study is descriptive-analytical and was conducted on 270 individuals at some point in 2021. The study population consisted of all heads, managers, matrons, quality managers and heads of international patients of public and private hospitals affiliated to Iran University of Medical Sciences. The data collection tool was a researcher-made questionnaire. Data were analyzed by using SPSS software version 23.
Results: The results of study showed a significant difference between the components of price, place, promotion and people in the two types of hospitals (P-value <0.05). While no significant difference was observed between other components (product, physical evidence and process) (P-value <0.05).
Conclusion: Providing the needs of medical tourists will increase their satisfaction. Therefore, paying attention to the effective factors in marketing and trying to solve the shortcomings of this field can be very effective in attracting health tourists and turning Iran into a medical tourist destination.

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Background and aim: Having weakness and lethargy and feeling the need for hospital emergency services is one of the most important reasons for patients to go to hospital emergency rooms. The aim of the present study was to investigate the relationship between morbidity and mortality of patients with weakness and lethargy.
Method: The present study was conducted in an observational and prospective manner in the emergency department of Rasool Akram and Firouzgar hospitals. The patients were divided into 5 groups by the evaluation team in the emergency triage unit using the international valid triage tool "Emergency Severity Index (ESI)". The patients were followed up for 2 months after the time of discharge and the patient's condition was examined in terms of illness, health or death.
Result: Between levels 1 and 2 (patients with high severity conditions) and 3 (patient needs two or more emergency facilities in case of no disturbance in vital signs), level 3 had the highest frequency of referrals (61.9%). 90.7% had an underlying disease and 66.1% of the patients were taking medication at the time of visit. 11% of patients died in the first visit. In the initial follow-up, 23.7% of people were still sick, 40.7% had recovered and 17.8% had died.
Conclusion: According to results in the final follow-up, 3.9% of people were still sick; the rate of recovered patients in the final follow-up was 44.1% and the percentage of deaths in the final follow-up was 24.6%. The high mortality rate indicates that the patients' concern was not due to weakness and lethargy, but due to a dangerous underlying disease that forced them to go to the hospital.