Journal of

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Introduction: Evaluations of a system of information, without analyzing its users understand is impossible. User satisfaction is as key factor of success information system. It is essential to consider information system context (user, task, equipment and environment), user type and user experience in quality ergonomic computerized information systems. Therefore in this study HIS quality ergonomic of Iran compared with other software.

Methods: A comparative study in 1389 was conducted. In order to compare the evaluation results of hospital information system with other software, applications were selected that already were evaluated using isometric questionnaire. These software are a) IS-H * med (software evaluated by Hamburg and colleagues in 2004), b) SAP-HR (software evaluated by Gruber 2000) and c) Microsoft word for Windows (software evaluated by Gediga and colleagues in 1999). Users view analyzed through descriptive statistical and one sample t-test. Data analyzed through SPSS and Excel.

Results: HIS than IS-H * med of is significantly more usable. HIS than SAP-HR in terms of the IsoMetric Scales such as "suitable for task," "suitable for learning", "Error tolerance" and "learning ability" is significantly more usable. HIS vs. Microsoft's word is significantly less usable.

Conclusion: The results of this study showed that hospital information system in Iran than the other software studied is average level in terms of ergonomic software quality. It is recommended regarding user expectations when designing and developing of information systems.

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Background: Most hospitals face with incremental demands, low facilities and readmission of patients as well as dissatisfaction of the clients in regarding to the quality and access of services. Investigating the reasons for readmission and solutions for decreasing the rate of these kinds of admissions can decrease hospital expenditures and improve the efficiency of hospital recourses. By offering high quality standard services and establishing appropriate procedures we can satisfy patients' needs and relieve their pains and discomfort. In this study we are going to evaluate the reasons for patients' readmission in Tehran University of Medical Sciences hospitals

Materials and Method:  This is a descriptive and cross- sectional study consisting of 9 hospitals. The samples were consisted of patients who readmitted in hospitals affiliated to Tehran University of Medical Sciences. The required information has been registered in a questionnaire by means of computer, admission forms and index cards. The medical records of 250 patients were collected and analyzed by t test, Fisher Exact Test and Chi Square test.

Result: 17.8% of understudy patients were admitted two times and 80.7% were admitted more than two times in the hospital. Most of these 80.7% of patients were over 60 years old. It was seen a significant relation between patients' age and readmission also occurring infection. In categorizing diseases according to the reason of patients' readmission (23.1% in the second period and 20.2% in the third period) encountered diseases related to body blood system while readmitting in the hospital. The average cost of patients bedridden admitted for the second and third times because of the same reason was 3241532 and 1576593 tomans. There was a significant relationship between readmission and length of stay in both periods. Pursuit of treatment in 101 cases with average cost of 1802757 tomans in second time and 84 cases with average cost of 1205283 tomans in the third period was among the highest costs of readmission causes. Also the highest length of stay was related to surgery unit (9.98 days). The highest average of patients' costs related to surgery unit was 3543854 and 3911168 tomans for second and third periods.

Conclusion: Most of readmissions are among 60 years old patients and the most important reasons for the second and third readmissions are as a result of treatment follow up, adverse effect and illness complication which can be for the reason of incomplete treatment, non compliance of clinical protocols and lacking standard instruments. Results show that readmissions can increase patients' length of stay and additional burden of costs for patients, hospitals and insurance institutes. Therefore we can prevent these unnecessary costs and increase patients' satisfaction by complying clinical protocols, standardizing hospital procedures and instruments, personnel training and using new methods of diagnosis and treatment. The reform in Health care policies and focusing on the health care quality on the side of the administrators also paying more attention to home visits and home care are recommended to this case.

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Background: Nowadays Medical devices have an important role in diagnosis, treatment, rehabilitation of patients and also in medical education. However, in the recent years usage and maintenance of these devices have not been in a good situation in developing and even some developed countries. Therefore fundamental changes and reprocessing has begun among management and usability of medical devices in these countries. This research is aimed to determine the management situation with the approach of usability evaluation in order to change and reprocess the management system among Tehran University of Medical Sciences general teaching hospitals at 2012-2013. Materials& Methods: This study was a descriptive and cross sectional research among eight general teaching hospitals of Tehran University of Medical Sciences in 1391. The research tool was a self-made check list consisting of 38 questions about medical devices management condition and Nielsen questionnaire about usability of these devices which were completed by head nurses of CCU, ICU and OR departments with the help of medical devices supervisor in 56 departments of these hospitals. Data were collected and analyzed by SPSS software. Results: We found that medical device management and the usability of these devices were not in a good situation in these hospitals as well as usage of electronic information technology. Conclusion: Regarding the results of this research specially in the usability of medical devices, we recommend that users and supervisors of medical devices should be trained about usability criteria and evaluation procedures of these criteria, and the relationship between management styles and applications of quality improvement and pay attention to reprocessing of medical devices management among hospitals administrators and healthcare policy makers to select and purchase the best devices.

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Background: Concerning to the importance of team learning and process change, the clinical laboratories employees should be familiar with organizational learning. This study aimed at assessing and determining organizational learning capability among clinical laboratories employees of Tehran University of Medical Sciences hospitals.

Materials and Methods: This study was a descriptive-analytical and cross-sectional one which conducted among 85 employees of clinical laboratories using Cochran formula at five general teaching hospitals of Tehran University of Medical Sciences. The research instrument was Gomez et al. questionnaire consisted of four dimensions such management commitment, systematic approach, open climate and knowledge transfer in 17 questions. Five point Likert scale was used to rank questions. SPSS software 19 version was utilized to data analysis using t- test, Pearson Correlation Coefficient and Welch method.

Results: The average score of organizational learning among employees of studied clinical laboratories was 3.11 which showed relative desirable situation. Also, management commitment as an element of organizational learning had significant difference among the clinical laboratories (p=0.002). There was a significant relationship between employees education level with knowledge transfer and integration capability (p=0.04).

Conclusion: The process of organizational learning capability of the studied clinical laboratories was not desirable. Therefore, in order to complete establishment of organizational learning in clinical laboratories, should pay attention to some elements such establishment of patient safety system, initiation of error registration system and encouraging employees to report the errors

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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: Physicians' full time attendance is related to increment of many hospitals performance. Regarding the present challenges, this study aimed to analyze this plan using SWOT technique and present TOWS model in Tehran University of Medical Sciences (TUMS).
 
Materials and Methods: This study was a descriptive-analytical and cross-sectional one conducted during 2016-2017. Based on Cochran formula, 234 full time attending physicians randomly selected using simple randomization method. The research tool was a researcher made SWOT questionnaire which confirmed its content validity and reliability. Collected data was analyzed by SPSS software using SWOT technique and suggested TOWS strategic model.
 
Results: The most valuable weaknesses of mentioned plan were inappropriate coordination of physicians; lack of compensatory system, and the most important strengths were employment of young physicians and better education for medical students. The most important opportunities and threads of mentioned plan were establishment of competitive work between public and private hospitals and burnout and dispensing of experienced physicians moving to private sector, respectively.
 
Conclusion: Based on study findings, TOWS model strategies can be suggested for improvement of the plan.
 

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Background: Human resources form the basis of health care systems and nurses are a large part of this community; therefore, paying attention to factors affecting the performance of nurses is necessary. The aim of this study was to investigate the relationship between mental health dimensions with organizational commitment and work ethics among nurses working in general hospitals affiliated to Tehran University of Medical Sciences. The mental health status among nurses was also investigated.
Materials and Methods: This is a descriptive-correlation study and the study population included nurses from general hospitals affiliated to Tehran University of Medical Sciences. 242 nurses were selected from Vali-Asr, Imam-Khomeini, Baharlu, Sina, and Amir-Alam hospitals using stratified sampling and responded to self-monitoring questionnaires including GHQ-28, Allen & Meyer's organizational commitment (OCQ), and work ethics (Petty, 1995). Data were analyzed using SPSS-23 software as well as Pearson correlation coefficient, ANOVA, one sample t-test, and independent t-test.
Results: Dimensions of social impairment(r=-0/19, p<0/01) and depression(r=-0/33, p<0/01) correlated with work ethics. Dimension of hypochondriasis correlated with nurses organizational commitment (r=-0/15, p<0/05). The mean of dimensions of hypochondriasis (7.45±0.28), anxiety and insomnia (6.97±0.27) and social impairment (6.33±0.19) among female nurses was higher than the average.
Conclusion: The dimensions of mental health of nurses are related to their organizational commitment and work ethics. Also, the mental health status among nurses is undesirable. Therefore, it is essential to address the issues of nurses at high levels, such as the Ministry of Health and the Nursing Organization, and low levels such as hospitals nursing management.
 

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Background: Employees’ empowerment is the best and efficient organizational strategy for improvement of human resources productivity. Therefore, the present study was aimed to investigate the relationship between empowerment training courses with human resources productivity among Tehran University of Medical Sciences employees.
Materials and Methods: This was a descriptive-analytical and cross-sectional study. The study population included 1452 employees of the university deputies. Research sample was calculated 304 according to Krejcie and Morgan table. The research tool consisted of Hersey's empowerment training courses effectiveness translated by Jafari “et al.” and Hersey-Goldsmith's human resources productivity questionnaires. The content and structural validity including convergent and divergent validity of questionnaires were determined, and their reliability was confirmed by Alpha Cronbach with 0.86 and 0.89 coefficient, respectively. Data were analyzed by SPSS version 23, and descriptive results were presented by absolute and relative frequency and analytical results by inferential statistical techniques and Structural Equation Modeling.
Results: The mean of empowerment training courses effectiveness of employees and human resources productivity was relatively desirable. Also, the relationship between empowerment courses effectiveness and human resources productively of employees was confirmed.
Conclusion: Using different procedures of employees’ empowerment in early period of employment including organizational socialization, on-the-job training courses by workshops, distance learning and in-person training for empowerment of self-esteem, compatibility, and innovation of employees’ for promotion of organizational and individual productivity is recommended.

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Background: The development of the health system increases the health level of the society. The present study was carried out with the aim of development of "Health System Development Scale".
Methods: The study was qualitative-quantitative. For qualitative part, a semi-structured interview with 11 experts was conducted in a targeted manner with maximum diversity and the results were analyzed by open, central and selective coding method. For quantitative part, first the validity of the questionnaire was carried out through interviews with 10 experts. Finally, the construct validity was conducted according to the opinion of 220 experts by exploratory factor analysis (with the Kaiser-Meyer-Elkin scale) and confirmatory factor analysis (in the form of divergent, convergent validity and fit indices) using SPSS and Lisrel software. Reliability was also measured by calculating Cronbach's alpha coefficient and composite reliability.
Results: The scale was designed with 40 statements obtained from the findings of the qualitative study. In the quantitative part, the appearance and content validity ratio of the dimensions of the questionnaire was qualitatively confirmed (for all statements between 0.80 and 0.1). Construct validity was done by exploratory and confirmatory factor analysis and convergent validity was between 0.53 and 0.75 and divergent validity was between 0.54 and 1. The internal consistency of the tool was approved with Cronbach's alpha coefficient between 0.75 and 0.86 and composite reliability coefficient was between 0.72 and 0.80.
Conclusion: The validity and reliability of the scale was confirmed. It is suggested to use it to measure the level of development in the health system by experts in this field.