Journal of

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Background: There are various departments in hospital that produce hazardous, infectious, pathological and radioactive wastes. Utilizing proper methods of waste management is of high priority in order to prevent from releasing these wastes to environment. This study aimed to evaluate waste management efficiency in Karaj hospitals.

Material & Methods: This cross - sectional study was conducted in Karaj during 2011-2013. All hospitals of Karaj had been selected as statistical population of this study (n=8) by census. The data had been collected by separating and weighting produced hospital wastes for 4 month (during one week at each month) and filling related checklists of health ministry. Collected Data had been analyzed using SPSS software.

                               

Results: The daily capita of waste was 4.1 kg per active bed, 5.6 kg per occupied bed  and 9.4 kg per patient. The overall percentage score of present status of hospital waste management was assessed 88% and in 12% which indicate moderate and weak levels respectively. Hospital waste management had been evaluated weak in terms of collection, transportation and personnel but seen from the viewpoint in the separation and temporary storage, it was assessed moderate. However, in terms of disposal, assessment of hospital waste management showed it is in a desirable status.

Conclusion: The present status of hospital waste management was far beyond the expectations  among studies hospitals. Thus, developing an operational plan and monitoring its implementation is highly recommended to. Given the main weakness of hospital waste management was related to production, collection, separation, and transportation, taking these areas consideration  is of high priority.  

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Background: Assessment of appropriate and inappropriate services offered at the hospital is a very important topic to improve resource allocation. Thus, this study performed to assess inappropriate admission and length of stay to modify extra costs and effective resource management.  
 
Materials and Methods: This study was a descriptive-analytic one which conducted as a cross sectional study in the first half of 2017. The Appropriateness Evaluation Protocol(AEP) was used to collect data. A total of 420 patients hospitalized in Haft Tir and Firoozgar Hospitals were selected using stratified sampling method. collecting data was analyzed using descriptive and analytical statistics by SPSS₁₈.
 
Result:  391 individuals were admitted appropriately and 29 were classified as inappropriate admission. The rate of inappropriate admission estimated about 7% in the hospitals. female Sex, type of admission, the length of admission and place of patient residence had effect on prediction of inappropriate admission rate (p ≤ 0.05).
 
Conclusion: Considering the high percentage of inappropriate admission and stay length of patients as well as high costs of health services in these hospitals, the problems can be greatly reduced using proper planning, admissions management between the hospital units.

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   Introduction: The concept of patient satisfaction has become very important in the field of healthcare and the major part of this satisfaction is affected by the quality and variety of hospital hotel services.

The main purpose of this study is to analyzing the effect of quality of non-medical services (hoteling) of hospitals on satisfaction considering the mediating role of satisfaction with health services in Shahid Fayyaz Bakhsh, Shahid Hasheminejad and Masih Daneshvari hospitals.
Method: The type of this study is of applied and descriptive-correlational. The statistical population of this study included 48043 recipients of services in the mentioned hospitals. The sampling method is simple relative random judgment and Krejcie and Morgan table was used to determine the sample size.  information collected through a researcher-made questionnaire. In order to analyze the data and test the hypotheses from descriptive and inferential statistics through SPSS22 software and also to check the model fit and confirmatory factor analysis from Lee software. Shannon entropy method was used to measure the importance and weight of the studied variables.
Results: The weight and priority of each of the research variables implied that the views of service recipients in the field of non-medical services of hospitals, services during treatment, cleaning services, welfare services, human resources, buildings and facilities, and patient nutrition were respectively high to low priorities.
Conclusion: Recipients satisfaction of non-medical services was average. Establishing partnership management system and determining their medical priorities and needs might increase their satisfaction .

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Background and Purpose: Discharge planning, as a process for the safe transfer of patients, has always been challenged by the interventions of medical social workers. Identifying these challenges prevents disruptions in effective planning. This research aims to explore the challenges faced by medical social workers in discharge planning.
Materials and Methods: This is a qualitative study conducted in Iran in 2023. Data were collected through semi-structured face-to-face and telephone interviews with 16 social workers working in hospitals and were manually analyzed using thematic analysis.
Results: The findings of this study revealed that hospital social workers encounter structural and professional challenges during discharge planning. As a result, themes such as professional isolation, erosive environment, back-breaking costs, inefficient structures, and professional pressures were identified, with the main theme being unattended discharge.
Conclusion: The results indicate that social workers in hospitals are faced with poor cooperation and participation, a lack of facilities and equipment, and socio-economic barriers at the community level. They encounter professional challenges in adhering to professional principles and values and in maintaining the quality of social work services in discharge planning. Given the importance of post-discharge interventions, organizational, structural, and professional reforms at both the micro and macro levels are recommended.

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Background and purpose: The COVID-19 pandemic has brought a significant shock to healthcare systems worldwide, including Iran. The mental health of nurses, who have been at the forefront of the fight against the virus, has been profoundly impacted. This study aims to examine the mental health status of Iranian nurses during the pandemic.
Methods: This rapid review was conducted by searching keywords such as "Mental Health," "Nurse," and "COVID-19" in databases including Google Scholar, PubMed, ScienceDirect, ProQuest, Mag Iran, and Civilica. Articles were selected based on their titles, abstracts, and full texts in alignment with the study’s research objectives.
Results: The reviewed studies revealed a range of mental health disorders among nurses working in COVID-19 wards, with stress, anxiety, and depression being the most common. Several factors, such as demographic variables and the specific departments where nurses served, were identified as influencing their mental health. Given that the mental health of nurses affects the quality of care, resilience, and job satisfaction, various strategies have been proposed to improve their mental health.
Conclusion: The findings suggest that the mental health status of nurses is not at an optimal level, and neglecting this issue could lead to long-term harm to the healthcare system and its economic stability. It is recommended that healthcare managers and policymakers implement appropriate measures to address this critical concern.

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Background and purpose: A fearless organization fosters psychological safety, ensuring that every member feels secure to express concerns, ask questions, or share mistakes without fear of humiliation, ridicule, or punishment. This research aims to introduce the Fearless Organization Model in Iran's healthcare sector, with a focus on the Ta’amin Ejtemaie hospitals.
Methods: This research employs a mixed-methods approach. In the qualitative phase, methods such as meta-synthesis, expert Delphi, and Shannon’s entropy were used to identify the components of a fearless organization. The quantitative phase involved structural equation modeling (using surveys distributed among the staff of Ta’amin Ejtemaie hospitals in Tehran) to validate the research model.
Results: The Fearless Organization Model consists of two main dimensions: “Behavioral” and “Structural.” The behavioral dimension includes "managers' behavioral components" and "employees' behavioral components." The structural dimension includes "organizational components," "human resource components," and "environmental components." Key characteristics of a fearless organization include: creating psychological security, openness, transparency, accountability, humble listening, quick employee feedback, learning from mistakes, encouraging knowledge sharing, avoiding silence, and promoting open communication. Effective response systems and coherent organizational structures for extracting ideas and concerns, as well as fostering a supportive culture, are essential.
Conclusion: The findings of this study emphasize the importance of addressing both behavioral and structural dimensions in creating a fearless organization. However, the behavioral dimension plays a more significant role than the structural one. Within the behavioral dimensions, "employee behavior" is the most crucial factor. Managers should focus on cultivating behaviors that promote security and openness within the organization. This research can serve as a foundation for further studies on the drivers and barriers to establishing fearless organizations in different contexts.

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Background and purpose: In the current decade, the development of intellectual capital has emerged as a key driver for enhancing both individual and organizational performance. The deployment of electronic service desks can contribute significantly to this development, particularly in strengthening structural capital. This study aimed to examine the impact of implementing an electronic service desk on the structural capital of Tehran University of Medical Sciences during the COVID-19 pandemic.
Methods: This qualitative study employed a multi-case research approach. Data were collected through semi-structured interviews with managers and experts in the domains of service desk operations and university education. Additional data were gathered by reviewing institutional documents and client feedback reports. Identified factors were subsequently validated through focus group discussions. Content analysis was used to analyze the data.
Results: The most prominent impact of the electronic service desk was improved management of client-related statistics and enhanced reporting capabilities to relevant authorities. Other significant effects included easier user access, the ability to refer documents to other departments or organizations, improved resolution of requests during initial user contact, and enhanced interactions with clients.
Conclusion: The electronic service desk played a vital role in sustaining and enhancing the quality of educational services during the pandemic, while aligning with public health protocols. Furthermore, it laid the foundation for managerial innovation within the university’s educational service delivery system.

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Background and purpose: The aim of this study was to investigate the waiting time of patients referred to the emergency department and the factors affecting it in the country.
Methods: A search was conducted in the scientific databases PubMed, Science Direct, ProQuest, Scopus, Web of Science, Mag Iran and Civilica with the keywords waiting time, duration, emergency, Iran, etc. The Search period was up to 2024/02/06. After applying the search strategy, 26 studies were included in the study.
Results: The findings of the present review study (rapid review) showed that the average time from patient arrival in the emergency department to the first doctor's visit ranged from about 2 minutes to about 32 minutes, the average time from patient arrival in the emergency department to the first treatment ranged from 3.7 minutes to 262 minutes, the average time from request to the first test result was from 20.17 to 629.2 minutes, the average time from request to the first radiology result was from 5.85 to 1080 minutes, and the average time from request to the first ECG result was from 3.7 to 32.3 minutes. Also, the most important factors affecting the waiting time of patients referred to the emergency department included individual factors related to the patient, reason for referral, factors related to the hospital and emergency department, and factors related to human resources in the emergency department.
Conclusion: This study showed that patients' waiting time in the emergency department depends on various factors. To reduce it, improvements in triage, workforce management, the use of smart technologies, infrastructure enhancement, and patient education are recommended.