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Background: Health care providers`culture about the patient safety means accepting and considering patient safety as the first priority and organizational core value or health center`s staffs beliefs, perceptions and trends of on patient safetywhich is reflected in their behavior. This study is aimed to assess nurses perceptions of patient safety culture`s dimensions which is working in hamadan`s hospital. Materials & Methods:The method of this study is descriptive- analytical type and statistical society includes 215 nurses of 3 hospitals of Hamadan which had been selected by random sampling. Stanford patient safety culture questionnaire was used to assess dimensions of patient safety culture.The data were analyzed by SPSS 15 software and descriptive tests. Results: The result indicated that all dimensions of patient safety culture through nurses` perception are weak . Among these dimensions, the " Unit Leadership for Safety " with 25.21 percentage and "Learning and Feedback " with 41.82 percentage were the lowest and highest positive rating in all three hospitals respictively . Conclusion: According to weak rate of all patient safety culture`s dimensions in studied hospitals, performing training programs by head nurses is suggested in order to improve cultural concepts such as establishing “supportive mechanisms for patients families” and "culture of discussion of errors among nurses" .

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Background: Pre hospital emergency medical service (EMS) as the first line of emergency care and treatment in the out- of -hospital has a considerable importance in the health care system. Planning on finding about strengths and weaknesses and improve the quality of EMS by exploring the problems of this section has considerable important.This study aimed to explore the challenges of pre hospital emergency medical service in Mashhad.

Materials and methods: A qualitative study was done with 14 personnel working in EMS sites in Mashhad using purposeful sampling. Data was collected by semi structured interview and analyzed using conventional content analysis approach according to Graneheim and Lund man 2004 with ATLAS.ti  software.

Results: Three general themes were identified including 1) "challenges in Human resources"( Individual characteristics of human resources and personnel's dissatisfaction 2) "challenges in organization" (Structural challenges, lake of equipment and human resource limitation 3) "socio-cultural challenges"(Environmental-social challenges and cultural challenges) were determined.

Conclusion: personnel's dissatisfaction, structural challenges, human resource limitation, lake of equipment   and Environmental-social challenges were the most important challenges in pre-hospital emergency system. Organizational independence , create organizational rows, regulation of laws and administrative regulations reform in relation to the range of services offered by emergency personnel, attention to the facilities and cooperation And the participation of other organizations, such as media and traffic to enhance pre-hospital emergency services at the community level can be effective in reducing the challenges in hospital emergency system.

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Background: Job stress is a part of physician, nurses and hospital executives lives. Medical is tense basicly and tension affects the quality of life and health of physician. This study aimed to determine the occupational stress and its relates factors among medical residents in Kurdistan University of Medical Sciences.
 
Materials and Methods: In a cross-sectional study, all of seventy-one medical residents of Kurdistan University of Medical Sciences (first to fourth of residency in 2012) in the field of internal medicine, obstetrics and gynecology, pediatrics and psychiatry were recruited in the study. Data collection was performed using standard questionnaire of job stress, Osipow. In the descriptive analysis, mean, standard deviation (SD) and range were determined for quantitative variables. For hypothesis analysis t-test and chi-square were used.
 
Results: Mean age and SD was 32.3 ± 3.05 years. Thirty-nine of participants (54.9%) were female and 32 (45.1%) male respectively. Job stress was moderate to severe and low to moderate in 80.3% and 19.7% participants respectively. Average job stress score were almost th same in different scales. But, stress in ​​responsibility subscale was more than the others. Gender, specialty field and all subscales of job stressors had significant relationship with Job stress (P<0.05). But age, marital status and years of residency were not associated with job stress (P>0.05).
 
Conclusion: As the majority of medical residents experiencie moderate stress, providing interventions in residency training programs management in order to reduce the stress in Kurdistan University of Medical Sciences seems necessary.

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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: Nursing is one of the health care base and nursing services are in effect on ill-health indicators. This study aimed to investigate the relationship between professional behavior and job well-being of nurses employed at two Shahrekord educational hospitals in 2018.
Materials and Methods: This descriptive-analytic study was performed on nurses employing at two educational hospitals in Shahrekord. A total of 269 nurses in both sexes were selected using stratified random sampling method. The Goz standard professional questionnaire for nurses and the Demo and Paschoal Survival Questionnaire were used. Data were analyzed by SPSS₂₂ software using independent t-test, ANOVA, Kolmogorov Smearnov, Pearson Correlation Coefficient and simple linear regression at a significant level of 0.05.
Results: Mean age of the respondents was 33.2 years old, 48% were aged between 31 to 40 years old while 3% were aged more than 50 years old, 58% and 42%were female and male, respectively. The average score of professional behavior and job well-being were 17.8 ± 104.5 (moderate to high) and 89.3 ± 12.9 (moderate), respectively. Regression analysis revealed that per unit increasing in the nurses professional behavior, 0.661 units were added to job well-being; and also, there was a significant correlation between "professional behavior" and "job well-being" (R²=0.328).
Conclusion: The comprehensive national plan should be designed paying more attention to creation of the necessary infrastructure to promote professional behavior which can be result in long-range consequences of job well-being improvement; also, promotion of job well-being components should be considered.

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Background: In service organizations such as hospitals, human resources (HR) play a key role in the quality of service delivery. Lack of a systemic attitude in terms of system dynamics, HR planning have been somewhat distant from reality. In order to solve such a problem, this study aimed to modeling the dynamics of human resources capacity management system in healthcare services.
 
Materials and Methods: This case study is one of the cases at a clinic of Khatam -al-Anbia Eye Hospital of Mashhad which was used to simulate the system dynamics approach. In the implementation process, after modeling and formulating in Vensim software, the model was validated and appropriate policies were identified based on simulation results.
 
Results: The simulation results revealed a gap existence between service capacity and desired capacity led to a work pressure. Consequently, time per service relative to the standard time per service (0.333 hours equivalent to 20 minutes) as the core of service quality has been reduced (cutting corners of time).  To counteract such a situation, appropriate policies were identified during the time in a dynamic manner using sensitivity analysis based on changing patient acceptance rates and human resource changes.
 
Conclusion: The proposed model provides the status for hospital managers which allows them to manage appropriate human resources in the same conditions with a viewpoint of causal relationships with respect to system dynamics.
 

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Background: One of the main concerns of managers is work deviant behaviors of employees. Workplace deviance is voluntary behavior that violates significant norms and in so doing threatens the well-being of an organization, its members or both. The study aimed to explore the relationship between emotional intelligence and organizational citizenship behavior with work deviant behaviors.
 
Materials and Methods: This study was a cross-sectional descriptive analytical one. This study was conducted on 290 employees (administrative workers and nurses) working in four selected hospitals in Tehran city including Shahid Motahati, Shahid Rajaii, Hazrat-E-Rasol, and Dr. Shariati. Sampling method was stratified random sampling method. Data collection instruments were three questionnaires including Schutte’s emotional intelligence, Padsakof organizational citizenship behavior, Bennett and Robinson’s work deviant behavior. Validity and reliability of the questionnaires has already been verified in studies before. Data analysis was performed using independent T-test, ANOVA, Tukey and parametric Pearson's Correlation Coefficient.
 
Results: Among demographic and organizational variables, There was a significant relationship between age and work deviant behavior (P=0.012). Reverse significant statistical relationship between emotional intelligence, organizational citizenship behavior and courtesy with work deviant behavior was observed (P=0.0001).
 
Conclusion: The study results revealed that personnel with higher emotional intelligence will have a more positive attitude and more allegiance and commitment toward the organization; therefore they will show more organizational citizenship behavior and less inclined to abuse in the workplace.
 

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Background: Human Resources in the health sector not only is the most crucial source in health providing but account for nearly three-quarters of the health sector's costs. The purpose of this study was to estimate the required Human Resources of the CT scan department of the Reza Radiotherapy-Oncology Center based on the workload indicator of staffing needs in 2019.
Materials and Methods: This cross-sectional descriptive study used human resources determination based on staffing needs' workload indicators. The method of conducting expert meetings was used to determine the components of workload and standard time. Also, Interviews and rules, and personnel systems were used to determine the amount and factors related to available working time, and to determine the annual workload, the hospital management system and observation of activity logs were used. Excel and SPSS19 software were used to analyze the data for determining the required human resources and timing data, respectively.
Results: 7 factors related to staff annually available work time were identified. The available work time for CT scans staff was 1113 hours per year. In this study, imaging and simulation were determined as the main activities of the CT scans ward. The results of the workload indicator calculations showed that the CT scan section lacked 3 Personnel.
Conclusion: This study showed that Reza Radiotherapy Oncology Center is experiencing a shortage of professional CT scan staff, and the work pressure is (0.4). Therefore, CT scans are a top priority to provide the human resource.

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Introduction: Management is one of the most important factors that can affect the performance of an organization such as hospital. Therefore, identifying the management style used in hospitals can be useful empirical evidence to solve many hospital problems. In this study, the management styles used in the educational-medical centers of Qazvin University of Medical Sciences have been studied and determined.
Methods: In this descriptive-analytical study, a sample of 411 people was selected using random sampling method from a population of 2265 employees working in university hospitals in Qazvin. The required data were collected using a valid Clark management style questionnaire and through employee perception survey. Finally, the obtained information was analyzed in the space of STATA 15 and SPSS 16 software.
Results: Individuals reported the highest frequency (42%) for autocratic style items and the lowest frequency (25%) for delegating style items. Autocratic style had the highest total mean (3.22 of 5) and delegating style had the lowest total mean (2.87 of 5). Apart from autocratic style, there was a significant difference between hospitals in terms of the use of participative and delegating styles (p <0.05).
Conclusion: In all hospitals, the dominant management style was autocratic style. It is suggested that managers be taught about the techniques and functional benefits of participative and delegating styles.

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Introduction: The present study qualitatively investigated the main components that should be considered for the implementation of the referral system in Bojnord city.
Methods: In this study, data were collected through doing interviews with experts, and finally, the importance of all the extracted components was evaluated using a researcher-made questionnaire. Also, the exploratory factor analysis method was used to classify the components in main sets. Kolmogorov-Smirnov, one-sample t-test, performed in Excel and SPSS software, was used for statistical analysis.
Results: The most frequent noted components by the experts included "empowerment (knowledge, skill, psychological) of human resources involved in the referral system", "paying attention to the motivation of human resources involved in the referral system", and "developing suitable processes for the referral system and re-engineering the processes to meet the conditions". Finally, the main requirements in the referral system of Bojnord city were divided into three categories included organizational and management, manpower, and technology-based requirements.
Conclusion: Briefly, some components may lead to improvement of the referral system, which can be categorized into organizational and management, manpower, and technology-based requirements. Detailed planning to improve the referral system can lead to the improvement of the health system.

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Background and purpose: Considering the important role of doctors in the implementation of accreditation standards and the necessity of their involvement in this process, this study was conducted in order to identify the views of doctors regarding the challenges of participating in accreditation programs in social security hospitals in Mashhad.
Materials and methods: This study is a cross-sectional descriptive-analytical research that was conducted in two hospitals of the Social Security Organization of Mashhad, Iran. in 2022. The participants were 56 full-time working doctors with at least one year of work experience in the hospital. Data analysis was done using SPSS version 26 software.
Findings: Among the challenges of doctors' participation in accreditation programs , the dimensions of the motivational mechanism (3.96±0.63) , provision of suitable resources for the implementation of accreditation (3.83±0.78), physician empowerment programs (3.78±0.73) and the role of the quality improvement office in attracting doctors' participation (3.75±0.74) were more important from the doctors' point of view, and  patients' demands (2.90±0.75) and role ambiguity 2.77±0.96), were less important in their opinion.
Conclusion: Managers should consider that employee motivation and resource allocation are necessary for the effective implementation of the accreditation standard. Empowering doctors in the implementation of accreditation standards as well as the participation of quality improvement offices to interact with doctors and attract their participation are very important factors.

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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.

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Background and purpose: With the establishment of a comprehensive health information system (SIB system) in the health department of Iran's health system, one of the important programs of this country to improve health care through the integration of health information was keyed. This study analyzed the performance of this program from the point of view of the end users of the system in the health centers of Boyar Ahmad city.
Materials and Methods: This study was a qualitative research that was conducted using semi-structured interviews and focus group meetings with 25 system users, support officials and staff experts at different levels, reviewing relevant documents and also observing users' performance. The snowball sampling method was carried out in a targeted and networked manner. Qualitative content analysis was used to analyze the data. MAXQDA10 software was used to record, organize and manage study data after collection.
Results: The findings of this study showed that the deployment of this system from the users' point of view contains many positive and negative points, which can be categorized in five general axes, data management system, caregivers' performance, care management, quality of care and infrastructure. The most important challenges of the system included technical inefficiencies, operational inefficiencies, the challenge of statistics and reporting, and technical and social infrastructure, and the most important benefits were improving the quality of care, tracking and reporting, facilitating the care process, and improving the performance of caregivers.
Conclusion: From the point of view of users, the Sib system can be considered as a positive experience in improving the quality of health care, but due to the existence of many challenges, it is far from its final goals

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Background and purpose: Evaluating hospital efficiency serves as a critical tool for assessing the preparedness and responsiveness of health systems in times of crisis. Accordingly, this study examines the performance of hospitals affiliated with Tehran University of Medical Sciences in response to the COVID-19 pandemic during the years 2019 to 2022.
Methods: This analytical study assessed hospital efficiency using the Pabon Lasso model over the period 2019–2022. Additionally, statistical correlation analysis was employed to explore the relationship between changes in COVID-19 admissions and variations in hospital expenditures, revenues, average length of stay, and bed occupancy rates.
Results: The outbreak of COVID-19 led to a temporary improvement in performance indicators and more optimal utilization of hospital resources. However, following the subsidence of the crisis, hospitals reverted to their previous inefficient structures. In 2022, the operational structure of hospitals returned to pre-pandemic conditions, with only 14% of hospitals falling within the efficient zone. Compared to 2019, a 33% increase in hospitals located in Zone 1 and a 17% decrease in those in Zone 4 indicated a lack of progress in enhancing systemic efficiency. Moreover, the rise in COVID-19 admissions was associated with increased expenditures and subsidies, yet had no significant impact on hospitals’ direct income from patients. Functional effects were limited to a slight reduction in average length of stay and a modest increase in bed occupancy rates.
Conclusion: The findings highlight the absence of mechanisms necessary to sustain crisis management achievements and promote long-term efficiency. Health system preparedness for future crises requires continuous integration of crisis experiences, proactive planning, resource allocation, and the establishment of frameworks to maintain and enhance productivity under all conditions. Therefore, crisis management should not be viewed as a temporary response but rather as an integral component of the strategic and permanent structure of healthcare organizations.

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Background and purpose: Ensuring continuous access to healthcare services is critical for patients with hypertension, particularly during pandemics and public health crises. This study aimed to evaluate the resilience of service delivery by Primary Healthcare Centers (PHCs) to hypertensive patients during such emergencies.
Methods: This descriptive cross-sectional study was conducted in 2023 across 10 PHCs in Markazi Province, Iran. A total of 250 patients with hypertension were recruited using a systematic random sampling method. Data were collected using a researcher-designed questionnaire assessing four dimensions of resilience: quality, accessibility, continuity, and coordination. Data were analyzed using descriptive statistics and multiple linear regression in SPSS software (version 24).
Results: The overall service resilience score was 2.95 (±0.32), indicating a "relatively weak" level of resilience. The mean scores for the dimensions were: Accessibility 3.08 (±0.28), Coordination 3.03 (±0.76), Quality 2.93 (±0.41), and Continuity 2.88 (±0.35). Multiple regression analysis revealed that these four dimensions collectively explained 96.1% of the variance in service resilience. Accessibility (β = 0.478) was the strongest predictor, followed by Quality (β = 0.379), Continuity (β = 0.352), and Coordination (β = 0.178).
Conclusion: The resilience of services provided by PHCs to hypertensive patients during pandemics was assessed as suboptimal. These findings highlight an urgent need for strategic operational planning by health policymakers. Developing protocols to ensure service continuity and expanding infrastructure for remote care (telemedicine) are recommended as key priorities to enhance system resilience.