Journal of

Background: Today's Hospitals operate in an inconstant and competitive environment. To have a successful presence in this environment, there is a need to recognize their own strengths and weakness points which can design appropriate strategies towards. The purpose of this study was to assess the internal environment of a hospital based on Weisbord model and analyze its relation with organizational success dimensions.

Materials and Methods: This study was a cross – sectional and applied one. The study instrument consisted of three sections including demographic information, Weisbord Model questionnaire and dimensions of organizational success assessment.124 out of 150 staff of Oil Industry hospital in Gachsaran participated in the study. In order to data analysis, descriptive statistics and Pearson correlation coefficient test were utilized.

Results: The studied hospital had a relative strength at the scoping (3.63) and leadership dimensions score (3.65) and also a relative weakness at the score of rewards (4.64) and communication dimensions (4.11). In terms of organizational success dimensions, speed (3.28) and flexibility (3.83) had better status than innovation (4.12) and cohesion (4.05). There was a positive and significant correlation between all organizational success dimensions and internal environment. In general, hospital success had the strongest relation with communication dimension(r=0.521).

Conclusion: Hospitals are able to take action through accurate recognition of weakness and strengths points and attempting appropriate modification to achieve organizational success in competitive fields. Then, they take steps towards optimization by improving programs.

Background: providing human resources is one of the most important factors to achieve the organization goals. Human resources are the most valuable aspect in production and service delivery. Staff shortages and excesses can be effective in reducing quality of services.This study aimed at assessing the hospitals' human resources condition from 2001 to 2014.

Materials and Methods: This review article extracted required information from ISI, Pubmed, Scopus, Wiley, Proquest, Emerald, Magiran, SID ,Iranmedex, Google, Google scholar and other related database considering keywords Human resource, Human resource management, Staff, Workforce, Hospital ,Iran, staff nursing, medical, physician personnel with Persian equation.  Searched Articles Search Based on article objectives analyzed step to step with arrangement with study title, abstract and full text.

Results: Findings revealed that the majority of hospitals faced to lack and inappropriate distribution of human resources especially in medicine and nursing but there was no shortage in logistic, financial, paramedics and allied professional human resources.

Conclusions: Correct and appropriate human resources management, planning due to compensated inadequate human resources and raising them to a standard level can enhance the efficiency and effectiveness of hospital activities. 

Background: Providing high quality, safe and effective health care services requires competent and motivated employees. Employee’s creativity plays a significant role in motivation and health care system productivity. Various individual and organizational factors influence employees’ creativity. This study aimed to examine the relationship between managers’ leadership style and employees’ creativity in Qazvin hospitals.

Materials and Methods: Creativity and leadership questionnaires were used to conduct this descriptive and cross-sectional study. The questionnaires were distributed among 800 employees in ten hospitals using stratified sampling method. Descriptive and analytical methods utilized for data analysis using SPSS software.

Results: The mean score of hospital employees’ creativity was 47.5 out of 60 (moderate level). The prevalent leadership style of managers was transformational. There was a significant statistical association between employees’ creativity and managers’ transformational leadership style.

• Since, leadership styles of hospital managers influence employees’ creativity, they have to apply appropriate leadership style to motivate employees and develop their creativity in order to improve hospital productivity.

Background: Nowadays, it is essential to employ medical and clinical librarians to provide the required information for healthcare professionals and enhance accessibility to evidence based information in hospital libraries. Thus, this study aimed at assessing the medical librarians' employment status in hospital libraries in Tehran city in 2013.

Materials and Methods: This was a descriptive and cross-sectional study. Study population considered from all 152 hospitals in Tehran city. Data collected using a questionnaire and analyzed by SPSS version 18 using descriptive statistics.

Results: only thirteen participants had medical librarianship and information science degree. While 28 persons graduated in librarianship and information science from universities affiliated to Ministry of Science, Research and Technology and others had degree in non relevant fields. The majority of participants (51.3 %) with non-related degree were educated empirically and others had learned librarianship skills with other methods. Most of participants were employed based on hiring official process and friends and relatives recommendation.

Conclusions: There is a real lack of medical librarians in the hospital libraries in Tehran city. Thus, these libraries are not able to perform their professional duties such preparing information and omitting healthcare professionals' needs in hospitals. It is necessary that hospitals’ managers attempt to hire medical librarians' and overcome employment barriers.

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.

Background: Nowadays, managers should develop working conditions which attracts new nurses, retains current nurses and prevents their absenteeism. This study at aim at determining Effective Factor Analysis on Health Related Absence among Nurses of Clinical Wards in General Hospitals Affiliated to Tehran University of Medical Sciences

Materials and Methods: four hundred nurses of clinical wards selected as sample size to participate in this descriptive-analytical; cross-sectional study from general hospitals of Tehran University of Medical Sciences. The instrument was a questionnaire in 100 items and two sections including demographic characteristics (13 items) and effective factors of sickness absence (organizational-directorial factors in 49 questions, physical factors in 16 questions and mental factors in 22 questions). The validity of questionnaire confirmed by experts and reliability was calculated 0.79.Absenssism criterion was based on Rajbhandary and Basu' definition (2010); total numbers of days that they didn't present at ward/hospital due to sickness. Data gathered retrospectively from nurses' records. Data analyzed by SPSS using descriptive statistics tests, simple and multiple linear regressions.

Results: The mean age of participants was 44.97±5.910 and 73.8 of them were women. Explaining power of predicting factors was very well (F=71.121, P<0.01). Variables such as Marital Status (β=0.150, P<0.001), ward's type (β=-0.553, P<0.001), physical factors (β=0.101, P=0.001) and mental factors (β=0.226, P<0.001) explained 42% of the absence variance.

Conclusion: considering some aspects such as physical and mental factors and also health issues of nursing staff  based on wards' type  can be result in  absenteeism reduction. 

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

Background: Todays, hospitals are facing with shortage of resources and increasing costs challenges, So, cost information and cost calculation of hospital delivered services can be effective in efficient resources allocation and tariff rates reforming and budget. This study aimed at calculating the cost of services and  physiotherapy department's income of Sina hospital and comparing with approved tariffs in 2013-2014.

Materials and Methods: This study was a cross sectional and retrospective one. The cost price of 13 physiotherapy services calculated using Activity Based Costing method for physiotherapy unit of Sina hospital of Tehran in 2013-2014. Data collection tool included some forms related to services costs of physiotherapy and related activity centers. Also, in order to estimate cost proportion of other wards in physiotherapy unit, the proportional allocation bases was determined, then direct allocation method was utilized.

Results: The most costs of 13 provided services were less than tariffs in 2013. Generally, the costs pertain of physiotherapy services computed 794286777 Rials which workforce costs (48.4 percent) was the most proportion and then energy buildings depreciation and equipment costs. This issue is due to equipment dependency in physiotherapy unit services.

Conclusions: study results revealed there was difference between real cost of services and approved tariffs, therefore, in order to more accurate pricing, exact calculation methods such as Activity Based Costing recommended. Considering high personnel and capital costs pay special attention to these resources, appropriate use, identifying and omitting wasted costs can be effective in increasing efficiency and saving costs.

Background: Intravascular imaging is a tool to detect coronary artery atherosclerosis which plays the major role in vessel stenosis degree determination and plaque pathology as a supplement of invasive angiography. This study aimed at comparing Intravascular imaging with invasive angiography.

Materials and Methods: For retrieving second type studies, PubMed, Cochrane Library and Centre for Review and Dissemination (CRD) were searched up to September 2013.  Searching was carried out by two persons using angiography and intravascular imaging keywords. Studies which compared intravascular ultrasound technology with invasive angiography were analyzed.

Results: Based on studies which reported the rate of target lesion revascularization (TLR) after one year of follow-up, there was a statistically significant difference between intravascular ultrasound and invasive angiography alone. It seems that TLR rate was lower with intravascular ultrasound (P = 0.02).In terms of cost effectiveness, approximately 54, 000 USD spend per each QALY using IVUS method.

Conclusion: Although, intravascular ultrasound could be able to detect coronary arteries damages and help out physician in selecting the most appropriate treatment, but due to the high cost of an intravascular ultrasound catheter, the invasive angiography is choice of physicians and patients in coronary intervention. 

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.

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. 

Background:In the healthcare system, teamwork is important to improve the quality of services and provide safe and effective cares. Operation room, as a high-risk environment, requires high levels of teamwork employees to secure performance. This study aimed at assessing the teamwork among surgical teams of hospitals affiliated to Social Security Organizations in Tehran City.

Materials and Methods: In this cross-sectional study "Observational Teamwork Assessment for Surgery" checklist was used to evaluate teamwork skill in surgical teams. Sixty surgical teams from two hospitals were assessed. In order to data analysis, descriptive statistics was used to calculate mean and standard deviation of age, work experience and teamwork scores in surgical, nursing and anesthesia sub teams. Two-Way ANOVA test was used to study relationship between scores of three surgical phases, sub teams and behaviors domains.

Results: Mean and standard deviation of age and work experience of participants were 42.81±8.57 and 10.62±6.18 years, respectively. Mean score of teamwork was 3.60±0.51 (out of 6) that showed higher than average team performance level. Among three sub teams, nursing achieved the highest score (3.78±0.44). There was a significant difference between nursing sub team and others (p<0.05).

Conclusion: Although mean score of teamwork was in higher than average level in studied teams, but discrepancies between three sub teams were high and worrisome. Use of educational solutions utilization can be effective to improve teamwork and increase quality of behaviors in operation room. 

Background: One of the main pillars of quality in health services is patient-centered that brings the best outcomes for patients. This study was aimed at comparing the patient-centered situation in selected hospitals affiliated to Tehran University of Medical Sciences (TUMS) from the viewpoint of nurses and patients in 2014.

Materials and Methods: This descriptive cross-sectional study was done among 220 nurses (n=103) and hospitalized patients (n=117) in selected hospitals of TUMS. The data gathering instrument was a researcher-made questionnaire which measured seven dimensions of the patient-centered. The validty was confirmed by the opinions of experts and its reliability was 0.96 by Cronbach's alpha. Data analyzes were performed by SPSS software and using one-way ANOVAtest.

Results: Mean score of patient-centered in the studied hospitals from the nurses and patients viewpoint was 2.79 (±0.50) and 2.87 (±0.58), respectively. From the viewpointof nurses and patients, the highest and the lowest mean score were related to the confidentiality and dignity dimension and the patient choice dimension, respectively. Based on ANOVA analysis, there was a significant difference between the mean scores of nurses and patients in quality of amenity and social support dimension (p<0.05).

Conclusion: Patient choice, quality of amenity and prompt attention were identified as priorities for action to improve patient-centered situation in studied hospitals. It is recommended that hospital authorities should be place in a matter of priority the dimensions of the patient-centered which are in poor condition in order to increase the level of patient satisfaction and loyalty.

Background: Many hospitals of Iran make use of their therapeutic capacities in order to attract medical tourists and increase revenue and efficiency of their affiliated hospitals. This issue has major benefits for hospital and tourists. This study assessed the potential of medical tourists' attraction in a military hospital in Tehran.

Materials and Methods: This was a descriptive- analytical one which used secondary data to analyze. Data gained from quality improvement and finance offices, recipients of service and health information management units from the first of 2014 to the first semester of 2015. Strategic plan document were used to analyze the opportunities and strengths points.

Results: The mean of studied hospital performance indicators like bed occupancy rate, length of stay, Bed turnover, rate of admissions to bed, mortality and bedsores rates, nosocomial infections, medication error, patients' rights and patient satisfaction were  4.68 ,  3.3,  5.1 , 6.6 ,  5.2, 1,  69, 9.74 , 70 percent respectively. The strengths points of the studied hospital were diverse expertise, updated equipment and minimum waiting time.

Conclusion: Because of skilled man power, physical resources and especially modern equipment, the hospital does not need huge investment in medical tourists' attraction. This issue will increase admission, productivity and satisfaction of clients and staff.

  Abstract

  Background and Aim: Especially in the case of Hospital services, quality assesment is an complicated and vague issue. For achieving this goal Multiple Criteria Decision Making methods help us. These studies aims to knowledge and prioritize quality indicators and rank selected inpatient wards in an elected hospital of Tehran university of medical science by using Analytical Hierarchy Process and TOPSIS methods.

  Materials and Methods: This is a descriptive-analytical and cross-sectional research. At the first, with an overview of the research literature and expert opinion, indicators of quality assessment were selected. Then we did prioritization of these indicators with using of expert opinion and AHP method. In the final stage, selected inpatient wards the Hospital were ranked in terms of quality of service using TOPSIS by a sample consist of 300 of inpatients.

  Results: Eight main domains (Responsiveness, Safety and risk management, Tangibles, attention to patient, Health communications, Competency and professionalism, accessibility, Credit and assurance) were selected for quality assessment. Among these indicators, competency had the highest priority and attention to patient had the lowest priority. Also the department of Heart had the highest quality of service and the department of Neurology had the lowest quality.

  Conclusion: According to crucial role of the service quality on patients’ satisfaction, the use of appropriate indicators for quality of services, prioritizing them and also proper assessment of the quality of hospital services can play a major role in health policies.

Background: Reward system program is an investment tools in order to improve quality of services. Accordingly, this study was conducted aimed to identify the challenges of the reward system and the solutions for improving that based on the views of stakeholders in Tehran University of Medical Sciences hospitals.
Materials and Methods: This directional content analysis qualitative study was performed in Tehran University of Medical Sciences during 2014and 2015 using content analysis method. Targeted sampling was done and in-depth semi structured and face to face interviews were performed with a wide variety of experts and professionals including managers, faculties and hospital staffs. After word by word transcripting and extracting codes (meaningful phrases), these codes was reviewed again in
order to achieve subcategories. Based on subcategories, information was classified to assossiated  categories. For validity and reliability checking, stakeholders and faculties member check and peer debriefing were used.Results: Eventually, a total of 29 interviews were held. The comments were classified within 6 main categories, 19 subcategories and 1100 codes. The main categories included existing arrangements in hospitals in order to improve staff motivation; reward system challenges; derived opportunities from rewarding experiences; rewarding systematic actions; types of appropriate rewards and making
infrastructure for better rewarding system implementation.
Conclusion: Regarding multiple aspects of a reward system which could have an effective role in increasing staff motivation or a contradictory effect when it is inefficient, implementation of an effective reward system in hospitals by designing an appropriate model based on identified key factors in this study, is recommended.

Background: Considering the importance of standard precautions to prevent needle stick injuries and health care staff, this study aimed to determine the effectiveness of educational interventions to improve adherence to standard precautions, health belief model based on professional clinical staff needle stick two hospital "yaftabad" and "Ghiyasi" done.

Materials and Methods: This study was an experimental study of two group. The study population was 90 persons of professional clinical staff Shohada Hospital Yaftabad as the intervention group and 90 patients from the hospital Ghiyasi as compared to randomly selected and three part questionnaire including demographic, structures, health belief model , and practice questions were completed. In analyzing the data, descriptive and inferential statistical methods were used.

Results: At baseline, the two groups regarding demographic variables, health belief model structures and functional do not different between them. After intervention structures perceived severity, perceived susceptibility, perceived barriers, self-efficacy and performance of the experimental group showed statistically significant change (p< 0.05) that the effect of education based on health belief model.

Conclusion: education based on health belief model, you can increase the level of knowledge and capacity building and efficacy in clinical staff needs people to observe standard precautions

Introduction: In the hospital’s environment, conflict is unavoidable due to differences in gender, educations, and Career goals, frequent and complex interactions between their personnels. Both of two extremely level of conflict (minimum & maximum) are preventing desired performance. Appropriate level of conflict should avoid recession, encourage creativity and reduce stress. The present research aims to determine the amount of conflict in Tehran University of Medical Science’s hospitals. (TUMS).

Method: This study is descriptive - analytic. The study population consists of 706 managers (senior, intermediate, basic) from 14 hospitals affiliated with TUMS. Data was collected by a self-made questionnaire and was analyzed with SPSS software.

Results: The level of conflict in Tehran University of Medical Science’s hospitals was average. 84% of total conflict was caused by organizational factors. There were a significant association between conflict and level of management, educations, work experience, type of unit, bed numbers, the number of employee under supervision, conflict management training course

Conclusion: Hospital managers should change their organizational cultures and revise some structural variables such as goals, procedures…  In order to maintain the optimal level of conflict.

Keywords: Conflict, a mount of Conflict, Managers, Hospital.

Background: health-oriented lifestyle in today’s world is the best way for preventing illness and healthy life. This study conducted to determine the predictor ofhealth-orientedlifestyle in health workers of Amol city.

Materials and Methods: This study was a cross-sectional research conducted on 222 persons of health workers of Amol city. Instrument was a questionnaire including two parts; demographic information was extracted through 15 questionsand the data collected fromthe reliable and valid questionnaire of lifestyle .Data collection. Health workers filled questionnaires in a self-declaration way. To data analyze,t-tests, Mann-Whitney, ANOVA or Kruskal-Wallis and logistic regression used. Data were analyzed statically using SPSS.

Results: This study showed that there is a significant relationship between living place of Prairie village with dimensions of sport , malnutrition , self-care ; and malnutrition dimension in persons below 35, below diploma degree, suffering a chronic disease , suffering high blood pressure ;and tobacco and alcohol consumption dimension in individuals less than35 years;men with medical advice,sport,Malnutrition,tobacco and alcohol consumption ,Health of buying,daily mobility,proper nutrition and owning a personal car with the consumption of tobacco and alcohol dimension ,safety in driving,Health of buying .

Conclusion: Considering that most of the health workers especially men do not behave based on the health-orientedlifestyle, some actions should be taken to change thebehaviorof these individuals, professional educationalworkshops or workshops that do not need to basic information shouldbe activated, because these individuals have health knowledge but do not behave according to this knowledge.

Background: This study aimed at assessing and economic analysis of the existing market of treatment devices of infectious waste in Iranian hospitals.

Material and Methods: In the current descriptive- analytical study which was performed in 2013, the data resulting from national cross- sectional study in Center of Environmental and Occupation Health in 2012 and interview with relevant authorities in 14 Tehran's hospital with at least three years experience using the facilities were utilized.

Results: Until 2012, 883 hospitals have been active in nationwide that more than 64% of them owned by university of medical sciences and SBMU and TUMS with 114 and 45 centers have the highest number of hospitals respectively. Also hospital beds per 1000 population in the country were calculated 1.78. About 80% of hospitals utilized wet thermal and mostly based on autoclave machines for treatment which market share of domestic products is about 55% that Koosha Company, TEM and KAZU have the largest share with 39%, 23.5% and 12.9% respectively.

Conclusion: Existence a large heterogeneity in the type and function of the studied devices has created possible of Cartel in an oligopoly atmosphere  which  with a targeted regulation and policy making toward protectionism, it can be observed price decreasing, enhancing effectiveness, quality and safety increasing of infectious waste treatment facilities