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Background: One of the main goals in each organization is to achieve success. The only way to achieve this goal is resort a kind of systematic, native and functional views. Remarkable successes in the recent decades by organizations with the minimum facilities and failure of the organizations by the best material capabilities is on the other hand, demonstrates the significant role in non-material and spiritual factors in reach to success. The organizational culture is considered as an effective factor in organizational performance. The present study has been done to find relationships between these two categories organizational culture and organizational success in the public hospitals of the Kerman cities (Kerman, Sirjan, Rafsanjan). Materials and Methods: This was a descriptive analytical cross-sectional study during the last six months in 2009.The sample size composed the public hospitals in three selected cities of the Kerman province. To define organizational culture, Richard Deft Model was used, and also to identify the organizational success orator elements were used. Simple random sampling used to choose samples and the Cochrane Formula used to define sample size. The gathered data were analyzed by descriptive (frequencies tables and diagrams) and analytical (correlation tests: Pearson, Spearman, XSquare, t-tests, ANOVA test) statistics methods through SPSS software. Results: The results showed that among all kinds of existed organizational culture, bureaucratic culture was the dominant culture with average score 3/162 and the others were: participatory:2/722, flexibility:2/525 and missionary:2/405 respectively. Comparing average score of organizational success elements showed that flexibility element with average score 2/96 was the most important element and the others were: cohesiveness: 2/885, speed:2/88 and innovation:2/725 respectively. The dominant organizational culture of subordinate hospitals in the Ministry of Health and Medical Education are bureaucratic culture. The dominant culture in subordinate hospitals of the Social Security Organization is a participatory culture. Also the average number of organization success in subordinate hospitals of the Social Security Organization is significantly greater than the average number of organization success in subordinate hospitals of the Ministry of Health and Medical Education. In relationship between the organizational culture and organization success, the participatory culture only had a positive correlation with organization success and in the other cultures, either an assumption of lack of relationship confirmed or a negative correlation was concluded. Conclusion: Hospitals are the main organizations in providing services in the health care system in each country. Implementing participatory culture, increasing hospital flexibility in an accountability to customers and patients needs play basic roles in patient’s satisfaction to achieve the main mission of the hospital organization that is providing services

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Background: The existed difference statistical indicators is necessary to measure the efficiency of the health organization and as an exact strategy, could be removed the developed problems in heath services sectors. Materials and methods: This is a descriptive research as a cross sectional study throughout obstetric and gynecology wards in the general hospital of RASOOL. The questionnaires and statistical Forms applied for data gathering. The methods were completed questionnaires, statistical Forms, face to face interviews and observation. The Delphi technique, standardized questionnaires and references’ text books used to determining the reliability and validity. Data analysis was done by using likret ranking. results: The results showed that some indicators, such as inpatient bed occupied rate (63%), bed turnover interval(5) & mean length of stay(4), patient per nurse(19), meanwhile service education(10),staff per active bed(1for 12), midwife per delivery bed(0), staff(50.9%) and patient satisfaction(89%) were lower than expected. Some indicators such as rooming in technique(100%), breast feeding(100%), patient information access from HIS system(100%), emergency and hostelling medicine access(100%), round and morning reports(100%), the mean admitted time in the ward(30 minutes), Infant and maternal mortality rate per total deliveries(0), and the percentage of trained patient(100%) were as expected. Some indicators such as expert physician per active bed (1 for 7) and C/S per total delivery ratio (69%) which was higher than expected, and the necessary data for calculating book & papers per assistant professor & non colonial infection rate were not found. Conclusion: Hospital indicators showed the performance of hospitals in the various bases. Therefore,the broad attentions to these indicators are necessary. Meanwhile, it should be compared them and to distinct time periods.

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Background: With more than 12 million new cases of cancers and nearly 7.6 million deaths all around the world in 2007, cancer currently is the third leading cause of death in the world. This study was conducted to determine medical and non-medical direct costs of cancer patients’ hospitalized in the cancer institute affiliated with Imam Khomeini hospital. Materials and Methods: This was a cross-sectional study. All patients over 18 years old with kind of head, neck, and stomach cancers that undertaken of oncology treatments in the cancer institute which affiliated ” Imam Khomeini Hospital”. Initially eligible patients invited to participate in this study. The data was collected through structured interviews with patients and or their carers. The data, then, was analyzed by SPSS software. Results: The average medical and non-medical direct out-of-pocket costs during primary treatment were 2,609,000 and 245,000 Tomans per patient, respectively. Furthermore, the direct average of medical costs for patients who lived in Tehran and other cities were 3,313,000 and 1,870,000 Tomans while the direct average of non-medical costs for patients who lived in Tehran and other cities were 136,000 and 360,000 Tomans, respectively. Conclusion: The new policies for costs coverage related to cancer patients’, particularly the medical insurance organizations, financial supports from finance intuits like as banks or charity organizations, appropriate distribution of cancer’s centers or providing accommodation to cancer patients who are referred from the remote sites in other cities, and also achieving the equities in health sectors could be reduced the financial costs of cancer patients and might be helped them to manage of cancers efficiently and effectively

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Background: Focusing on making opportunities to participate of patients in all levels of health care system is important in order to develop of system capability that could make improving of patients’ safety and quality of care services. The aim of this study was to determine inpatient perceptions in general hospitals of Tehran medical university regarding patient participate in treatment decisions and safety. Material and methods: This was a cross-sectional study in 1390. First, the list of eight general hospitals affiliated to Tehran University of medical sciences and all clinical wards were obtained through the university website. Then, stratified random sampling method applied to collect 300 patients as a sample size. Data were collected by using a structured questionnaire that validity and reliability were accepted. Descriptive statistical methods, linear regression and multivariate logistic regression were applied to analyze. Results: From total of 300 patients, 60% of them were female. The level of participating by patients in cure decision making were at high level (59.7%) and 27% in low level. The range of patients’ safety was at high (60%) and low (26%). The level of participate in decision making of cure process had high rate among young people and employed participants. The patients who were unmarried, educated, and employed had lower score in patients’ safety. The participants’ perception had no effect on the patients’ safety perceptions. Conclusion: The symptoms that might be interpreted as an abnormal could be interpreted in different ways by the others. These unusual results could come from dissimilarities in demographic features

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Background: The hospital is one of the main organizations which offering health care and medical services in a high level allocated sources in the health sectors. Therefore, considering to efficiency costs is great importance. This study aims in considering the efficiency of the hospitals of Medical University in Tabriz, Iran, by using Data Exhaustive Analysis Method.
Materials & Methods: The study inspected and analyzed the technical efficiency and also effective factors on it in selected hospitals by using Data Exhaustive Analysis Method during the 3 period years (1384-1387). In order to conduct this study, the comprehensive Input-oriented Form of Data Exhaustive Analysis Method assuming in the variable return compared with the scale. The variables of the inputs in this study included number of physicians, non-physician staff, and active bed and annual costs of the hospital. The variables of the outputs included the coefficient of the occupied beds, number of admitted patients, and surgeries. To data analyzing, SPSS and data envelopment analysis software were used. It is worth mention that the data in this study were accumulated by using the forms devised by the authors and standardized questionnaire via referring and going to the hospitals.
Results: The findings of data exhaustive analysis method showed that there was %5(TE=0/953) possible capacity augment in the technical efficiency. The findings also suggest that there is a potential frugality in consuming the inputs in order to produce a constant amount of the output. Meanwhile, there is a potential augment of the output by using a constant amount of the input, as well. The findings also represent the effect of the demographic factors and functional factors on the efficiency of the hospitals.
Conclusion: It is suggested that to leave out the surplus staff, decrease the surplus costs of the hospital through replacing the energy consumption and a proper management of energy and other surplus inputs, hire sophisticated managers and applying the graduated field of management in health care and medical services and also hire the managers with high quality degrees, create the data envelopment analysis of enhancing efficiency should be one of the useful way to provide qualified medical services in our society as a comprehensive programming. Based on the findings of the data Exhaustive analysis method, improving the efficiency of the hospitals, health care system and medical section are essential as well.

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Background: Patients' safety is a critical component of health care quality. As health care organizations continually strive to improve, there is important growing recognize of establishing a culture of patients' safety. To establish a safety culture in a healthcare organization, the first step is measuring the current culture. The aim of the study was to measure physicians, nurses and Para clinical personnel perceptions in patient safety culture in Tehran's selected hospitals, and to compare findings with U.S. hospitals.
Materials & Methods: Physicians, nurses, and Para clinical personnel who worked in training hospitals affiliated with Tehran university of medical sciences were asked to complete a self-administrated patients' safety culture survey (n = 145). Data collection was carried by using the Persian version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Cronbach's alpha and chi-square tests were employed in statistical analyses.
Results: Among the dimensions of patients' safety culture with the highest percentage of positive responses the teamwork within units (67%) was higher, whereas that with the lowest percentage of positive responses was non-punitive response to error (51%). Except to Handoffs and transitions dimension the entire dimension scores were lower than the benchmark scores. The study revealed that more than half of the participants were not reported the errors.
Conclusion: Improving patients' safety culture should be a priority among hospital administrators. Meanwhile, Healthcare staff should be encouraged to report errors without fear of punishment action.

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Background: Job Burnout is one of the important factors to reduce productivity, making mental and physical adverse effects on jobs related to human services and losing efficient manpower by considering the important role of nurses in the health care systems. This study has been done to survey the association between mental health and job burnout syndrome among nurses' staff in training hospitals in Qom province.

Materials & Methods: This is an analytic-descriptive study which has been performed among 200 nurses personnel in the training hospitals of Qom province with applying proboblity multistage statistical method.Three quetionnaires including demographic data,general health and Maslach,s Burnout questionnaire (Inventory) were used to data gathering by which validity and reliability were certified in the previous studies. Data analyzed by SPSS18. Descriptive statistics such as frequency, percentage, inferential statistics (Chi-square test and correlation coefficient of spearman and pearson) and also man-whitney test applied.
Results: Average score of job burnout was 60.8. Respecting general health, 53% of nurses was in danger. Average score of emotional fatique,the personalization and personal accomplishment was 27.2,12.17 and 21.7,respectively. 50 percent of nurses had physical dysfunction,44.5% suffered from anxiety and sleep disorders, 32.5 and 44.5% had social dysfunction and depression, respectively. There was a significant correlation between burnout syndrome and general health. Based on the spearman correlation test, there was a significant correlation between emotional fatique and physical disorders, anxiety and sleep disorders and social dysfunction.
Conclusion: Regarding srtessful nature of nursing job and high prevalence of disorders in general and mental health of nurses incomparision to others and also high prevalence of burnout among nurses in Qom province,it is nesecary to decrease these sort of problems through applying arrangements such as enhancing motivation, increasing work stability, increasing job satisfaction, clearance in how individuals respond to take actions and tasks division among personnels to reduce workload.

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Background: Patient safety is one of the most important components of health care quality. Given that assessing the current culture of patient safety is the first step in improving patient safety, we decided to translate and validate one of the most used patient safety culture assessment tool (HSOPS questionnaire) for the first time in Iran, and in this way take a step toward improving patient safety in our hospitals.
Materials & Methods: This cross sectional study was done among four general hospitals of Tehran University of Medical Sciences (TUMS), which were selected purposefully. Questionnaires randomly distributed among 420 members of the study population, and were collected after completion. Results were analyzed using Confirmatory Factor Analysis (CFA), internal Consistency and correlation.
Results: The value of Fitness function (FF) was 14.25 and according to that, the value of Goodness of Fit Index (GFI) was 0.96. Almost in all of the dimensions, the internal consistency of items in the translated Persian questionnaire was lower than the original one and ranged between 0.57 to 0.8.
Conclusion: Regarding to the findings of this study the Persian translation of the HSOPS questionnaire is a valid tool for the assessment of patient safety culture in Iran's hospitals.

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Background: Payment method is one of the most important control knobs in the health system. All organizations that mobilize funds for health sector must be decided: who should be paid? Why this money should be paid to them? And how much should be paid? So the main purpose of this study is to identify different methods of paying to the doctors in referral system of selected countries, and ultimately providing some suggestions for Iranian social security organizations- direct medical service provision.
Materials & Methods: This was a comparative study designed in 2008. First we studied theoretical issues and analyzed them within the framework of the current situation. Then we conducted a comparative study to find some solutions for it. Then we validated selected suggestions using by Delphi technique.
Results: Most selected countries use a combination of methods to pay to the physicians. Usually for employed physicians in insurance organizations, salary makes a large part of doctor`s income. In countries where GPs play the role of gatekeeper, the per capita payment method has a special room. In American Health Maintenance Organizations (HMOs), based on employment or contractual relationship, they pay physicians by one of three methods: "Per Capita", "Salary Monthly" or "Prepayment". In addition to Salaries (if any employment relationship), specialists usually receive some fees for their Services widely.
Conclusion: Bonus payment in exchange for quality indicators is considered as a recently developed payment method for both GPs and specialists, but due to wide infrastructures, it needs accurate designing and plenty of arrangements.

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Background: Insurance coverage has a tendency to alter the consumer and provider's behavior. Moral hazard is a serious problem in all risk pooling systems, such as insurance and taxes-based financial systems that cause negative consequences as increased costs in the health system. Therefore we decide, at this review article, to discuss about moral hazard, in different classifications and effects on the insurance marketing and health system.
Materials & Methods: This is a review article. Relevant materials selected from published articles, studies, and sites. The databases of Medline, Web of Science, Science Direct, Google Scholar, and Springer were explored to use the key words of moral hazard and health insurance.
Results: Insurance covered individuals, knowing that their health expenditures will be reimbursed by insurance in the time of illness, and their demand medical services are more than un insurance covered individuals. On the other hand the providers have financial incentive to provide unnecessary and excess medical services. Different types of moral hazard like as ex ante and ex post moral hazard hidden information and hidden action moral hazard provider and consumer moral hazard may arise due to insurance coverage. These lead to negative consequences such as consumption of unnecessary care services, alteration of consumption pattern for inefficient use of resources, welfare loss, and an increase in the health expenditures.
Conclusion: Studying and controlling the effects of moral hazards seems necessary to prevent unwelcome outcomes as well as misallocation of financial resources.

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Background: People give you an idea about variety of behaviors when confronting diseases. Different factors such as age, sex, economic and social situations have effect on its. Recognition of these behaviors helps politicians to deliver better services. This study aimed to identify health seeking behaviors of Zoroastrian residing in Yazd province due to advanced number of them in comparison to the other provinces.
Materials & Methods: This study is a cross sectional. The sample size was 196 cases which selected by using simple sampling method. The data was collected via the questionnaire, then data were analyzed by spss.11 software with two test of chi square and exact test of Fisher.
Results: The findings showed that 64.3% of the population was female whereas remaining 35.7% were male. 15.58% of participants were single, 76.5% married and the rest of them (7.7%) were widow. Data indicated that 4.1% of individuals were illiterate, 17.3% were high school , 51.3% had diploma, 23.5% had Bachelors degree and 3.6% had Masters Degree or Ph.D. 43.4% of studied population were unemployed and the rest of them (46.7%) were employed. 94.4% of participants had health insurance whereas 5.6% did not had uninsured card. The results showed that the following direct variables had relation with the following mentioned indirect variables sex with the action during the period of being sick, Place of born with reasons of neglecting sickness, marital status with action during the period of being sick, educational status with action during the period of being sick and referring to practitioner in different stages if sickness and using consultation of different groups, occupational status with the first place to get medical treatment, economical status with reasons of neglecting sickness and completion of treatment period and having health insurance with action during the period of being sick and using consultation of different groups.
Conclusion: Considering the fact that educational, occupational and economic status have relation with health seeking behaviors in individuals, developed in education and occupation status could be lead a chance to choose a better health behavior in people.

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Background: Increasing the receivables collection period make problems in the payment of personal salaries, medicine fees & facilities under surveillance centers. It finally has negative effects on delivered services. At present economic circumstances, paying attention to liquidity and its present value is very important to doing economic activities and to decreasing receivables collection period. The aim of the study was calculating the receivables collection and turnover period in selected hospital of the Qom University of Medical Sciences.
Materials & Methods: This is a descriptive research that conducted in the selected hospital of Qom university of medical sciences during the fourth national development program (2005-2009). Data was Collected from information based on the financial documents of the kamkar hospital and registered into information sheets and analyzed by excel software.
Results: Results show that during the fourth national development program , Receivables turnover has gradually decreased and unlike thereceivables collection period increased. Both of these relations showed an undesirable circumstances and graving with the contracting insurance companies in the payment of their obligation with the hospital.
Conclusion: Findings indicated that the receivables collection period of insurance companies takes Long and taken a long way from its normal .It needs a serious monitoring & intervention in the large scale decision making, except by using the power of law during the fourth development national program which it hasn 't a good impact in repayment approach of the policy makers in this issue that expected all of the general managers in the giving of services.

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Background: Regarding to the escalating costs of health care and limited resources in this field, the appropriate identification and control of costs is inevitable. This Study aimed to determine the unit cost of radiology services, in selected hospitals of TUMS.
Materials & Methods: This was a descriptive retrospective study. At first, we selected two hospitals (Shariati and Sina) out of general - teaching hospitals of TUMS randomly. After gathering data, using activity based costing method, the unit costs of radiography services in these centers in 1389 fiscal year (2010-2011) were calculated.
Results: The unit costs of radiography services in Shariati and Sina hospitals were 251255,5 and 334996,2 respectively. Building rent and human resources costs included the most share of total costs.
Conclusion: The unit cost of radiography services in this study is very different comparing with other studies. Calculated building rent costs in this study could be one of the possible reasons of this difference (other studies did not consider this costs). The other point is that, regarding the high share of human resources and building costs from total costs, special attention to these sources of costs and appropriate and adequate use of them, can be an important step toward improving the efficiency and cost savings in our national health system.

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Background: Health literacy is the degree to which individuals have the capacity to obtain, process, and understanding basic health information and services needed to make appropriate health decisions. The aim of this study was to assess relationship between health literacy and knowledge of women with type 2 diabetes.
Materials & Methods: In this cross sectional survey, 160 women with type 2 diabetes were selected by convenience sampling method. Data collected by using a STOHFLA standard questionnaire and knowledge was measured by self-administrated questionnaire. Obtained data analyzed by SPSS16 software in two categories of descriptive and inferential statistics (Chi-square and Pearson coefficient).
Results: The mean age of studied population was 52.73±8.56 years old. The means of health literacy and knowledge was 40.57±15.87 and 21.52±2.94, respectively. There was a relation between occupation, education and family history with knowledge and health literacy score, and also between incomes with knowledge. There was reverse significant relation between age and disease duration with knowledge and health literacy.
Conclusion: Results indicated that patients did not have the appropriate knowledge in type 2 diabetes, as well as health literacy which was also moderate. These results confirmed the need to develop of education for improving and increasing the appropriate knowledge and health literacy among studied women.

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Background: The scarcity of resources and growing demand for health care, as well as moral, socioeconomic and political imperatives for efficient use of resources, make cost information and adoption of an accurate methodology an integral part of the modern management.
Materials & Methods: At first, a research protocol including literature review strategies, inclusion and exclusion criteria and data gathering methods, was designed. Afterwards, using an electronic search of several databases, some relevant studies were identified.
Results: In the costing literature the economic and accounting approaches are distinguishable. Two methods of marginal and average unit cost analyses are attributable to these approaches. Considering the type of the problem to be decided about and cost targets, costing methods can be different. Factors such as types of cost analyses and economic evaluation, timing overview, analysis approach and advantage or disadvantage of economy of scale have a significant role in determining the costs.
Conclusion: Having no consensus of opinion on the most appropriate principles to use in costing process is one of the main challenges of the time. There is a trade-off between the accuracy and cost of achieving cost information... Therefore, standardization of costing methodologies and adoption of comprehensive approaches for the main issues will predispose an economical international and organizational comparability.

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Background: In order to achieve the goals of health system, trying to evaluate and improve of health system performance via policy and decision makers is necessary.
Materials & Methods: This is a descriptive and practical study .Information gathered through sheets through World Health Organization statistical reports. data analyzed by using DEAP software(version of 2) and Data Envelopment Analysis (DEA).
Results: Based on study technical efficiency in various scenarios were different. The results showed that health systems are high sensitive to human resources, and health sector's usually share the national expenditure difference scenarios during the period of study which show the managing efficiency and scale improvement s in Iranian health system.
Conclusion: This study showed the countries with the highest and lowest performance and efficient states (reference) for the inefficient countries among a few countries which increased their health resources to improve performance. However, with high efficient resource allocations in the most countries to achieve into these results are very significant to economic savings.

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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.