Journal of

---

Background: The purpose of this study is to survey the Working Life Quality of specialists working in affiliated hospitals of Tehran University of Medical Sciences.

Materials & Methods: The statistical population of this study includes 400 specialists and a crosssectional Descriptive & analytical method has been used to gain credible results.. Van lar working life quality questionnaire was used to gather the data needed.. The data were analyzed with the SPSS software through T-test and Anova statistical tests. In addition, the simultaneous effect of independent variables in the model was evaluated using the Backward Regression Model.

Results: The average total working life quality of specialists working in affiliated hospitals of Tehran university of medical sciences is estimated to be 48.75 percent. Total working life quality of male specialists is higher than the females and the index is higher in specialists resident in Tehran compared to the other ones but these differences are not significant statistically.. Working life quality of specialists which are satisfied with the facilities in their working places are higher compared to the others and these differences are significant statistically. In addition working life quality has decreased with the increase in the experience.

Conclusion: Working life quality of the Specialists studied is not in a satisfying level, thus more attention and effective plans are needed from responsible authorities in the ministry of health and the managers of the hospitals studied in order to improve specialist`s working life quality.

---

Background: The environmental hygiene standards are one of the factors that compliance with them can help hospitals achieve their goals. Therefore having enough information about the environmental hygiene status of the hospital is of great importance. This study evaluates the environmental hygiene indexes status in hospitals.
Materials and Methods: A cross sectional - descriptive study was conducted in 2011. Using the census method, all of Karaj's hospitals formed the statistical population of this study (n=8). Data was collected from the checklist of National Program of Public Hospitals Accreditation (the hygiene and cleanliness segment) which included 68 questions with the overall score of 800 and evaluated the hygienic status of the hospital from 6 different aspects.. These checklists were filled, making interviews and observation of the status of each hospital. Data were analyzed using Excel and SPSS software (version 16).
Results: The results showed that among the different aspects of hygienic and cleanness situation of hospitals, water and wastewater hygiene and professional hygiene of the hospital had respectively the largest and lowest difference percentage with their highest standard levels. Overall, the average score of compliance with hygienic standards was about 742 ±1.9 in the entire centers. This average score was respectively, 716.5± 18, 760± 11.5 and 768 in university-related hospitals, private hospitals and hospitals related with the social security organization.
Conclusion: To improve the environment hygiene status of the hospitals, more effort through developing practical strategies, making appropriate decisions and allocating enough resources are recommended.

---

Background: This study aimed to survey the relationship between job stress, self- efficiency and coping ability among staff of therapeutic- educational hospitals of Tabriz University of Medical sciences.
Materials & Methods: This cross-sectional study was conducted in 2009 among therapeuticeducational hospitals of based on a two stage random sampling. Initially seven hospitals were selected using a simple random method and then 288 persons from the therapeutic and administrative staff were chosen as the sample to be studied using a classified random method. Data were collected using 4 questionnaires titled personal information, self-efficiency, Tores Theorell's job stress scale and Schwarzer's self efficacy and Coping Inventory for Stressful Situation CISS-21 ( Dutch's coping). Data were analyzed Using SPSS software version 11.5 and also Chi-Squared test, T -test, One-Way Anova , Regression analysis and Pearson correlation coefficient.
Results: All the demographic variables including age, gender, marital status, working hours and work experience had a significant relationship with job stress. Pearson correlation test indicated a negative correlation between job stress and self- efficiency, working hours, age and work experience (P<0.001). Additionally there was a positive correlation between self- efficiency and working hours and age and coping ability with work experience ( p< 0.05).
Conclusion: Considering the importance of staff`s mental health issue it is suggested that background factors such as high work load ,dignity level and social value and social supportive programs are taken into close consideration staff`s needs related to these issues are fully satisfied so that better health services are provided.

---

Background: Establishing an effective communication between health team professionals and diabetic patients is an important issue in living with type 2 diabetes. This study was conducted to assess communication between health workers as an obstacle in living with diabetes among type 2 diabetic patients referring to affiliated hospitals of Tehran University of Medical Sciences.
Materials and Methods: This survey was a descriptive, analytic cross-sectional with 600 patients selected by a simple random method. Data were collected using a two part questionnaire including demographic information, health and disease related variables and HbA1C index (containing 10 questions) and communication of health workers with diabetic patients (containing 18 questions) which was measured by a five-level Likert scale [absolutely agree (5) to absolutely disagree (1)]. Validity and reliability of the questionnaire was verified. Questionnaires was filled by interview. SPSS software version 11.5 and descriptive statistical tests (mean and standard deviation) and inferential tests (chisquared, logistic regression model) were used for data analysis. Level of significance was assumed to be less than 0.05.
Results: Mean and standard deviation of communication between health workers and patients as an obstacle were 56.78± 7.17. Study results indicated that there were statistically significant relationships between sex(p<0.001), disease duration (p<0.001) , level of education (p<0.001) , type of treatment (p<0.001), occupation status (p<0.001), age categories (p<0.001), income status (p<0.001), marital status (p<0.001) and HbA1C index (p<0.001) and communication with health care as an obstacle. In addition results of the logistic regression model showed that the ratio of intensity of health worker communication as an obstacle was 0.38 times in 5-10 years and 1.32 times in more than 10 years diabetic patients compared to patients with less than 5 years disease duration. This ratio was significant in the group of diabetic patients with 5-10 years disease duration (p=0.004) and was effectively significant in intensity of health worker communication as an obstacle.
Conclusion: Study results indicated that several factors affect communication between health workers and patients and the factor of years diabetic duration is related to ratio of the intensity of communication as an obstacle which can be helpful due to the planning health improvement interventions.

---

Background: The family physician program is considered to be one of the most remarkable reforms in the health care system which will probably Increase accessibility to physicians especially in deprived areas. This study aims to assess the strengths and weaknesses of family physician program in Fouman and Shaft cities in 1390.
Materials and Methods: This is a descriptive cross-sectional and applied study in which all of the health care team`s members including family physicians, midwives, health workers, experts, technicians and also 856 individuals of service recipients in these two cities were involved .Data collection method was questionnaire of which. Validity and reliability was verified.
Results: The most important strengths of family physician program and referral system from perspectives of service providers included: easy access of people to medical services and decreased medical cost for the patients and the main weaknesses were low salary for physicians, reverse referral and inaccessibility to family physicians round the clock. The main strengths from perspectives of service recipients were easy access to physicians and the main weaknesses were inappropriate reception of hospitals and lack of services through the 24 hours of the day.
Conclusion: In order to eliminate the weaknesses and improve the quality of services, training the health staff in different levels of referral system, more comprehensive supervision, periodic assessments and effective supervision on the performance of family physician process owners is suggested

---

Background: One of the most important advantages of calculating the cost and the bed-day expense is that the government can analyze and compare this cost among different centers and regions of the country and adjust an accurate plan and budget and require governmental units to perform it.
Materials and Methods: this research has been done using a descriptive-analytic with a temporary and retrospective approach. sample selection has been done regarding the question that "whether the orthopedic section is beneficial or not" -based on hospital chief`s demands and with experts
consultation. Related data has been gathered through studying documents, performing interviews and observing related checklists .initially all of the active centers were verified and then each activity`s cost was calculated using the ABC technique.
Results: in the year 1387, cost of each occupied bed for the orthopedic section of Imam Khomeini hospital has been 326818 rials per day. Considering the issue that this sector`s income is provided by selling services based on approved tariffs of ministry of health and medical education which has been 217500 rilas for a double-bed room of first grade hospitals in Tehran in the same year, we could conclude that the occupied Bed-Day cost is 109318 rials more compared to the approved tariff of the targeted year, which shows that the tariff's value is highly less than the bed-day cost.
Conclusion: The enormous variance between Bed-Day cost and the tariff approved by the iranian cabinet will result in forfeit of service providing centers and this could make them serious problems in providing quality services in long term. Therefore, it is essential to set the diagnostic and treatment service's tariffs based on the real cost of these kind of services.

---

Background: Patient`s self-discharge from the hospital is a process in which a patient leaves the hospital before completing his or her determined treatment period by his own will. This study is aimed to survey the factors affecting patient`s self-discharge from the hospital in emergency ward of a referred hospital. Materials and Methods: This is a case-control study. The 280 selected samples were divided to two groups, each with 140 members. The data were gathered using a questionnaire evaluating the scale of patients and their companions` satisfaction of the hospital services. Chi-square test was used for analyzing the relationship between independent variables and the patient discharge type. Moreover logistic regression was used in order to identify the effect of significant independent variables on own will-discharge possibility. Results: Results indicate that there is a meaningful relationship between variables such as age, having supplementary insurance, residency, income rate, reference shift, reference day, satisfaction of the physicians, satisfaction of the physical environment and welfare facilities, the patient`s satisfaction, the waiting time, satisfaction of the instructions given by nurses and physicians and total satisfaction with discharge type(p<0.05). Conclusion: The matter of patient`s self-discharge is a multi-dimensional phenomenon and depends on patient’s characteristics and structural and medical factors. Therefore predicting its scale and determining factors might play an effective role in controlling this phenomenon.

---

Background: Achieving equitable financial contribution and removing the risk of households' exposure to catastrophic expenditures are the most important challenges for health systems all over the world. This study aimes to measure Iranian households' exposure to catastrophic health care expenditures and surveying the factors affecting this expenditure, based on the World Health Organization and the World Bank approach.
Materials & Methods: Sectional data of the World Health Survey in Iran in 2001 has been analyzed. This survey covered 10300 urban and rural households across the country. The catastrophic expenditure has been calculated based on the ability to pay in the thresholds of 40, 50, and 60 percent and the income at the threshold of 20 percent. Logistic regression model was used to examine factors influencing catastrophic health expenditures.
Results: The proportion of families confronting catastrophic health expenditures was estimated at 9-15 per cent. Facing catastrophic expenditures showed a statistically significant relationship with variables such as having a family member suffering from a chronic disease, family`s financial condition, and living in rural areas regardless of the thresholds used. The insurance coverage showed a statistically significant relationship with exposure of catastrophic health expenditure just in case it was measured using the 40% threshold.
Conclusion: Political interventions and policies of the government such as implementing fee exemptions for certain target groups, designing benefits packages, extending population coverage through prepayment mechanisms and protecting the poor and disadvantaged groups can protect households from experiencing catastrophic health expenditures.

---

Background: One of the behaviors taken into consideration in organizations such as hospitals is organizational citizenship behavior. Recent studies have shown that organization employees show interest in organizational citizenship behavior and this subject may be influenced by demographic specifications.This study aims to determine the relationship between organizational citizenship behavior and demographic specification (gender, age, marital status, educational qualifications, salary&wage ,ethnicity,employment type, work type, organizational post, place of employment and work experience) among selected hospitals employees of selected hospitals of Tehran and Shahid Beheshti Medical Sciencesis Universities. Materials and Methods: This research has been implemented in six selected Hospitals of Tehran and Shahid Beheshti Medical Sciencesis Universities and data was collected by distributing a questionnaire among 429 employees of these hospitals using a two-stages random sampling method.The research methodology has been cross-sectional- descriptive using field study. In order to accept or reject the research hypothesis kruskal-wallis and mann-whitneyU tests have been used. Results: Results showed that, the most studied demographic characteristics have an effect on organizational citizenship behavior of the staff of selected hospitals employees in Tehran and Shahid Beheshti Universities of Medical Sciences. Conclusion: Findings of this research indicated that men have shown more organizational citizenship behavior compared to women, Married people have shown higher organizational citizenship behavior compared to single and divorced people and people in the age class of 50 to 54 years have been the highest organizational citizenship behavior average. In addition to, people with master degree, have been the highest organizational citizenship behavior. Also our findings show that Ethnicity does not have effect on the incidence of organizational citizenship behavior.

---

Background: Oppression as a phenomenon experienced by most of nurses might have a background in the historical, social, cultural, political and economic structures of a country. This study aimed to criticize and explore the phenomenon of oppression in nursing literature in order to find an explanation to manage the problem.

Materials & Methods: A literature review was conducted by performing a search on scientific databases (Pub Med, CINAHL & Ovid) using the key terms such as ―nurse/ nursing‖, and ―oppression‖ systematically. Eventually 31 articles published during recent two decades were selected to get reviewed.

Results: In this study, there has been an effort to define the terminology of oppression`s concepts and its historical background, attributes, and consequences. Furthermore, this study considered introducing available models and theories and preventive approaches and managing this phenomenon in nursing profession.

Conclusion: Hierarchal structures in hospital environment provide conducive conditions for the oppression to emerge. Presence and consistency of the phenomenon and its consequences have irreparable effects on nurses as well as  their organization, patients and care quality. Adopting practical and effective strategies in a framework of supportive, informative, and educational actions and managerial policies from authorities and related organizations could create an effective environment, which will result in unity, empowerment and self-confidence of nurses.

---

Abstract Background: Family physician plan is a form of health care delivery system which its correct implementation results in health promotion. Being aware of family physicians’ viewpoints towards their occupation would play an important role in its better implementation. The present study aims to to investigate family physicians` attitude who are working in health centers affiliated with Tehran University of Medical Sciences towards their profession. Materials and Methods: This qualitative study was conducted in 2011. In order to reach information saturation , the data were collected by performing two singular interviews and four focus group discussions among all 33 physicians working at health care centers of Tehran University of Medical Sciences. Eventually, data were analyzed using conceptual framework method. Results: Data analysis indicated three general concepts. The first issue is the factors that encourage physicians to choose family physician profession and continue doing it (including economical, cultural and environmental factors and work conditions). The second one is the study challenges (including preparation to implement the plan, work conditions and professional limits) and the final one is the reforms needed for its correct and proper implementation ( in policy making and administrative level). Conclusion: Regarding the issue that economical, cultural and environmental factors and work atmosphere have the main role in motivating family physicians, the most important challenges the plan confronts are also related to these factors and major and minor reforms are needed to overcome these challenges. Moreover preparing society’s culture would surely result in better implementation of the plan.

---

Abstract Background: Today there is still a shortage of postgraduates of medicine for multiple reasons. This study aims to determine factors related to Tehran, Shahid Beheshti and Iran Universities students' educational and career tendencies. Materials and Methods: This is a descriptive cross-sectional study. The study population consists of medical students of Tehran, Shahid Beheshti and Iran Universities of Medical Sciences. A sample of 510 individuals was selected using simple random sampling method proportional to the category size.Data were collected using a structured questionnaire of acceptable validity and reliability. Descriptive statistical methods were used for data analysis. Results: Medicine was selected due to its social dignity, motivation to serve the people and interest in medical sciences affect studying medicine as a major .Existence of Medical Universities, improving information and abilities and the need for medical services in different areas affect physician’s choice of working location .Simultaneous activity in both private and governmental sectors , disorganized in governmental sectors compared to well organized and well equipped private sector , affect physicians` choice of working sector . Realistic thinking instead of idealism, lack of adequate support from students and differences between the academic environment with student`s interest affect changing the students' educational and career tendency. Conclusion: Actions like regulating the capacity of medical students admission, improving the quality of studies, modification of human resources , better familiarity of students with medicine field while choosing the university field and financial support for young physicians could improve the situation.

---

Abstract Background: Hospital managers' decision-making styles indicate the usual pattern managers use to make their decisions. This paper is aimed to determine the variety of managers' decision-making styles` in public and private hospitals in Shiraz. Materials & Methods: In this cross-sectional study, 106 administrative, financial, internal and nursing managers were selected from 28 public and private hospitals through census sampling technique to participate in this study. The data were collected by a 22-item questionnaire (α = 0.86) and analyzed using T-Test and ANOVA in significance level of 0.05. Results: Studied managers used rational decision-making style more often than avoidance of decision-making style. Older and official managers and private hospital managers used the intuitive decision-making style more often.Managers who had not attended management training courses used the intuitive and dependent decision-making styles more often. Managers who were teaching in the fields of nursing and midwifery used rational decision-making patterns more often. Conclusion: It seems necessary to provide sufficient ground for scientific and evidence-based decision making for all hospital managers. Therefore identifying present obstacles and providing an environment in which managers could improve their decision-making skills is recommended.

---

Abstract Background: Medical tourism industry as one of the tourism dimensions results in a sustainable development and dynamic economy in countries. This study was conducted to examine performance of Tehran’s selected public and private hospitals in attracting medical tourists from foreign costumers’ points of view. Materials & Methods: This cross - sectional study was conducted in Tehran’s selected public and private hospitals in 2011. The study population included 79 foreign patients who referred to four hospitals in Tehran as medical tourists. Data were collected using a self-made questionnaire which consisted of 23 questions which evaluated eight hospital performance components in attracting medical tourists. Descriptive and analytic statistics was used for data analysis. Results: Overall, the hospitals` performances were evaluated to be in an appropriate level. Through Patients` viewpoint, three components including staff number, staff performance quality and staff`s up to date knowledge and skills were in a proper level. Moreover, Staff’s acquaintance with foreign languages and giving proper notifications were reported to be in a very poor level. There was a significant relationship between all of the performance components in attracting medical tourists and hospital ownership excluding staff’s acquaintance with foreign languages and their familiarity with the facilities. Conclusion: Teaching international languages to key staffs and empowering their communication skills can be effective in attracting medical tourists. Considering this, both public and private hospitals must have a serious plan to achieve this goal.

---

Background: This study is aimed to compare organizational commitment and intention to leave among employees in Teheran`s hospitals. Materials and Methods: In this survey 3 hospitals with different ownership`s type were examined included: A public hospital, a hospital owned by Social Security Organization, and a private hospital. The data were collected by distributing 450, questionnaires among 450 employees, which were randomly chosen. Results: Among all studied subjects few employees allocated high score of organizational commitment to themselves .This average rate is nearly 20%. Committed employees were impressively low in the Social Security hospitals compared to others. Comparing intention to leave indicate revealed the Public hospital`s employees have lowest scores among all subjects. There is a statistical significant correlation between commitment`s components and intention to leave. Conclusion: Generally the majority of employees have average and low organizational commitment. Employees with high level of commitment and high level of intention to leave make a small proportion of all hospital employees. Social security hospitals must be taken into consideration due to the levels of commitment and intention to leave.

---

Background: In the hospital setting, the potential for conflict is considerably high, because of the frequent and complicated interactions among nurses, physicians and other medical team staff and also the variety of their roles. With regards to the destructive conflict between physician and nurse which can negatively impact on the quality of health care delivery, this study aimed to investigate sources of conflict between physicians and nurses. Materials & Methods: The study population involved a total of physicians and nursing cadre employed in 4 hospitals affiliated to Ardebil University of Medical Sciences. 260 subjects were selected by both census and Simple random sampling methods. Data collection process was accomplished through questionnaire that its reliability and validity were confirmed. Data analysis was done using the Descriptive statistics and Mann-Whitney, Kruskal-Wallis tests. Results: Inequality in the social status between physicians and nurses from the perspective of patients and their attendants and also inequality in distribution of immaterial benefits between two forementioned groups (mean=3.23) were the most leading factors in arising conflict. The Social economic system (p<0.001), the health system (p=0.013), the hospital system (p<0.001) and interpersonal relations (p<0.001) variables had a significant relationship with the organizational position. Conclusion: creating appropriate social and cultural contexts in order to promote the social status of nursing profession as well as improving the organization and its management could be effective to prevent or at least mitigate conflict between physicians and nurses.

---

Background: Emergency department (ED) is the first place for providing diagnostic and therapeutic services to emergency patients. Due to importance of speed and accuracy in providing services the proper allocation of resources, the department must consider this matter in a particular way. Planning Emergency resources implements regardless of patient overcrowding which occurs at different times. In conclusion the emergency department may faces lack of resources and it results in delay of providing services, a whole mess in functions and decreasing in quality of services. This study is aimed to overcome these problems by suggesting a model for predicting the number of arrival patients at ED. Materials and Methods: The number of arrival patients is predicted based on the data colleted by counting arrival patients and using the data mining technique and neural network model (Multi-layer Perceptron). Results: The number of arrival patients during whole days of a week and 24 hours a day were calculated by sorting out 1, 2 and 3 priorities . The highest number of arrival patients counted was for Saturdays and the lowest for Fridays. Holidays and non-holidays` number of arrival patients differ . The number of arrival patients on formal holidays was similar to Fridays. The highest number of arrivals was between 9 am and 11 and also between 20 pm and 23 pm and the lowest arrivals was between 2 am and 7 am. Conclusion: prediction the number of ED arrival patients can be used for estimating required sources and distributing them appropriately and improving quality of services.

---

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" .

---

Background: Hospital waste is one of the environmental problems .Ignoring the proper management of these wastes can lead to outbreak of diseases and epidemics which threat the public health and rise high costs as a result. This study is aimed to assess the level of staff awareness and hospital performance concerning waste management in selected hospitals of Tehran University of Medical Sciences in 2010. Materials & Methods: This is a descriptive-analytical study. The data were collected by distributing a multipartite Likert scale questionnaire among 351 individuals which had been used to measure hospital awareness and performance. The collected data were analyzed by SPSS software. Among Descriptive tests Chi-Square test was used to determine the correlation of qualitative variables and Pearson correlation coefficient was used for quantitative variables. The significance level was considered at 0.05. Results: Significant differences had been seen among different professions` level of awareness .There were no significant difference among different hospitals ` average awareness level although there were significant statistical differences among each hospital`s performance level (p ≤ 0.001). Conclusion: Due to relatively poor status of hospital`s waste management and hospital staff `s performance , better planning for proper management and wastes `excretion is needed to achieve sustainable development, public health protection and the environmental preservation. Staff Training and their performance monitoring and improving is one of the most important factors of hospital waste management plan success.

---

Background: A method of performance assessment is required to improve Productivity and reduce hospital costs . Pabon Lasso diagram is known as a tool for performance assessment. The current study is aimed to assess and compare Kerman province`s hospitals performance by using Pabon Lasso diagram. Materials & Methods: This descriptive and cross-sectional study was conducted retrospectively between 2008 and 2010. All hospitals of Kerman province in three groups of public, social security and private were selected by census method (N=23). The data were gathered from statistics unit and entered into SPSS 18.0. Three indicators include bed occupancy rate, bed turnover and average of length of stay were calculated and then hospitals` performance were analyzed by Pabon Lasso diagram. Results: In first two years, seven and eight hospitals out of twenty-three and in third year nine hospitals out of twenty-two located in third zone of the model (desired productivity) respectively. Among all hospitals, regarding number and ownership type, social security hospitals had better performance in 2008. Additionally Public hospitals had better performance than others in 2009 and 2010,. Conclusion: Public hospitals had better performance.Although studied hospitals` performance experienced growing trend, only one third of the them had desired performance. It can be caused by changing the provided services type from inpatient to outpatient services.It seems that Considering type of ownership and assessing past trend of 3 studied indicators concurrently is necessary for Planning for development of a broader range of inpatient services and diversified medical services based on province`s need.