Journal of

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Background: The present study performed with the purpose of nursing care quality assessment and its association with process management in Shahid Beheshti hospital of Kashan in 2014.

Materials and Methods: In this applied, cross sectional and correlation study with the purpose of assessing the nursing care quality, 200 hospitalized patients who had more than 48 hours length time selected randomly conducting modified four parts SERVQUAL questionnaire in likert scale. In order to evaluate hospital performance based on process management model (EFQM) Excellence model questionnaire was utilized. Data analyzed using SPSS software version 16 by descriptive statistics and multivariate regression tests at a significance level of less than 0.05.

Results: Data extracted from 200 completed questionnaires analyzed. Respondents included 104 women and 96 men. The mean duration of hospitalization was 6.9 ±12.9 hours and the mean age of patients was 37 ± 12.02 years. Total nursing quality services were more than average and it assessed good (3.8 ± 0.92).Scores of Shahid Beheshi hospital were 215.66 and 217.64 in empowerment and results EFQM dimensions respectively. Multivariate regression coefficient was assessed 0.57.

Conclusions: Based on study results, it is necessary to make use of new management system and professional training to nurses in order to improve nursing quality services in hospitals. 

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Background: Medical centers and hospitals need to expand internet, Application Service Providing (ASP) to convert it to a long-lasting choice to compete. Hence, the present study carried out with the aim of determining the relationship between quality of service providing software systems and customer satisfaction in selected hospitals of Tehran University of Medical Sciences with similar hospital information systems.

Materials and Methods: This study was a descriptive-analytical and correlation one. The study population consisted of revenue and clearance employees' unit in selected hospitals. Study method was census using Kim et al questionnaire. Descriptive statistics such as frequency, percentage and average; and inferential statistics like Kolmogorov-Smirnove Test and Pearson correlation coefficient utilized in order to data analysis.

Results: There was a significant positive correlation between quality of Application System Provider variables and users satisfaction in order of severity in system quality (r = 0.734, P = 0.01), service quality(r=0.721, P = 0.01) and information quality(r=0.521, P = 0.01). As, system quality had the most impact on users' satisfaction.

Conclusion: There was a significant relationship between the quality of Application Service Providing (ASP) with the users' satisfaction in selected hospitals of Tehran University of medical sciences. Although, all variables had positive and significant relationship with user satisfaction, their average was less than moderate limit. So, the health managers are advised to consider these issues in management methods.

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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. 

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Background: Demographic prediction indicates that Iran population move towards an aged society until 2025, Hence, the need for medical care will be increased.  The study aimed at predicting geriatric specialists based on dynamic system approach for the Iranian elderly.

Materials and Methods: After an exploratory study, data gathering and building similar structured in order to determine geriatrics number prediction by considering the important factors. Causal loop diagram to show relationship between variables, stock-flow diagrams for quantitative analysis of system dynamic behavior was conducted and model equations in Vensim software version 5 used.

Results: After simulation, intake students' simulated model revealed increased trend then a sharp decline and finally the pattern had fixed trend from 2009 to 2012. Pattern of physician who was still in study and also graduated physician was in growing trend. Employed physician had growing trend and then it fixed, and retired physician had fixed trend at first and then had an incremental trend. Finally, the various behavior of workforce assessed in three level.

Conclusion: According to increasing  growth of the elderly population until 2025,  we will encounter  with shortage  more than 2500  geriatrics which can be  compensate by 50% graduated admissions of the major annually. 

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Background: Enhancing the need for health care services and its related costs, lead hospitals to improve and organize their processes. The aim of current study was to assess the Patients' Hospitalization and Discharge Processes Based on Kaizen approach and Multiple-Criteria Decision Making (MCDM) in an internal ward of one Hospital.

Materials and Methods: In this descriptive analytical study, ten managers completed the hospitalization and discharge questionnaires and answered three open questions according to Kaizen principles. Then, satisfaction score was measured for 100 patients using a reliable questionnaire (α=0.93). At third phase, after evaluating the proposed solutions using Analytic Hierarchy Process (AHP), the managers prioritized them based on cost, time and effectiveness considering indicators.

Results: Study findings revealed that mean scores of activity in hospitalization and discharge processes were 88.52 and 90.33 (out of 100) respectively, which showed high conformity with Kaizen approach. Also, mean scores of hospitalization and discharge satisfaction which indicated desirable satisfaction were 76.75 and 78.6 (out of 100), respectively. Based on managers' view points, results of MCDM and AHP methods indicated that effectiveness was the most important indicator and time as well as cost gained next priorities for solutions implementation.

Conclusion: This study showed that although, hospitalization and discharge processes were relatively desirable in the internal ward in mentioned hospitals, it is still a necessary to seek the best solutions in terms of effectiveness, time and cost for patients' satisfaction.

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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.

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Background: microbial contamination of hospital wards is one of the most important factors in the transmission of hospital infections among inpatients in hospital units.
This study aimed to analyze the error in the diagnosis of microbial contamination in the hospital's intensive care unit and its root causes analysis in 2015.
 
Materials and Methods: This study was conducted in three stages. The first stage conducted as a case report. The second stage was designed to identify the factors affecting the occurrence of error by Root Causes Analysis and conducting an interview and panel. Third stage was provided using self-made questionnaire and Delphi technique to obtain appropriate strategies to identified errors. In order to data analysis SPSS software was utilized.
 
Results: The main causes of hospital infections were organizational and managerial causes, task related causes, laboratory-related causes, causes associated with training, causes associated with work teams and causes related to working conditions in the intensive care unit. The study findings extracted from the Delphi technique revealed that simple actions such as hand wash and disposable appliances usage are significantly effective in hospital infection prevention.
 
Conclusion: One of the most important ways of preventing and controlling hospital infections is investigating the root causes of these infections. Also, personnel training regarding effective methods to nosocomial infections’ care and control and patient safety culture should be considered by managers.

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Background: Priority setting and resource allocation are assumed to be the most important issues of health-sector and fairness thereof requires considering various criteria. This study was performed to identify the criteria used for priority setting and resource allocation in the world health systems through comprehensive review.
 
Materials and Methods: Cochrane, PubMed and SCOPUS database were searched systematically from Jan.1,2005 to Oct.10,2016. The English articles with codified and specified qualitative and quantitative criteria in the resource allocation context in health sector were included in the study. The obtained data were synthetized thematically.
 
Results: Overall, 9162 papers were extracted. At the beginning of review of the included articles, 9089 papers were removed due to duplication and also based on the title. The abstracts of the remained papers were reviewed and 17 papers were removed. Full text of 59 remained papers were reviewed and based on matching with the inclusion criteria, 34 other papers were removed, too, and ultimately 25 papers were included in the final phase of the study. Extracted criteria were categorized into four dimentions based on economic, management, structural and contextual, out of which the most frequent ones were related to cost, health system goals, local capacity and disease status, respectively.
 

Conclusion: In this study, the most important criteria used by policy makers and decision makers of health system in the world were extracted for priority setting and resource allocation. The results indicated that in the world, priority setting and resource allocation in the health system is made mainly based on criteria such as cost-effectiveness, disease status, equity/equality and the need. 

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Background: The Pabon Laso Model is one of the most important models of evaluating efficiency. Many studies are implemented with this model in Iranian hospitals. This study aimed to review related articles with systemic review and meta-analysis method.
Materials and Methods: The data was gathered using related keywords in databases such as IranMedex, MagIran, IranDoc, Medlib, SID, PubMed, Google Scholar, Elsevier, and Scopus. The articles were searched during 2001 to 2015. Inclusion criteria were determined as articles published in Persian and English, Pointing at least one of three criteria Pabon Lasso model in Iran and access to full-text articles. Exclusion criteria were articles other than hospital performance assessment, and articles which presented as conferences event, case reports, letters to the editor and educational articles. Meta-analysis method was used for calculating Pabon Lasso indices. CMA: 2(Comprehensive Meta-Analysis) was utilized.
Results: 27 articles out of 396 articles were reviewed. The results of 348 hospitals had shown 79.9(22.9%), 76.8(21.7%), 117.8(33.8%), and 74.6(21.4%) of hospitals were in areas one, two, three, and four, respectively. The average of length of stay, bed occupancy, and bed turnover were 3.4 (3-3.7, 95% CI), 63 (41-95,95% CI), and 78.4 (71.8-85.2, 95% CI) per year, respectively.
Conclusion: Study results revealed that only one-third of hospitals were in area three in Pabon Lasso model. The performance status of three fields were average in the length of stay (approximately standard), bed occupancy (upper than standard), and bed turnover (lower than standard).
 

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Background: Responsiveness is one of the main goals of the health system for policymakers and managers. Information Technology (IT) capabilities typically affect organization performance in cases like customer responsiveness and provide high standards of its business. This study aimed to investigate the relationship between information technology capabilities and the responsiveness of Baharlo hospital in Tehran.
                               
Materials and Methods: This study was a descriptive-survey one in terms of method and an applied one in terms of purpose. Data collection tool was a questionnaire. A sample of 248 employees and 381 patients from 26 selected sections of Baharlo Hospital were selected randomly. Data were analyzed using descriptive statistics and inferential statistics such as Pearson correlation coefficient and regression analysis.
 
Results: According to study results, the overall hospital responsiveness rate was higher than the average (3.82) and the hospital's IT capacity was moderate (3.07). Based on regression analysis at 95% confidence level (error less than 5%), IT capabilities with IT architecture dimensions (p= 0.020), IT infrastructure (p =0.004), IT human resources (p < 0.0001) IT communication resources (p < 0.001) were positively correlated with the responsiveness of Baharlo Hospital.
 
Conclusion: The positive relationship between all aspects and the overall IT capability with the responsiveness of the illustrated hospital reveale that the capacity of information technology as well as other modern industries in hospitals is considered as a key competence. Therefore, it is obvious hospital managers should pay serious attention to upgrade this key competence to improve responsiveness in their hospital.

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Background: Brand loyalty is one of the most important factors in maintaining and success of huge organizations such as hospitals. This study aimed to survey the factors that affect the patients’ loyalty to hospital brands in teaching hospitals affiliated to Shiraz University of Medical Sciences (SUMS).
 
Materials and Methods: This cross-sectional descriptive-analytic study conducted in 2017. The study population consisted of 385 clearance patients who were admitted to educational hospitals in Shiraz using stratified sampling method in February 2017 to March 2018. Information was collected using a researcher-made questionnaire and data analyzed by descriptive statistics, T-test, ANOVA, and multiple regressions using SPSS version 23 at a significant level of α = 5%.
 
Results: Patients’ satisfaction (β=0.333, P<0.001), trust in brand (β=0.265, P=0.007), and commitment (β=0.181, P=0.011) had a direct and positive effect on the patients’ loyalty to the hospital brand.
 
Conclusion: According to this study results, hospital managers should pay an attempt to inform the patients about their treatment procedure, follow up the patients’ health after discharge, and increase the communication between personnel and patients. These could contribute to better image and experience for patients resulting in loyalty to the hospital brand.
 

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Bachground: The use of optimal purchasing methods in the medical equipment sector, along with the implementation of state laws and regulations by the government, can serve as a way to move towards smart purchases. To be raised. The aim of investigating the factors affecting the decision making of purchasing capital equipment in hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods: In this applied research, which was conducted in the year 2017, the statistical population of the study were directors, heads and supervisors of the diagnostic and therapeutic sections and medical equipment of all hospitals, and managers and experts of medical equipment of the University of Medical Sciences who were 631 They formed. Data gathering tool was a researcher-made questionnaire. After verifying their validity and reliability, the data were collected and analyzed using SPSS software.

Results: The most effective variables of the actual price of capital equipment at purchase time with a regression coefficient of 0.368 and against the least effective variable in this area is the competitive or exclusive sale of the market with a regression coefficient of 0.162.

Conclusion: Therapeutic centers to purchase capital equipment should use standard decision-making criteria. Considering the sensitive role of identifying and selecting the best brand for the purchase of equipment, as well as the costs that these purchases bring to the health system, the use of quantitative and qualitative criteria as well as the use of experts is very important, in this way, equipment Provides economical and quality services to provide the right services.

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Background: The purpose of this study was to investigate the quality of life of employees working in a psychiatric hospital.
 
Materials & Methods: The present study is a descriptive cross-sectional study conducted in Roozbeh Hospital in 2018. The sample size was calculated using Cochran's formula and 112 questionnaires were analyzed. Quality of life was assessed using the 36-item Short Form questionnaire (SF-36). Data analysis was conducted using SPSS software, descriptive statistics, Kruskal-Wallis, Chi-Square and Cramer's post-test.
 
Results: The findings revealed that the overall score of quality of life was 68.8. The highest mean of quality of life score was related to Physical functioning function (84.2) and energy fatigue had the least score (58.7). Also, the results of the study showed that there was a significant relationship between education groups and quality of life in terms of physical functioning (P-value=0.007); work experience and quality of life in social functioning dimensions (P-value<0.02); between having hospital patient communication and caregivers' communication with the quality of life in energy fatigue and pain dimensions (0.005, 0.05> P-Value); in Roozbeh Psychiatric Hospital staff.
 
Conclusion: According to the research findings, the quality of life of Roozbeh Psychiatric Hospital staff is moderate and educational and therapeutic interventions are recommended to improve the quality of life of the staff.

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Technological progress and changes have affected the field of medicine and health. Also, the electronic health record is used for convenience of treatment, prevention and diagnosis, but it has advantages and disadvantages that we have studied them in this research.
Method: Qualitative research methods and Grounded theory  were used for the sociological study of electronic health record, and in order to achieve a comprehensive theory in this field by using the theoretical saturation method, twenty experts in the fields of medicine, policy, sociology and informatics that They were familiar with electronic health records, were selected from the community of experts as the statistical population and by using the three stages of open, axial and selective coding, important concepts and categories were extracted in each stage.
Results: The most important result of the research is multidimensional effects of electronic health record. Electronic health record by reducing emotional interaction and prioritizing registered data reduces the intimacy in the patient- physician relationship, and recording data in the specific political and economic environment of the country bring a fear of social stigma and disclosure, especially when system security, investing, and training employees face some problems, and the constant changes of managers reduce their risk-taking and positive effects.
Conclusion: In order to have a proper system and comprehensive and pervasive use of electronic health record, cultural, managerial and technological changes are necessary. Cultural contextualization in the society and among individuals, risky and efficient management and the use of integrated information systems along with system security can increase efficiency. Moreover, this efficiency will lead to research, development and progress.

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Background: One of the fundamental changes in the health system of Iran in recent years is the "health system reform plan", that the effects of which should be examined from various dimensions. The purpose of this study is to determining the effect of health system reform plan on health indicators in population covered by Ahvaz University of Medical Sciences.
 
Materials & Methods: In this descriptive-analytical study, the data of the selected health indicators of Ahvaz University of Medical Sciences in the period before and after the health care system reform plan (from 2012 to 2018) was collected, described and analyzed with SPSS.
 
Results: The highest rate of change in mortality indices was between 2013 and 2015, orderly in U5MR, IMR & NMR, With the mean difference 13.282, 10.825 & 7.955 (P=0.001, P=0.002 & P=0.004). The highest rate of change in Care Coverage for Children Under-five, is between 2014 and 2015 with mean difference of 11.335 and about the Antenatal Care Coverage, between 2014 and 2017, with mean difference 10.050 (orderly p=0.002 & p>0.001). MMR was not significant.
 
Conclusion: The time trend analysis on health indicators confirms that the changes in the early years of the reform plan have been a lot, then it has slow down. Most of the change in health indicators is related to years of 2015 and 2016. The findings indicate that the latest health reform plan in Iran has improved the mortality indices (Reduce in NMR, IMR & U5MR), Care Coverage for Children Under-five and Antenatal Care Coverage (6+). Health reform plan has not affected on MMR.

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Introduction: Hemodialysis is one of the effective therapies in patients with chronic renal failure. Along with increasing life expectancy as a benefit of this treatment; this type of service can threaten the quality of life of recipients. Therefore, the present study was conducted to investigate the effectiveness of emotional schema-based therapy on improving the quality of life of dialysis patients.
 
Materials and Methods: The current semi-experimental, applied study was designed and implemented as pretest-posttest research with a control group. All outpatients treated with dialysis instrument in medical centres affiliated to Tehran University of Medical Sciences in 2009-2010 were the statistical population of the study and the quality of life questionnaire related to kidney patients used for data collection. After the research team performed the treatment protocol in 8 sessions of 90 minutes in the intervention group, the research data were analyzed using SPSS24.
 
Results: The results of the study showed that the treatment protocol based on emotional schema therapy influence all aspects of quality of life and increase the mean score compared to the pretest. Also, there is a significant difference between the groups, both in the general dimension and specific dimension of dialysis patient's quality of life.
 
Conclusion: As the study findings show, it can be stated that emotional schema therapy is effective in improving the quality of life of dialysis patients and can be used as a useful intervention to improve the quality of life of patients.

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Background and Purpose: The importance of hospital quality services in order to best utiliz available resources are not unknown to managers. This is especially important in the maternity sector due to the high density of referrals. Implementation of LDR (Labor, Delivery, Recovery) is one of the new approaches to improve delivery services in the country. The purpose of this study was to evaluate the effectiveness of LDR system on quality of delivery services in two selected hospitals of Qom.
Methods and Materials: This is a descriptive-survey study. Data were collected with a cross-sectional approach to compare the quality of service indicators of a hospital with LDR system as a case and a hospital without LDR system as a control group. Data were collected using a standard questionnaire by Poisson sampling and analyzed by SPSS software.
Results: There was no significant difference between the two hospitals except for LDR implementation. There was no significant association between LDR implementation in delivery sector with overall quality of service indicators (3 vs. 2.5) , input, process and output quality indices. However, LDR implementation had a significant effect on some items of these indices (level of significance = 0.05).
Conclusion: According to the research findings, implementation of LDR did not have a significant effect on overall quality of services, but it did affect the subscales of these indices. Therefore, it seems clear that there is a need for proper management policy to control the costs involved in implementing this system.

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Background
In today's medical information system, various data are stored to be analyzed or retrieved when necessary. Therefore, this study was conducted to determine the needs of stakeholders of athletes' medical information management system based on international standards.
 
Materials & Methods
The study population included athletes, clinical service providers and managers of sports medicine centers in Iran. In this study, comparison tables of selected countries were used to assess the needs of stakeholders and were quantitative-descriptive. To analyze the data obtained from the questionnaire, the number of answers obtained for each component was determined based on the Likert scale and according to the frequency of answers related to the options, the percentage of each was calculated and the components that were more than 50% were agreed upon.
 
Results
Findings identified the initial data set, general components of the system and the initial assets of the Athlete Sports Medicine Information System. The results showed that the highest collective agreement about the presence of drug allergies and diabetes in the family's history was in the individual health records of athletes and the lowest agreement was reached on how to join the team. Stakeholder needs, compared to selected countries, included more details, including mental health information, that were not given much attention in the selected countries' datasets.
 
Conclusion
Based on the findings, it seems that a person's access to sports medicine information is a key point and a person can see and receive their information, problems and related health needs in a patient-centered treatment.

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Introduction:The purpose of this study is Investigating the effect of strategic planning on human performance from the perspective of the staff of Shohada Tajrish Hospital in Tehran.
Materials and Methods: This research is applied-practical in terms of purpose and correlational in terms of nature and descriptive method. The statistical population of the present study includes all permanent staff of Shohada Tajrish Hospital. Using simple random sampling method and according to Cochran's formula, 184 people were selected as a statistical sample. In this study, the Strategic Human Resources Management Questionnaire and the Performance Questionnaire were used to collect data. Experts' opinions were used to confirm the validity of the questionnaire and SPSS software was used to assess the reliability. Cronbach's alpha was 0.868 and 0.751. SPSS software and simple linear regression were used to analyze the data.
Results: The results showed that planning, supply, development, performance management, reward and employee relations have a significant effect on the performance of employees of Shohada Tajrish Hospital in Tehran.
Conclusion: Since the results of the research indicate a very strong relationship between strategic human resource management and the performance of the organization in Shohada Tajrish Hospital, it is necessary to pay sufficient attention to human resource management in health centers. It is also necessary to pay special attention to categories such as human education and development, effective interaction and communication with employees, and hiring and hiring.

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Background and Aim: Today we are witnessing tremendous advances in medical data mining. The data, by analyzing and discovering the relationships between them, can lead to algorithms that help us prevent or treat many diseases. Meanwhile, genetic diseases have attracted a large part of the attention of the medical world because the birth of children with genetic disorders imposes a great financial, psychological and emotional burden on society. Therefore, the aim of this study is to present an algorithm as a secondary screening test before performing cell and molecular tests.
 
Material and Methods: In this study, 1000 cases of pregnant women who were in moderate or high risk group after screening tests were studied. Their clinical information was stored, missing data was deleted, and records were integrated. Then, using Clementine software, data mining and data correlation were performed, and finally a suitable algorithm for diagnosing the disease was performed. Genetic mutations were identified.
 
Results: By applying five algorithms, neural networks, support vector machine, binary decision tree, multiple decision tree and logistic regression on the data, it was found that the neural network algorithm with 97.522% accuracy has the highest success rate in Diagnosis of genetic-chromosomal diseases before birth.
 
Conclusion: The use of genetic algorithm as a screening test causes less people to be candidates for costly and dangerous cellular and molecular tests and can be used as a tool to help detect the disease. To be used in the medical world.