Journal of

---

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.

---

Abstract Background: Hospital Emergency ward plays a pivotal role in hospital and health care system regarding necessity of immediate,qualicative and effective performance due to numerous and complicated processes happens in the emergency ward. QFD is one of the most effective methods used for designing and improving the quality in order to fulfill customers' expectations and improve their satisfaction from provided service. Materials & Methods: This study is aimed to investigate following subjects : 1)identifying the customers' expectations (n=80) and service`s components (n=15) through interviews, 2) defining the relationship between patients' expectations and the service`s components, and also relationship between the service`s component themselves 3) designing the service quality model based on the house of quality diagram” Results: After identifying 13 components of customers' expectations and 20 components of service, 9 components of service were prioritized as parts of service quality model in 3 levels: 1) Physician's office physical environment 2) Improving Nursing performance`s and hospital hotel`s service facilities ,equipping inpatient` room, physician`s room and triage space 3) Improving guide systems, providing adequate welfare for the patients' families, and facilitating the waiting room. Conclusion: The current quality model designed in this study can be a general guide to improve the quality of services provided by the emergency ward. However, using this model has its limitations such as being complex and time-consuming. Key words: QFD, House of Quality, Services of Emergency Ward

---

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: Several factors have an impact on hospitals` crisis preparedness including the status of “internal factor ”. This study is aimed to investigate the relationship between the status of hospitals `internal factors and their level of preparedness in crisis. Materials and Methods: This correlative, applied, and cross-sectional study was conducted in 12 hospitals of Kurdistan University of Medical Science in 2008. The data were collected using the standard Weisbord questionnaire and hospital preparedness checklist to measure the status of internal factors and the hospitals` level of crisis preparedness ,respectively. The data were analyzed using descriptive and analytical statistical methods. Results: Changing internal factors would result in 74% of the changes in level of hospital preparedness in crisis in all studied hospitals . The preparedness level and the organizational structure of the hospital had strongest relationship and preparedness level and personnel’s attitude to changes had the weakest respectively . Conclusions: Hospitals should analyze their internal factors status in order to improve their preparedness level in crisis. Concentrating on different aspects of internal factors, reviewing objectives, improving increasing teamwork, involving personnel in decision-making, using performance-based rewards, forming communication committee, improving leadership styles, training organization `s managers and leaders, and facilitating internal and external coordination could be effective .

---

Abstract Background: There are different attitudes about family presence during CPR. This study was conducted in order to compare the attitudes of physicians, nurses and patients` immediate family towards presence of family members during adult resuscitation in teaching hospitals of Mazandaran University of Medical Sciences. Material and Methods: In this descriptive survey, the attitudes of 120 physicians, 200 nurses and 148 patients` immediate family were compared. Random stratified sampling was used as the sampling method. The data were collected using a self-developed questionnaire which its validity and reliability had been confirmed by “Content validity” and “Test-Retest” respectively (r=0/83).This questionnaire included some questions about demographic characteristics, positive and negative experiences and the attitudes towards family presence during CPR. Data were analyzed using Chi-square x2 and Fisher tests by the SPSS 16 software. Results: The majority of physicians and nurses (92/5% physicians, 80%nurses) believed that family presence during CPR is harmful. Fisher exact test showed significant difference between physicians and nurses views (x2=9.037 df=1 p value=0/002). The most important reason of negative attitudes of physicians and nurses has been interference of family members in CPR (90/8% physicians, 86/5% nurses).Less than half of the patients` immediate family (48%) wanted to be present during the CPR. There was a significant difference between attitudes of patients` immediate family and physicians and nurses (p=000) Conclusion: Regarding differences between physicians, nurses and patients` immediate family` attitudes towards family presence during CPR, it would be better to provide a determined plan identifying the family presence`s conditions during CPR in every hospital respectively.

---

Objective: This study was aimed to assess Service Quality (SQ) of maternity care from the perception of pregnant women. Methods and materials: A cross-sectional study was conducted using a sample of 185 pregnant women at the 9th month of pregnancy were selected randomly from 40 health posts and urban health centers in Tabriz, Iran. Service Quality was calculated using: SQ = 10 – (Importance × Performance) based on importance and performance of non-health aspects from the customer’ perspective. Data collection used a researcher-developed questionnaire whose validity and reliability was reviewed and confirmed. Data analyzed using SPSS-17 software. Independent sample T-test and ANOVA were used to investigate relationship between service quality dimensions and categorical variables. Results: From the customers’ perspective the average service quality score was 7.59 of 10. Service quality aspects of “confidentiality” achieved scores at the level of good quality (≥9) and “support group” (3.48) reached low service quality scores. Also, result indicate housewife assess SQ better than worker (p=0.047) and mother who's have planned pregnancy has had greater SQ score (p=0.022). Although, in the linear regression analysis, job status and planned pregnancy were significantly and independently related to SQ score. Conclusion: Findings revealed a significant room for quality improvement in most aspects of provided care, particularly support group and safety from the perception of people who received maternity care.

---

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: 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.

---

Abstract Background: Human resource management has a critical role in organizations and organization culture is an outcome of human resource management performance. One of the dimensions of the organizational culture is power distance. This study aims to investigate the attitude of employees of selected hospitals of Tehran University of medical sciences towards the power distance in the organization and its consequences. Materials and Method: This is a cross sectional study with a descriptive research design conducted in a sample of 306 employees and managers from Tehran University of Medical Sciences hospitals located in Tehran, Iran. A distinctive questionnaire for each group was developed, distributed and collected as a main procedure to gather data. Data were analyzed using SPSS 16. Results: Study results indicates that there is a positive and significant relationship between power distance and employee participation, organizational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities in the level of 95%(p value<0.05). The moderated multiple regression results also supported the hypothesis that managers’ attitude towards power distance had a significant relationship with their manner with the employees, noticing their qualifications and abilities, giving them independence and responsibility and supporting them in their role. Conclusion: A limited power distance in an organization will result in more committed and satisfied employees with positive perception toward justice in the organizational interactions and ready to accept job responsibilities and movement toward the organization objectives.

---

Background: Shift work can be associated with decreasing performance, changing eating habits, getting into conditions such as fatigue and insomnia, developing individual and social life disorders and health problems. This study is aimed to investigate the prevalence of shift work disorders among nurses working in Ilam’s teaching hospitals in order to provide solutions for dealing with these disorders. Materials and Methods: This is a descriptive – analytical study in which 84 nurses of Ilam’s teaching hospitals had been chosen by simple random sampling. The data had been collected by “Survey of Shift Worker” (SOS) questionnaire and analyzed using SPSS (version 18) and descriptive statistics and Chi-2 test. Results: Results indicated that shift work disorders are prevalence among nurses. Emotional and Mental problems (96.4%), Social Life (84.5%), digestive problems (81%) have the highest prevalence rate respectively. Nurses who volunteered to work shifts have more job satisfaction than the ones who were obliged to do that (P<0.05). In addition prevalence of problems was far less among nurses who get satisfaction from shift work than the others who do not. Conclusion: Choosing shift work voluntarily results in more satisfaction with shift work which eventually decrease problems caused by shift work.

---

Background: Responsibility and job satisfaction are important issues. This study is aimed to investigate the relationship between responsibility and job satisfaction of nurses working in teaching hospitals of Tabriz University of Medical Sciences. Materials &Methods: Statistical population includes, nurses in teaching hospitals of Tabriz University of Medical Sciences. 316 samples had been selected by stratified random sampling. The data had been collected through a questionnaire and analyzed by using SPSS software. Results: There is a significant relationship between responsibility and two dimensions of job satisfaction (job satisfaction and promotion satisfaction) but there is not significant relationship between responsibility and other three job satisfaction dimensions (satisfaction of supervision and monitoring, satisfaction of colleagues, satisfaction of salaries and payments). Conclusion: Responsibility is an accurate predictor of performance in wide range of occupations .It has a significant relationship with job satisfaction. The more a nurse feels responsible for her or his duties, the more efficient she or he is in delivering health services to patients .Therefor nurses feel more satisfied of their jobs.

---

Background: Educating patients and improving their self-care skills are main factors to achieve maintaining and improving health as health care organizations prime priorities all over the world. This study is aimed to assess nurses and doctors viewpoints on obstacles and facilitators of educating patients. Materials and Methods :This quasi experimental research were undertaken in Kermanshah Razi hospital.85 nurses and doctors were selected by Simple Random Sampling method. The data were collected by a questionnaire based on Likert scale consisted 32 questions in 3 parts. Validity and reliability of the questionnaire were confirmed by Content validity and Test-Retest methods respectively. Results : Shortage of nurses and lack of sufficient financial resources among inhibiting factors and holding seminars on teaching and learning strategies and also considering educating patients as a annual evaluation determinant among enhancing factors were the most important ones . Conclusion: Providing efficient resources and facilities and running personnel`s training courses seems necessary to overcome current obstacles.

---

Backgrounds: Explanation of Cognitive empowerment & Human Sources Productivity is theoretically & practically important . This research is aimed to examine the relationship between psychological empowerment of staff with human resources’ productivity. Materials & Methods: This study is applied by purpose and survey by method and correlation was used to investigate the mentioned relationship . The statistical population consist of administrative and financial stuff of Hashemi Nejad hospital. The data were collected by questionnaire and interviewing and observing. Two types of questionnaire had been distributed among statistical samples for testing survey’s hypotheses witch their questions were based on Likert scale of seven. First questionnaire’s reliability was 0.95 and second one was 0.93. Due to achieve survey’s objectives, both analytical and descriptive statistic had been used. Results: using Pearson correlation coefficient, the survey’s testing hypothesis showed a significant correlation between component of cognitive empowerment and four variables of human recourses productivity (organizational commitment, organizational participation, job creativity and job satisfaction). The relationship between the empowerment component and four other variables were 0.95, 0.90, .0.86 and 0.85 respectively. Conclusion: using effective psychological empowerment components can play a major role in stuff’s productivity.

---

Background: Identification of development needs is a first important step in a systematic management development effort. This study aimed at assessing management development needs from the viewpoint of middle managers of hospitals affiliated to Tehran University of Medical Sciences. Material and Methods: This cross-sectional study was conducted in the hospitals affiliated to Tehran University of Medical Sciences. The population study was 227 of middle managers employed in 16 hospitals. Data were collected using a 42-items questionnaire which its reliability and validity was confirmed. Data were analyzed using main components analysis in software SPSS17. Results: designing and innovation indicator among managerial roles, human skills indicators in managerial skills, psychological abilities among managerial talents, social trust in personal characteristics, comprehensive thinking indicator in philosophic mindedness and leadership in managerial knowledge components were the most important from the perspective of the middle managers Conclusion: managers play the specific managerial roles in order to perform their managerial tasks. They need to develop administrative skills, abilities, knowledge, personality and philosophic mindedness to play the best managerial roles.

---

Background:Hospital is the most important health care services provider center.Undoubtedly, properand effective management performance can be very important. This study aimed at assessing professional and non-professional managers’ performance among selected hospitals in Tehran. Materials and Methods: In thisdescriptive study the population was staffs of ten selected hospitals in Tehran. With the intention of performing the study, a 41-items questionnaire was used which confirmed its validity by experts and its reliability by Cronbach alpha(=90).After data entry in SPSS software,frequency distribution tables, diagrams and central tendency and dispersion were used. With the intention of measure probable correlation Contingency Correlation Coefficient - C was utilized. Results:The comparison betweenprofessional managers’ responses with non-professional ones revealed an incremental trendfrom “seldom” to “always” in all domains of management functions (including planning, organizing, coordinating and control)and Contingency Correlation Coefficient - C indicated statisticallysignificant relation between domains and types of managers (professional and non-professional)P = 0.003, P = 0.006, P = 0.001, P0.0001 respectively. Conclusion:Managers’ professional education is inevitable for hospital managing duties.

---

Abstract Background: This study attempts to review dimensions and indicators of organizational culture in Petroleum Industry Health Organizations utilizing Denison navigation framework and provide practical solutions to improve the situation based on strengths and weaknesses identification. Material and Methods: Thisapplied study was a descriptive - analytical one which performed using field assessment.Population study included all staffs of the organization's headquarters in Petroleum Industry Health Organization using systematic random sampling based on employeeslist and 110 staffs were selectedfinally. SurveyingOrganizational Culture Denison (DOCS, 2007) was used for data collectionin which the overall cultureOrganization and its characteristics and indicators were measured and the results compared with the global average. Results:The overall score of the corporate culture was in the middle status (2.8) and score of four maincharacters had fluctuation in the range 2.6 to 2.9. Fundamental values (3.1) had the most score and customer orientation (2.2) and development of capabilities (2.4) obtained the least scores in 12th indicators which these two indicators were identified as significant points to improve organizational culture. Conclusion:The scores revealed considerable distance with average global rates, but the scores are similar to other Iranian studies. The weakness of organizational culture in two indicators including “customer orientation” and “development of capabilities”can affect optimal organization performance through organization's compliance ability with environmental changes

---

Abstract Background: Organizational commitment is an important occupational attitude which demonstrates personnel staffs liability for their organization. This study aimed at assessing the level of nurses’ organizational commitment in selected hospitals of Tehran University of Medical Sciences in 2011. Materials and Methods: In this cross - sectional study, 363 nurses with BS and MS degree who employed in selected hospitals of TUMS were chosen using random sampling method. Data were collected using a 2-section questionnaire including demographic variables and organizational commitment. With the intention of data analysis, descriptive statistics, independent t -test, chi square, Kruskal-Wallis, Mann-Whitney tests were conducted. Significant level assumed at 0.05. Results: Study results confirmed that organizational commitment and its all dimensions (affective, continuous and normative) were in moderate level (65.87± 15.32). The Level of organizational commitment had significant relation to job position (P<0.001), ward type (P<0.001), years of experience (P=0.03), and the hospitals (P=0.004). There was no significant relationship between demographic variables and organizational commitment (P>0.05). Conclusion: Since, None of the demographic variables revealed significant association with organizational commitment and occupational and organizational factors had significant relation with organizational commitment, it seems that personal factors should not be considered as the main criteria of recruiting committed nurses

---

In many countries, different methods and tools for improving the quality of health cares have been used. Among these methods, the NHS clinical governance provided by the NHS British government as a strategy to enhance the quality of clinical cares was introduced in 1998. Clinical governance both responsibilities for maintain the current level of cares and improving the quality of future care are emphasized. Materials & Methods: The aim of this study was to investigate the relationship between clinical governance and organizational performance of hospitals in Ardabil. The research is an applied one questionnaire is used to collecting data. The population comprises patients, doctors employees and hospitals managers of Ardabil 180 were selected as the sample. To investigate the hypothesis test, correlation and regression analysis were used. Results: According to data, there is a significant relationship between organizational performance and clinical governance. On the other hand, the results of F test showed meaningful level for the components of %99, so we can use linear regression. Furthermore, the coefficient of all the components of clinical governance has a positive and significant effect on performance. Among the components of clinical governance, clinical audit component has %163 of the minimum amount, and staff management component 908 percent has the most effect on hospital performance. Conclusion: According to the results, are considered essential patient’s engagement in treatment, the use of information and patients' family’s experiences to provide more services to patients, credit allocation for staff training and staff expertise in the field of employees training.

---

Background: Hospital as core of health and care system requires an effective leadership style and suitable strategy for organizational differences and conflict’ solving. Main goal of this study is to survey of relationship between leadership style and strategy of conflict management among chief executive officers of Urmia hospitals. Materials and Methods: This analytical-descriptive cross-sectional study was implemented in Urmia hospitals in 2013. Study population of the research includes thirty top managers in ten hospitals of Urmia. Data gathered through three questionnaires (personal and job characteristic leadership style with method of Fiedler LPC and conflict management). Data analyzed through SPSS software, mainly by Chi 2, Kruskal–Wallis and Spearman's Rho tests. Results: Results showed that Leadership style had significant statistical relationship with average of managers work experience (p=0.040). Also age and strategy of control had significant statistical relationship (p=0.01). Leadership styles and strategies of conflict management weren’t significantly with other descriptive variables such as (position, level of education, marriage situation, work experience, managerial studies and second job). Leadership styles and strategy of conflict management weren’t significant relationship, finally. Conclusion: Since that the determination of leadership style and methods of dealing with conflict management in hospitals is important, it is recommended that ever done comprehensive research on the effects of other factors such as organizational culture, social culture, character on leadership style and conflict management.

---