Journal of

Background: Knowledge management plays an imperative role in the success of organizations. Many factors such as organizational culture affected on knowledge management. Therefore, this study aims at investigating the association between dimensions of organizational culture with knowledge management.

Materials and Methods: A cross-sectional descriptive analytical study was conducted in 2013. Three hundred twenty two employees of three hospitals related to the Zahedan University of Medical Sciences selected through a stratified-randomized sampling. Standard instrument of organizational culture and a self-designed questionnaire of knowledge management were used for data collection. Collected data was analyzed using SPSS version 18 by descriptively and inferential statistics methods.

Results: study results indicated that there was a positive and significant association between organizational culture and knowledge management. Also, results on other objectives pointed out a positive and significant association among dimensions of organizational culture (clan, market, adhocracy) and knowledge management. There was a negative and significant relation between organizational bureaucratic culture and knowledge management.

Conclusion: Organizational culture is one of the most important tools of a successful implementation of knowledge management in organizations. Modifications of organizational culture in health care teaching hospitals of Zahedan University of medical sciences should be set towards establishing knowledge management considering organizational tribe culture and organizational adhocracy culture more than other cultures.

Background: one of the most essential components in patient- physician relationship is the length of visit. Short time visit can affect visit quality and patient- physician relationship. This study aimed at comparing specialists visit length with standards in general hospitals of Qazvin.

Materials and Methods: This cross-sectional study conducted in general hospitals of Qazvin  in 2013. 428 patients were randomly selected to participate who were referred to the outpatient clinics of selected general hospitals. Studied specialties were including Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. In order to data collection, a Checklist including physician and patient related items was used and data analysis performed using SPSS version 19.

Results: The study results revealed the mean score of outpatients' visits length was 4.67±2.43 minutes which had a significant difference from standards (p<0.0001).Higher mean score was relate to  pediatrics (2.55±7.08) and the lower one was internal physicians (1.82±3.93).

Conclusion: In this study, Visit time in developed countries was lower than developing ones. Several factors were identified which affect visit time. Thus, decision makers should use the results to improve outpatients visit quality.

Background: Chronic renal failure disease is considered as a health problem . Because of their high prevalence and economic burden on the society, health system managers consider to the disease as a public health concern.  This study aimed at comparing the cost-effectiveness of long-term dialysis treatments and kidney transplant using DALY index.

Materials and Methods:This cross-sectional study was designed to compare the cost-effectiveness of two methods such as long-term hemodialysis and kidney transplant using Disability Adjusted Life Years (DALY) in Afzalipour Hospital of Kerman in 2012. The decision tree model and TreeAge software were used for data analysis. In this research, costs and effects were studied from the patient perspective.

Results: The cost of a kidney transplant was 165 million Rials, effectiveness of a kidney transplant was 4.40 DALY, chronic dialysis cost was 1.283 billion Rials and its effectiveness was 6.52 DALY. Cost-effectiveness ratio for dialysis was 196 million Rials per DALY and this ratio is 37 million Rials per DALY for a kidney transplant respectively. According to the findings, kidney transplant is more cost effective than dialysis.

Conclusion: This study suggests kidney transplant over dialysis due to its better quality of life and more life expectancy. The results can help out the government to decide about the more resource allocation to kidney transplant programs. The method in this research can be applied to measure the cost-effectiveness of other organs transplantation.

Background: Nursing is considered as one of the most stressful occupation which influences their quality of work and life. The inevitable fact of occupational stress and low emotional intelligence management leads to negative effect on the nurses’ performance. The study aimed at determining the relationship between emotional intelligence and occupational stress among the nurses of alzahra hospital in Isfahan.

Materials and Methods: This study was an applied and descriptive survey. The study population consisted of 960 nurses of alzahra hospital in Isfahan. Sample size calculated 247 using Cochran formula. Sampling method was stratified random sampling. Data gathering was used by two questionnaires including emotional intelligence (sybershring) with 0.85 reliability coefficient and Health and Safety Institution of England (HSE) questionnaire with 0.84 reliability coefficients. Data analysis performed by SPSS software using independent t-test and Pierson Correlation Coefficient tests.

Results: Findings revealed that the stress level and its measuring scales such as expectations, control, management support, colleague’s support and role ranked more and the interrelation scale  ranked less than average among nurses. Emotional intelligence level of nurses and scales such as self-awareness and self-regulation ranked average  and empathy, self-motivation and social skills ranked less than average. Therefore, there was a significant relation between the emotional intelligence level and nurses' stress in p<0.05. With increasing the emotional intelligence level, the occupational stress in nurses decreased.

Conclusions: Having emotional intelligence skills can result in experiencing stress less and improving nursing performance; and better service quality among patients.  Hence, hospital’s managers should be adopting proper policies with respect to the emotional intelligence.

Background: Given that Tabriz Shohada hospital is the place of admitting emergency patients including accident victims, Nurses are exposed to double stress at hospital. This study conducted to predict nursing stress based on personality traits and job engagement among nurses in Shohada hospital of Tabriz.

Materials and Methods: The current study was a correlational one. Randomly selected 105 nurses from Tabriz Shohada hospital sections such as sixth general sections including Rehabilitation, ICU & Emergency Department participated. Contributors answered to Nursing Stress Scale, Eysenck Personality Questionnaire Revised (EPQ-R) and Job Engagement Scale. Data were analyzed using stepwise multiple regression analysis.

Results: The study results indicated that nursing stress was more strongly associated with the neuroticism; there were no relationships among nursing stress and extraversion or psychoticism. Also, nursing stress revealed a positive relationship with job engagement. Using the multivariate regression analysis showed that the neuroticism trait (p< 0.001, F=10.68) and job engagement (p= 0.004, F=10.12) were suitable predictors for nursing stress among three personality factors and job engagement.

Conclusions: Nursing stress influenced by internal factors more than demographic variables and two important predictive variables (neuroticism trait and job engagement) had more important roles in nursing stress prediction.

Background: Partnership between public and private section is the cooperation between institutions in these sectors which perform to attain common goals and eliminate the limitations. This study aimed at investigating the important criteria for attraction of private section in health sector.

Material and Methods: Based on studies and sample surveys, governments have essential role for codification of health policies and special programs in any country. In recent years, the costs of delivered health services increased exponentially and governments are looking for alternative mechanisms for cost reduction; meanwhile, the increased capacity in social programs is accompanied with considerable investments in infrastructures. This article investigated the utilization of different models by previous literature assessment in public- private partnership field and determined key and substantial criteria for these projects' success /failure. Although, the experience of their implementation is still very limited in our country and there is no accurate assessment based on case studies.

Results: Based on study results, some criteria like possibility of returning part of participation costs in tendering for tender, goals and responsibility's clarity, fair and correct mutual risk attocation , lower public costs through less incumbency, private section motivation, clear mechanism monitoring ,conflict resolution and supporting policies from private investment have essential role for successful public- private partnership which special attention should  be drawn.

Conclusion: Governments can have a suitable partnership with private sector in order to prevent increasing costs in rebuilding, maintenance and operation of public facilities like hospitals, considering budget limitations in public sector, providing innovation through opportunism in private section and more efficient risk management.

Background: The issue of access to urban services is one of the important one that affects different aspects of urban affairs. In some cases, lack of proper access to some land, people's health is exposed to risk, for example Health care services especially in hospitals that impose requirements in a timely and appropriate access to it for all members of society. This study aimed at analyzing the distribution of hospitals and locates new hospitals regards to the lack in Saqqez city.

Materials and Methods: This study was a cross sectional and descriptive one. In order to classify and analyze data, the models of AHP and network analysis have been used. Also, ARC / GIS software and Expert choice has been used to map layers.

Results: According to assessed studies about the distribution of available hospitals and determination of their standard performance, 62.93 percent of the city area has not access to the hospitals.

Conclusion: This study results showed that hospitals in terms of compatibility with other land uses and access is inappropriate in the city. Thus, optimal areas for construction of new hospitals in five final maps from very good to very poor were classified and proposed using combining different layers of effective land uses.  

Background: Data Envelopment Analysis (DEA) is a mathematical model that evaluates the relative efficiency of Decision Making Units (DMUs) with multiple input and output. The purpose of this paper was systematic study of applying this technique in Iranian hospitals.

Materials and Methods: In this systematic review which was conducted in September 2015 and February2016, attempted to search the research which conducted in Iranian hospitals regardless of the time of publication using searching keywords in six scientific databases and with the help of Google search engine. A total of 6,613 researches found. Then, 6,566 researches removed from the study because of the irrelevant, repetitive and Inaccessibility to the full text. Then,  attempted to statistical analysis of 47 remaining researches via Excel 2010 software.

Results: 93.6 percent of the researches were published in 2009 onwards. The most research and least research have been conducted in three and eleven provinces respectively. The diversity of output indexes have been more than diversity of input indexes. In 81 percent of researches; input oriented model was used and in 74.5 percent of researches variable returns to scale is assumed. In most studies, referred to Iran's inefficient hospitals because of existence of excess resources.

Conclusions: In last seven years, the interest of Iranian researchers has increased about DEA application in hospitals especially in Tehran, Yazd and Khoozestan provinces. Scientific and rational use of resources is a proposal to the relevant authorities.

Background: Lack of financial resources or their poor organization is one of the service delivery challenges and Fraction of dedicated revenues is significant problem in health centers in financial resources management. Hence, this study conducted to investigate causes of dedicated revenue's fraction and strategies to reduce them.

Materials and Methods: This qualitative study was carried out based on phenomenology approach in East Azerbaijan Province in 2014. Data collection methods were Focus Group Discussion (FGD) and semi-structure interview guide based which continued to saturation. their participants were selected using purposeful sampling method. Data were analyzed using content analysis method.

Results: Based on participants' experiences, six themes were extracted for causes of fraction and strategies to reduce them. These themes included causes and strategies related to fractions per capita, insurance fractions, fractions related to sending documents, registration fractions, clients' deductions and fractions related to incomplete deposit of cash incomes. In general, eighteen causes and twenty three strategies were identified in dedicated revenues fractions.  

Conclusion: The causes of fractions were related to all stages of changing service process to revenue and insurance obligations in health care centers and strategies and identified interventions emphasize on mentioned fields. 

Introduction: High quality health care service leads us towards a healthy society. Present paper aimed to use the service quality concept in health care sector based on service quality approach (SERVQUAL) in public hospitals. Methods: In present research a hybrid approach based on Analytic Network Process (ANP) and Fuzzy TOPSIS was used where the former was used for prioritization of healthcare service quality measures and the latter was used to operationalize the hospitals. Questionnaires and ANP and Fuzzy TOPSIS were used for data collection and analysis. Five public hospitals in Rash were evaluated. The time period of the study including data collection was 2014-2015. Results: The service quality criteria comprised of 6 main criteria and 19 sub-criteria in present study. Among five hospitals studied in present research, Rasoul Akram hospital obtained the first rank and other hospitals obtained the other ranks. All criteria and sub-criteria used in present study obtained some rank indicating their importance in the research context. Conclusions: With conducting present research, various criteria and sub-criteria related to service quality (SERVQAL) and their importance were identified and this may contribute to improved performance of health care services

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

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

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

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

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

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

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

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

Background: The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.

Materials and Methods: A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department.  Related data were collected before and after the intervention to determine the effect of quality management system on deductions.

Results: The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.

Conclusion: Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively

Background: Recently, the medical tourism is developing more and more over the world. Due to the potential of medical tourism in Iran, this study aimed at identifying medical tourism characteristics in terms of tourist destination and therapeutic centers in Iran.

Materials and Methods: According to literature reviews and experts interviews, components of medical tourists attraction were investigated ana a questionnaire provided. After baseline, items which were not valid and reliable omitted and final questionnaire distributed and completed among experts Such as physicions, academic members, managers and medical staff in eight public and private hospitals in Tehran city.

Results:  Regarding the study results based on the respondance view, the more and the less important components of medical tourist's attraction in Iran included hospital validity, costs, quality of care, hospital staff training, position and political environment, regulatory policy, infrastructure and location of hospital and economic situation. The main problem of medical tourism represented as lack of obvious treatment process and support system. In similar studies, low tretmant costs in destination country was the important motivation of medical travel and factors such as political, economic, regulations and standards and medical centers validity have been addressed to make decisions about the origin country.

Conclusion: This study based on current and priorities assessed the developing dimensions of the medical tourism in macro and micro levels from perspective of medical tourism activists. Medical tourism development requires comprehensive and integrated approach which has been achived using coordinate cooperation, planning and implementation of micro and macro strategies among relevant organizations. 

Background: Pre hospital emergency medical service (EMS) as the first line of emergency care and treatment in the out- of -hospital has a considerable importance in the health care system. Planning on finding about strengths and weaknesses and improve the quality of EMS by exploring the problems of this section has considerable important.This study aimed to explore the challenges of pre hospital emergency medical service in Mashhad.

Materials and methods: A qualitative study was done with 14 personnel working in EMS sites in Mashhad using purposeful sampling. Data was collected by semi structured interview and analyzed using conventional content analysis approach according to Graneheim and Lund man 2004 with ATLAS.ti  software.

Results: Three general themes were identified including 1) "challenges in Human resources"( Individual characteristics of human resources and personnel's dissatisfaction 2) "challenges in organization" (Structural challenges, lake of equipment and human resource limitation 3) "socio-cultural challenges"(Environmental-social challenges and cultural challenges) were determined.

Conclusion: personnel's dissatisfaction, structural challenges, human resource limitation, lake of equipment   and Environmental-social challenges were the most important challenges in pre-hospital emergency system. Organizational independence , create organizational rows, regulation of laws and administrative regulations reform in relation to the range of services offered by emergency personnel, attention to the facilities and cooperation And the participation of other organizations, such as media and traffic to enhance pre-hospital emergency services at the community level can be effective in reducing the challenges in hospital emergency system.

Background: Organizational culture has a crucial role in hospitals’ productivity. The success or failure of strategies and plans in organisational change depend on organizational culture. This study aimed to examine the organizational culture of Tehran hospitals in 2014.

Material  and Methods: This descriptive-analytical study was carried out in 18 hospitals (public, private and semi-public hospitals) that were selected out of 114 hospitals of Tehran using quota- randomized sampling method. About 696 employees in diagnostic, curative, administrative and logistic departments participated in the study. Data was collected through a valid and reliable questionnaire and analyzed using SPSS20. Spearman, U Man- Whitney and Kruskal- Wallis statistical tests were applied.

Results: The mean score of organizational culture was 3.62 out of 6 (moderate). There was a significant relationship between organizational culture and the type of hospitals (p=0.002). The mean score of organizational culture was higher in Private and Semi-public ecurity hospitals respectivey. Attention to details and customer orientation dimensions were high in public and semi-public hospitals and private hospitals respectively. The most and the least mean score of organizational culture was related to administrative and support services units. 

Conclusion: Organization culture was evaluated in moderate status in hospitals of Tehran city. Thus, it is recommended  that hospital managers  improve hospitals 'organizational culture  specially in creativity, innovation, integration and teamwork dimensions using organizational engineering culture plans.

Background: Accidents are one of the important health problems in the medical community and the third cause of death after cardiovascular disease and cancer in the world, which can cause irreversible damage and lesion, impose heavy costs and depreciation. Therefore, this study aimed to identify epidemiological aspects of the accidents in the first six months in 2012.

Materials and Methods: This applied, descriptive and analytical study was conducted during the first 6 months of 2012. Study population was 1952 injured who referred to emergency department to selected hospitals of Mazandaran Province. Data collection performed using checklist of Center for Disease Control as well as interviews and observations. Data was analysis through SPSS version 17 using descriptive and interfere (x² and Regression) tests.

Results: Study results revealed that there was a significant relationship between incidents leading to injury or death among referred to hospitals with age (p=0.03), gender (p=0.04), type of incident (p<0.001), place of injury ( p=0.005) and type of transfer to hospital ( p<0.001).

Conclusion: Regarding to the significant variables such as the type and location of accident, type of transfer the injured to the hospital, age and gender with accidents and death, planning appropriate education of law to youth, providing air bag and safety improvement of all cars, planning relevant road assistance system, accurate monitoring to its implementation, qualitative and quantitative development of medical centers recommended to Policy makers in health issues.

Background: Hospitals directly affected by disasters and crises which will be provided services facing with crises by well-informed and high performing personnel. This study aimed to determine self-efficacy level in disasters among senior managers of hospitals.

Materials and Methods: This study was a descriptive-analytical and applied one which was conducted in all public and private hospitals affiliated to Tehran University of Medical Sciences in 2015. Study population was all senior managers of hospitals and data was collected by a researcher-developed, valid and reliable questionnaire.  Data analyzed using descriptive and Inferential statistics.

Results: Self-efficacy facing with crisis was assessed on average level (101 out of 130) and high among married men with previous experience in disasters. Also, self-efficacy level reported high among aged and position of ED managers. Nevertheless, there was no significant relationship between self-efficacy and participation in educational course and hospital ICS membership.

Conclusion: Given the relationship of self-efficacy with the aged and prior experience in disasters, these variables should be considered in selecting proper people for these positions. Moreover, having successful experiences dealing with challenges enhances the level of Self-efficacy among managers. Hence, using some techniques such as simulation or providing maneuvers can acquaint managers with the possible conditions facing with disasters. 

Background:  Equitable and suitable access of all citizens to the urban public service is one of the primary principles of urban planning, which with the rise of the justice-centered approaches in recent decades has been double care. In the meantime, access to health services as one of the vital public service has greater sensitivity. This research has been performed with aim of identify enjoyed and non-enjoyed regions regarding health care and its distribution assessment applications in Tabriz city.
Materials and Methods: For the access analysis ARC GIS software, specially Network Analysis tool and Williamson and entropy index and has been utilized. Also, considering respective per capita, Tabriz city population needs and the existing deficiencies have been specified.
Results: The study results indicate that %76 of Tabriz city population have optimal access to healthcare facilities. In contrast, in the analysis of access to hospitals %36 of population have optimal access to theme and %64 have Undesirable access. Also, in urban zones analyses unit, based on Williamson index analysis, the index was calculated 0.67 to Tabriz city, which indicates an imbalance in the distribution of health care Facilities in the Tabriz city.
Conclusion: In general, zone 2 has the most balanced distribution of health care facilities and zone 9 is suffering from imbalanced distribution of health care facilities. It is suggested that in order to reduce the inequalities in the enjoyment of health care facilities, proper assessment about to existing facilities and future planning, in terms of Threshold, capacity and access should be conducted.

Background: Necessity of development, quantity and quality improvement needs of medical tourists had been unavoidable based on medical tourism growth with its competitive function. This study aimed to determine satisfaction rate of medical tourists referee to Tabriz hospitals to get treatment services.
Materials and Methods: This descriptive and analytical study was conducted on 82 medical tourists referee to all wards of selected hospitals using convenient sampling method in Tabriz city. Data was collected using a-28 items valid and reliable researcher made questionnaire. Cronbach’s Alpha was calculated 0.708. In order to data analysis, SPSS Software version 23 was utilized. Also, Spearman’s correlation coefficient was used to assess the association between different aspects of patients’ satisfaction.
Results: Satisfaction rate was obtained in five main aspects including cultural problems (51.88%), structural issue (57.50%), insurance payment system (16.04%), information system and communication channels (41.34%) the economic challenges (50.35%). The information system and communication channels had high effect on economic aspects (p<0.001).
Conclusion: It seems necessary that health policy makers and managers pay more attention to foreign medical tourists and faced challenges correction in order to change Tabriz city to a medical tourism center of excellence and improving regional economic development.