Journal of

---

Background: Hospital managers' success depends not only on internal of the hospital environment, but also on the external. Considering the importance of the social responsibility of hospitals as an external organizational issue, this study aimed to assess the importance of social responsibility and the implementation status of hospitals.
Materials and Methods: This analytical descriptive study was conducted in Kermanshah educational hospitals in 2016. The study population consisted of management team of each hospital in middle and first-line level, of which 150 were selected using census sampling method. The data gathering tool was a researcher-made questionnaire. Validity and reliability of the instrument was confirmed. Data analysis was performed using SPSS20 software, descriptive and inferential statistics.
Results: The mean score of importance and status of social responsibility implementation were high (86.20 ± 9.98) and moderate (60.62 ± 12.41), respectively. Among the domains, the highest and the least attention were paid to environment (11.65 ± 88.30) and suppliers (13.47 ± 81.48) domains, respectively. The highest level of accountability in patients was (68.87 ± 26/14) and the least was found in organizational processes (14.47 ± 42.02). There was a significant statistically difference in social status according to organizational status and employment type (p <0.05).
Conclusion: The results revealed that the rate of social responsibility of hospitals was moderate. It seems that providing a systematic assessment of managers performance and authorities, functional feedback and using the successful experiences of organizations in the field of social responsibility are necessary.
 

---

Background: The success of organizations depnds on their managers’ performance. This study aimed to measure hospital managers’ performance in the city of sari in 2017, Iran.
Materials and Methods: About 294 top, middle and first-line managers working in the hospitals in Sari (including four public, two private and one social security hospital) particaipated in this descriptive and cross-sectional study. A valid and reliable questionnaire was used to assess managers’ performance in eight functions including decision making, planning, organizing, coordinating, leadership, communication, budgeting and control. SPSS software, the 21^st version, was used for data analysis.
Results: The mean score of hospital managers’ performance was 3.87 out of 5.  Managers scored high in organizing (4.12), leadership (4.06), and decision making (3.97) and low in budgeting (3.27), planning (3.83), and coordinating (3.84). Managers’ performance was linked to their age, marital status, education level, and educational background. Those managers who worked in a position related to their educational background had better performance.
Conclusion: Hospital managers rated their performance as good. Measuring managers’ performance, determining their strengths and weaknesses and applying corrective actions are beneficial to the improvement of hospitals’ performance.

---

Background: Patient complaints from the healthcare system can be helpful to respond patients’ needs using identifying the weaknesses. In this study, the complaints trend of patients has been investigated before and after healthcare system reform progress in a public hospital.
 
Materials and Methods: This descriptive-analytic study was carried out to assess trend of patient's complaints in two period of time in a northeast governmental hospital before and after healthcare system reform implementation (2012-2016). In order to collect data, the checklist designed by the ministry of Health was used. Data entered to SPSS version 21 and analyzed using descriptive statistics and analytical tests such as Chi-square.
 
Results: The study results revealed that the number of complaints were 29 and 198 before and after implementation of healthcare system reform, respectively. Most complaints were related to the emergency sector (31%) and about 40% of the complaints were from physicians. Most of the registered complaints were related to the quality of provided services (33.5%) and personnel exposure (30%), respectively. Accordance to study results, there was a significant difference between the number of complaints before and after implementation of the health system reform with the type of complainant (P <0.05).
 
Conclusion: Implementation of healthcare reform plan has led to systematic registration and special attention to complaints in assessed hospital. Most of registered complaints were related to the emergency department which requires managers and hospital officials to pay special attention to this sector and take effective steps to improve quality of services.

---

Background: Insurance companies sometimes do not reimburse hospitals completely. Reducing the amount of deduction of bills increases hospital’s income and efficiency. This study compares the deductions imposed by social insurance organization on Imam Khomeini hospital’s bills before and after the implementation of health transformation plan.
 
Material and Methods: Data of this descriptive-descriptive study calculated from the deductions applied to the hospital of outpatient and inpatient bills of social insurance organization in second six months of 2013 (before implementation of health transformation plan) and the same time of 2014 (after implementation of of health transformation plan). This quasi experimental study was conducted using the data. Data was analyzed by SPSS software using paired t test.
 
Results: The bill deductions in the second six months of 2013 compare to the same time in 2014 were 2.9 and 11.1 percent, respectively. Hospital bill deductions increased 282.8 percent after the health transformation plan implementation. The deductions on inpatients and outpatients records increased 6 and 12 times, respectively. Most deduction was imposed on surgical and laboratory bills in 2013 and on radiotherapy, chemotherapy and hoteling bills in 2014.
 
Conclusion: Deductions of hospital bills extremely increased from social insurance organization after implementation of health transformation plan. In order to identify deductions causes, providing related education to staff and physicians and relative process improvement are necessary.

---

Background: Among various emergency services, the air emergency due to access to the extreme areas, possibility to move more patients, providing higher quality treatment to the patient being carried and also access to the hospital without problems such as traffic and sudden crashes, is one of the most important types of emergencies in the health sector. So, the right location according to the scientific principles, enhances the efficiency of the aerial emergency.
Materials and Methods: This descriptive- analytical present study was conducted as an applied research in Sistan and Baluchestan province in 2016. At first, indicators affecting the location of ambulances were identified. Then, the location using deploying a Fuzzy network analysis process model next to the Fuzzy Dematel technique and the integration with geographic information system was performed.
Results: Criteria for selecting the best places for deploying air ambulances in Sistan and Baluchestan province are considered as proximity to the roads, appropriate tilt area, proximity to crowded areas, proximity to high risk passages, and the convenient distance from the medical emergencies. Output weights of the technique used for affecting on GIS software were calculated 0.244, 0.083, 0.435, 0.182 and 0.057, respectively.
Conclusion: Study results revealed that number and coverage of aerial ambulances in cities and roads of Sistan and Baluchestan province are not suitable. Therefore, the map derived from the Fuzzy integration of the information layers identified by the effective factors, illustrated that the districts of Zabol and Iranshahr cities have the best status of selected criteria to establish the air emergencies bases in the province of Sistan and Baluchestan.
 

---

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.

---

Background: Recent years, many efforts provided to design hospitals ;as the most stressful environments; to  reduce stress , improve health , patients' remedy  and satisfaction based on patients 'points of view. This study aimed to identify the physical and mental factors effective on patient view in hospitals of Yazd city.
 
Materials and Methods:  Regarding the purpose, this study was an applied one which used survey and correlation methods. In order to determine the normality of data distribution, Kolmogorov – Smirnove, the type, amount and direction of relation between the variables Persons correlation coefficient and linear regression analysis were used, respectively. Additionally, in order to clarify the multi regression model, variance analyze method of ANOVA has been utilized. According to data gathering literature and instrument review have been utilized.
 
Results: Study results revealed that there was a significant relation between physical factors and individuals' satisfaction (P<0.05). There was no significant association between mental factors and individuals' satisfaction. 
 
Conclusion: It seems it is necessary that conditions and facilities need to be provided regarding physical and subjecting factors improving in wards which can be result in stress reduction and satisfaction increasing in the hospital environment, as well. Also, in patients' point of view, using appropriate colors, providing positive entertainment (films and comic books), proper ventilation and fresh air are some of the most important factors in patients ' satisfaction in wards.

---

Background: Women's health has a broad concept that various biological, social, political, economic and environmental factors affect it. This study aimed to prioritize the factors affecting women's health promotion, provide a model for decision making and choose the best option for decision makers and health system planners to achieve the goal of promoting women's health.
 
Materials and Methods: In this descriptive-analytical study, the factors affecting women's health were extracted based on theoretical background and Farmehr's conceptual model. Then, the points of view of five women's health experts on the criteria and options of the model were collected and analyzed using paired comparison tables and Likert measure, and analyzed according to the hierarchical decision-making process. After analyzing the experts 'opinion individually, two methods of computing the geometric meanings and the experts' opinions were combined and the priorities were determined based on group views. The Excel software was utilized to perform the calculations.
 
Results: Among the four main factors, priorities included the individual factors (subcategory of lifestyle), family factors (family relationships) and underlying factors (attitudes and beliefs). In the first level of decision making related to intervention methods in women's health promotion, the multidisciplinary approach was determined; and in the second level of decision-making related to health management, the partnership of governmental and nongovernmental organizations established in the first priority.
 
Conclusion: Based on study results, designing and planning interventions with the prioritization of individual, family and infrastructure factors using multi-disciplinary approach and participation of governmental and nongovernmental organizations for promoting women's health are recommended.

---

Background: Organizational culture is one of the important predictor of organizational effectiveness, and a key factor success of the organization as a competitive advantage. Todays, a continuous assessment of organizational culture status is considered essential; therefore, this study aimed to identify and measure organizational culture of the Ministry of Health and Medical Education.
Materials and Methods: This descriptive-analytical study was conducted on the headquarters of the Ministry of Health and Medical Education in 2018. The study population consisted of all employees of the Ministry of Health and Medical Education (N=2200), 327 personals were selected through Cochran formula and stratified sampling method. The data collection instrument was a researcher-made questionnaire whose validity and reliability were confirmed (Cronbach's alpha =86.5%). In order to data analysis SPSS₂₄ using descriptive and inferential statistics tests were utilized.
Results: The mean score of total organizational culture was 3.30 ± 0.70 from 5 which was higher than the theoretical average. Also, there was also a significant difference in partnership dimension in terms of employment type and in participation dimensions, accountability to the upstream institutions as well as total organizational culture score in terms of deputy. There was a direct statistical association between dimensions of organizational culture.
Conclusion: According to study results, strong organizational culture will lead to improved performance in the organization and alignment of individuals and activities. Given the importance of specific role of culture in each organization, plans success and change strategies, human resources managers should take appropriate actions to improve internal and external communication and increase teamwork and accountability. 
 

---

Background: Considering the increasing growth in health care costs along with the resources finitude; therefore, improving the efficiency and efficient use of resources is considered as one of the main priorities of the health system. The aim of this study was to determine the efficiency of direct medical services affiliated with Iranian Social Security Organization using Stochastic Frontier Analysis (SFA) Method in 2008-2015.
 
Materials & Methods: In this descriptive- analytical study, performance of 30 units of direct medical services affiliated with Iranian Social Security Organization was analyzed using Stochastic Frontier Analysis (SFA) Method. The number of active beds, physicians, nurses and staff were used as inputs and combined variables obtained from factor analysis were selected as output. Frontier version 4.1 was used to determine the efficiency and Stata version 14 was used to study the effective factors on efficiency.
 
Results: The average technical efficiency of studied units was 0.816. Based on the value of index of likelihood ratio test ( LR = 100.45 ), Cobb-Douglas production function was selected as the best model.
 
Conclusion: Based on the findings of this study, adjusting surplus manpower, congenital planning for increasing efficiency and resource management should be the priority of the managers so that they can increase the level of efficiency of studied units and reduce the costs to the least possible.
 

---

Background: One of the most important ways to promote the quality and attractiveness of the journal for readers is the accurate evaluation of the published articles research methodology in the journals. The purpose of this study was to investigate the research methods of the articles published in the Journal of Hospital.
 
Materials & Methods: In this descriptive study, the research methods of all articles published in the Journal of Hospital from Fall 2016 to Fall 2018 including qualitative or quantitative, field or library research , data collection methods, data analysis software, location of research, nature of the research (descriptive or analytical, etc.), topics, as well as the number of authors were investigated.
 
Results: Data of 55.29% of papers was qualitative that was turned to quantitative, 47.06% of articles had descriptive-analytical method, and 68.24% of papers had employed a field research method. In addition, 51.76% of articles had used questionnaire and the SPSS software was used in 52.08% of the articles. The location of 45.45% of researches was in Tehran province. Finally, the subject of 23.53% of papers was policy making, planning, leadership, and management in hospitals.
 
Conclusion: Most authors of the articles have followed a very similar research method during the mentioned period. So, creating diversity in the nature of the researches, using other methods of collecting information rather than questionnaires, doing more library research, and not limiting the researches to Tehran province are the most important suggestions for future researchers.
 

---

Background: with increasing demand for treatment, patients are monitored with help of Internet of Things(IOT). Patient's monitoring devices and technologies include heart rate measurement, blood pressure measurement, blood glucose and other vital signs. The purpose of study is to provide a model of clustering patient physical monitoring gadgets and apps in Healthcare Internet of Things (HIOT) environment using data mining techniques, so based on the needs and characteristics of the user, the more appropriate results of choosing technologies acquired.

Materials and methods: This study is a review and functional since its result. The data includes 6 unique features of 60 selected technologies including function, price, connectivity route, power supply, location and type of use that has been extracted from R&D and advertising sites of technologies and also relevant articles. data analysis method is clustering technique and K-medoids algorithm. to identify the most effective features, random forest algorithm has been used.

Results: the proposed clustering model takes into account 6 as inputs and clusters gadgets and apps in accordance with selected characteristics as the model outputs. clustering problem data is clustered in 4 categories.  Silhouette index is 0.45, which indicates the validity of the model. The type of application and then the price had the greatest impact on clustering.

Conclusion: By this model, patients or users can find the most appropriate technology based on the type of disease and other effective features, such as price. So with accurate physical and momentary monitoring, disease progression decrease and prevention of disease will improve.

---

Background: Information technology application in health care is increasing. The aim of  this study, is to introduce a scientific model for designing an electronic system for managing patient transfer.
Materials and Methods: This study is an exploratory qualitative study. At first a review of literature was carried out for identifying clinical, managerial and process indicators necessary for patient transfer. Then 30 experts, who had vast experiences on patient transfer, were selected using purposive sampling approach and their informational needs were extracted using focus group discussion and semi-structured interviews. Then clinical indicators extracted from literature review and informational needs collected from interviews were distributed among 51 experts in the form of Delphi questionnaires. Process indicators were also distributed among 35 experts to summarize all necessary indicators for designing patient transfer system. At the final step an expert panel approved the model.
Results: Thirty eight process indicators and 249 clinical and managerial components were finalized for designing the system. The process indicators were used for designing “monitoring and reports sections” of the system. The clinical indicators were used for designing “main sections” of the system including request for patient transfer, automatic algorithm for selecting destination hospital, information flow cycle, communicating clinical data and documentation. Final model also includes user interfaces relevant to responsibility of the user.
Conclusion: The proposed model, which contains necessary indicators for patient transfer, can communicate clinical information among hospitals and by providing proper infrastructure, will be able to improve patient transfer process.
 

---

Background: Assessing and improving the quality of services in hospitals because deal with the health of humans is very important. The purpose of this study is to identify and weigh quality criteria and ranking of four hospitals in Mashhad.
 
Materials & Methods: The present study is of type  Applied Studies  that is a cross-sectional study conducted in the winter of 1396. In this study, by literature review, dimensions of service quality in the hospital was identified. Then, a paired comparison questionnaire (including 8 people) was used to conduct the survey. Then coefficients of importance of each dimension were calculated through the process of hierarchical analysis in a fuzzy environment. Decision-making matrix questionnaire was completed by a 400-person sample of patient companions in four hospitals.Then, hospitals were ranked using GRA-TOPSIS method. The validity of questionnaires were confirmed by the expert group.
 
Results:Using FAHP, knowledge and skills of medicine obtained the most important coefficient. Also, using GRA-TOPSIS, third hospital received the fourth place in the provision of services. Also in the third hospital the quality of access requires the greatest improvement.
 
Conclusion: In addition to ranking hospitals based on quality of service criteria, the GRA-TOPSIS method is able to identify each hospital's weaknesses in each criterion. As a result, the priorities for improving the quality of service in each hospital were identified, and the hospital manager could work to improve performance on the criteria that he or she achieved with lower performance than other hospitals.

---

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.

---

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.

---

Background and Objective: The aim of this study was to investigate the factors affecting the physicians' decisions in prescribing medicine and in using national and foreign brands of medicine with the help of decision-making styles of Sprolls and Kendall models among physicians in Urmia. Given the prevalence of COVID-19 disease worldwide, physicians' decisions and preferences in prescribing medication are considered vital.
Methods: The present study is an applied survey.  The study population included 400 general practitioners, specialists and subspecialists in Urmia. The normality of data was measured using Kolmogorov-Smirnov test. Cronbach's alpha was also used for reliability of the questionnaire. Regression analysis was used to measure the strength or degree of linear relationship between two independent variables. SPSS software was also used for data analysis.
Results: The results showed that out of six influential factors, five factors (quality, brand, newness, price, and loyalty) were identified among physicians. In addition to identified factors, a new factor namely "time and energy saving" was also a determining factor.
Conclusion: Considering the 7 factors influencing physicians 'decision-making, the results showed that physicians pay a great amount of attention to prescribing quality medicine in their preferences. On the other hand, the brand has a special place in physicians' decisions; therefore, drug companies and manufacturers should also care about branding their products.

---

Narcissism is a type of personality disorder in which a person considers himself great and important and exaggeratedly feels capable and worthy. One of the places in which this disorder can occur is at the university level. The symptoms of this type of disorder can be seen in some faculty members and it seems that these people also have some kind of scientific-academic narcissism disorder. In this type of narcissism, the person has a sense of overconfidence and is fascinated by power and dominance, becomes disinterested in others, demands the attention of others, and believes that he deserves special attention. At the scientific and academic level, these people try to promote themselves in various ways and by abusing students (using their ability to write essays and making them do research with threats and intimidation). These people often claim to be superior in terms of scientific literacy and have a high IQ, and constantly slander their colleagues and criticize their performance unfairly. It is necessary that while preventing them from holding any managerial positions, they should also be evaluated through academic counseling centers and, if necessary, be cured through informing colleagues and family.

---

---