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Background: Payment method is one of the most important control knobs in the health system. All organizations that mobilize funds for health sector must be decided: who should be paid? Why this money should be paid to them? And how much should be paid? So the main purpose of this study is to identify different methods of paying to the doctors in referral system of selected countries, and ultimately providing some suggestions for Iranian social security organizations- direct medical service provision.
Materials & Methods: This was a comparative study designed in 2008. First we studied theoretical issues and analyzed them within the framework of the current situation. Then we conducted a comparative study to find some solutions for it. Then we validated selected suggestions using by Delphi technique.
Results: Most selected countries use a combination of methods to pay to the physicians. Usually for employed physicians in insurance organizations, salary makes a large part of doctor`s income. In countries where GPs play the role of gatekeeper, the per capita payment method has a special room. In American Health Maintenance Organizations (HMOs), based on employment or contractual relationship, they pay physicians by one of three methods: "Per Capita", "Salary Monthly" or "Prepayment". In addition to Salaries (if any employment relationship), specialists usually receive some fees for their Services widely.
Conclusion: Bonus payment in exchange for quality indicators is considered as a recently developed payment method for both GPs and specialists, but due to wide infrastructures, it needs accurate designing and plenty of arrangements.

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Background: Health service providers' attitude profoundly influence quality of patient care and safety, and lead to increase effectiveness, cost controlling and decreasing complaint. This study aims to examine staff attitudes' about patients' safety culture in Noor & Ali Asghar hospitals in Isfahan province.
Materials & Methods: The survey was a cross-sectional study and was done in 2011. Data were collected from all the staff groups in hospital (n=106). A standard questionnaire from Agency of Healthcare Research and Quality (AHRQ) with a =79% is used to evaluate staff attitudes' toward different aspects of patients' safety culture. This study used SPSS 16.0 to perform the statistical analysis.
Results: The response rate for the survey was 89%. The study revealed that 53.7% of the personnel were not reporting errors in 12 months before. Results showed that the average of staff attitudes' scale toward patients' safety culture was (64±5.28) the highest scale was belong to supervisor/ manager expectations & actions promoting patient safety (72.8±15.8) and the lowest one to handoffs & transitions (56.4±14.8).
Conclusions: According to scale of staff attitudes about patients' safety culture and its effect on service quality, doing reengineering of work environment, Patients' Safety Initiatives including personnel collaborative, communication openness about error, designing of education plan and making error reporting should be recommended.

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Background: There are various departments in hospital that produce hazardous, infectious, pathological and radioactive wastes. Utilizing proper methods of waste management is of high priority in order to prevent from releasing these wastes to environment. This study aimed to evaluate waste management efficiency in Karaj hospitals.

Material & Methods: This cross - sectional study was conducted in Karaj during 2011-2013. All hospitals of Karaj had been selected as statistical population of this study (n=8) by census. The data had been collected by separating and weighting produced hospital wastes for 4 month (during one week at each month) and filling related checklists of health ministry. Collected Data had been analyzed using SPSS software.

                               

Results: The daily capita of waste was 4.1 kg per active bed, 5.6 kg per occupied bed  and 9.4 kg per patient. The overall percentage score of present status of hospital waste management was assessed 88% and in 12% which indicate moderate and weak levels respectively. Hospital waste management had been evaluated weak in terms of collection, transportation and personnel but seen from the viewpoint in the separation and temporary storage, it was assessed moderate. However, in terms of disposal, assessment of hospital waste management showed it is in a desirable status.

Conclusion: The present status of hospital waste management was far beyond the expectations  among studies hospitals. Thus, developing an operational plan and monitoring its implementation is highly recommended to. Given the main weakness of hospital waste management was related to production, collection, separation, and transportation, taking these areas consideration  is of high priority.  

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Background: Emergency response of hospitals to deal with disasters is essential to success in providing qualified emergency services. The aim of current study was to evaluate emergency response of hospitals in Karaj against disasters.

Materials and Methods: This study was a cross sectional one which performed among 13 Karaj hospitals in 2013. To collect data, emergency response Checklist WHO (2011) was utilized with 90 questions prepared in 9 domains (Command and control, Communication,  Safety and security, Triage, Surge capacity, Continuity of essential services, Human resources, Logistics and supply management and Post-disaster recovery).  Data analysis carried out using SPSS version 20 with descriptive tests.

Results: mean score of emergency response was 44.17%. The most and the worst dimensions were hospital triage 70.30% and accident reconstruction after the emergency 24.84% respectively.

Conclusions: Based on WHO checklist, only 44.17% of studied hospitals were able to respond disaster events. Planning and providing a systematic framework to deal with disasters is a necessity, and the major role of hospitals should not be ignored in providing services considering its priority in plans and budgets in disasters conditions. 

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Background: providing human resources is one of the most important factors to achieve the organization goals. Human resources are the most valuable aspect in production and service delivery. Staff shortages and excesses can be effective in reducing quality of services.This study aimed at assessing the hospitals' human resources condition from 2001 to 2014.

Materials and Methods: This review article extracted required information from ISI, Pubmed, Scopus, Wiley, Proquest, Emerald, Magiran, SID ,Iranmedex, Google, Google scholar and other related database considering keywords Human resource, Human resource management, Staff, Workforce, Hospital ,Iran, staff nursing, medical, physician personnel with Persian equation.  Searched Articles Search Based on article objectives analyzed step to step with arrangement with study title, abstract and full text.

Results: Findings revealed that the majority of hospitals faced to lack and inappropriate distribution of human resources especially in medicine and nursing but there was no shortage in logistic, financial, paramedics and allied professional human resources.

Conclusions: Correct and appropriate human resources management, planning due to compensated inadequate human resources and raising them to a standard level can enhance the efficiency and effectiveness of hospital activities. 

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Background: Informative hospital website is a suitable system to exchange information between patients, hospital and health professionals and attracting consumers in hospitals. This study aimed at determining quality indicators of hospitals' websites.

Materials and Methods: A literature review study was performed by searching in different databases  such as ProQuest, Ovid, Science direct, Scopus, Google scholar, PMC, PubMed  and Persian Electronic Databases  like  Iranmedex ،Magiran ، SID, Iran doc)  using Quality and Hospital website keywords. Full text of articles including English and Persian were reviewed from 2001 to 2014. Selection criteria were articles' subject which were about quality websites hospital and some articles which found from other health-related Websites (85 articles). According to the requirements and selection criteria 45 article were utilized.

Results: In this review, some indicators notified such as Alexa rank, Google page rank, website type, technical content of website, information and hospital facilities, medical and admission service, online interactive services, research scientific activities, accessibility, speed of website, comprehensive plan of website, protect users' personal data, website language, user satisfaction, website map, possibility to navigating in hospital website, email of website and impartiality.

Conclusion: Today, regarding to the importance of hospital websites' quality and addressing to biotourism, it is recommended that hospital websites become so efficient, accessible, useful, credible and accessible in order to further clients satisfaction.

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Background: The subjects' demographic characteristics are factors influencing their viewpoints about healthcare quality and have a positive association with the clients’ satisfaction. This study aimed at investigating the role of demographic variables on medical tourists' viewpoints about service quality of hospitals in Shiraz.

Materials and Methods: This descriptive-analytical and cross-sectional study was conducted on 200 foreign patients who referred to Shiraz hospitals during the first six months of 2013. Data collection tool was a questionnaire consisting of two parts. In the first part, medical tourists' information was collected and in the second part, their expectations and perceptions of services quality were measured using adapted SERVQUAL scale. The validity was checked out by experts and reliability confirmed by Cronbach’s Alpha test for expectations and perceptions separately (90% and 89%).  Finally, data analyzed through SPSS v.16 software using independent t-test and ANOVA.

Result: According to the results, the mean score of the quality gap was estimated -0.26 for people over the age of 50 years, as it was lower than other groups. Also, the lowest total values of this quantity were related to the individuals with low level of literacy and those who stayed less than 7 days for treatment which were estimated -0.32 and -0.36 respectively. In addition, based on statistically significant dimensions, married tourists, people from Oman and those who had received eye surgery had lower gap mean score than the other patients as their total values were estimated -0.42, -0.21 and -0.22, respectively.

Conclusion: In order to develop the medical tourism industry, the demographic characteristics of the subjects should be considered in policy making and service design which can be result in majority satisfaction.

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Background: In year 1995, new system administration plan of hospitals (fee for service) was notified. This scheme was implemented in hospitals for 20 years. In the early September 2104, new guidelines of performance-based fee for service plan with the aim of deficiencies in the previous plan was reviewed and implemented in hospitals in Isfahan. This study aimed at investigating reform strategies to improve monitoring performance and infrastructure implementation development of the new scheme of fee guidelines in 2014.

Materials and Methods: This study was a qualitative one based of phenomenology. Depth interviews were used to collect data. Eleven individuals assessed including top and middle managers and professors of Isfahan University of Medical Sciences using content analysis method.

Results: In this study, eight main themes and ten sub-themes extracted including appropriate policy making, health management reform in health system, cultural building in monitoring, proper planning, physicians' motivation, infrastructure improvement, improving training, informatics and constructive interactions between senior managers and hospitals' directors.

Conclusion: With the aim of rationalizing the health system, new instructions and fee for service plan should be considered well to tackle weak points. It seems that coping with these weak spots in new fee for service plan, has feasibility to provide more satisfaction among physicians and staff. To achieve main goal of the project which defined as patients and staff satisfaction, using new reform strategies to facilitate plan implementation, continuing observation and stronger mentoring recommended.

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Background: Physical and verbal violence against hospital personnel is very critical problems that could influence the quality of clinical and nursing cares. Today, problem prevention and identification of related factors with domestic violence against women have been considered as a health priority in many countries. Therefore, due to the importance of this issue, this study aimed to determine related factors with domestic violence against women in educational hospitals affiliated to Isfahan University of Medical Sciences.
 
Materials and Methods: This cross-sectional study was a descriptive-analytical one which conducted on 836 female employees using census method. Data collection performed using a researcher-made questionnaire. This questionnaire consisted of 34 items in four dimensions (physical, verbal and mental, sexual) and violence experienced by the husband. Data were analyzed using SPSS version 16 with descriptive statistics and analytic statistics such as Kolmogorov–Smirnov, ANOVA, independent t test, and Pearson correlation coefficient and multivariate regression.
 
Results: Study results revealed that verbal and mental (55.33%), physical (36.16%), and sexual (6.66%) violence were the most common type of violence against women, respectively. There was a significant statistically association between age gap, forced marriage, husband’s addiction, income and precedent violence Experience and violence against women.
 
Conclusion: This study presented prevalence and related factors of demotic violence among women. Therefore, it is imperative that health authorities, especially hospital managers, pay attention to this phenomenon assessing further investigation of factors related to violence against women in order to take the necessary steps to mitigate and reduce related factors using life skills workshop, training and counseling for couples.

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Background: Job burnout is a result of long-term job stress, which can reduce the quality ofeducation and provision of services. This study aimed to investigate the relationship between jobburnout and its dimensions with occupational stress in Isfahan University of Medical Sciences in 2018.
Materials and Methods: The present study was a descriptive-analytic one. The sample of studyconsisted of 137 staff in faculties of Management and Medical Information, Advanced Technologies inMedicine, Rehabilitation and Nursing and Midwifery in Isfahan University of Medical Sciences using
convenience sampling method in 2018.The study tools were demographic s , Maslach and OSIPOWquestionnaires. Data was analyzed using SPSS version 23 software by descriptive statistics andinferential statistics such as ANOVA, T-test and Pearson correlation coefficient.
Results: Emotional exhaustion calculated in low level (45.2%), depersonalization in high level (45.2%), personal accomplishment in high level (75.3%) and the most participants had normal stress(54.8%). Similarly, based on Pearson Correlation Coefficient, there was a positive significantrelationship between job stress and job burnout and its dimensions, but there was no significantrelationship between personal accomplishment and job stress.
Conclusion: Study results revealed that the higher job stress among employees, the higher jobburnout among employees. As a result, implementing the interventions to reduce occupational stressand strengthen some resources can be helpful to reduce the burnout of employees.

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Background: Calculating the cost of services enables the existing resources to be used in the most efficient and effective way possible. Time- Driven Activity Based Costing is a method that, in addition to costing, also calculates the efficiency and unused capacity of resources. The purpose of this study was to use this method to calculate the costs of radiology and CT scans services in two hospitals.
 
Materials & Methods: The present cross-sectional and retrospective research was done in a descriptive-analytic manner in two hospitals affiliated to Isfahan University of Medical Sciences in 2018. Data were collected in designed Excel forms, and costs of services were calculated using Time- Driven Activity-Based Costing (TDABC) method.
 
 Results: The cost of most radiology services and total CT scan services in the government sector was more than that of the private sector. The unused capacity of resources in the public sector was more than private sector. The time spent for providing the services in the two hospitals was the same except for the technician's career. The average cost of radiology services was 223324 in hospital (A), and 194094 Rials in hospital (B). The average cost of the CT scan services was 600522 in hospital (A), and 485230 Rials in hospital (B).
 
Conclusion: According to the findings of the study, the need for human resources management to reduce unused capacity and increase efficiency, as well as improving service delivery processes in order to reduce the time required to provide services seems necessary. Replacing low-cost resources is another solution that is effective in reducing costs. The standards of the most efficient centers of health services are often worth the benchmarking.

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Context: The intention to quit is a step before the actual leaving the job. The complex conditions of treating covid 19 patients, nurses physical pressures and mental tensions during the covid-19 pandemic, encourage them to quit their jobs. The present study was conducted to determine the factors related to the willingness of nurses to quit during the covid-19 pandemic in the hospitals of Isfahan city.
Method: 416 nurses working in the hospitals of Isfahan participated in this cross-sectional descriptive-analytical research in the form of quota sampling and systematic random stratification. The data collection tool was a researcher-made questionnaire with high validity and reliability (0.95) that measured the intention to quit of nurses during the covid-19 pandemic in 4 dimensions of individual, occupational, organizational and transorganizational factors. SPSS version 25 software was used for data analysis.
Findings The average score of nurses' willingness to leave during the corona pandemic in Isfahan hospitals was 2.98 out of 5. The average of Transorganizational factors (3.30) was higher than the average of organizational factors (3.05) in driving the intention to leave of nurses. A relation was seen between demographic information such as; received compensation, secondary job and total income and intention to quit.
Conclusion: During the covid-19 pandemic, several factors lead to the quit in the group of nurses. Since the willingness to leave the job in public hospitals is higher than in private hospitals, managers of these organizations should pay more attention to evaluating factors, determining their impact and making effective decisions.

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Background and purpose: Accreditation is one of the most widely recognized and reliable methods for evaluating the quality of hospital services. However, its implementation is often accompanied by various challenges for hospitals. This study aimed to identify the challenges associated with accreditation in small and single-specialty hospitals from the perspective of those involved in the process.
Methods: This qualitative descriptive study was conducted with the participation of 30 individuals, including hospital staff, national accreditation evaluators, and experts from the Ministry of Health's Monitoring and Accreditation Office. Data were collected through semi-structured interviews and individual sessions. Content analysis was used to process the data, which was analyzed using Max-QDA software (version 20).
Results: The accreditation challenges of small hospitals were categorized into four main themes: "accreditation process," "human resources," "structural issues," and "financial constraints." For single-specialty hospitals, challenges were grouped into three themes: "accreditation process," "human resources," and "uniformity of accreditation standards." Common challenges for both hospital types included low staff motivation, insufficient training in accreditation procedures, and issues related to evaluators.
Conclusion: In addition to general accreditation challenges, small and single-specialty hospitals face unique obstacles due to their specific conditions and inherent differences from other hospitals. To ensure the successful implementation of accreditation programs in Iran, policymakers should thoroughly examine the identified challenges and incorporate these insights into national hospital accreditation planning and implementation strategies.

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Background and purpose: The Emergency Operations Center (EOC) is a centralized facility designed to coordinate disaster management activities across all phases of the disaster management cycle. EOCs play a vital role in facilitating efficient and effective responses by coordinating information and resources. This study aims to highlight the importance of establishing a standardized framework for EOCs in Iranian universities of medical sciences and to examine its key dimensions.
Methods: This study is a commentary article that compiles information from published literature on the framework of emergency operations centers. It focuses on two prominent global frameworks: the World Health Organization’s Public Health Emergency Operations Center Framework and the U.S. Federal Emergency Management Agency’s Emergency Operations Center Guidelines. The study emphasizes the necessity of creating a standardized framework for emergency operations centers in Iranian universities of medical sciences.
Results: EOCs across different countries vary in terms of their missions, authorities, and resources. Consequently, the frameworks used in these centers are not uniform, and are largely shaped by the governance and regulatory requirements specific to each country.
Conclusion: A standardized framework, tailored to the specific needs and conditions of Iran, is essential for EOCs at universities of medical sciences. Such a framework could enhance the operational capabilities of these centers during incidents and disasters, improving their responsiveness and effectiveness.

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Background and purpose: The complexity and extreme fluctuations in the healthcare environment, along with the occurrence of unforeseen disasters and risks, have increased the likelihood of disruptions in hospital supply chains. Strengthening supply chain resilience is a key strategy to mitigate these challenges and ensure the continued delivery of efficient and effective hospital services during crises. This study aims to conduct a structural analysis of the factors influencing the resilience of the hospital medical equipment supply chain using the Fuzzy MICMAC approach.
Methods: This mixed-method (qualitative-quantitative) study included faculty members knowledgeable in the field, heads of medical equipment departments in universities and hospitals, senior managers from medical equipment manufacturing and importing companies, and healthcare administrators. Data were collected through checklists and semi-structured interviews. Fuzzy matrix completion and MICMAC analysis were used for data processing, performed using Fuzzy MICMAC software.
Results: Among the identified factors, logistics management was found to have the highest impact on the resilience of the hospital medical equipment supply chain. In contrast, factors such as integration and coordination, cooperative relationships, competition, flexibility, human resource management, and risk/crisis management had the lowest direct impact. Environmental conditions, transparency and protection, information-sharing systems, and human resource management were identified as the least affected factors. Economic factors emerged as a highly influential indirect factor, significantly affecting supply chain resilience.
Conclusion: To enhance the resilience of hospital medical equipment supply chains, logistics management and economic factorsmust be prioritized. Additionally, agility and speed, risk/crisis management, competition, and the development of integrated and cooperative relationships play a moderately indirect role and should be considered in strategic planning.