Journal of

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Introduction: Since incorrect selection of  a manager might lead to incorrect choices of other members, organizations need to consider this important issue  and use well-sought mechanisms for managers’ selection process. Accordingly, this study aims to rank the key factors associated with the selection of operational managers in Tehran University of Medical Sciences.
 
Materials and Methods: This research employed a logical and systematic trend to develop and rank the indicators using fuzzy TOPSIS method. In order for prioritization of key indicators of qualification of operational-level;  after reviewing the literature and using experts’ viewpoints , the dimensions of performance have been selected and using, the SMART technique the key criteria were weighted. A validated and reliable questionnaire was used for data collection.
 
Results: Fifty individuals participated in this study. 37 (74%) and 13 (26%) were male and female respectively. The mean and standard deviation of age of participants were 41.68 and 7.06 years. Literature reviews and related studies indicated 48 indices  for choosing qualified managers. Among these, according to the  expert’s opinion in management science and managers, 36 indices were selected as key indicators. Based on the FTOPSIS analysis, indicators of higher education in the field of management, compliance time, power of expression, adornment and belief in law and order achieved coefficients as 0.205, 0.204, 0.203, 0.202 and 0.197, rank first to fifth.
 
Conclusion: According to the results management related education and expertise in technical aspects of organizational management control  were at the top of ranking . Results of this study can help  medical universities and health service organizations to develop guidelines for selecting their managers.

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Background: Today, in order to reduce costs along with the realization of superior qualities, assignment of all or part of the responsibility for performing a specific organizational task outside the organization is a great importance. Therefore, this study aimed to assess the role of corporate culture on the quality of working relationships in outsourcing activities at Tehran University of Medical Sciences.
 
Materials and Methods: This research was a correlational study. The study population consisted of all the staff of the outsourced units of Tehran University of Medical Sciences. Staff who were in contact with outsourced units included 600 individuals. To collect data, a questionnaire based on Zoghbi et al study (2014) was utilized. Two hundred fourteen analyzable questionnaires were collected using multistage cluster sampling method.
 
Results: Structural simulation results with LISREL software revealed that corporate culture had a positive impact on the quality of working relationships during outsourcing of activities. Hierarchical culture was associated with adverse impacts on disruptions in customer service and orientation. Ethnic culture had a positive effect on both components. The market culture had a positive impact on obstruction and had a negative effect on customer oriented. Temporary culture had no significant impact on both of components.
 
Conclusion: given that the quality of working relationships between staffs of outsourced units and organizational staffs is of utmost significance for organizational productivity; the interest of managers affiliated to Tehran University of Medical Sciences regarding corporate culture, and also, strengthening hierarchical and ethnical culture is noteworthy to improve customer orientation and reducing disruptions in customer services.
 

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Background: Hospital accreditation is assumed as an effective control mechanism for health systems to improve quality and efficiency. Current study thus, seeks to look into the relationship between hospitals’ accreditation and efficiency
Materials and Methods: In order to measure efficiency, hospital inputs and outputs included the ratio of physician and nurse to bed, mortality and nosocomial infection rate and quality of inpatientservices were used. A sample of 554 hospitalized patients selected using stratified random sampling
method. Data gathering instruments were researcher-developed questionnaire and checklists. DEAP and SPSS software deployed to assess correlation between accreditation rank and technical efficiency
Results: Average hospitals’ technical efficiency score was 0.94 indicating an improvement capacityof %5.1 for hospitals efficiency. The mean quality score was 4.13 out of 5( in the range of 3.9-4.3)There was no correlation between hospitals accreditation rank and their technical efficiency
Conclusion: According to the results, it seems efficiency should be also considered in accreditationmetrics. In addition, for measuring efficiency, performance based inputs and specifically outputs tohave reliable results should be chosen

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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.

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Background: Accreditation is one of the health sector evaluation methods that used to promote healthcare quality. The study aimed to identifiy the strength and weakness of accreditation surveyors and the impact of their performances.
Materials and Methods: This study is a qualitative research which conducted between hospital accreditation stakeholders in 2016- 2017. Data were gathered using semi-structured interviews and analyzed by a thematic analysis method.
Results: The findings of in strengthen were categorized in 7 themes. The main strengthen was acceptance of accreditation by surveyors, educational approach, reputation, personal effort to develop knowledge and skills, and existence of senior surveyors. Our results for weakness were classified in 8 themes. The main weaknesses were lack of sufficient knowledge, experience, skills and weakness in personal characteristics. Based on the findings, the accreditation surveyors’ performance was evaluated as under-moderate in past two periods of hospital accreditation. The interviewees announced that weakness of surveyors’ performances was one of the main effective factors of low stability of accreditation results.
Conclusion: Recruitment of surveyors based on main competence, education and empowerment of surveyors, and assessing the surveyors can lead to more validity of accreditation results and finally lead to increasing the commitment of hospitals to quality.
 

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Background: Administrative violations are a person-centered behavior that violates the accepted organizational norms, and thus, can threaten the organization health. Therefore, the present study aimed to identify the causes of prolonging the time of taken to deal with administrative violations were at the staff of Ministry of Health and Medical Education.
 
Materials and Methods: This study was a qualitative content analysis one. For sampling, convenience, purposeful and snowball sampling methods were used. The sample size continued to saturate the interview data with each group of people. Data collection was performed with open questions and interviews using semi-structured interviews. Finally, all interviews were analyzed using MAXQDA software.
 
Results: After implementing and data analysis, the causes for prolonging the time spent on administrative violations in primary and recruiting boards were divided into five main categories including "member characteristics"; "actual proceedings"; "Inevitable factors"; " legal factors "and" organizational factors".
 
Conclusion: According to the findings and experts’ opinions, the most problems in the process of handling administrative violations are related to the time lag in the notification process, investigation and expertise. Membership training, teamwork, and the use of members with different expertise can prevent employees from handling administrative offenses.
 

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Background:  Development of the tourism sector and health tourism specifically can improve the Non-Oil GDP. In this regard, in accordance with the policies of the Ministry of Health and Medical Education, international patient department establishment has been facilitatated health tourism development in the affiliated hospitals. This study aimed to evaluate the performance of international patient department  and its effect on the attraction of medical tourists among hospitals affiliated to Medical Sciences Universities in Tehran City.
Matrials and Methods: This analytical cross-sectional study was designed and conducted in 2017. Study population consisted of all hospitals affilliated to  Tehran University of Medical Sciences (TUMS), Iran University of Medical Sciences (IUMS) and Shahid Beheshti University of Medical Sciences (SBMU). In this study,  hospital entrance criteria was certified by the Health Tourism Department of MOHME. Data was collected using the health tourism assessment checklist which approved by the MOHME. SPSS version 24 utilized to data analysis using descriptive and Inferential statistics.
Results: The study results revealed that  the overall performance of international patient department was evaluated at a desirable level (87.5 score) in hospitals of Tehran city.  Hospitals had the highest rank of hoteling indices (95/100), in compliance with the regulations and functional indicators gained 87.03 and 82.2 score, respectively.  Also, data analysis highlighted that there was no significant difference between hospitals of TUMS, IUMS and SBMU. The establishment of international patient department had no effect on health tourists attraction.
Conclusion: Considering the purpose and mission of international patient department to facilitate the provision of quality and satisfactory services in health tourists, management and oversight mechanisms for the standards implementation such as patient admission, follow up in the origin country and development of hospital marketing policies in order to attract international patients and increase hospital incomes are recommended.

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Background: Femoral fracture surgery is one of the most common and expensive surgical procedures and forearm fracture surgery is common performed by Ilam Imam Khomeini Therapeutic Center. This study conducted to analyze the difference in actual cost and global surgery tariffs in this hospital.Also, the related factors acutal cost of mentioned surgery were identified.
 
Materials and Methods: This cross-sectional and descriptive study was conducted on factors related to the actual costs of femoral and forearm fractures. The Activity-Based Costing approach identifies the related cost  associated with these surgeries in through six steps. Data analysis was performed using Excel 2016 software.
 
Results: The  avarage actual cost of the femur fracturs , the code 2 forearm and  the code 1 forearm were 953 thousand and 700 tomans, 444 thousand and 400 tomans and 337 thousand and 800 tomans , respectively. The actual cost of surgery for femoral fracture per unit surgery was 406,000 and 400 tomans lower than the Ministry of Health's tariff. But ,the real cost of the code 2 forearm was 33 thousand tomans higher, as well as the code 1 forearm 20 thousand tomans higher than the global tariff.
 
Conclusion: Overall,  there are significant differences between hospital costs and the Ministry of Health's global tariff. That can be corrected by improving the hospital's performance, as well as carefully examining the cost of global surgical procedures for amending the system of tariff regulation and make the actual amount closer to the tariff level.
 

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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. 
 

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Background: Physicians' full time attendance is related to increment of many hospitals performance. Regarding the present challenges, this study aimed to analyze this plan using SWOT technique and present TOWS model in Tehran University of Medical Sciences (TUMS).
 
Materials and Methods: This study was a descriptive-analytical and cross-sectional one conducted during 2016-2017. Based on Cochran formula, 234 full time attending physicians randomly selected using simple randomization method. The research tool was a researcher made SWOT questionnaire which confirmed its content validity and reliability. Collected data was analyzed by SPSS software using SWOT technique and suggested TOWS strategic model.
 
Results: The most valuable weaknesses of mentioned plan were inappropriate coordination of physicians; lack of compensatory system, and the most important strengths were employment of young physicians and better education for medical students. The most important opportunities and threads of mentioned plan were establishment of competitive work between public and private hospitals and burnout and dispensing of experienced physicians moving to private sector, respectively.
 
Conclusion: Based on study findings, TOWS model strategies can be suggested for improvement of the plan.
 

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Background: Visual disorders in old age is one of the most important factors in decreasing quality of life of older people. This study aimed to access the vision-related quality of life of older people in Tehran and to examine some of the underlying factors.
Materials and Methods: This was a population-based cross-sectional study among 566 older people aged 60 years and over, living in Tehran. A multistage cluster randomized sampling method was used to select study population, data was gathered using interviewing them at their home. NEI-25 VFQ (Visual-Functioning Questionnaire) was used to measure the vision-related quality of life of the participants. Multi-level linear regression analysis was used to data analysis.

Results: The average score of the vision-related quality of life was 80 out of 100. Among 12 dimensions of Visual-Functioning Questionnaire, the dimensions of color vision (CV), vision specificsocial functioning (VSSF) and peripheral vision with the scores of 96.8, 96.7 and 95 gained the highest and the dimensions of driving and vision specific dependency (VSD) with the scores of 42.6 and 50.3 had the lowest scores, respectively. Significant associations were observed between being a women, older, and having a lower education with poorer vision-related quality of life. 

Conclusion: This study results provides an evidence for policymakers in prioritizing visual health services based on more impaired visual function and also at risk older people.
 

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Background: Due to the presence of valuable and expensive equipments in hospitals’ warehouses, scientific management and continuous evaluation plays an important role to improve the performance of warehouses and whereby the performance of hospitals’ wards. This study aimed to evaluate the performance of the central stores of hospitals affiliated to Tehran University of Medical Sciences (TUMS).
Materials and Methods: In order to conduct this cross-sectional study, a checklist was designed and validated to examine the warehouses’ status considering structural, process and outcome dimensions of 39 depots in 14 hospitals. The status of hospitals’ warehouses were assessed using descriptive analysis and in order to assess association between performance evaluation score and charchetristics of warehouses and its staff Pearson Correlation Coefficient was utilized.
Results: Although, warehouses’ performance of studied hospitals in general was satisfactory, there were some items in unsuitable condition particularly in structural and process dimensions which should be addressed quickly. Also, performance of warehouses revealed a positive and significant correlation with number of beds, area and size of warehouse and number of staff (p <0.05).
Conclusion: Given that fair warehouses status, some items particularly in structural and process dimensions were in inappropriate condition which needed rapid consideration. Furthermore, hospitals with more beds have more and bigger warehouses achieved better evaluation score, but some of warehouses without these condition should be addressed in priority.
 

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Background: Iranian health system transformation plan has been implemented since 2014 with the aim of financial protection of people, equity establishment in access to health services and quality improvement of hospital services. Hospital performance evaluation is essential in order to monitor the health system transformation plan. One of the tools for evaluating hospital performance is the dynamic multi-attribute decision-making method. The purpose of this study was to use the dynamic multi-attribute decision-making method to evaluate the performance of the hospital before and after the implementation of the health system transformation plan.
Materials and Methods: In this cross-sectional study, the performance of Shariati Hospital in Tehran was evaluated for 48 consecutive months (24 months before and 24 months after the Health System Transformation plan, 2012-2016). Each month was addressed as an option in the decision-making matrix and ,with considering six important health indicators, the hospital performance was dynamically assessed  using the weighted aggregated sum product assessment and through EXCEL software 2010. 
Results: Hospital performance scores had some fluctuations over time; however, in general, it had an increasing trend over forty-eight months. The highest and lowest values were for months 42 and 13 (0.4932 and 0.9408, respectively). In addition, in the first month of the solar year, the hospital performance score declined significantly for each year.
Conclusion: Changes in hospital performance scores during the study period show improvement in hospital performance. Nevertheless, this incremental process cannot be considered as a positive outcome of the health system transformation plan. Therefore, while improving the current process, continuing the hospital performance evaluation can lead to the hospital's performance promotion.
 

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Background: The present research aimed to assess the readiness of selected hospitals of Tehran University of Medical Sciences to implement quality improvement programs and clinical audits from the viewpoint of managers.
Materials and Methods: A descriptive-analytic study was conducted in May 2017 in four selected hospitals of Tehran University of Medical Sciences. The study population of this study was 20 managers of selected hospitals who were selected by census sampling method and entered the study. The data gathering tool was a two-part questionnaire whose validity and reliability were confirmed. In this study, we used SPSS software version 23 and statistical tests to analyze the data.
Results: The effectiveness and readiness of hospitals to implement a clinical audit program was equal to 60% in the field of data and information, cardiology and feedback; 55% in resources, design and implementation, clinical audit management, and evidence and standards; 50% in illness and education; and 45% in manpower. Also, with increasing frequency of clinical audits, hospital readiness for quality improvement processes increases.
Conclusion: Due to the effectiveness and low readiness of hospitals in implementing a clinical audit program, especially in the field of human resources (45%), it is necessary that managers and planners of clinical audit programs in hospitals have a precise knowledge of these factors in order to control the organizational environment and help improve the effectiveness of audit programs.
 

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Background: Human resources form the basis of health care systems and nurses are a large part of this community; therefore, paying attention to factors affecting the performance of nurses is necessary. The aim of this study was to investigate the relationship between mental health dimensions with organizational commitment and work ethics among nurses working in general hospitals affiliated to Tehran University of Medical Sciences. The mental health status among nurses was also investigated.
Materials and Methods: This is a descriptive-correlation study and the study population included nurses from general hospitals affiliated to Tehran University of Medical Sciences. 242 nurses were selected from Vali-Asr, Imam-Khomeini, Baharlu, Sina, and Amir-Alam hospitals using stratified sampling and responded to self-monitoring questionnaires including GHQ-28, Allen & Meyer's organizational commitment (OCQ), and work ethics (Petty, 1995). Data were analyzed using SPSS-23 software as well as Pearson correlation coefficient, ANOVA, one sample t-test, and independent t-test.
Results: Dimensions of social impairment(r=-0/19, p<0/01) and depression(r=-0/33, p<0/01) correlated with work ethics. Dimension of hypochondriasis correlated with nurses organizational commitment (r=-0/15, p<0/05). The mean of dimensions of hypochondriasis (7.45±0.28), anxiety and insomnia (6.97±0.27) and social impairment (6.33±0.19) among female nurses was higher than the average.
Conclusion: The dimensions of mental health of nurses are related to their organizational commitment and work ethics. Also, the mental health status among nurses is undesirable. Therefore, it is essential to address the issues of nurses at high levels, such as the Ministry of Health and the Nursing Organization, and low levels such as hospitals nursing management.
 

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Background: Strategic planning is an appropriate strategy for improving hospitals’ performance and increasing managers’ responsiveness and accountability. Iranian hospitals were requested to have mandatory strategic plans due to the accreditation requrements since 2012. As a result, they faced several challenges in formulating and implementing strategic plans. Hence, this study aimed to identify the perquisites of hospital strategic planning.
Materials and Methods: This qualitative study was conducted using semi-structured interviews with 47 managers of teaching, private, military, social security and charity hospitals in 2016. Hospitals were selected purposefully from Tehran province hospitals. Content thematic analysis was used for data analysis using inductive approach.  
Results: Justifying the need for strategic planning, using an appropriate strategic planning model, training hospital managers and employees on strategic planning process, providing necessary resources, promoting a collaborative and innovative culture, providing incentives for formulating and implementing strategic plans and managers’ and employees’ commitment and involvement are the main prerequisites of strategic planning in hospitals.
Conclusion: Hospitals managers must commit the strategic planning prerequisites prior to formulating and implementing strategic plans. Otherwise, they will encounter several serious challenges.
 

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Background & Aim: The purpose of this study was to investigate the current organizational culture in Tehran University of Medical Sciences, which is to be considered in order to strengthen organizational culture.
 
Material & Method: The present study is a descriptive cross-sectional study and an applied research-based survey that was conducted in Tehran University of Medical Sciences in 2019. The sample size was calculated and analyzed using Cochran's formula for 306 people. In this study, Denison's Organizational Culture Questionnaire was used to collect data. Data were analyzed using SPSS software, descriptive statistical methods, one-sample mean and Pearson Correlation Tests.
 
Results: The average of organizational culture in Tehran University of Medical Sciences, in each component, culture of Involvement (2.29), culture of consistency (2.63), culture of adaptability (2.66) and culture of mission (2.58), Which represented a higher-than-average culture in all aspects of Denison's view.
 
Conclusion: The organization should do some corrective actions with respect to the components of adaptability (subculture of organizational learning) and Involvement (Capability Development), which has earned a lower score.
 

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Background: Nosocomial Infections (Nis) Are Regarded As The Most Common Complications Of Health Cares. These Infections Affect Patient’s Safety in Developing and Developed Countries. The Aim Of This Study Was To Epidemiology and Determine the Causes of Nosocomial Infectioin Teaching Hospital of Tehran In A Teaching Hospital In Tehran.
Materials and Methods: This Cross-Sectional, Descriptive And Analytical Study Was Designed In 2019 At A Teaching Hospital Affiliated With Iran University Of Medical Sciences. The Nosocomial Infection Registry Data between 2017 and 2018 Was Used. The SPSS24.0 Software Package Was Used To Analyze Data Into Descriptive (Frequency, Percentage, Mean and Standard Deviation( And Analytical) ANOVA) Statistics.
Result: The Most Frequent Type of Infections Were Urinary Tract (39.76%), Ventilator Associated Events (20.92%), Bloodstream (20.71%), Respectively. Skin and Soft Tissue Infections (0.7%) Had The Lowest Prevalence. The Highest Incidence Of Nosocomial Infection Was In The ICU With 200 Patients And The Lowest Incidence Was In The ENT With 23.1 Patients And The Overall Incidence Of Nosocomial Infections Was 84.9 Patients Per 10,000 Patient-Days.

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

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Background & Aims of study: Hospital care and paramedical services has become one of the most important and problematic issues in the field of health and critical concern of health planners and policymakers. In current study, contribution of various paramedical services costs were extracted from the total household health expenditure.
Materials and Methods: The current study is a descriptive study that was conducted in a 5-year study period from 2011 to 2015. The annual income-based survey data of the household provided by Statistics Center during 2011-2015 was used to achieve the study aims. Excel_2013 software was used. Contribution of household and paramedical services cost were calculated from household health expenditures per year in urban and rural areas.
Results: Regarding the results of the current study, on average, 20 % of total household health expenditure is allocated to paramedical services in urban and rural areas. The cost of radiology, sonography, radiotherapy, scan, echo cardiac stress test, endoscopy, electrocardiogram (ECG) etc, accounts for the largest contribution of hospital and non-hospital paramedical services costs, which include an averagely about 50 %t of paramedical services costs.
Conclusion: Understanding paramedical services costs can guide policymakers and decision-makers in the field of paramedical services to decide better. Moreover it helps them to reduce direct payments from the pocket of household health expenditures. Therefore, considering the laboratory sector and radiology, sonography, radiotherapy sectors and so on are very important to reduce paramedical services costs.