Journal of

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Background: If a managers try for further income or productivity so they must attentive their staff incentive. One of the most issue in the management process is that managers can distinguish strength of staff but they can't determine their weakness . ACHIEVE model present seven factors ( ability, clarify, help, incentive , evaluation, validity , environment ) that effective to staff performance . and this model help manager to determine cause of performance problem. And create change strategy for solving those problem .
Material & Methods: It is descriptive , survey and inferential study , the population is university hospital managers in Esfahan university. data is gathered through achieve questionnaire that supported by member of management faculty.The reliability is supported based on α koren bakh . for analysis of data use spss soft ware .
Results: Finding show that : Average number of ability factor is (87/5+12/2) , clarify factor (82/3+14/8), help factor (82/6+15/7) , incentive factor ( 81/4+ 15/4), evaluation factor (77/2+15/6) , validity factor (82/7+ 17/3),and environment factor is (85/2+12/8). and base on Pierson test (p<0/05) all of the factor are effective on staff performance.
Conclusion: Today the important problem in health care organization is staff effectiveness . in fact , performance improvement is the most step for organization improvement.

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Background: the competitive of existing area in servicing organizations which are showing the desired services, the importance and satisfy customers and making content about their needs more than before.

Material & Methods: The present study descriptive survey of practical purpose and its method correlation study has been done. Statistical Society of  this research is all referred patients to outpatient clinics in private and governmental hospitals at Tehran province(N=260). The data collecting tools have included two questionnaires, so for measuring of services quality was used from servqual standard questionnaire and part of parasoraman, zitamel and berry(1996) standard questionnaire about customer's behavioral tendencies for measuring of loyalty.

Results: T-test was used  for comparing the average in private and governmental section at all the five dimentions and  pierson correlation coefficient was used for determining the relation between one by one the five dimentions of services quality with patient 's loyalty and also used regression  test. 36% of variance in patients' loyalty is due to components of service quality. A change of one unit in tangible factors, ensuring, and empathy results in 0.263, 0.285, and 0.116 change in patient 's loyalty, respectively. Regression model cannot make any prediction for other components because the significance levels of components are greater than 0.05.

Conclusion: whereas in this research there is meaningful relation between services quality and patient's loyaltyit seems that in such organizations the strategic application which cause the improving of qualitywill redound the increasing of patient'sloyalty and finally it will cause more profitability for hospitals.

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Background: Organizational Citizenship Behavior indicates an individual cautious behavior that although is not known by formal organizational reward system directly, can have a positive and effective role on the organizational performance and lead to functional improvement. In this study the relationship between Organizational Citizenship Behavior and its determinant factors has been surveyed.

Materials & Method: This is  a cross- sectional study that was done on an accidental sample of 130 staff working in Shiraz University of  Medical Sciences (SUMS). The required data was gathered by using a questionnaire and descriptive statistics and person regression test were applied in significant level of 0.05.

 Results: Results showed that there were statistically positive significant differences   between OCB and organizational culture, personality and internal control focus (p<0.001) in contrast with the reversed and significant differences between OCB and job stress (p<0.001).In addition there were statistically positive significant differences   between various dimensions of OCB with each other (p<0.001). furthermore , between courtesy  and organizational culture, control focus and personality, citizenship behavior and organizational culture, sacrifice with culture and personality and between conscience and culture, the statistically positive significant differences   were observed in spite of the statistically negative significant differences between courtesy, citizenship behavior,  conscience with job stress and also between  conscience and personality(p<0.05).

Conclusion: reducing job stress , existing organizational justice and the group oriented organizational culture and also staff` characteristics the same as personality , control focus, etc can have an effective role on the incidence rate of Organizational Citizenship Behavior shown by staff in Shiraz University of  Medical Sciences . So attention to each of these dimensions and key factors and attempts for amplifying and supporting them by managers can develop these behaviors and lead to functional improvement in the organizations.

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Background: Medical tourism is an increasing industry that patients travel to abroad for receiving health care services. The countries which are successful in this industry have global accrediting quality. This research is aimed to access capabilities of selected hospitals in Iran University of Medical Sciences in attracting medical tourists according to JCI patient-oriented standards. 

Materials & Methods: This research is a descriptive, cross-sectional study that carried out in Hasheminejad, Rajaie and Motahhari hospitals. To collect data patient-oriented checklist of JCI standard used. Data analyzed by using descriptive statistic techniques.

Results: The results showed the high rates of consideration is related to medication  manage­­ment and standards used (84/5%), and anesthesia and surgical care standards (80%) that both of them are related to Hashemi­­nejad hospital and also patient and family rights standards (47/5%) are low rates of considerations that are related to Motahhari hospital. Generally, the mean rates of consideration in Hasheminejad (71/8%) are more than Rajaie hospital (67%) and these hospitals are more than Motahhari hospital (62/3%).

Conclusion: Generally, the selected hospitals had rather readiness and possible and appropriate capabilities in attracting medical tourists. Some standards (access to care and continuity of care, patient and family education, assessment of patients, anesthesia and surgical care) were appropriate and some of them were insufficient (patient and family rights, care of patients and patient and family education). According to identify strengths and weaknesses of the hospitals in medical tourism, they could use SWOT analytical model to increase their capabilities.

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Background: Hospital is the most expensive part of a health system. Manpower is the mainly valuable factor in productivity and service delivery. Since personnel costs make up more than 60% of hospital costs, increasing productivity and efficiency of human resources are significant. The most important ways to increase utilization of this valuable resource is to standardize the quantity and composition of the human distribution. This study determined the standardizing of nurses resources in a sample hospital.

Materials & Methods: The descriptive and cross-sectional study applied in 2008. Data of study collected by questionnaires and library studies by using descriptive statistics were analyzed. Sample of study is the private general hospital with 85 active beds, including gynecology, surgery, men and children, women, surgery, neonatal intensive care wards. Data collection tools were tables containing the number and composition of nurses and hospital performance indicators. After gathering data, it compared with the standards and recommendations were conducted. Using standard of job hours of nursing care required for each group of patients and protocols of Ministry of Health and Medical Education.

Findings: The numbers of nursing staff in the hospital were 96 people, including 38 nurses, 16 assistance nurses and 42 aid nurses. The optimum numbers based on average annual bed occupancy in different sectors were: 94 nurses, including 60 nurses, 34 assistance nurses and aid nurses.

Conclusion: A sample hospital uses healthcare workers as an aid nurses to assist in a wide range of patients' care. With regard to development of medical sciences and become more specialized nursing care industry and major changes in techniques and equipments, to move on from traditional invasive surgical procedures to non-invasive medical practices and the incidence of further complex cases, it will be effected to replace them with educated nurses to care of patients.

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Background: Medical tariff is one of the most important tools for health policy making in a country that influences equity, efficiency, quality and accountability of service deliveries. If relative values for different services are not determined correctly, it may have negative consequences on availability and sustainability of care. This study was designed to assess the challenges and respective solutions of the tariff system in Iranian health sectors. Materials & methods: This is a qualitative study, involving nine face to face interviews with health managers, policy makers and researchers at the Ministry of Health and Medical Education and relevant organizations, as well as public and private institutions and service providers who had experiences in medical tariff. We used the thematic framework method for analyzing qualitative data. Results: The problems and respective solutions were classified into stewardship power, policy making and surveillance for tariff setting, structural organization of medical tariff system, methods and principles of setting the tariffs, medical costs recording systems and other concepts related to the medical tariff system in the health sector. Conclusion: To improve medical tariffs system in the country, one need to have a deep understanding of the current challenges and potential solutions in different levels. It is advisable to follow a clear model based on focus on policy-making and stewardship of medical tariffs system as an important cornerstone of any effort to rectify the current situation.

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Background: One of the main goals in each organization is to achieve success. The only way to achieve this goal is resort a kind of systematic, native and functional views. Remarkable successes in the recent decades by organizations with the minimum facilities and failure of the organizations by the best material capabilities is on the other hand, demonstrates the significant role in non-material and spiritual factors in reach to success. The organizational culture is considered as an effective factor in organizational performance. The present study has been done to find relationships between these two categories organizational culture and organizational success in the public hospitals of the Kerman cities (Kerman, Sirjan, Rafsanjan). Materials and Methods: This was a descriptive analytical cross-sectional study during the last six months in 2009.The sample size composed the public hospitals in three selected cities of the Kerman province. To define organizational culture, Richard Deft Model was used, and also to identify the organizational success orator elements were used. Simple random sampling used to choose samples and the Cochrane Formula used to define sample size. The gathered data were analyzed by descriptive (frequencies tables and diagrams) and analytical (correlation tests: Pearson, Spearman, XSquare, t-tests, ANOVA test) statistics methods through SPSS software. Results: The results showed that among all kinds of existed organizational culture, bureaucratic culture was the dominant culture with average score 3/162 and the others were: participatory:2/722, flexibility:2/525 and missionary:2/405 respectively. Comparing average score of organizational success elements showed that flexibility element with average score 2/96 was the most important element and the others were: cohesiveness: 2/885, speed:2/88 and innovation:2/725 respectively. The dominant organizational culture of subordinate hospitals in the Ministry of Health and Medical Education are bureaucratic culture. The dominant culture in subordinate hospitals of the Social Security Organization is a participatory culture. Also the average number of organization success in subordinate hospitals of the Social Security Organization is significantly greater than the average number of organization success in subordinate hospitals of the Ministry of Health and Medical Education. In relationship between the organizational culture and organization success, the participatory culture only had a positive correlation with organization success and in the other cultures, either an assumption of lack of relationship confirmed or a negative correlation was concluded. Conclusion: Hospitals are the main organizations in providing services in the health care system in each country. Implementing participatory culture, increasing hospital flexibility in an accountability to customers and patients needs play basic roles in patient’s satisfaction to achieve the main mission of the hospital organization that is providing services

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Background: Developing countries request to alternative revenue resources. Iran as one of the developing countries with high potentiality for attracting medical tourist is seeking to enter medical tourism marketing .This study aimed to analyze the importance- performance of the Tehran as a capital city to medical tourism viewed by medical tourists and medical service providers. Materials and methods: This descriptive, cross-sectional study was carried out in Tehran selected hospitals in the 3th first months of 2011. The data were gathered by using a validated self-constructed questionnaire. The data were analyzed by descriptive statistical techniques. Results: The results indicate that the majority of the medical tourists are attracted from the United Arab Emirates (22.3%). The respondents considered medical tourism factors as an importance (M=4/40±0/61).The Tehran selected hospitals` performance is average as related to medical tourism factors (M=2/75±0/66). Conclusion: Despite the importance given to medical tourism factors by medical tourists and medical services providers, Tehran selected hospitals` performance is an average and there is no serious attempts are being made to attract medical tourists at macro levels. In spite the quality, variety and costs of the medical services and equipments in the selected hospitals are satisfactory, international accreditation of the hospitals are still in a major problems

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Background: The inefficiency of financing health care in developing countries made led in manyhealth policy-makers to consider alternate means of service provisions. Outsourcing public financed health services in private sector organization is one of the interventions. Advocates claim that the contracting out of health care services will improve the service delivery performances throughstimulating competition among providers and also by creating economic incentives to improve performance through linking payment to provider performance. Materials and methods: The purpose of this cross sectional study was to provide decision matrix to guide decision-makers whether outsource hospital services or not. Tow kind of questionnaire were developed and used. Results: Findings showed that the most propensities of outsource is in nutrition services (87%), and the least is in nursing services (43.4%) based on administrators’ attitude. Shaping of decision matrixshowed propensity to outsourcing of nursing, radiology, laboratory services are high while nutrition services is been low.some differences between results of decision matrix and administrators’ propensity to outsourcing in radiology and laboratory services. Lack of attention in characteristics of the hospital services might be one of the reasons. Cost saving is the main reason for outsourcing the services while administrators should consider as an effect and side effect ofoutsourcings

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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: Patient safety is one of the most important components of health care quality. Given that assessing the current culture of patient safety is the first step in improving patient safety, we decided to translate and validate one of the most used patient safety culture assessment tool (HSOPS questionnaire) for the first time in Iran, and in this way take a step toward improving patient safety in our hospitals.
Materials & Methods: This cross sectional study was done among four general hospitals of Tehran University of Medical Sciences (TUMS), which were selected purposefully. Questionnaires randomly distributed among 420 members of the study population, and were collected after completion. Results were analyzed using Confirmatory Factor Analysis (CFA), internal Consistency and correlation.
Results: The value of Fitness function (FF) was 14.25 and according to that, the value of Goodness of Fit Index (GFI) was 0.96. Almost in all of the dimensions, the internal consistency of items in the translated Persian questionnaire was lower than the original one and ranged between 0.57 to 0.8.
Conclusion: Regarding to the findings of this study the Persian translation of the HSOPS questionnaire is a valid tool for the assessment of patient safety culture in Iran's hospitals.

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Background: Patients' safety is a critical component of health care quality. As health care organizations continually strive to improve, there is important growing recognize of establishing a culture of patients' safety. To establish a safety culture in a healthcare organization, the first step is measuring the current culture. The aim of the study was to measure physicians, nurses and Para clinical personnel perceptions in patient safety culture in Tehran's selected hospitals, and to compare findings with U.S. hospitals.
Materials & Methods: Physicians, nurses, and Para clinical personnel who worked in training hospitals affiliated with Tehran university of medical sciences were asked to complete a self-administrated patients' safety culture survey (n = 145). Data collection was carried by using the Persian version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Cronbach's alpha and chi-square tests were employed in statistical analyses.
Results: Among the dimensions of patients' safety culture with the highest percentage of positive responses the teamwork within units (67%) was higher, whereas that with the lowest percentage of positive responses was non-punitive response to error (51%). Except to Handoffs and transitions dimension the entire dimension scores were lower than the benchmark scores. The study revealed that more than half of the participants were not reported the errors.
Conclusion: Improving patients' safety culture should be a priority among hospital administrators. Meanwhile, Healthcare staff should be encouraged to report errors without fear of punishment action.

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Background: Regarding to the escalating costs of health care and limited resources in this field, the appropriate identification and control of costs is inevitable. This Study aimed to determine the unit cost of radiology services, in selected hospitals of TUMS.
Materials & Methods: This was a descriptive retrospective study. At first, we selected two hospitals (Shariati and Sina) out of general - teaching hospitals of TUMS randomly. After gathering data, using activity based costing method, the unit costs of radiography services in these centers in 1389 fiscal year (2010-2011) were calculated.
Results: The unit costs of radiography services in Shariati and Sina hospitals were 251255,5 and 334996,2 respectively. Building rent and human resources costs included the most share of total costs.
Conclusion: The unit cost of radiography services in this study is very different comparing with other studies. Calculated building rent costs in this study could be one of the possible reasons of this difference (other studies did not consider this costs). The other point is that, regarding the high share of human resources and building costs from total costs, special attention to these sources of costs and appropriate and adequate use of them, can be an important step toward improving the efficiency and cost savings in our national health system.

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Background: The different effective factors on out of pocket payment (OOP)have been introduced as follows: low salary of the employee's, low governmental tariff, chronic disease, gifts to personnel, physician and other cadre's requests, fear of bad or no services. In addition OOP has negative effects on the accessibility of services .This article studies the distribution of effective factors on OOP (formal and informal) through cardiac patients and its side effects.
Materials & Methods: This is a descriptive-exploratory study. The data were collected byinterviews and questionnaires reliability of which was approved by specialists and their validity were approved by simulation-in Shahid Madani hospital in Tabriz in the winter of 2010.
Results: all the persons studied had an experience of OOP. Formal payments included the free cost of the services with no insurance cover and the margin between the tariff and the rate that the physician or the hospital declares (83% of OOP). In addition 10% of persons encountered informal payments 80% of which was due to the physician's request and 20%as a gift. The results describes the OOP`s side effects so that 52% of patients faced a postpone in getting services because of the OOP and 72% pointed that OOP has had an enormous effect on providing the necessary needs of the families.
Conclusion: The high rate of OOP and the weak performance of insurance system will result in injustice and intensifies the unfavorable effects of OOP on the health system and society.

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Background: The purpose of this study is to survey the Working Life Quality of specialists working in affiliated hospitals of Tehran University of Medical Sciences.

Materials & Methods: The statistical population of this study includes 400 specialists and a crosssectional Descriptive & analytical method has been used to gain credible results.. Van lar working life quality questionnaire was used to gather the data needed.. The data were analyzed with the SPSS software through T-test and Anova statistical tests. In addition, the simultaneous effect of independent variables in the model was evaluated using the Backward Regression Model.

Results: The average total working life quality of specialists working in affiliated hospitals of Tehran university of medical sciences is estimated to be 48.75 percent. Total working life quality of male specialists is higher than the females and the index is higher in specialists resident in Tehran compared to the other ones but these differences are not significant statistically.. Working life quality of specialists which are satisfied with the facilities in their working places are higher compared to the others and these differences are significant statistically. In addition working life quality has decreased with the increase in the experience.

Conclusion: Working life quality of the Specialists studied is not in a satisfying level, thus more attention and effective plans are needed from responsible authorities in the ministry of health and the managers of the hospitals studied in order to improve specialist`s working life quality.