Journal of

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. 

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. 

Background: Providing high quality, safe and effective health care services requires competent and motivated employees. Employee’s creativity plays a significant role in motivation and health care system productivity. Various individual and organizational factors influence employees’ creativity. This study aimed to examine the relationship between managers’ leadership style and employees’ creativity in Qazvin hospitals.

Materials and Methods: Creativity and leadership questionnaires were used to conduct this descriptive and cross-sectional study. The questionnaires were distributed among 800 employees in ten hospitals using stratified sampling method. Descriptive and analytical methods utilized for data analysis using SPSS software.

Results: The mean score of hospital employees’ creativity was 47.5 out of 60 (moderate level). The prevalent leadership style of managers was transformational. There was a significant statistical association between employees’ creativity and managers’ transformational leadership style.

• Since, leadership styles of hospital managers influence employees’ creativity, they have to apply appropriate leadership style to motivate employees and develop their creativity in order to improve hospital productivity.

Background: Nowadays, it is essential to employ medical and clinical librarians to provide the required information for healthcare professionals and enhance accessibility to evidence based information in hospital libraries. Thus, this study aimed at assessing the medical librarians' employment status in hospital libraries in Tehran city in 2013.

Materials and Methods: This was a descriptive and cross-sectional study. Study population considered from all 152 hospitals in Tehran city. Data collected using a questionnaire and analyzed by SPSS version 18 using descriptive statistics.

Results: only thirteen participants had medical librarianship and information science degree. While 28 persons graduated in librarianship and information science from universities affiliated to Ministry of Science, Research and Technology and others had degree in non relevant fields. The majority of participants (51.3 %) with non-related degree were educated empirically and others had learned librarianship skills with other methods. Most of participants were employed based on hiring official process and friends and relatives recommendation.

Conclusions: There is a real lack of medical librarians in the hospital libraries in Tehran city. Thus, these libraries are not able to perform their professional duties such preparing information and omitting healthcare professionals' needs in hospitals. It is necessary that hospitals’ managers attempt to hire medical librarians' and overcome employment barriers.

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.

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

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

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

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

Background: Suitable budget allocation of organizational activities can deliver the resources distribution, enabling operational monitoring and providing expected access to the cost results. The aim of this study was to calculate the cost of final units in one of the Armed Forces Hospitals.

Materials and Methods: One of the Armed Forces Hospitals selected in 2013.Data gathered from all cost centers to costs calculation and evaluated based on theory of Activity-Based Costing analysis. General wards and intensive care units, operating rooms, dental, emergency and dialysis were considered as final units. Cost calculation performed using Excel software version 2007.

• Total cost of hospital was 244,416 million rails in 2013 which direct and indirect allocated costs were 52% and 48%, respectively. The CCU, surgery ward, ICU and operating rooms had the highest and clinics and dental had the lowest in case of costs. More than 50 percent of the direct costs of all the units have been spent on manpower except the operating room. After labor costs, medication costs accounted for the largest percentage of direct spending units.

Conclusion: Paying attention to human resources in terms of number and distribution of all units especially in the final units, also considering medications use particularly in middle units and consumables in overhead ones especially can be result in reduction and adjusting hospital costs.

Background: The organizational learning has been influenced in different theories and model based on theoretical and practical dimensions in organizations development and provides a favorable context for changing and development. Organizational learning capacity can play a main role in clinical governance implemention.
Materials and Methods: This study was a descriptive- analitical and cross-sectional one which performed during the first six months of 2014. Study population included staff of Ardabil Social Security hospital. One hundred and seventy participants selected using simple random sampling. A four dimensional standard questionnaire of Gumejeet et al  and a seven dimensional self administrated questionnaire were conducted to examine organizational learning capacity and clinical governance assessment, respectively. Data analysis was carried out using Pierson Correlation Coefficient and Mulivariate regression analysis. Data was analyzed by SPSS₁₈ software.

Results: Study results revealed that there was a positive and significant relation between organizational learning capacity and clinical governance implementation (R= 0.507). This correlation coefficient was 0.644 in management commitment, 0.498 in systematic approach, 0.446 in open climate and 0.261 in knowledge transfer.

Conclusion: According to the main role of organizational learning on implementing clinical governance, providing an essential background to enforce organizational learning capacity in four components especially management commitment and systematic approach to implement efficient clinical governance is recommended.

Background: Today, due to the diversity of organizational structure and culture, the diversity is one of the basic principle in crisis management.Crisis management consists of six components including flexibility, inclusion, trust, risk perception, adaptability and equity.This study aimed at investigating the managers' perception about components of crisis management in hospitals affiliated to Tehran and Iran University of Medical Sciences.

Materials and Methods: This study was a cross-sectional one. A questionnaire was used to collect data using five likert scale. Validity and reliability of questionnaire assessed by content validity and Cronbach's alpha coefficient. Sixty six questionnaire were collected. Data analysis was performed by SPSS software using ANOVA and independent t-test.

Results: The highest and the lowest level of managers' perception were inclusion and equity(3.19 ± 0.51) and adaptability(2.73 ± 0.75), respectively. There was a statistical significant difference between crisis management components with gender and job type. The highest level of importance was regarded to inclusion and mutual trust between personnel and managers, and  the lowest level was related to flexibility in hospital crisis management .

Conclusion: Employees in diverse positions have different definitions of adaptability in crisis. It is necessary to perform further research and educate hospital manager’s duties. 

Background: Concerning to the importance of team learning and process change, the clinical laboratories employees should be familiar with organizational learning. This study aimed at assessing and determining organizational learning capability among clinical laboratories employees of Tehran University of Medical Sciences hospitals.

Materials and Methods: This study was a descriptive-analytical and cross-sectional one which conducted among 85 employees of clinical laboratories using Cochran formula at five general teaching hospitals of Tehran University of Medical Sciences. The research instrument was Gomez et al. questionnaire consisted of four dimensions such management commitment, systematic approach, open climate and knowledge transfer in 17 questions. Five point Likert scale was used to rank questions. SPSS software 19 version was utilized to data analysis using t- test, Pearson Correlation Coefficient and Welch method.

Results: The average score of organizational learning among employees of studied clinical laboratories was 3.11 which showed relative desirable situation. Also, management commitment as an element of organizational learning had significant difference among the clinical laboratories (p=0.002). There was a significant relationship between employees education level with knowledge transfer and integration capability (p=0.04).

Conclusion: The process of organizational learning capability of the studied clinical laboratories was not desirable. Therefore, in order to complete establishment of organizational learning in clinical laboratories, should pay attention to some elements such establishment of patient safety system, initiation of error registration system and encouraging employees to report the errors

Background: Since, energy consumption per square meter in hospitals is much higher than other types of service institutions; in this study, some actions performed toward optimizing energy consumption improvement projects based on the definition and prioritization in hospital.

Materials and Methods: The necessity of optimizing energy consumption in hospitals were described according to some scales including the average consumption and cost of water, electricity and gas for bed days and active bed, and these indices calculated in the case. Then, improvement actions were identified using energy audit, interviews with hospital experts and conducted studies in hospitals. Next, projects with high importance were extracted regarding to impact on energy consumption indices, expert opinion, aggregation, feasibility, and limitations such as prerequisite, synchronicity and post-requisite. Finally, specific criteria were identified in three dimensions, i.e., factors affecting the level of energy consumption, trying to execute project and risk and the projects were prioritized using questionnaire and FAHP.

Results: The study results revealed that energy consumption was higher than the world standards in the studied hospital; this confirmed the necessity of optimizing energy consumption and using energy management systems. The results of prioritization also showed the first four priorities.

Conclusion: It seems necessary to save energy consumption through improvement projects implementation in the hospitals. Regarding the number and resources limitation, hospitals can choose to implement some low risk and payback period projects based on existing priority and budget annually.

Background: Todays, hospitals are facing with shortage of resources and increasing costs challenges, So, cost information and cost calculation of hospital delivered services can be effective in efficient resources allocation and tariff rates reforming and budget. This study aimed at calculating the cost of services and  physiotherapy department's income of Sina hospital and comparing with approved tariffs in 2013-2014.

Materials and Methods: This study was a cross sectional and retrospective one. The cost price of 13 physiotherapy services calculated using Activity Based Costing method for physiotherapy unit of Sina hospital of Tehran in 2013-2014. Data collection tool included some forms related to services costs of physiotherapy and related activity centers. Also, in order to estimate cost proportion of other wards in physiotherapy unit, the proportional allocation bases was determined, then direct allocation method was utilized.

Results: The most costs of 13 provided services were less than tariffs in 2013. Generally, the costs pertain of physiotherapy services computed 794286777 Rials which workforce costs (48.4 percent) was the most proportion and then energy buildings depreciation and equipment costs. This issue is due to equipment dependency in physiotherapy unit services.

Conclusions: study results revealed there was difference between real cost of services and approved tariffs, therefore, in order to more accurate pricing, exact calculation methods such as Activity Based Costing recommended. Considering high personnel and capital costs pay special attention to these resources, appropriate use, identifying and omitting wasted costs can be effective in increasing efficiency and saving costs.

Background: Medical centers and hospitals need to expand internet, Application Service Providing (ASP) to convert it to a long-lasting choice to compete. Hence, the present study carried out with the aim of determining the relationship between quality of service providing software systems and customer satisfaction in selected hospitals of Tehran University of Medical Sciences with similar hospital information systems.

Materials and Methods: This study was a descriptive-analytical and correlation one. The study population consisted of revenue and clearance employees' unit in selected hospitals. Study method was census using Kim et al questionnaire. Descriptive statistics such as frequency, percentage and average; and inferential statistics like Kolmogorov-Smirnove Test and Pearson correlation coefficient utilized in order to data analysis.

Results: There was a significant positive correlation between quality of Application System Provider variables and users satisfaction in order of severity in system quality (r = 0.734, P = 0.01), service quality(r=0.721, P = 0.01) and information quality(r=0.521, P = 0.01). As, system quality had the most impact on users' satisfaction.

Conclusion: There was a significant relationship between the quality of Application Service Providing (ASP) with the users' satisfaction in selected hospitals of Tehran University of medical sciences. Although, all variables had positive and significant relationship with user satisfaction, their average was less than moderate limit. So, the health managers are advised to consider these issues in management methods.

• Background: Improper distribution of medical care creates access inequality to the services in developing countries. This study aimed at investigating inequalities in access to medical facilities in Kermanshah's Metropolitan Area.

  Materials and Methods: The study was an applied and descriptive – analytical one. Due to the spatiotemporal nature of current research, Geographic Information Systems (GIS) were used. Research data was included hospital addresses and demographic data from statistical blocks of Kermanshah based on Iran’s 2011 census report.

  Results: The study results represented that spatial distribution of hospitals was concerned on a random pattern in metropolitan of Kermanshah and there was not a special mechanism in hospitals' spatial distribution. In total, Kermanshah city has 13 hospitals with 2342 hospital bed till 2014 which the most of them were related to general hospitals. In existing situation, the statistics revealed that only 48.51% of population has covered by hospitals and 51.49% of households have no standard access. The number of existing hospitals cannot response to the citizen's needs.In this study; current location of the most hospitals was not compatible with scientific criteria; standards and usage requirement.

  Conclusion: It is concluded that all residents had not equal access to hospitals; and also their distribution was not proportionate with population distribution and households. There is inequality in access to medical facilities focused on hospitals of Kermanshah's Metropolitan Area.

  Keywords: Inequalities, Management, Health, Accessibility, Hospital, Geographical Information System

Background:Nosocomial infections due to mortality and economic costs are one of the main challenges in current century. Gram-negative bacilli infections acquired in hospitals and hospital environment is one of the most important places of residence and publication of these types of bacteria. This study aimed to investigate the prevalence of gram-negative bacilli from the equipment of hospital in Western region of Golestan province in 2015.
Materials and Methods: During this descriptive study, 1210 devices were examined with sterile swab of environment and equipments which used in various wards of seven teaching hospitals of Golestan province using census sampling. After identification of the isolated colonies based on biochemical standard tests, results analyzed using SPSS version 22.
Results:Based of isolated samples, 352 positive microbial cultures (29.1%) contaminated with gram-negative bacilli which the highest bacterial contamination was related to Enterobacter (10.7%). among different hospital wards the highest bacterial contamination observed in ICU_s (19.32%) and among assessed equipment, the highest contamination was related to laryngoscope blades (10.51%), phone (7.1%) , ECG sensor device and  monitoring interface (6.25%).
Conclusion:The study findings confirmed that microbial contamination with gram-negative bacilli of hospitals equipment is highly considerable in West of Golestan province. Periodic assessments can be effective in nosocomial infections prevention.

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

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

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

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

Background: One of the main pillars of quality in health services is patient-centered that brings the best outcomes for patients. This study was aimed at comparing the patient-centered situation in selected hospitals affiliated to Tehran University of Medical Sciences (TUMS) from the viewpoint of nurses and patients in 2014.

Materials and Methods: This descriptive cross-sectional study was done among 220 nurses (n=103) and hospitalized patients (n=117) in selected hospitals of TUMS. The data gathering instrument was a researcher-made questionnaire which measured seven dimensions of the patient-centered. The validty was confirmed by the opinions of experts and its reliability was 0.96 by Cronbach's alpha. Data analyzes were performed by SPSS software and using one-way ANOVAtest.

Results: Mean score of patient-centered in the studied hospitals from the nurses and patients viewpoint was 2.79 (±0.50) and 2.87 (±0.58), respectively. From the viewpointof nurses and patients, the highest and the lowest mean score were related to the confidentiality and dignity dimension and the patient choice dimension, respectively. Based on ANOVA analysis, there was a significant difference between the mean scores of nurses and patients in quality of amenity and social support dimension (p<0.05).

Conclusion: Patient choice, quality of amenity and prompt attention were identified as priorities for action to improve patient-centered situation in studied hospitals. It is recommended that hospital authorities should be place in a matter of priority the dimensions of the patient-centered which are in poor condition in order to increase the level of patient satisfaction and loyalty.

Background: Enhancing the need for health care services and its related costs, lead hospitals to improve and organize their processes. The aim of current study was to assess the Patients' Hospitalization and Discharge Processes Based on Kaizen approach and Multiple-Criteria Decision Making (MCDM) in an internal ward of one Hospital.

Materials and Methods: In this descriptive analytical study, ten managers completed the hospitalization and discharge questionnaires and answered three open questions according to Kaizen principles. Then, satisfaction score was measured for 100 patients using a reliable questionnaire (α=0.93). At third phase, after evaluating the proposed solutions using Analytic Hierarchy Process (AHP), the managers prioritized them based on cost, time and effectiveness considering indicators.

Results: Study findings revealed that mean scores of activity in hospitalization and discharge processes were 88.52 and 90.33 (out of 100) respectively, which showed high conformity with Kaizen approach. Also, mean scores of hospitalization and discharge satisfaction which indicated desirable satisfaction were 76.75 and 78.6 (out of 100), respectively. Based on managers' view points, results of MCDM and AHP methods indicated that effectiveness was the most important indicator and time as well as cost gained next priorities for solutions implementation.

Conclusion: This study showed that although, hospitalization and discharge processes were relatively desirable in the internal ward in mentioned hospitals, it is still a necessary to seek the best solutions in terms of effectiveness, time and cost for patients' satisfaction.

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.

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

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

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

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