Journal of

Background: Data Envelopment Analysis (DEA) is a mathematical model that evaluates the relative efficiency of Decision Making Units (DMUs) with multiple input and output. The purpose of this paper was systematic study of applying this technique in Iranian hospitals.

Materials and Methods: In this systematic review which was conducted in September 2015 and February2016, attempted to search the research which conducted in Iranian hospitals regardless of the time of publication using searching keywords in six scientific databases and with the help of Google search engine. A total of 6,613 researches found. Then, 6,566 researches removed from the study because of the irrelevant, repetitive and Inaccessibility to the full text. Then,  attempted to statistical analysis of 47 remaining researches via Excel 2010 software.

Results: 93.6 percent of the researches were published in 2009 onwards. The most research and least research have been conducted in three and eleven provinces respectively. The diversity of output indexes have been more than diversity of input indexes. In 81 percent of researches; input oriented model was used and in 74.5 percent of researches variable returns to scale is assumed. In most studies, referred to Iran's inefficient hospitals because of existence of excess resources.

Conclusions: In last seven years, the interest of Iranian researchers has increased about DEA application in hospitals especially in Tehran, Yazd and Khoozestan provinces. Scientific and rational use of resources is a proposal to the relevant authorities.

Background: Many hospitals of Iran make use of their therapeutic capacities in order to attract medical tourists and increase revenue and efficiency of their affiliated hospitals. This issue has major benefits for hospital and tourists. This study assessed the potential of medical tourists' attraction in a military hospital in Tehran.

Materials and Methods: This was a descriptive- analytical one which used secondary data to analyze. Data gained from quality improvement and finance offices, recipients of service and health information management units from the first of 2014 to the first semester of 2015. Strategic plan document were used to analyze the opportunities and strengths points.

Results: The mean of studied hospital performance indicators like bed occupancy rate, length of stay, Bed turnover, rate of admissions to bed, mortality and bedsores rates, nosocomial infections, medication error, patients' rights and patient satisfaction were  4.68 ,  3.3,  5.1 , 6.6 ,  5.2, 1,  69, 9.74 , 70 percent respectively. The strengths points of the studied hospital were diverse expertise, updated equipment and minimum waiting time.

Conclusion: Because of skilled man power, physical resources and especially modern equipment, the hospital does not need huge investment in medical tourists' attraction. This issue will increase admission, productivity and satisfaction of clients and staff.

  Abstract

  Background and Aim: Especially in the case of Hospital services, quality assesment is an complicated and vague issue. For achieving this goal Multiple Criteria Decision Making methods help us. These studies aims to knowledge and prioritize quality indicators and rank selected inpatient wards in an elected hospital of Tehran university of medical science by using Analytical Hierarchy Process and TOPSIS methods.

  Materials and Methods: This is a descriptive-analytical and cross-sectional research. At the first, with an overview of the research literature and expert opinion, indicators of quality assessment were selected. Then we did prioritization of these indicators with using of expert opinion and AHP method. In the final stage, selected inpatient wards the Hospital were ranked in terms of quality of service using TOPSIS by a sample consist of 300 of inpatients.

  Results: Eight main domains (Responsiveness, Safety and risk management, Tangibles, attention to patient, Health communications, Competency and professionalism, accessibility, Credit and assurance) were selected for quality assessment. Among these indicators, competency had the highest priority and attention to patient had the lowest priority. Also the department of Heart had the highest quality of service and the department of Neurology had the lowest quality.

  Conclusion: According to crucial role of the service quality on patients’ satisfaction, the use of appropriate indicators for quality of services, prioritizing them and also proper assessment of the quality of hospital services can play a major role in health policies.

Background: Although the role of Spirituality has been acknowledged in the social entrepreneurship literature, we know of no research that has empirically investigated relationships between spiritual intelligence and health and care benefactors. Thus, this paper aims to propose and empirically test a theoretical model positing relationships among spiritual intelligence and intentions of hospital-makers benefactors. Materials & Methods: This study is descriptive which is conducted with total number of 164 hospital-makers benefactors, and is tested by path analysis. For measuring spiritual intelligence, three questionnaires distributed between every subject and two of his/her acquaintances. Results: The results suggest that spiritual intelligence and other related variables explained 41 per cent of the variance in the rate of hospital-makers benefactors intentions (R2=0/41) that is a sizable amount in behavioral studies. Results provide strong support for the proposition that social mission and social responsibility fully mediate the positive effect of spiritual intelligence on intentions of hospital-makers benefactor. Conclusion: With existence of opportunities for merely finical investments, hospital-makers benefactors should have high levels of spiritual intelligence to gain motivation for social wealth creation. Policy-makers of health system, to increase charitable activities, should focus on heightening spiritual intelligence in health and care sector.

Introduction: High quality health care service leads us towards a healthy society. Present paper aimed to use the service quality concept in health care sector based on service quality approach (SERVQUAL) in public hospitals. Methods: In present research a hybrid approach based on Analytic Network Process (ANP) and Fuzzy TOPSIS was used where the former was used for prioritization of healthcare service quality measures and the latter was used to operationalize the hospitals. Questionnaires and ANP and Fuzzy TOPSIS were used for data collection and analysis. Five public hospitals in Rash were evaluated. The time period of the study including data collection was 2014-2015. Results: The service quality criteria comprised of 6 main criteria and 19 sub-criteria in present study. Among five hospitals studied in present research, Rasoul Akram hospital obtained the first rank and other hospitals obtained the other ranks. All criteria and sub-criteria used in present study obtained some rank indicating their importance in the research context. Conclusions: With conducting present research, various criteria and sub-criteria related to service quality (SERVQAL) and their importance were identified and this may contribute to improved performance of health care services

Background: The growing importance of hospitals in physical and mental health improvement has led to focus on improving service quality; and hospitals have considered it as a major competitive advantage. This study aimed at investigating the role of improving services quality on hospital brand preference in healthcare industry.

Materials and Methods: This applied study was a descriptive one. A sample of 394 patients selected using stratified and convenient sampling from hospitals of Shiraz city. Data gathering using questionnaire; in order to data analysis, LISREL_8.80 and SPSS₁₉ were utilized using confirmatory factor analysis and structural equation modeling techniques. Data analysis was used to confirm the relationships between variables.

Results: Study results indicated that there was a significant positive effect of service quality on patient satisfaction, patient loyalty and brand equity of hospital. Patient satisfaction had positive effect on patient loyalty to the hospital and the loyalty had significant effect on hospital’s brand equity. Finally, the effect of hospital brand equity was confirmed on hospital brand preference.

Conclusion: According to the study results, it can be suggested that hospitals management take some measures for service quality improvement which can be enhanced hospital brand preference among other hospitals, both spreading justly public health in all layers of society as well as increasing profitability.

Keywords: Service quality, Brand Preference, Hospital

Introduction: In the hospital’s environment, conflict is unavoidable due to differences in gender, educations, and Career goals, frequent and complex interactions between their personnels. Both of two extremely level of conflict (minimum & maximum) are preventing desired performance. Appropriate level of conflict should avoid recession, encourage creativity and reduce stress. The present research aims to determine the amount of conflict in Tehran University of Medical Science’s hospitals. (TUMS).

Method: This study is descriptive - analytic. The study population consists of 706 managers (senior, intermediate, basic) from 14 hospitals affiliated with TUMS. Data was collected by a self-made questionnaire and was analyzed with SPSS software.

Results: The level of conflict in Tehran University of Medical Science’s hospitals was average. 84% of total conflict was caused by organizational factors. There were a significant association between conflict and level of management, educations, work experience, type of unit, bed numbers, the number of employee under supervision, conflict management training course

Conclusion: Hospital managers should change their organizational cultures and revise some structural variables such as goals, procedures…  In order to maintain the optimal level of conflict.

Keywords: Conflict, a mount of Conflict, Managers, Hospital.

Background: Considering the importance of standard precautions to prevent needle stick injuries and health care staff, this study aimed to determine the effectiveness of educational interventions to improve adherence to standard precautions, health belief model based on professional clinical staff needle stick two hospital "yaftabad" and "Ghiyasi" done.

Materials and Methods: This study was an experimental study of two group. The study population was 90 persons of professional clinical staff Shohada Hospital Yaftabad as the intervention group and 90 patients from the hospital Ghiyasi as compared to randomly selected and three part questionnaire including demographic, structures, health belief model , and practice questions were completed. In analyzing the data, descriptive and inferential statistical methods were used.

Results: At baseline, the two groups regarding demographic variables, health belief model structures and functional do not different between them. After intervention structures perceived severity, perceived susceptibility, perceived barriers, self-efficacy and performance of the experimental group showed statistically significant change (p< 0.05) that the effect of education based on health belief model.

Conclusion: education based on health belief model, you can increase the level of knowledge and capacity building and efficacy in clinical staff needs people to observe standard precautions

Background: Reward system program is an investment tools in order to improve quality of services. Accordingly, this study was conducted aimed to identify the challenges of the reward system and the solutions for improving that based on the views of stakeholders in Tehran University of Medical Sciences hospitals.
Materials and Methods: This directional content analysis qualitative study was performed in Tehran University of Medical Sciences during 2014and 2015 using content analysis method. Targeted sampling was done and in-depth semi structured and face to face interviews were performed with a wide variety of experts and professionals including managers, faculties and hospital staffs. After word by word transcripting and extracting codes (meaningful phrases), these codes was reviewed again in
order to achieve subcategories. Based on subcategories, information was classified to assossiated  categories. For validity and reliability checking, stakeholders and faculties member check and peer debriefing were used.Results: Eventually, a total of 29 interviews were held. The comments were classified within 6 main categories, 19 subcategories and 1100 codes. The main categories included existing arrangements in hospitals in order to improve staff motivation; reward system challenges; derived opportunities from rewarding experiences; rewarding systematic actions; types of appropriate rewards and making
infrastructure for better rewarding system implementation.
Conclusion: Regarding multiple aspects of a reward system which could have an effective role in increasing staff motivation or a contradictory effect when it is inefficient, implementation of an effective reward system in hospitals by designing an appropriate model based on identified key factors in this study, is recommended.

Background: In the current turbulent world of business, organizations have to try and compete to identify, recruit and retain the most qualified managers as a competitive advantage. The aim of this study was to investigate the relationship between leadership competencies of managers and administrative staff with the performance of hospitals.

Materials and Methods: This descriptive correlational study was conducted in2015. This study was done in a public teaching hospital, a public non-teaching hospital and a private hospital in Tehran that were general and in average size. The study population was head for all units and departments in accordance with accreditation standards. Sampling methods was Census and leadership competencies using clinical leadership competency framework(CLCF) questionnaire and hospital performance using evaluation scores based on national accreditation standards in2014 that were used in2015 as the basis for the ranking were assessed. Data using Pearson correlation coefficient and test-t, chi-square, regression and ANOVA analyzed.

Results: results showed significant positive correlation between leadership competencies and performance of hospitals(α=0/001,R=0/556). All components of competency (personal qualities(R=0/446), working with others(R=0/529), managing services(R=0/569), improving services(R=0/445), setting direction(R=0/269)) have also positive and significant correlation with performance. Leadership competencies with education (R=0/368), type of employment(f=5/209) and type of hospital(f=15/252) and performance with marital status(R=0/038), type of hospital(f=4/352) and management experience(R=0/273) have showed a significant positive correlation.

Conclusion: Today, organizations will be success if they able to attract and maintenance the most qualified, and employ their services in proper place. Neglect of this important and non-use of existing potentials could have negatively impact the performance of individuals, units and hospitals.

Background: This study aimed at assessing and economic analysis of the existing market of treatment devices of infectious waste in Iranian hospitals.

Material and Methods: In the current descriptive- analytical study which was performed in 2013, the data resulting from national cross- sectional study in Center of Environmental and Occupation Health in 2012 and interview with relevant authorities in 14 Tehran's hospital with at least three years experience using the facilities were utilized.

Results: Until 2012, 883 hospitals have been active in nationwide that more than 64% of them owned by university of medical sciences and SBMU and TUMS with 114 and 45 centers have the highest number of hospitals respectively. Also hospital beds per 1000 population in the country were calculated 1.78. About 80% of hospitals utilized wet thermal and mostly based on autoclave machines for treatment which market share of domestic products is about 55% that Koosha Company, TEM and KAZU have the largest share with 39%, 23.5% and 12.9% respectively.

Conclusion: Existence a large heterogeneity in the type and function of the studied devices has created possible of Cartel in an oligopoly atmosphere  which  with a targeted regulation and policy making toward protectionism, it can be observed price decreasing, enhancing effectiveness, quality and safety increasing of infectious waste treatment facilities

Background: The health system of Iran is suffering from resources shortage. The health insurance companies (payers) do not confirm all hospitals’ claims (bills) and as a result do not reimburse them completely. Decreasing the amount of these deductions helps healthcare managers to use their resources efficiently. This study aimed to examine the impact of a quality management model on reducing the amount of healthcare insurance deductions at operating theatre department of Valiasr hospital in 2014-2015.

Materials and Methods: A participatory action research was used for the intervention. A quality improvement team was established and using the ten-step quality management model improved operational processes at operating theatre department.  Related data were collected before and after the intervention to determine the effect of quality management system on deductions.

Results: The average deduction per patient at the beginning of the study was 339572 Rials. Illegible and uncompleted patient’s medical records, using wrong codes of surgery and anesthetics in documents and miscalculation were the main reasons of deductions. The reasons for deductions were identified and appropriate solutions were applied to decrease the amount of deductions at operating theatre department. The average deduction per patient at the end of study was 262818 Rials. The amount of deductions has decreased from 6.9 % to 3.8 %. The quality management system helped reduce the amount of deductions by 44.9%.

Conclusion: Implementing an appropriate quality management model appropriately helps reduce deductions in hospitals effectively

Background: Beside qualified and capable nursing personnel, nursing care development requires motivated nurses to work in an appropriate environment. This study aimed  at determining the relationship between organizational climate and nurses' job motivation in selected Army hospitals of Tehran city in 2015.

Materials and Methods: In this study was a descriptive -analytical and cross sectional one. The sample size consisted of 340 employed nurses in hospitals with at least one year work experience which were stratified randomly selected based on work experience among four army hospitals in Tehran. Data were collected using two questionnaires including job motivation and organizational climate. In order to data .analysis, descriptive and analytical tests such as Pearson correlation coefficient were utilized.

Results: One hundred and eighty nine of participants (55.4%) were female. Mean age of nurses’ average was 32.22 ±9.8 years. More than half of nurses had evaluated group spirit as high level and hindrance, engagement, intimacy, consideration, spacing, thrust and production emphasis as moderate level. There was a direct significant relationship between all components of job motivation and engagement, intimacy, consideration, spacing, thrust and production emphasis (P<0.05). Furthermore, mental and official components of job motivation had an inverse significant relationship with hindrance component respectively (P=0.014, P=0.019).

Conclusion: Regarding the relationship between all components of the organizational climate with job motivation, attempt to improve these components will have significant impact on motivation improvement, reducing absenteeism and job dissatisfaction.

Background: Recently, the medical tourism is developing more and more over the world. Due to the potential of medical tourism in Iran, this study aimed at identifying medical tourism characteristics in terms of tourist destination and therapeutic centers in Iran.

Materials and Methods: According to literature reviews and experts interviews, components of medical tourists attraction were investigated ana a questionnaire provided. After baseline, items which were not valid and reliable omitted and final questionnaire distributed and completed among experts Such as physicions, academic members, managers and medical staff in eight public and private hospitals in Tehran city.

Results:  Regarding the study results based on the respondance view, the more and the less important components of medical tourist's attraction in Iran included hospital validity, costs, quality of care, hospital staff training, position and political environment, regulatory policy, infrastructure and location of hospital and economic situation. The main problem of medical tourism represented as lack of obvious treatment process and support system. In similar studies, low tretmant costs in destination country was the important motivation of medical travel and factors such as political, economic, regulations and standards and medical centers validity have been addressed to make decisions about the origin country.

Conclusion: This study based on current and priorities assessed the developing dimensions of the medical tourism in macro and micro levels from perspective of medical tourism activists. Medical tourism development requires comprehensive and integrated approach which has been achived using coordinate cooperation, planning and implementation of micro and macro strategies among relevant organizations. 

Background: Hospital managers inevitably have a major impact on their employees' health and because professional cohesion acheives in the shadow of psychological balance; possessing mental health is important among hospital staff. Therefore, current study aimed to determine the status of managers' leadership style and its relationship with mental health staff of hospitals affiliated to Tehran University of Medical Sciences in 2014.

Materials and Methods: This study was a cross-sectional and descriptive-analytical one and sample size consisted of 91 executives, intermediate managers and 320 employees of hospitals affiliated to Tehran University of Medical Sciences. Fiedler leadership style instrument and general health questionnaire were used. Collected data was analyzed by SPSS software version 22 using descriptive and inferential statistics tests.

Results: Responsive rate was85% (272/320). Most of managers adopted task-oriented leadership style. There was a statistically significant relationship between leadership style and mental health, physical problems, anxiety, social function and depression among staff (P<0.05).

Conclusion: Managers can be effective on mental health staff using relationship-oriented leadership style adoption and it seems necessary to train managers in adopting appropriate leadership models and styles in order to prevent and reduce mental health disorders among employees in different situations.

Background: The emergency department is as heart of hospital and is one of the first points of contact for patients with health care system are facing a variety of challenges. This study aimed to explore the challenges of emergency departments in teaching hospitals of Mashhad University of Medical Sciences.

Materials and Methods: This study was carried out through a qualitative approach and phenomenology method in 2013 in Mashhad, Iran. Twenty nurses and two emergency medicine specialists were recruited from four teaching hospitals in Mashhad Iran using purposive sampling. Data were collected through semi-structured in-depth interviews. Interviews were transcribed verbatim and analyzed using conventional content analysis approach according to colaizzi  with MAXQDA 3 software. 

Results: The results of this study indicated that challenges of emergency department lay in

Three main aspects including: "challenges in Human resources"(personal characteristics,  professional characteristics and human resource limitations), "nurses' dissatisfaction"(less quality hospital hoteling and services for staff, disproportion between the workload and salaries, Lack of support from nurses) and " challenges in human resources management "(Structural challenges, the performance challenges and challenges in human resource management). Each theme included several category and subcategory that explain various aspects of the challenges in emergency department.

Conclusion: Human resource limitations, nurses' dissatisfaction and poor management were the most important challenges. Providing adequate human resources, support of nurses and determination guidelines and process for nursing care can reduce these challenges in hospital emergency departments.

Background: Despite the fact that only one-third of chest pains occur due to heart diseases, still physicians have tendency to admit most of these patients to reduce risk of negligence and its consequences.Clinical decision support systems (CDSS) enable physicians to distinguish better cardiac from non-cardiac chest pain. This study reviewed articles which focused on this issue.

Materials and Methods: Google scholar and PubMed database were targeted for search. Out of ninety primary matching articles based on the title, abstract and keywords, 28 full texts were relevant which were included in this study.

Results: Included articles were classified into two categories such as managing hospital resources and increasing the accuracy of diagnosis. Study results in the first categoryshowed decrease in both reception and referral time up to 30% and length of hospital stay up to 26% using CDSS. In the second category, the highest reported accuracy of diagnosis was 97% and the maximum sensitivity and specificity were 100% and 89.43% respectively. Even though, the results of a study revealed that the accuracy of decision support system in diagnosing cardiac chest pain was better than the compared cardiologists.

Conclusion: Considering the role of CDSS in managing hospital resources and improving accuracy of diagnosing cardiac chest pain, it is suggested that emergency wards and cardiac screening centers equipped by these systems.

Background: Hospital staffs including physicians, nurses and crew are exposed to various risks including physical and mental illnesses. The study aimed at predicting job performance based on humor components and mental health among staff of Ziaeyan hospital.

Materials and Methods: This study was a descriptive- analytical one. Sample size was 120 individuals (74 females and 46 males) who selected via non- randomly and Voluntary With a diverse range of staff including nurses, physicians in 2014.  After explaining about  research type and filling voluntary questionnaires with informed consent, job performance Paterson, Martin et al humor components  and Goldberg mental health instruments were disseminated. SPSS Software version 17 utilized to data analysis using regression and cluster analysis.

Results: Among of humor components and mental health, Self-enhancing, depression and social performance predicted job performance positively. Depression has the largest ß coefficient(0.26)  for job performance  which revealed this variable the strongest one  and provided main contribution to explain the criterion variable. Also, there was a statistically difference between negative morbid humor clusters and positive and healthy clusters of humor in the significant level less than 0.05(t= -7.97, p<0.001).

Conclusion: Selection of humor style and enhancing mental health of hospital staff will cause job performance improvement. Regarding stressful environment of hospital, it seems providing better mental health and applying healthy styles of humor as a proper way to staff performance improvement which should be considered.

Background: Pre hospital emergency medical service (EMS) as the first line of emergency care and treatment in the out- of -hospital has a considerable importance in the health care system. Planning on finding about strengths and weaknesses and improve the quality of EMS by exploring the problems of this section has considerable important.This study aimed to explore the challenges of pre hospital emergency medical service in Mashhad.

Materials and methods: A qualitative study was done with 14 personnel working in EMS sites in Mashhad using purposeful sampling. Data was collected by semi structured interview and analyzed using conventional content analysis approach according to Graneheim and Lund man 2004 with ATLAS.ti  software.

Results: Three general themes were identified including 1) "challenges in Human resources"( Individual characteristics of human resources and personnel's dissatisfaction 2) "challenges in organization" (Structural challenges, lake of equipment and human resource limitation 3) "socio-cultural challenges"(Environmental-social challenges and cultural challenges) were determined.

Conclusion: personnel's dissatisfaction, structural challenges, human resource limitation, lake of equipment   and Environmental-social challenges were the most important challenges in pre-hospital emergency system. Organizational independence , create organizational rows, regulation of laws and administrative regulations reform in relation to the range of services offered by emergency personnel, attention to the facilities and cooperation And the participation of other organizations, such as media and traffic to enhance pre-hospital emergency services at the community level can be effective in reducing the challenges in hospital emergency system.

Background: Organizational culture has a crucial role in hospitals’ productivity. The success or failure of strategies and plans in organisational change depend on organizational culture. This study aimed to examine the organizational culture of Tehran hospitals in 2014.

Material  and Methods: This descriptive-analytical study was carried out in 18 hospitals (public, private and semi-public hospitals) that were selected out of 114 hospitals of Tehran using quota- randomized sampling method. About 696 employees in diagnostic, curative, administrative and logistic departments participated in the study. Data was collected through a valid and reliable questionnaire and analyzed using SPSS20. Spearman, U Man- Whitney and Kruskal- Wallis statistical tests were applied.

Results: The mean score of organizational culture was 3.62 out of 6 (moderate). There was a significant relationship between organizational culture and the type of hospitals (p=0.002). The mean score of organizational culture was higher in Private and Semi-public ecurity hospitals respectivey. Attention to details and customer orientation dimensions were high in public and semi-public hospitals and private hospitals respectively. The most and the least mean score of organizational culture was related to administrative and support services units. 

Conclusion: Organization culture was evaluated in moderate status in hospitals of Tehran city. Thus, it is recommended  that hospital managers  improve hospitals 'organizational culture  specially in creativity, innovation, integration and teamwork dimensions using organizational engineering culture plans.