Journal of

Background: The emotional intelligence of nurses has several effects on their behavior skills. In this study, the relation between Emotional Intelligence (EI) and Communication Skills (CS) among emergency unit nurses was assessed.

Materials and Methods: In the descriptive analytical study, 253 nurses of fifteen IUMS hospitals were selected using census sampling method. The Golmans instrument for EI assessment and self -administered CS questionnaire filled by study participants. Validity and reliability of the questionnaire confirmed. SPSS software version 18 utilized to analysis using ANOVA, Spearman correlation test and Pearson correlation coefficient.

Results: mean of total EI estimated 78.31 which the highest and lowest score were in self-cognitive dimension (20.83) and self-management dimension (18.19) respectively. The total mean of CS was 70.90. There was a significant statistical correlation between EI and CS (r=0. 775, p<0.001). Moreover, there was a significant statistical correlation between CS and four dimensions of EI.

Conclusion: Based on study results, emotional intelligence and its dimensions had positive effect on communication skills among emergency unit nurses. Hospital managers can reinforce emotional intelligence by providing educational sessions. They should promote communication skills in emergency unit nurses and provide improvement emergency services quality.  

Background: Today's Hospitals operate in an inconstant and competitive environment. To have a successful presence in this environment, there is a need to recognize their own strengths and weakness points which can design appropriate strategies towards. The purpose of this study was to assess the internal environment of a hospital based on Weisbord model and analyze its relation with organizational success dimensions.

Materials and Methods: This study was a cross – sectional and applied one. The study instrument consisted of three sections including demographic information, Weisbord Model questionnaire and dimensions of organizational success assessment.124 out of 150 staff of Oil Industry hospital in Gachsaran participated in the study. In order to data analysis, descriptive statistics and Pearson correlation coefficient test were utilized.

Results: The studied hospital had a relative strength at the scoping (3.63) and leadership dimensions score (3.65) and also a relative weakness at the score of rewards (4.64) and communication dimensions (4.11). In terms of organizational success dimensions, speed (3.28) and flexibility (3.83) had better status than innovation (4.12) and cohesion (4.05). There was a positive and significant correlation between all organizational success dimensions and internal environment. In general, hospital success had the strongest relation with communication dimension(r=0.521).

Conclusion: Hospitals are able to take action through accurate recognition of weakness and strengths points and attempting appropriate modification to achieve organizational success in competitive fields. Then, they take steps towards optimization by improving programs.

Background: Strategic plan in hospitals will not be run spontaneously and managers encountered with some barriers in order to have a successful strategic planning implementation. This study aimed at recognizing the barriers of strategic plan implementation from hospital managers' perspective.

Materials and Methods: This cross-sectional study was performed in all Kerman hospitals in 2014. Fifty three individuals including chairmen, internal administrators, quality improvement managers, matrons and strategic plan executers participated by census sampling method. Data was collected using a questionnaire including demographic information and human, processes, structures and institutions factors affecting the strategies implementation. Data analysis was performed by SPSS software version21.

Results:  Study results revealed that the barriers to strategic plan implementation were structural factors (27.71±6.68), process agents (19.54±10.06), human factors (19.09±5.37) and institutional factors (15.73±4.52) respectively. There was no significant association between management background and barriers of strategic plan implementation in hospitals (P < 0.05).

Conclusions: In order to achieve desired results, chairmen and hospitals managers should be entirely conscious about barriers /failure factors of strategic decisions concerning foresight and appropriate managing or approaches change during strategic management process implementation. 

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, Patient Safety is considered as a fundamental concept of the healthcare system. Hence, recognizing the effective factors such as illegible orders, dosage errors, and drug usage can reduce serious side effects leading to the patients' disability, prolonged hospitalization and even death.

Materials and Methods: This descriptive-analytical study performed as a cross-sectional one. 1800 inpatient records selected in a teaching hospital during one year. The physician  first order was examined through a self-adminstrated checklist including physicians’ ID and workshifts, and variables  like legibility and recorded dosage. Data analysis conducted via SPSS using descriptive statistics and analytical statistics tests.

Results: Among 1800  studied records, there were 66.3% recorded by male, 17.6% illegible, 3.2% with no  stamp, 8.2% without signing, 11.9% without time and 4.9% with no date.23% of physician records didn't have coherence and logical sequence, 69.5% did not indicate to the primary items, 17.8% with no medicine dosage, 21.8% without pharmaceutical forms, 11.5% with no usage time, 25.9% without usage method, 14.3% had scribbles and 13% were devoid of numbering.  Also, there were a significant relation between demographic variables and some medical recording errors. 

Conclusion: it is necessary to endeavor physicians in patient records documentation improvement and can be used some strategies such as educating the newly arrived residents, considering commendatory techniques and record periodic evaluation.

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: 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: 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: 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.

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.

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

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

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

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

Background: Decision to stop or continue the treatment after awareness about complications and risks is patients' rights. On the other hand, patient`s discharge against medical advice could threaten patients' health. This study aimed to determine the causes of patient`s discharge against medical advice to prevent negative effects on patients and health costs.

Materials and Methods: In this study, 342 patients who left hospitals regarding discharge against medical advice were enrolled. Up to 48 hours of leaving hospital, the patients were received telephone contact, and if consented, were asked about the potential causes and whether or not the explanation of nurses or physician about the risks and side effects of discharge against medical advice. Furthermore, causes of discharge against medical advice were categorized as patient, hospital condition and combined causes.

Results: Study findings revealed that 48.5% of patients with personal reasons, 26% because of dissatisfaction with the service and 25.5% due to a combination of causes left the hospital. Most of the patients were in emergency department (p<0.001). There was relationship between type of disease (p= 0.037) and referred shift of patients (p=0.002) with type of discharge.

Conclusion: Given to the study results, it seems that planning for providing and maintaining human resources, training staff especially new entrance, monitoring medical team performance and organizing the triage system are essential in patient`s discharge against medical advice.

Background: Personnel training and development of readiness are important to attain individuals to personal and orgnazational purposes‌ (job career) and Mentor/ coach quality performance is crucial in this regard. The sensitivity of this issue can be in the spotlight in hospitals. The present study aims to examine relationship between emotional intelligence, job satisfaction, perceived organizational commitment and justice with mentoring performance in hospitals personnel.
 
Materials and Methods: The present research was a cross-sectional one which study population included all of physicians, nurses, radiology and administrative staff and service workers of Poursina public Hospital in Rasht. Four hundred and three individuals were selected by quota sampling and responded to demographic information, emotional intelligence, organizational justice, job satisfaction, organizational commitment and mentoring function questionnaire. data was analyzed using SPSS software version 20.
 
Results: hierarchical regression analyses with enter method revealed that each three component of Organizational Justice, namely distributive justice, ‌interactional justice, procedural justice‌ could explain significantly 60% shared variance results of Mentoring function of one component of job satisfaction specifically Supervisor Satisfaction‌, and one component of emotional intelligence specifically self-management (F=26.18, P<0.0001).
 
 
Conclusion: The employees' perceptions of organizational justice, supervisor satisfaction and also the ability of people to control emotions and appropriate reactivity in different situations is related to quality of Mentor/ coach function in hospital. According to the obtained results and effective variable on Mentoring, it is recommended to make decisions for hospital/manageral interventions related to emotional intelligence, organizational justice and job satisfaction.

Background: One of the main goals of health sector evolution plan is reducing the amount of out of pocket payment by patients receiving hospital services in public sectors. This study aimed to assess the amount of out of pocket payment by inpatients in public hospitals affiliated to Shahid Beheshti University of Medical Science in Tehran city in 2015.
 
Materials and Methods: In this cross-sectional study, 405 discharged patients from four public and teaching hospitals were selected using convenient sampling method. Data were collected using a researcher made checklist and investigating the hospital bills. In order to data analysis, descriptive statistics and regression analysis were utilized through SPSS Software version16.
 
Results:  The amount of out of pocket payment was 10.2 percent included 9.9 percent formal payment, 0.2 percent bought & brought goods and 0.1 percent informal payment. The most portion of the hospital costs was related to medical supplies and pharmaceuticals, surgeries services and hosteling with 32.6, 20.6 and 17.36, respectively. Type of hospital, having surgery, average length of stay, family size and gender had significant effect on the out of pocket payment amount (p ≤ 0.05).
 
Conclusion: The amount of out of pocket payment by inpatient in public hospitals was in accordance with goal of the health sector evolution plan, which reveals the appropriate government support. It is recommended to tailor and implement enormous plans regarding outpatients and private sector in national level to attain sustained reduction in out of pocket payment.