Journal of

---

Background: Hospitals are considered as the largest and most costly unit of the health system. The present study aims to determine the efficiency of hospitals in Mashhad.
Materials and Methods: This is a descriptive-survey study that was carried out in 2016-2017. The population of the study consisted of patients referring to hospitals in Mashhad. For data collection, records were used in hospitals and the SERVQUAL questionnaire. Data analysis was performed in soft Gams software.
Results: The results of the study indicate that in the SERVQUAL section, three dimensions of empathy response and Warranty were the most important dimensions. Also, 3 characteristics of 26 qualitative features of the service were classified as "attractive". 4 qualitative features are classified as "essential" and 16 features in "single-dimensional". The rankings obtained in the bilingual network method are approximately the same and only in the case of the last four ranks of the final ranking is done by the voting method with equal weights. And it was determined that the hospital number (3) is the lowest and hospital number (5) has the best performance.
Conclusion: By combining the fuzzy SERVQUAL method with network data envelopment analysis, we can eliminate weaknesses in the selection of indicators in different layers of network analysis and calculate the efficiency of such networks. Hospitals need to increase and plan appropriately by designing a hospital that has the highest efficiency and optimal utilization of its resources and cost-effectiveness.
 

---

Background: This study aimed to explore the process of establishing a non-governmental and nonprofit  hospital, as a corporate infantry, and a model for the establishment of autonomous and corporate hospitals.
Materials and Methods: This was a qualitative case study. The data were collected by interviewing the founders of Moheb Mehr Hospital, staff and some university officials and charity organizations. The data analysis was conducted based on grounded theory principles and data were coded in three stages of open, axial and selective coding.
Results: The primary factors behind the establishment of Moheb Hospital were the low level of physicians' fees and the physicians’ dual practice in the public and private sectors. The existence of unused spaces at Hashemi-Nejad Hospital and the possibility of contracting supplementary insurance were the secondary factors. The reaction included welcoming from hospital physicians and opposition from the government and the Ministry of Health. A good patient access was created due to the lower charges, in comparison to the private sector, and having contract with the supplementary insurance. The negative comments from the government and the Ministry were gradually adjusted.
Conclusion: The decentralization initiatives of the public sector in hospitals should be considered as a bottom-up process. Instead of turning government hospitals into independent or corporate, it is better to re-establish them in an autonomous or corporate form. Also, before any decentralization action, financial and managerial stability must be created in the organizations. Morevoer, employee benefits must be preserved. Instead of receiving government funding, it is better to use the capacity of the endowment and receive bank loans.
 

---

Background & Aim: Regarding the chronic course of obstructive pulmonary disease and multiple problems which it brings to individuals and the community in terms of physical, mental, and economic aspects; this study aimed to investigate the role of life-style factors in disease exacerbation and hospitalization among COPD patients.
Methods & Materials: This is a descriptive, prospective study of outpatients with COPD in a tertiary care clinic. To collect data, a demographic questionnaire (including age, gender, marital status, occupation, and educational level), an international physical activity questionnaire (IPAQ), and a mini-nutritional assessment (MNA) tool were used. Disease severity was also determined by Initiative for Chronic Obstructive Lung Disease (GOLD) index.
Results: A total of 128 patients (78.1% male) were recruited with a mean age of 65.3+11.9 years. Findings revealed significant correlations among physical activity level of patients and their nutrition, smoking behavior, BMI, and disease exacerbation. In fact patients with older age, lower BMI, smoking habit for a long time, and limited physical activity were more probable to face with disease exacerbation and hospitalization.
Conclusion: Evidence suggests that adoption of health promotion strategies and emphasis on health based approaches can be helpful in reducing hospitalization among COPD patients. Due to their effectiveness and low cost, such policies are regarded as cost effective strategies in dealing with chronic diseases.
 

---

Background and Aim: Conflict between health workers is an important problem in health care units around the world. The aim of this study was to identify the causes of conflict between nursing staff and other occupational groups in the hospital.
 
Materials and Methods: This descriptive-analytical study was conducted in 2018. A researcher-made questionnaire was used to collect data. The questionnaire was designed in two parts: demographic variables and causes of conflict between nursing and other occupational groups with a Likert scale of 5 points. 120 nursing staff of Ardabil University of Medical Sciences randomly selected were surveyed. Data were analyzed by SPSS software15 using descriptive and inferential statistical methods.
 
Results: The highest rate of conflict reported by nurses was related to the conflict with the group of managers (4.17±0.94) and the lowest rate was with administrative, financial and support staff (3.55±1.13). The most important reasons for conflict between nursing staff and different groups were: imposing non-specialist roles (such as completing doctors' documentation); perceived inequality in workload distribution; insufficient understanding of nursing work conditions; unreasonable differences in salaries and other benefits, and unfair distribution of manpower. There was also a statistically significant correlation between the level of conflict with marital status, work experience, age group (p <0.05).
 
Conclusion: The results of the present study showed the role of some factors causing conflict between nursing staff and other occupational groups. These findings could be a practical guide for hospital managers in making practical decisions and strategies for managing workplace conflicts.

---

Background: Performance appraisal and quality evaluation of the services provided will achieve the organizational goals and improve the level of staff capability. In order to evaluate accurately and efficiently, we need to use standard indices, to compare the quality and quantity of work with standards, to know the current conditions and to solve its problems
 Methods: This study is an applied study. This was done through a combined method of reviewing the texts and consensus of experts. Initially, the literature review and emergency evaluation indices were extracted, then the duplicate indices were removed and similar indices were merged, then weighted experts and questionnaires were compiled with the indices. Content validity, Cronbach's alpha coefficient and test-retest were used to assess the validity, internal consistency and reproducibility of the questionnaire, respectively. Data were analyzed using Excel and SPSS 20 software.
 Finding: Final questionnaire with 105 questions in 8 areas including management and leadership (15); human resources (22); physical space and facilities (18); medicine and medical equipment (6); guidelines and policies (17); patient-centered (10); documentation of patient records (5); quality and time indices in the emergency department (12). The results showed that the final questionnaire was reliable (0.89) and repeatable (ICC = 0.98).
Conclusion: The Hospital Emergency Performance Assessment Questionnaire is a valid and reliable instrument and can be used to evaluate the performance of hospital emergency services.

---

Background: The Family Physician Program, one of the most important efforts of the Iran health system to establish a referral system, was developed and implemented in several provinces, but it faced challenges due to several reasons that prevented the program's progress. So This study was conducted to analyze the family physician program to identify the causes and challenges of the program failure.
Materials & Methods: This retrospective study of policy analysis is a qualitative study with Purposive sampling. Semi-open interviews and document analysis were used for data collection. Data analysis was performed through thematic analysis in the policy triangle framework using MAXQDA software.
Results: According to the study framework, the challenges of the Family Physician Program in the context are conflict of interest, dependency of plans to oneself, instability in management and plans, insufficient attention to culture, resources, and infrastructure. In terms of content include disproportionate executive approach, Lack of localization, selection of inappropriate tools, insufficient transparency, and ambiguity in goals, tasks, and responsibilities; The challenges of the process were examined based on the policy cycle.
Conclusion: The implementation of the family physician program is influenced by cultural, social, political, managerial, and economic factors. As the Ministry of Health officials has re-introduced this crucial program, reviewing the content and methods of program implementation seems necessary.

---

Background: Scenario planning is one of the most crucial future study methods in uncertain and complex situations. Hospital supply chain resilience also requires an understanding of future events due to the complexity of relationships and exposure to unexpected circumstances. The purpose of this study is to formulate scenarios for the future development of hospital supply chain resilience.
Materials & Methods: This research is the second stage of research with a mixed approach, and it is in the category of normative scenarios based on intuitive logic. Participants in this study were purposefully selected from the experts of two hospitals. In the first phase, the impact-uncertainty questionnaire and the effect-uncertainty diagram were used to determine the critical uncertainties. After forming the scenario team, based on the impact diagram and the scenario matrix, The cause and effect relationships of the variables were determined in the second phase.
Results: Drivers of Hospital supply chain resilience were clustered into 14 main categories, and the results of the impact-uncertainty diagram showed that "people's culture" and "accident nature" play a more significant role in scenario development as critical uncertainties. Four scenarios were developed based on the opinion of experts for these two drivers.
Conclusion: four scenarios, "compatible," "turbulent," "broken," and "combative," were developed based on the critical drivers in supply chain hospital resilience. Use the inspirational feature of these scenarios can help managers in health and crisis management be more prepared to face the crisis. Scenarios based on intuitive logic can be used for futures studies in other areas of the health system.

---

Background: Hospital, as the largest and most important health system unit, has the highest costs. Governments cannot finance all of the costs of this sector, so reforms are inevitable. In this regard, researchers have explained the underlying factors in financing policy and its commanding.
Materials & Methods: This study is a descriptive study done by qualitatively and quantitatively method in 2019. The statistical population included experts from the health sector, the capital market, and the Social Security Organization. A purposive sampling method was used. Data collection tools were receipts and a semi-structured questionnaire for interviews. MAXQDA 11 software was used to analyze the interviews, and the Delphi technique was used for validation. Walt Gilson and Kingdon models were used for policy analysis and commanding.
 Results: Underlying factors in policy-making and commanding the financing of hospitals from the capital market are macro-factors (governance and legal, political, social, and economic factors) and micro-factors (stewardship, financing, and technical factors). The financing problem stream of hospitals, the policy flow that includes public-private partnership models, and the political flow that began with sanctions open a window of opportunity to finance hospitals through the capital market.
 Conclusion: Upstream documents and development plans allow the privatization of governmental organizations; therefore, in addition to government budgets and dedicated revenues, hospitals can use private-sector financing strategies. In the meantime, easy and inexpensive financing, transparency, and accountability are the capital market characteristics that introduce it as an appropriate strategy. 

---

Background and Aim: The aim of this study was to investigate the income changes resulting from the implementation of this book in the hospitals of the University of Medical Sciences.
Materials & Methods: This cross-sectional study was conducted based on retrospective information related to the first half of 1398 of Shahid Beheshti University of Medical Sciences. Data related to this study were collected from patients' records using hospital information system and hospital intelligent management system of Shahid Beheshti University of Medical Sciences. In order to analyze the data, the average of Rials per service was used for each hospital and type of admission.
Results: The results showed that with the implementation of the book of relative value 2018, the total income of the studied hospitals will increase by 10.67%. In total, the share of total book codes included in the study is 41% of the total, of which 20% is the professional component, 19% is the technical component and 2.4% is anesthesia. After book codes, hoteling with 26% and consumer goods with 14% and medicine with 11% make up the rest.
Conclusion: The approach of the 2018 book is more towards temporary inpatient services and encourages providers not to admit patients to receive services. Also in this book, the proper growth of the technical component of services will occur, which in other words indicates the approach and encouragement of investment in the hospital sector.

---

Background: The present study aimed to determine the causes of patients' readmission in hospitals affiliated to Bam University of Medical Sciences in 2019.
Materials & Methods: The current study was a descriptive-analytic study and the study population included patients readmitted in Pasteur Hospital in Bam, Javad Al-Aimeh Hospital in Narmashir, and Ayatollah Hashemi Rafsanjani Hospital in Regan in 2019. The samples consisted of 312 patient records which were chosen randomly. Data were collected by a checklist and were analyzed using SPSS software version 23 and descriptive and analytical tests (Chi-square and one-way analysis of variance).
Results: The results showed that the internal medicine department received 34% of readmissions. The average readmission cost was 17,265,353 Rials. The most common reasons for readmissions were having a new disease (46.2 percent) and recurrence of the former disease (39.8 percent). Findings of inferential statistics revealed no significant relationship between the causes of readmissions and gender (P = 0.566), age (P = 0.065), or costs (P = 0.625), but there was a significant relationship between the causes of readmissions and marital status (P = 0.049) and married people had more readmissions than single people.
Conclusion: It is necessary to pay more attention to readmissions caused by disease recurrence. It is also possible to prevent such readmissions and improve the quality of medical services by standardizing hospital processes and tools, standardizing staff training, and employing new diagnostic and treatment methods.

---

Background: Medical tourism has been considered in our country for many years. The arrival of international patients in the country will boost the medical tourism sector; however, the necessary infrastructure must be created for this. The guidelines for the establishment of the International Hospital Unit are one of the legal infrastructures for standardization in this field. Therefore, this study was conducted with the aim of strategic analysis of the establishment of an international patient unit in hospitals of Tehran University of Medical Sciences.
Materials & Methods: This combined study was performed in 2019 in three hospitals of Tehran University of Medical Sciences that had a license to operate this unit. In-depth interviews were conducted in each hospital with experts in this field. The data were then categorized into four categories of strengths, weaknesses, opportunities and threats, and according to the results of the SWOT technique, the necessary strategies were presented.
Results: There are opportunities including low cost of medical services in Iran, low value of Iranian Rial and political and religious ties with countries in the region. Significant threats also included the existence of professional competitors, the widespread activity of brokers, and the large number of trustees for the industry within the country. Finally, appropriate strategies were presented for each hospital.
Conclusion: This market in our country faces many threats and needs policies appropriate to the current situation with an immediate action. The results also showed that two hospitals are in a competitive state and one hospital is in a defensive state.

---

Introduction: Branding is one of the most important needs of any organization to survive and improve the quality of provided products and services.

Today, branding is also being increasingly used by health organizations and has become one of the important elements for improving the quality of services provided by hospitals as the main body of health services. In the present study, the factors affecting the customer-based brand equity were investigated in selected hospitals.

Materials and Methods: This is a descriptive-analytical and cross-sectional study. Using stratified random sampling method, 350 patients were selected from private hospitals in Tehran and Kerman in 2020. Data were collected through a questionnaire and the Stata software V.14 was used for data analysis.

Results: The average customer-based brand equity was higher in women, those with a degree lower than diploma, and in surgical treatment group. Different dimensions of hospital brand value including perceived quality (average), patient loyalty (average), brand image (good) and service brand value (very good) were evaluated and average customer-based brand equity received 76.38 points out of 100 and was at a high level.
Conclusion: Hospital brand value has an important effect on hospital marketing. Hospitals can take steps to attract and retain patients and can create a competitive advantage over others. The results showed the positive effect of perceived quality, patient loyalty, brand image and service brand value on customer-based brand equity.

---

Introduction: Inappropriate admission and inappropriate hospital days are two undesirable indicators in terms of controlling hospital costs. This study was conducted to determine the rate of inappropriate admission and hospital days and related factors in Shohada Hospital in Kermanshah.
Methods: This is descriptive-analytical study.The statistical population included patients admitted of Kermanshah shohada Hospital in 1397. 245 Inpatient records were selected using Cochran's formula and stratified random sampling. Appropriateness evaluation protocol was used to evaluate the inappropriate admission and inappropriate hospital days. The relationship between age, sex, type of admission, type of ward, type of treatment, coverage of cost hospitalization, place of residence, with rate of inappropriate admissions and inappropriate hospital days was assessed using spss16 software.
Results: 5.7% of admissions and 21.4% of hospital days were inappropriate. Inadequate admission was significantly related to gender, type of surgical or medical treatment, type of hospital ward in chi-square test in contingency tables with 95% confidence.  Inappropriate hospital days were related to the type of hospitalization ward in kruskal-Wallis test , type of treatment and place of residence in Mann-Whitney test.
Conclusion: By determining the amount of inappropriate admissions and inappropriate hospital days and related factors for policy makers and managers of hospitals and insurance organizations, it is possible to avoid unnecessary costs without reducing the quality of hospital services.

---

---

Background: The outlook for hospital care is changing rapidly. Supply and demand stimuli in the health service system are changing dramatically. The health department of the Social Security Administration has also been challenged by the growing number of patients. This study was conducted to help this organization with the aim of designing a conceptual causal model of the interaction between supply and demand of health care.
Materials and Methods: This research is a qualitative study that was conducted in 2020. It presented a conceptual model in two steps in the first step, semi-structured interviews were used to extract important factors in the supply and demand of health services in hospitals. In the second step, the system simulation approach was used and the feedback relationships between the patient's routes to the hospital and the provision of medical services were presented.
Results: According to the study hypothesis, the prevalence of disease and budget allocation as an indicator of medical need and expected medical demand, positively affect the number of visits to hospitals of the Social Security Organization. Accordingly, four sub-models of patient flow, health care budget, treatment staff (physician, nurse) and hospital capacity were extracted.
Conclusion: Medical budgets allocated to hospitals to improve medical facilities and increase the number of staff, have created positive expectations among social security insured regarding the use of hospital services. Paying attention to providing sufficient manpower (doctor, nurse) and bed capacity with the budget which is spent for this service are the indicators of improving the quality of services.

---

Background:The most important and difficult process in any organization is to create change in the organization because today organizations have to react to changes in the environment.The purpose of this study was to investigate the effect of transformational management on quality of work life of the staff of Shohada-ye Tajrish Hospital in Tehran.
Materials & Methods:The is a descriptive-analytic and cross-sectional study that was conducted in Shohada-ye Tajrish Hospital in Tehran in 2020. Data collection tools were Transformational Management Questionnaire(Bass and Olivier)and Quality of Work Life Questionnaire(Walton 1973). Based on Cochran's formula, 234 employees of Shohada-ye Tajrish Hospital in Tehran were selected as study population.The reliability and validity of the measuring tools were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis. Pearson correlation test and structural equation test were used to analyze the data.
Results:The research findings indicated that there was a positive and significant correlation between transformational management with safe and healthy work environment, growth opportunity and security, fair and adequate pay, employee legalism,social affiliation,social cohesion and integration, development of human capabilities and the general atmosphere of working life. In addition, 92% of the variance in quality of work life was explained by the research model.
Conclusion:Considering the impact of transformational management on the development of human capabilities, senior managers should formulate and implement appropriate programs to improve the quality of work life and provide conditions for employees to enjoy their organization and work.

---

Introduction: Management is one of the most important factors that can affect the performance of an organization such as hospital. Therefore, identifying the management style used in hospitals can be useful empirical evidence to solve many hospital problems. In this study, the management styles used in the educational-medical centers of Qazvin University of Medical Sciences have been studied and determined.
Methods: In this descriptive-analytical study, a sample of 411 people was selected using random sampling method from a population of 2265 employees working in university hospitals in Qazvin. The required data were collected using a valid Clark management style questionnaire and through employee perception survey. Finally, the obtained information was analyzed in the space of STATA 15 and SPSS 16 software.
Results: Individuals reported the highest frequency (42%) for autocratic style items and the lowest frequency (25%) for delegating style items. Autocratic style had the highest total mean (3.22 of 5) and delegating style had the lowest total mean (2.87 of 5). Apart from autocratic style, there was a significant difference between hospitals in terms of the use of participative and delegating styles (p <0.05).
Conclusion: In all hospitals, the dominant management style was autocratic style. It is suggested that managers be taught about the techniques and functional benefits of participative and delegating styles.

---

-

---

Introduction: After the increase in the incidence and global spread of Covid-19 virus, medical centers faced a number of problems and challenges following this crisis. In order to increase the quality and safety of medical services and their optimal management, both in critical and non-critical situations, health care providers in different countries of the world have used various methods that increase the organizational commitment to improve quality.
Method: This study is a cross-sectional analytical research. Data were collected through a researcher-made questionnaire based on 903 accreditation standards notified by the Ministry of Health by available sampling method from 326 employees of Masih Daneshvari Center in 2021. Data were analyzed using SPSS software version 22.
Results: The results showed that out of an average of 8 areas related to accreditation standards, participants in the areas of professional ethics and compliance with the recipient of services, infection control, environmental health and waste management mentioned the most compliance in the emergency situation caused by Covid-19 and areas of clinical management and patient safety were ranked next.
Discussion and conclusion: According to the participants, observing the areas of environmental health and waste, service recipients and infection control has been more practical during Corona pandemic. The principles of accreditation seem to be accepted as quality improvement standards and can be an effective guide in preparing medical centers for emergency conditions.

---

   Introduction: The concept of patient satisfaction has become very important in the field of healthcare and the major part of this satisfaction is affected by the quality and variety of hospital hotel services.

The main purpose of this study is to analyzing the effect of quality of non-medical services (hoteling) of hospitals on satisfaction considering the mediating role of satisfaction with health services in Shahid Fayyaz Bakhsh, Shahid Hasheminejad and Masih Daneshvari hospitals.
Method: The type of this study is of applied and descriptive-correlational. The statistical population of this study included 48043 recipients of services in the mentioned hospitals. The sampling method is simple relative random judgment and Krejcie and Morgan table was used to determine the sample size.  information collected through a researcher-made questionnaire. In order to analyze the data and test the hypotheses from descriptive and inferential statistics through SPSS22 software and also to check the model fit and confirmatory factor analysis from Lee software. Shannon entropy method was used to measure the importance and weight of the studied variables.
Results: The weight and priority of each of the research variables implied that the views of service recipients in the field of non-medical services of hospitals, services during treatment, cleaning services, welfare services, human resources, buildings and facilities, and patient nutrition were respectively high to low priorities.
Conclusion: Recipients satisfaction of non-medical services was average. Establishing partnership management system and determining their medical priorities and needs might increase their satisfaction .