Journal of

---

---

---

---

---

Background: Today, one of the effective ways of providing services is contracting with outside of organization and outsourcing. Objective: The current study aimed to investigate effect of outsourcing on performance of nutrition unit in studied hospitals. Methods: The current descriptive – analytical study performed in 2013, in two non-military hospitals and two military hospitals. 602 patients and 930 personnel were selected by simple randomized sampling. Data gathering performed by Patient and personnel satisfaction questionnaire, check list of kitchen's hygiene condition and check list of assessing the time spent by hospital manager for nutrition unit. Data on personnel cost were collected through accounting department. Data analysis performed by spss19 software. Findings: Patient and personnel satisfaction with food services of non-military specialized hospital (4.03±0.45) were more than military specialized hospital (p= 0/03 for patients & p= 0/021 for personnel) and in non-military general hospital were more military general hospital (p= 0/039 for patients & p= 0/028 for personnel). Hygiene condition of non-military hospitals kitchen was better than military hospitals, the time spent by hospital manager for nutrition affairs in military specialized hospital was 1.5 times more than non-military specialized hospital and in military general hospital it was 6.5 times more than non-military general hospital. Personnel cost in nutrition unit of military hospitals were 1.5 times more than non-military hospitals. Conclusion: Regarding the positive impact of outsourcing on performance of nutrition unit in hospitals, it is recommended that this strategy be applied in nutrition unit of military hospitals.

---

Background: Depression is a common disorder with incremental trend among patients with hemodialysis. This study conducted in order to determine correlation between social support and depression among patients undergoing hemodialysis of Kerman city.

Materials and Methods:  This study was a cross-sectional one. 182 hemodialysis patients referred to health centers of Kerman were selected by census sampling method. data was collected Using questionnaires  including demographic information, Beck's Depression Questionnaire (BDI) and Social Support Questionnaire (ESSI: Enriched Social Support Instrument) and analyzed  by SPSS  software version 17 utilizing descriptive statistics (mean and standard deviation) and Pearson Correlation Coefficient test.

Results: 68.1% of the subjects had some degree of depression. Also, 83% of participants reported good social support. Furthermore, Assessing the relation between depression and social support revealed an inverse relationship between depression and social support (P =0.005), increasing social support occurred decreasing depression as well. 

Conclusion: Study results indicated high prevalence of depression among the patients. It seems special attention in should be paid to psychological issues in hemodialysis wards. Nurses can prevent depression incidence by recognizing high risk individuals in term of perceiving social support among these patients. 

---

Background: Physiotherapy information system is one of health information systems which used to increase the efficiency and effectiveness of physiotherapy department. Studies have revealed due to usability problems, users' interaction with some information systems is complicated. This study aimed at evaluating users' interaction problems with physiotherapy information system.

Materials and Methods: This study was a cross-sectional and descriptive one which performed using heuristic evaluation method; the users' interaction problems of a physiotherapy system among 105 hospitals were identified, classified and rated based on their severities by three evaluators. Data were gathered using a data collection form designed in Excel software.

Results: In this study, 82 unique interactive problems identified which majority of them 28% (n=23) were related to unconformity of system design with real world conventions with major mean severity of the problems. The lowest numbers were related to the problems including lack of guidance, system documentation and error prevention with major and minor severity respectively.

Conclusion: A number of systems, which are used in many health care centers such as assessed system in this study suffer from several problems which endanger user interaction about the systems can lead to error and patients' harm. To identify and eliminate this type of problems, it is recommend that usability evaluation of these systems to be carried out regularly to enhance users' satisfaction, workflow improvement and patient safety. 

---

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

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

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

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

---

  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: Hospital accreditation is assumed as an effective control mechanism for health systems to improve quality and efficiency. Current study thus, seeks to look into the relationship between hospitals’ accreditation and efficiency
Materials and Methods: In order to measure efficiency, hospital inputs and outputs included the ratio of physician and nurse to bed, mortality and nosocomial infection rate and quality of inpatientservices were used. A sample of 554 hospitalized patients selected using stratified random sampling
method. Data gathering instruments were researcher-developed questionnaire and checklists. DEAP and SPSS software deployed to assess correlation between accreditation rank and technical efficiency
Results: Average hospitals’ technical efficiency score was 0.94 indicating an improvement capacityof %5.1 for hospitals efficiency. The mean quality score was 4.13 out of 5( in the range of 3.9-4.3)There was no correlation between hospitals accreditation rank and their technical efficiency
Conclusion: According to the results, it seems efficiency should be also considered in accreditationmetrics. In addition, for measuring efficiency, performance based inputs and specifically outputs tohave reliable results should be chosen

---

Background: Job burnout is a result of long-term job stress, which can reduce the quality ofeducation and provision of services. This study aimed to investigate the relationship between jobburnout and its dimensions with occupational stress in Isfahan University of Medical Sciences in 2018.
Materials and Methods: The present study was a descriptive-analytic one. The sample of studyconsisted of 137 staff in faculties of Management and Medical Information, Advanced Technologies inMedicine, Rehabilitation and Nursing and Midwifery in Isfahan University of Medical Sciences using
convenience sampling method in 2018.The study tools were demographic s , Maslach and OSIPOWquestionnaires. Data was analyzed using SPSS version 23 software by descriptive statistics andinferential statistics such as ANOVA, T-test and Pearson correlation coefficient.
Results: Emotional exhaustion calculated in low level (45.2%), depersonalization in high level (45.2%), personal accomplishment in high level (75.3%) and the most participants had normal stress(54.8%). Similarly, based on Pearson Correlation Coefficient, there was a positive significantrelationship between job stress and job burnout and its dimensions, but there was no significantrelationship between personal accomplishment and job stress.
Conclusion: Study results revealed that the higher job stress among employees, the higher jobburnout among employees. As a result, implementing the interventions to reduce occupational stressand strengthen some resources can be helpful to reduce the burnout of employees.

---

Background:  Development of the tourism sector and health tourism specifically can improve the Non-Oil GDP. In this regard, in accordance with the policies of the Ministry of Health and Medical Education, international patient department establishment has been facilitatated health tourism development in the affiliated hospitals. This study aimed to evaluate the performance of international patient department  and its effect on the attraction of medical tourists among hospitals affiliated to Medical Sciences Universities in Tehran City.
Matrials and Methods: This analytical cross-sectional study was designed and conducted in 2017. Study population consisted of all hospitals affilliated to  Tehran University of Medical Sciences (TUMS), Iran University of Medical Sciences (IUMS) and Shahid Beheshti University of Medical Sciences (SBMU). In this study,  hospital entrance criteria was certified by the Health Tourism Department of MOHME. Data was collected using the health tourism assessment checklist which approved by the MOHME. SPSS version 24 utilized to data analysis using descriptive and Inferential statistics.
Results: The study results revealed that  the overall performance of international patient department was evaluated at a desirable level (87.5 score) in hospitals of Tehran city.  Hospitals had the highest rank of hoteling indices (95/100), in compliance with the regulations and functional indicators gained 87.03 and 82.2 score, respectively.  Also, data analysis highlighted that there was no significant difference between hospitals of TUMS, IUMS and SBMU. The establishment of international patient department had no effect on health tourists attraction.
Conclusion: Considering the purpose and mission of international patient department to facilitate the provision of quality and satisfactory services in health tourists, management and oversight mechanisms for the standards implementation such as patient admission, follow up in the origin country and development of hospital marketing policies in order to attract international patients and increase hospital incomes are recommended.

---

Background: with increasing demand for treatment, patients are monitored with help of Internet of Things(IOT). Patient's monitoring devices and technologies include heart rate measurement, blood pressure measurement, blood glucose and other vital signs. The purpose of study is to provide a model of clustering patient physical monitoring gadgets and apps in Healthcare Internet of Things (HIOT) environment using data mining techniques, so based on the needs and characteristics of the user, the more appropriate results of choosing technologies acquired.

Materials and methods: This study is a review and functional since its result. The data includes 6 unique features of 60 selected technologies including function, price, connectivity route, power supply, location and type of use that has been extracted from R&D and advertising sites of technologies and also relevant articles. data analysis method is clustering technique and K-medoids algorithm. to identify the most effective features, random forest algorithm has been used.

Results: the proposed clustering model takes into account 6 as inputs and clusters gadgets and apps in accordance with selected characteristics as the model outputs. clustering problem data is clustered in 4 categories.  Silhouette index is 0.45, which indicates the validity of the model. The type of application and then the price had the greatest impact on clustering.

Conclusion: By this model, patients or users can find the most appropriate technology based on the type of disease and other effective features, such as price. So with accurate physical and momentary monitoring, disease progression decrease and prevention of disease will improve.

---

Background: Activity-Based Costing Analyzes the Activities Performed in the Service Delivery Process and Accurately Identifies Costs to Improve The Performance and Efficiency of The Delivery Units and Calculates the Cost of Each Activity by Identifying Services and Activities. The Purpose of This Study Was to Calculate the Cost of Radiology Services Based on Activity Based Costing Method In Firooz Abadi Hospital.
 
Materials and Methods: This is a descriptive retrospective study conducted in 2018. Data were collected through interview with Hospital officials, direct observation and from existing documents in hospital. Data entry was done through Excel software and analyzed Based on activity-based costing system in eight steps.
 
Results: Based on the Findings of this Study, Four Types of Imaging Services Were Commonly Found In Firooz Abadi Hospital. From Total Radiology Costs, 79.3% Were Estimated to Be Related to Direct Costs and 20.7% to Indirect Costs. Finally, the Cost Per CT Scan Service Was 725,133 Rials, Mammography 608,054 Rials, Radiology 809,165 Rials and Ultrasound Service 512,692 Rials.
 
Conclusion: Results of the Study Indicated that Direct Costs accounted for most Costs in Radiology Unit, So Improving Performance and Policies in Health System, Particularly in Human Resource Management, Service Consumption Standardization and Staff Training Suggested to Cost Reduction.
 

---

---

Introduction: change and innovation for gaining competitive advantage in health system will lead to the continuation of activities in health care. Therefore, managers ' entrepreneurial orientation to promote organizational goals in the turbulent health industry is one of the requirements of human capital managers. Materials and Methods: In this study , semi-structured interviews were conducted to identify promoting and obstacles in the organizational entrepreneurship factor to design entrepreneurial human resource management model and were analyzed by content analysis method . The population of the study consisted of operational and middle managers in the field of health, among which 20 were selected by non-probability and snowball sampling methods .
Results: The results showed that organizations in health care areas are influenced by three factors of managers , employees and environment of the organization and have an impact on the organizational entrepreneurship variable in human capital management. In the case of obstacles and promoting factors, employees and managers had the highest number of codes (meaning unit) respectively.
Conclusion : Human capital managers in the field of health by creating the necessary ground in strengthening the driving factors and overcoming the confounding factors of corporate entrepreneurship in their management strategies and processes promote the performance of the staff and personnel  and consequently play a significant role in the health of the entire society .

---

Management is a key pillar in order to achieve the goals of health systems. An efficient structure for identifying, recruiting, training, promoting, monitoring and evaluating the performance of managers is highly likely to help the specialization of management, prevent non-specialized selection processes and possible deviations. Given the managerial level in which they play a role, health managers ought to have the required competencies and characteristics. The leading countries generally thrive to have structures where proper candidates are systematically placed in the position of management and promoted to the higher positions. Therefore, the experiences of these countries should be solicited in line with the local social, political, economic and cultural factors in order to achieve the health system goals.

---

Background and purpose: One of the main challenges of human resource management in hospitals is the proper distribution of nurses, which is necessary to improve the efficiency and quality of health services. In this review, this rate is compared in selected countries and Iran in order to provide the necessary evidence for managers and policymakers in human resource management
Materials and Methods: This study was conducted as a field review in 2019 with the aim of comparing the standards of nurse distribution to beds/wards in selected studies. The search was conducted with related keywords in "Scopus", "Web of Science", "PubMed" databases without a time limit.
Results: The distribution of nursing per bed was reported in Australia, England, Northern Ireland, Wales, Israel, America, California, Pennsylvania and New Jersey. In Iran, the rate of nurses to intensive beds was slightly higher than the average and the ratio of nurses to ordinary and emergency beds was lower than the average of selected countries average.
Conclusion: Nurses' distribution was generally lower than the average of other countries, and this ratio was lower in some sectors and higher than the average in some sectors. Recruitment and redistribution of the appropriate nurse in different sectors by benchmarking successful countries are suggested.

---

Background and purpose: Considering the dimensions of organizational bullying and the context of its creation in the emergency department of the hospital, the decrease in the quality of patient care and the increase in dissatisfaction with the services received and the limited research studies in this area, the research was conducted in the emergency department of a hospital of Yazd University of Medical Sciences.
Materials and methods: To carry out this descriptive-analytical research, the interpretive structural modeling method was used. The experts included 30 doctors, nurses, and nurses who were either working in the emergency department of a Yazd University of Medical Sciences hospital or had experience of service in this department. From the extraction of these factors, they were returned to them for scoring, and the effects of these factors were measured from their point of view, and the final analysis was done by MATLAB software.
Results: The results show that the greatest effect in reducing bullying is related to "adequate training for personnel to communicate" and "proper and courteous treatment in the face of clients" (with influence power of 5) and the least effect is related to "creating a suitable comfortable environment". and "Perform appropriate triage" (with penetration power of 1).
Conclusion: Considering the destructive effects of bullying, creating appropriate mechanisms to reduce this phenomenon shown in this research and using the factors identified by the people involved in bullying can prevent this phenomenon, which occurs frequently in the emergency room of the hospital. 

---