Journal of

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Background and Aim: Burnout is one of the most important factors that reduces the productivity of personnel. Therefore, this study aimed to determine the relationship between human resources management functions and job burnout from the perspective of managers and staff of deputy of Health in Iran University of Medical Sciences.
Materials and Methods: Subjects of this cross-sectional study consisted of 657 managers and staff members of deputy of Health in Iran University of Medical Sciences that 242 individuals were selected according to Morgan's table as the study population. Research data were collected using two questionnaires of burnout and human resources management functions.
Results: 174 (70.7%) participants in the study were women, with mean age and work experience of 41.3 and 15.8 respectively and a standard deviation of 7.35 years. 78.9% of married people and 69.1% of the participants were dissatisfied with the status of their salaries. The dimensions of consequential evaluation, transparent job description and comprehensive training with averages of 4.17, 4.12 and 4.03 out of 7 had the highest score among the various dimensions of human resources functions. Different dimensions of burnout showed that the highest mean was related to feelings of personal inadequacy and depersonalization (4.72). The results of the Pearson correlation test showed that there was a statistically significant relationship between human resources management functions and burnout with a correlation coefficient of -0.439 (P <0.05).
Conclusion: Job burnout can be significantly reduced with the improvement of human resources management functions.

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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.

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Introduction: Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces.
Methods: Data required for the study were collected from the household expenditure and income survey (HIES). The study population included 5547 households in the western provinces of the country. Logistic regression method was used to determine the most important factors affecting the use of dental services, and the focus index was used to measure inequality between income groups. Data analysis was performed using Stata software version 14.
Results: The highest and lowest percentages of dental services among households were related to Hamedan (7.02%) and Lorestan (3.19%) provinces, respectively. The results of the focus index showed that the benefits and costs of dental services were concentrated among households with higher socio-economic status. In other words, inequality benefits the rich. Being a female head of household and increased size of the household leads to a decrease in the use of these services. The higher education level of the head of the household and the increase in the number of employed and literate household members showed a positive relationship with the utilization of dental services.
Conclusion: Benefiting from dental services was significantly higher among higher socio-economic groups. These inequalities can be avoided by introducing and implementing targeted policies. Low-income households, lower education levels, and the unemployed should be the focus of health policies to address unmet dental care needs.

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Background: The performance of nurses as the largest human resources element of health care organizations has an important impact on the quality and results of patients' treatment. The main purpose of this research is to investigate the impact of internal marketing orientation on nurses’ performance by considering the mediating role of nurses’ engagement.
Materials & Methods: In this regard, while reviewing the implications of internal marketing orientation, engagement with the job and performance of employees, using path analysis and structural equation modeling, we examined the effect of internal marketing orientation on the performance of nurses by examining the role of mediation in job engagement. The study population included nurses of Sasan and Parsian hospitals in Tehran. Stratified random sampling and a questionnaire were used to collect the data. In order to analyze the data, Kolmogorov-Smirnov tests were used for the normal test and Path Analysis and Structural Equation Modeling for confirmation of hypotheses.
Results: Results showed that internal marketing orientation, through the engagement of nurses, influences their performance. Moreover, it was proved that internal marketing orientation has a direct relationship with engagement, but it does not directly influence nurses’ performance.
Conclusion: The most significant achievement of this research is that the managers and executives of healthcare centers can provide a more suitable environment for nurses caring patients, through improving working conditions. Implementing internal marketing orientation is one of the practices that can enhance nurses’ performance through affecting work attitudes, especially work engagement.

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Introduction: Health tourism is one of the most lucrative and competitive industries in the world and is a new field of tourism. The purpose of this study is to present a conceptual model of health tourism development on community welfare.
Materials and Methods: This research is qualitatively exploratory. The study population included university professors and health tourism managers. Fifteen people participated in the study through purposive non-probabilistic sampling and through semi-structured and in-depth interviews. Data analysis was performed with MAXQDA10 software and a grounded theory approach based on three stages of open, axial and selective coding. To check the validity, two methods of participatory feedback and receiving the opinions of colleagues, and to ensure the reliability of the interviews, two methods of retesting and two coders were performed.
Results: The data analysis was based on 100 keywords (open source). By identifying the relationship between the codes, 18 common concepts were categorized. The main concepts were categorized according to the axial coding method. Because traces of medical and health facilities, health tourism infrastructure, and relationship development policies were seen in most of the interviewees' quotes, they were selected as the central sub-categories of health tourism and these three items were placed at the center of the model. And other categories were associated with it.
Conclusion: The development of health tourism is a tool for the development of society and increases investment in the political, social, cultural and economic sectors of society, creates employment, increases income and people's satisfaction and vitality, and promotes the development of welfare, the improvement of the quality of life and wellbeing.

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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.

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 Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization.
Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions.
Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres.
Conclusion: The abuse in the health service provision is a high risk for  health care managers  in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

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Introduction: Hospitals have conflicts because of their complex nature, so they need managers with high emotional intelligence for effective conflict management. There are contradictory results in the correlations between demographic characteristics, emotional intelligence and conflict management; therefore, this study was conducted to investigate the correlation between them in different managerial levels of the hospitals.
Material & Methods: This analytical observational study was conducted on 100 senior and middle level managers (samples) of 8 selected hospitals affiliated to Tehran University of Medical Sciences in 2019.  We used a three-part questionnaire: Demographic characteristics, Emotional intelligence and Conflict management strategies, to collect data. SPSS 20 and statistical correlation tests including Pearson, t-test and analysis of variance were used for data analysis.
Findings: There was a significant direct relationship between the mean score of emotional intelligence and its domains with problem-solving strategy (P <0.001). Also, statistically significant correlations were observed between age, marital status, major, organizational position, and work experience in a managerial position with emotional intelligence (P <0.05). In addition, there was a direct and statistically significant relationship between avoiding and problem-solving strategies with age and work experience, respectively (P <0.05).
Discussion& Conclusion: It is necessary to take appropriate action to raise emotional intelligence and improve conflict management in hospitals, and according to the significant and direct relationships that observed, we can pay attention to select relevant managers for the hospitals.

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Background and Objectives: the  purpose of this study was to assess the validity and reliability of the Yas Job Satisfaction Questionnaire in order to develop a useful tool for measuring and evaluating job satisfaction among Yas Hospital Complex staff.
Materials and Methods: Face validity, content validity ratio, and content validity index were used to evaluate the questionnaire's validity and reliability. Cronbach's alpha and the halving technique were used among 150 medical personnel in this cross-sectional study The key elements of the final questionnaire were four dimensions of leadership style, job nature, reward system, performance appraisal, and organizational climate.To report the mean of quantitative variables at different levels, qualitative factors were evaluated and analyzed using analysis of variance (ANOVA).
Results: There were 111 females and 39 males among the 150 participants. The content validity ratio and content validity index were both acceptable.Cronbach's alpha method reported a reliability of 0.92 for the questionnaire, indicating that the internal reliability is acceptable.The lowest level of satisfaction was in the leadership style dimension, with an average of 10.53 4.91, while the highest level of satisfaction was in the job nature dimension, with an average of 21.24 7.05.

Conclusion: The Yas Job Satisfaction Questionnaire has acceptable validity and reliability to assess the level of job satisfaction among medical staff, according to the findings of this study. Furthermore, job satisfaction was moderate in most of the dimentions surveyed.

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Objective: Organizational bullying leads to uncontrollable stressful situations in which people cannot perform their tasks properly and relax and this may lead to fatigue and exhaustion. The aim of this study is to determine the effect of organizational bullying on emotional exhaustion mediated by nurses' psychological distress.
Methodology: This study is applied research and descriptive. The population of the study is the nurses of Shariati Hospital in Tehran. 148 questionnaires returned Based on simple random sampling and the research data analyzed using SPSS and AMOS software. Research variables measured using the questionnaire of organizational bullying of Inerson et al. (2009), psychological distress of Kessler et al. (2003) and emotional Exhaustion of Maslaj and Jackson (1981).
Results: Organizational bullying has effect on nurses' emotional Exhaustion directly and also effect on nurses' emotional Exhaustion through mediation of psychological distress indirectly.
Conclusion: The results of the present study have brought innovations in the field of organizational bullying and psychological distress of nurses and also help hospital managers to understand the effect of organizational bullying on nurses' emotional Exhaustion by providing comfortable working conditions to prevent emotional Exhaustion. Also because of the effect of organizational bullying on psychological distress, managers have to create a friendly atmosphere to prevent such psychological states so that they can provide appropriate services. 

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Background: Covid-19 pandemic peak put additional strains on healthcare system. In this crisis, the resilience of nursing staff is critical. This study aimed to investigate the relationship between burnout and resilience in frontline nursing staff working in high-risk areas during the outbreak of Covid-19 pandemic.
Materials and Methods: The present study is a Descriptive-analytical survey, and the target group is Iranian nurses. According to the Ministry of Health statistics, 125369 people are participated in this study. information is collected from 384 people by cluster distribution using questionnaire. The statistical analysis in this study is performed by SPSS and SMART-PLS software
Results: According to the study, all the collected information is normal. Based on factor analysis, there is an inverse significant relationship between resilience and burnout, and also, the sense of success has a significant effect on resilience as part of burnout.
Conclusion: In order to increase the resilience of nursing staff in such conditions, it is necessary to pay more attention to the factors affecting their burnout and plan to minimize it. Developing educational programs and adding diversity in service delivery might be useful to enhance personal feelings and also reduce burnout.

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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.

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Background and Aim: As difficulties increase, the level of uncertainty and risk in the supply chain increases. Medicine is a strategic product and is directly related to community health. The aim of this study is to evaluate the risk factors of pharmaceutical supply chain with artificial intelligence methods.
Materials and Methods: By reviewing the texts and interviewed 6 adept experts who had a Master’s degree and Ph.D. and had experience between 7 and 15 years in the field of risk and pharmaceutical supply chain, risk factors were identified. Finally, using multilayered perceptron neural networks and support vector machines with polynomial linear kernel functions and radial base in two low-risk and high-risk classes were classified in Python software.
Results: 22 factors were identified and classified using neural networks in 5 categories: assets, network and transportation, government and market, strategy and supplier. Shift in interest and inflation, Changes in exchange rates, Inflexibility in production and disruption of customer service are the most important risks in the pharmaceutical supply chain, respectively. The results of evaluation criteria showed that the multilayer perceptron model had better performance than the support vector machines with linear, polynomial and radial basis functions.
Conclusion: The results showed that artificial neural networks are able to classify pharmaceutical supply chain risk factors with acceptable accuracy. As a result, classification of risk factors with an accuracy of 97/07% indicates the high ability of multilayer perceptron network in risk assessment of pharmaceutical supply chain.

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   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 .

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Introduction: Root cause analysis is one of the most important tools in disaster management that aims to identify the real causes of an issue and find ways to eliminate them. Surgery is one of the areas in which the possibility of clinical error is significant. Therefore, the study aims to explain the weaknesses and challenges of root cause analysis in surgical events and identify the experience of staff around the technology.
Materials and methods: This qualitative study was conducted through interviews in 2021. Twenty members of the root cause analysis team working in teaching hospitals affiliated to Iran University of Medical Sciences were interviewed. After conducting the interviews, MAXQDA software version 10 was used to analyze the thematic content and extract concepts related to the research objectives.
Results: The majority of participants were female, head nurse, aged 30 to 40, work experience of 11 to 15, and employed in Hasheminejad Hospital. The most important weaknesses identified for root cause analysis included the lack of proper implementation of the root cause analysis process and the lack of participation of individuals, hospitals and universities in this process.
Conclusion: Health managers and policymakers should address the weaknesses of root cause analysis by explaining the necessity of the process, root cause analysis immediately after each clinical event, evaluating the effectiveness of root cause analysis, and providing adequate feedback from the authorities. Upstream therapy, creating a culture of root cause analysis, providing the necessary facilities to perform these analyzes, providing clear instructions to encourage and punish employees.

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Background: The aim of this study was to evaluate the effect of health sector evolution plan (HSEP) on the prevalence of cesarean section and vaginal delivery in public hospitals in Kermanshah province.

Methods: In the present study, cesarean section (C-section) and vaginal delivery data were collected and evaluated in 17 public hospitals from 2009 to 2019. The main variables of this study included the prevalence of C-section and the prevalence of vaginal delivery for 121 months, both were obtained by dividing the number of deliveries by C-section and vaginal delivery by the total number. Interrupted time series analysis was used to examine the effect of HSEP on the prevalence of cesarean and vaginal delivery rates.

Results: The prevalence of C-section before and after the HSEP was 42.5% and 43.2%, respectively. Months before the intervention, the rate of C-section was increasing by 0.13%, which was statistically significant. In the first month after the intervention, the prevalence of     C-section decreased by 3.6% that was statistically significant. The share of C-section in the months after the implementation of the HSEP showed a monthly increase of 0.12% compared to before the intervention, which was statistically significant.

Conclusions: The results of the study showed that the HSEP has led to a significant reduction in C-section in short term, but in the months after the implementation of the plan, the prevalence of C-section has increased again.

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Background: Identification of competencies is necessary base for a succession plan and efficient human resource management. Studies show that this important issue has been neglected by using the competency model at the middle-level nurse managers.
Since, the methods based on fuzzy logic provide the possibility of mathematical formulation of ambiguous concepts, such as competence. The aim of this study was to design a competency model for middle-level nurse managers using FDM in the second half of 1399.
Materials & Methods: This study was conducted according to health system management studies. The population included all managers of nursing services (matrons) of hospitals affiliated to Tehran University of Medical Sciences. Census sampling used and research samples included 14 nursing service managers (as experts). After reviewing literatures, an initial conceptual model was designed. In the following, two next steps were conducted as a survey form was used to receive the opinions of experts confirming the model leveling. In the second step, the indicators were screened using the FDM.
Results: All participants were female and 9 people had a master degree. The experts' agreement with the model leveling was 90%, which indicated that it was approved. In FDM, the indicators with crisp values higher than 0/7 were confirmed by experts. The design model consisted of 3 dimensions technical, relational, perceptual, 6 components, 14 indicators and 28 sub-indicators.
Conclusion: This study showed that the criteria for selecting middle-level nurse managers include various dimensions of competence including technical, relational and perceptual. Senior managers can use the results of this research to achieve an appropriate planning for succession plan.

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Background: thousands of people die or suffer from irreversible damage due to lack of timely and adequate services in medical centers. This research seeks to identify and prioritize factors affecting the demand for patient transfer and provide the most effective measures to facilitate this process.
Materials and Methods: This research is combined in terms of method and inductive research in terms of type of research. The population of study is the senior and middle managers of Guilan University of Medical Sciences who were selected as a sample member using purposive sampling method. The factors affecting patient transfer demand were identified using qualitative data obtained from exploratory studies, then these factors were prioritized using fuzzy Delphi method.
Results: In the first part, a set of factors affecting the demand for patient transfer were identified, and in the second part, the importance and priority of these factors were determined. The results of the research showed fourteen main factors, including disproportionate distribution of specialized human resources, ineffective planning, inefficient management, and inefficiency of human resources.
Conclusion: Inefficient organizational processes and organizational structures along with real needs have been identified as reasons for patient transfer demand,which requires special attention of supervisors and management of organizational development and administrative transformation of universities. It seems that the formation of a special monitoring and planning working group to remove obstacles in a centralized manner at the highest organizational level and a special look at the reports of the care monitoring center as the most effective measure can be used to manage the dispatch process, planning, Monitor and remove obstacles.

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Background and Aim: Hospital is organization which its performance improvement is very important. In order to do this, we must evaluate the allocated resources and performance of hospitals. Calculating hospitals efficiency is one of the possible ways to evaluate the performance of them. In this study, the efficiency of allocated financial and human resources of public hospitals by provinces is examined.
Materials and Methods: This study was conducted in 2017-2018. Data were collected from 31 provinces of Iran. Input (including: number of physicians, number of nurses and number of active beds per ten thousand population) and output (number of hospitalizations and number of outpatients per ten thousand people). Data were collected from studies. The efficiency analyzing of the provincial treatment department was performed with DEAP software.
Results: The input population (nurse, doctor, bed) is related to hospitals and health centers in Semnan, Yazd and Mazandaran provinces And the least amount of input was related to Sistan and Baluchestan, Khuzestan, North Khorasan provinces. The highest output (inpatient and outpatient) belongs to East Azarbaijan province and the lowest output belonged to Hamedan province. Efficiency score, variable return to scale and constant return to scale for all hospitals in the country are 0.565, 0.813 and 0.47, respectively.
Conclusion: proper and correct distribution of resources between provinces may increase efficiency of resource distribution.

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Introduction: Despite many challenges, public-private partnership in hospitals is recognized as one of the most attractive investment platforms for the private sector. This study conducted to assess the challenges of private sector partnership with public hospitals using the public-private partnership model in public hospitals in Yazd.
Methods: The present qualitative research conducted in 2021. The viewpoints of 15 faculty members, directors, managers and operational experts on the participation of the private sector, those related to the transfer and contracts and the parties of the private sector are extracted through a semi-structured interview guide and analyzed using content analysis in three stages.
Results: A total of 10 main themes including economic and policymaking problems, insufficient manpower readiness, lack of support authority, weak partnership laws, lack of knowledge and experience of managers in partnership, lack of financial transparency, conflict of interest, poor coordination, lack of cultural readiness and trust-building and lack of plans and supervision in the field of partnership in 28 sub-themes extracted.
Conclusion: There are challenges related to policymaking issues and the resulting instability, incoordination of different units, unpreparedness of manpower and contract details in using different models of public-private partnership in hospitals, in which the use of the same procedures, transparency and the meeting requirements of the private sector are recommended for partnership and the formulation of laws and contracts free from any shortcomings and weaknesses that could lead to the loss of the public sector.