Journal of

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Background and Aim: Today we are witnessing tremendous advances in medical data mining. The data, by analyzing and discovering the relationships between them, can lead to algorithms that help us prevent or treat many diseases. Meanwhile, genetic diseases have attracted a large part of the attention of the medical world because the birth of children with genetic disorders imposes a great financial, psychological and emotional burden on society. Therefore, the aim of this study is to present an algorithm as a secondary screening test before performing cell and molecular tests.
 
Material and Methods: In this study, 1000 cases of pregnant women who were in moderate or high risk group after screening tests were studied. Their clinical information was stored, missing data was deleted, and records were integrated. Then, using Clementine software, data mining and data correlation were performed, and finally a suitable algorithm for diagnosing the disease was performed. Genetic mutations were identified.
 
Results: By applying five algorithms, neural networks, support vector machine, binary decision tree, multiple decision tree and logistic regression on the data, it was found that the neural network algorithm with 97.522% accuracy has the highest success rate in Diagnosis of genetic-chromosomal diseases before birth.
 
Conclusion: The use of genetic algorithm as a screening test causes less people to be candidates for costly and dangerous cellular and molecular tests and can be used as a tool to help detect the disease. To be used in the medical world.

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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.

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Introduction: In the present era, the implementation of open innovation process is necessary for any organization, and hospitals as the main medical centers are no exception. In fact, hospitals, as health operational units, are always directly exposed to changes in the field of health services. Therefore, the present study has investigated the factors affecting open innovation in public hospitals in Guilan province.
Methods: From the point of view of purpose, this research is an applied study and in terms of data collection, it is in the category of descriptive research, which was conducted cross-sectionally in 1400. The statistical population of the study was 1600 senior managers and staff of public hospitals in Guilan province. For sampling, a non-randomized judgmental sampling method was used to access community members (senior managers and employees with at least a bachelor's degree). 250 questionnaires were used to perform the test. Data collection tools are standard questionnaires. The reliability of the questionnaire was confirmed through Cronbach's alpha, and the validity of the questionnaires was confirmed through the face and content validity, convergent and divergent validity. The structural equation modeling method has been used to test the research hypotheses. The software used in this research is SPSS 26 and Smart PLS3.
Results: The results of the structural equation modeling test showed that among the external factors, cooperation with partners and the user, among the internal organizational factors, organizational structure, exploratory learning, and organizational culture, and finally among the individual internal factors, organizational motivation affects the open innovation of public hospitals in Guilan province. The impact of trust between partners, technology, personality traits, and knowledge on hospital open innovation has been rejected.
Conclusion: In collaboration with other health care services, universities, and users, hospitals should develop appropriate policies to transition from a closed innovation system to open innovation, and support effective measures in this regard.

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Background and purpose: This research was conducted with the aim of determining the relationship between the implementation of the strategic plan and the performance of the hospital. The importance of knowing the factors affecting the implementation of the strategic plan and its identification leads to better planning and the correct implementation of the strategic planning process.

Methods: The current research is a descriptive analytical research, in terms of cross-sectional time and practical results, and it was carried out in 2018. The research population is all the people who have played a role in the drafting of the strategic plan. This research has used the census, which filled the questionnaire in a high percentage of the statistical population. After collecting the data, the information was entered into the software and SPSS version 16 software was used to analyze the data.

Findings: The relationship between the implementation of the strategic plan and the performance of the hospital is direct and strong. Among all parts of the strategic plan, customer management plays a more important role than other parts of the strategic plan in improving the performance of the hospital.

Conclusion: In order to have optimal performance in a hospital, we need detailed strategic planning, and this plan must be implemented carefully and properly monitored so that it can bring us optimal performance.

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Background and Objectives
In recent years, medicine supply chain management has become more significant, especially after the Covid-19 pandemic. The most important issue is supply chain cost control. If the drug inventory is not properly managed, it will lead to issues such as the lack of inventory of certain drugs, provision of excess inventory, increased costs, and, finally, patient dissatisfaction.
Materials and Methods
In this study, an attempt has been made to predict and manage the pharmaceutical needs of hospitals using an efficient deep-learning algorithm. The drug consumption data for ten years of Besat General Hospital in Hamedan are extracted from the HIS database. As a case study, the accuracy of the predictive model is evaluated, especially for cefazolin. We use a deep model to analyze the medical time-series data efficiently. This model consists of a Long Short-Term Memory network, which can sufficiently recognize the change history in time-series prediction applications. The proposed model with many adjustable parameters in the deep architecture will bring good performance to overcome the complexities of the learning problem.
Results
Using the deep learning method can increase robustness by reducing the effects of complexity and uncertainty in medical data. The average forecasting error for the proposed method is 0.043, and the measured values for RMSE, MAE, and R2  are 0.335, 0.260, and 0.851, respectively.
Conclusion
A comprehensive comparison between some other predictive methods and the implemented model shows the outperformance of the proposed approach. Additionally, the evaluation results indicate the efficiency of the proposed approach.

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Background and purpose: In response to evolving external environments, organizations must renew their valuable resources to sustain competitive advantage. Dynamic capabilities empower organizations to effectively navigate these continual changes. Essentially, dynamic capabilities foster a stable behavioral orientation within organizations, facilitating integration, reformulation, renewal, and reconstruction of resources and capabilities, particularly enhancing and revitalizing core capabilities in response to dynamic environments to achieve sustainable competitive advantage. This study explores the influence of dynamic capabilities on constructive collaboration and supply chain performance within healthcare centers. Dynamic capabilities are categorized into four perspectives: sensitivity, learning, coordination, and integration. Constructive collaboration serves as a mediating variable, while technological orientation acts as a moderating variable in the model.
Methods: This study adopts an applied purpose and descriptive-survey method. The statistical population comprises employees at Ayatollah Taleghani Gonbadkavus Hospital. Using a questionnaire adapted from Mandal's (2022) study, the research establishes relationships between variables, categorized as descriptive-analytical. The questionnaire's validity was assessed using convergence and divergence methods, and reliability was confirmed using Cronbach's alpha and composite reliability. Data analysis employed structural equation modeling and Smart-PLS software.
Results: Data analysis reveals a significant relationship between the learning, coordination, and integration perspectives of the hospital and constructive collaboration. However, no significant relationship is observed between the sensitivity perspective and constructive collaboration, nor between constructive collaboration and the performance of the healthcare system's supply chain. A significant relationship exists, and technological orientation does not moderate the relationship between the sensitivity perspective and learning with constructive collaboration, but it moderates the relationship between the coordination and integration perspective with constructive collaboration.
Conclusion: Improvements in collaborative efforts across various hospital departments, decreased risks of medical errors, enhanced service quality, and elevated professional status of staff are among the outcomes of assessing the performance of hospitals' sustainable supply chains.

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Background and Purpose: Medical imaging is one of the most expensive sections of a hospital due to the use of superior technology, specialized personnel, and adherence to special protective regulations, all of which have a direct impact on the diagnosis and treatment of diseases. Time-driven activity-based costing (TDABC) provides an overview of hospital activities, enabling the identification and management of costs and resources with greater accuracy and ease. The purpose of this study is to examine the total costs of services and the unused capacity of resources to provide financial management solutions for hospital administrators.
Materials and Methods: This descriptive and retrospective study was conducted on the statistics and accounting data of a general hospital in Tehran in 2018. The study falls under the category of applied research due to the potential use of the results in financial management and resource consumption. The data collection method included the review of documents and financial statements, timing of all activities in the imaging department, and calculations based on the time-driven activity-based costing method, using Excel software, with the elimination of the cost of unused resources.
Results: The study found that the total cost was mostly below the approved tariffs, with the main cost components being 34% manpower, 23% overhead, 22% equipment, and 15% consumables. The findings indicated that only 58% of resource provisioning expenses played a role in determining the total cost of services.
Conclusion: The findings of this research suggest that reducing the unused capacity of resources and organizational reforms can decrease the total cost of services, increase profitability, and optimize resource usage to enhance the quality of hospital services.

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Background and Purpose: Experiential marketing is a type of marketing strategy that attracts and engages customers by creating real-life experiences, allowing them to form lasting positive memories. Creating an excellent customer experience in the healthcare sector is challenging. Therefore, the aim of this study is to investigate the effect of experiential marketing on the intention to revisit social security clinics in Qom province.
Methods: This quantitative and applied research utilized a survey approach for data collection. The statistical population comprised clients of the social security clinics in Qom province. A total of 522 individuals were invited to participate in the study using stratified random sampling. Data analysis was conducted using covariance-oriented structural equation modeling with the help of Amos V24 software.
Results: The effect of experiential marketing (with dimensions of sensory experience, physical experience, emotional experience, cognitive experience, and relational experience) on the intention to return to the clinic was confirmed, with a path coefficient value of +0.540. Additionally, the structural indicators of the model and the validity of the constructs demonstrated a good fit for the model.
Conclusion: Experiential marketing, along with the enhancement of patient-doctor relationships, is crucial. Patient-centered facilities can increase the likelihood of patients returning to clinics by focusing on experiential marketing, providing amenities, and utilizing technologies to improve service delivery.

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Background and purpose: The organ transplant network is among the most complex and challenging systems in the healthcare sector. This study presents a three-objective hierarchical location model for kidney transplants, aiming to simultaneously minimize total time and costs while maximizing geographic equity in the supply and demand network for donated kidneys. Various transportation modes within the network are also analyzed.
Materials and Methods: This applied research was conducted over a one-year period in 2022 (1401 in the Iranian calendar) in the province of Sistan and Baluchistan. The proposed mathematical model was implemented in GAMS software and solved using the Torabi-Hosseini method and epsilon constraint technique.
Results: The model recommended establishing candidate locations for organ collection units and transplant centers without the need for air transport equipment. It suggested that only the candidate location number 2 at Zabol Hospital Transplant Center should be equipped with air transport facilities, while the other proposed locations do not require the establishment or use of air emergency services.
Conclusion: The results indicate that the designed kidney transplant network is practical and feasible. Efficient network management ensures that all organ recipients, even those far from the provincial center and in remote areas, have timely access to the necessary facilities and equipment for transplant operations.

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Background and Purpose: Infections related to inadequate healthcare practices can have adverse effects on healthcare systems. This study aims to identify the gap between the current handwashing practices and standard levels by determining the frequency of handwashing among staff at Shahid Modares Hospital in Tehran.
Methods: This descriptive cross-sectional study was conducted in the wards of Shahid Modares Hospital between 2018 and 2019. The tool comprised two parts: job information and hand hygiene practices at different times and specific actions. Observers directly monitored all staff in each shift using a headcount method. Each column represented the hand hygiene compliance score of a specific professional group, allowing simultaneous performance evaluation.
Results: Out of 640 observed instances, 202 involved the use of disinfectants, 255 involved handwashing, 111 involved glove use, and in 71 instances, hand hygiene was not observed. The highest compliance occurred when staff intended to contact the patient's body, while the lowest compliance was observed after performing surgery on the patient.
Conclusion: Given the significant role of nurses in therapeutic interventions, multifaceted training interventions, the drafting of hand hygiene policies, and increasing awareness among department officials should prioritize this group of employees. These measures aim to bring practices closer to desired standards and prevent unwanted consequences.

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Background and purpose: The laundry unit is one of the most critical support services in a hospital. Optimizing processes and implementing effective management strategies in this unit can significantly impact cost management. This study aims to examine various aspects of hospital laundry units.
Methods: This research was conducted across the teaching hospitals affiliated with Tehran University of Medical Sciences. The study employed a multi-step approach. First, the most crucial performance criteria for laundry units were identified through a fuzzy Delphi technique, consulting 20 experts in the field. These criteria were then weighted using the Step-wise Weight Assessment Ratio Analysis (SWARA) method. Finally, hospitals were ranked using the VIseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method.
Results: The analysis of main criteria in the laundry unit revealed the following significance levels: "performance criteria" (56%), "equipment and facilities" (28%), and "cost management" (16%). Among the sub-criteria, "process" emerged as the top priority with a weight of 0.285, followed by "general laundry section regulations" (0.155), "safety and health" (0.139), and "general" (0.081).
Conclusion: The findings highlight the paramount importance of the "process" sub-criterion in hospital laundries. Consequently, we recommend updating guidelines for linen collection, washing, maintenance, and distribution. Furthermore, given that "general laundry section regulations" ranked as the second priority, we suggest implementing clear separation of dirty and clean pathways within the laundry unit and establishing a system for continuous recording and weighing of received garments. These measures can significantly enhance overall process management and cost efficiency.

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Background and purpose: Radiology departments are among the most critical units in hospitals due to their significant role in diagnosing and treating diseases. Given the high cost of radiology equipment and the revenue these departments generate, improving service delivery and enhancing efficiency are of paramount importance. This study aimed to evaluate the economic efficiency of radiology units in hospitals affiliated with Shahid Sadoughi University of Medical Sciences, Yazd.
Methods: This descriptive-survey research was conducted as an applied study. Data on input and output variables were collected from nine hospitals under Shahid Sadoughi University of Medical Sciences. Input variables included the number of expert staff, the number of radiologists, the number of radiology devices, and the number of CT scan devices. Output variables comprised the number of admitted patients, the number of registered radiological images, and the total revenue generated.
Results: The average technical and scale efficiency score was 0.910. Among the radiology units studied, 55% were found to be economically inefficient. Shahid Sadoughi Hospital exhibited decreasing returns to scale, while Shahid Beheshti Taft, Khatam al-Anbia Abarkouh, Waliasr (AS) Bafq, and Ziaei Ardakan hospitals showed increasing returns to scale. Additionally, Dr. Rahman, Afshar, Fatemeh Al-Zahra (S) Mehriz, and Imam Jafar Sadiq (AS) hospitals demonstrated constant returns to scale.
Conclusion: Eliminating surplus manpower, based on the results of the Data Envelopment Analysis (DEA) method, plays a crucial role in reducing hospital and healthcare sector costs and enhancing hospital efficiency.

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Background and purpose:
As people age, physical dysfunction often increases, leading to various challenges and a heightened need for urgent medical services. Elderly individuals are among the primary users of healthcare and pre-hospital emergency services. Their subjective experiences during emergencies are influenced by their need for timely and relevant information regarding emergency procedures and their clinical condition—a need that is also shared by their caregivers. This study aims to elucidate the experiences of elderly individuals who have used pre-hospital emergency services in Shiraz.
Methods:
This qualitative study was conducted in two phases. In Phase 1, semi-structured interviews were conducted with 21 elderly participants using purposeful and snowball sampling until data saturation was achieved. The interview transcripts were analyzed using Colaizzi’s method to extract key themes. In Phase 2, a panel of experts was convened to further discuss the findings and provide recommendations.
Results:
Analysis of the interviews revealed several themes related to the elderly’s experiences with pre-hospital emergency services. These themes were categorized into sub-themes including ambulance condition, performance of technicians, timeliness of emergency response, and issues related to emergency rules and regulations. In Phase 2, the expert panel offered practical solutions to address the identified challenges.
Conclusion:
The findings indicate that elderly patients face significant challenges when accessing pre-hospital emergency services, such as poor ambulance conditions, suboptimal technician performance, delayed emergency response times, and restrictive emergency protocols. The recommendations provided by the expert panel could inform policy development and lead to improvements in the quality of pre-hospital care for the elderly.

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Background and purpose: Hospital wastewater infrastructure is critical for safeguarding public health and protecting the environment. Deficiencies in the management of these systems can precipitate severe public health and environmental crises. This study aimed to identify and prioritize investment risks associated with hospital wastewater infrastructure.
Methods: This applied case study was conducted in a general hospital in Arak, Iran, during April 2025. Initial risk identification involved a comprehensive literature review and semi-structured interviews with 14 experts, with data analysis facilitated by MAXQDA 2022 software. Subsequently, a Failure Mode and Effects Analysis (FMEA) approach, utilizing a customized checklist, was employed to score each identified risk based on its severity, probability of occurrence, and detectability. The Risk Priority Number (RPN) for each risk was then calculated using Microsoft Excel. Finally, risks were ranked in descending order according to their RPN values.
Results: A total of 23 key risks were identified and categorized into five principal areas: design, technical, environmental, operational, and managerial. The highest RPNs were attributed to "lack of pre-treatment systems," "insufficient capacity planning," and "wastewater leakage into surrounding soil". Additionally, managerial and operational risks, such as "insufficient budget for maintenance" and "shortage of skilled personnel," were recognized as significant aggravating factors for other risks.
Conclusion: The findings underscore that many critical risks within hospital wastewater infrastructure originate from fundamental weaknesses in initial design and ongoing management. The FMEA method proved to be an effective and systematic tool for identifying and prioritizing these risks, thereby facilitating improved engineering and managerial decision-making and enhancing the overall effectiveness of investments in this vital infrastructure.

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Background and purpose: One of the health system reform programs is the Family Physician and Referral System Program. Therefore, the purpose of this study is to review how family physicians and referral systems are financed in selected countries and Iran.
Methods: This study was conducted as a comparative review in 1403. Information was extracted using related keywords and their English equivalents based on specific subject headings (Mesh) in various databases. In addition, data from the World Health Organization and health system reports of selected countries were also reviewed. Information was extracted based on a data extraction form (researcher-made). Finally, the information was categorized and analyzed by subject.
Results: The study results showed that the main source of financial resources was through the budget and public taxes, and the payment system in the family physician program in the majority of the countries studied was based on performance-based per capita payments. Finally, in addition to the weaknesses and challenges of the countries studied in implementing The family physician program, in Iran, lack of public awareness, poor supervision and management, incorrect policymaking, and challenges in implementing electronic health records were also identified as weaknesses of the family physician program.
Conclusion: Despite the many similarities in the implementation of the family physician program among the selected countries, there are differences in terms of policymaking, implementation methods, and funding methods. Based on the research findings, it is suggested that in order to successfully implement the family physician program, the successful experiences of other countries at the international level, as well as evidence and information in implementing this program, be used.