Journal of

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Background: A variety of methods are available for identifying and measuring adverse events and medical errors in healthcare. The aim of this study is to review these methods with their strengths and weaknesses.

Methods: Electronic databases including Medline, Embase, Google Scholar and Iran Medex were searched to identify and summaries relevant studies.

Results: Different methods have been used to identify adverse events and their nature, causes and consequences. Record review seems to be the most common and the best method for measuring the rate and consequences of adverse events. However, this method is relatively expensive and time consuming and still underestimates the rate of adverse events. It is also not suitable for identifying the underlying causes of adverse events. The other method commonly used is reporting system including critical incident reporting system. This method is relatively cheap and more suitable for exploring the underlying causes of adverse events, but it is not suitable for identifying the rate of adverse events as it may underestimate many adverse events. Other methods include critical incident technique, interview, questionnaire, direct observation and review of claims and none of them are suitable for identifying the rate of adverse events but they might be useful for other purposes including assessment of the causes of adverse events.

Conclusion: Several methods can be used for study of adverse events. No single method can serve all purposes. Each method has some strengths and weaknesses. Using a combination of methods is more suitable, but this approach is more expensive and time consuming. Which combination of methods are more appropriate, depends on several factors including the aim of the study and resources available.

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Background: In order to achieve the goals of health system, trying to evaluate and improve of health system performance via policy and decision makers is necessary.
Materials & Methods: This is a descriptive and practical study .Information gathered through sheets through World Health Organization statistical reports. data analyzed by using DEAP software(version of 2) and Data Envelopment Analysis (DEA).
Results: Based on study technical efficiency in various scenarios were different. The results showed that health systems are high sensitive to human resources, and health sector's usually share the national expenditure difference scenarios during the period of study which show the managing efficiency and scale improvement s in Iranian health system.
Conclusion: This study showed the countries with the highest and lowest performance and efficient states (reference) for the inefficient countries among a few countries which increased their health resources to improve performance. However, with high efficient resource allocations in the most countries to achieve into these results are very significant to economic savings.

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Background: Although the role of Spirituality has been acknowledged in the social entrepreneurship literature, we know of no research that has empirically investigated relationships between spiritual intelligence and health and care benefactors. Thus, this paper aims to propose and empirically test a theoretical model positing relationships among spiritual intelligence and intentions of hospital-makers benefactors. Materials & Methods: This study is descriptive which is conducted with total number of 164 hospital-makers benefactors, and is tested by path analysis. For measuring spiritual intelligence, three questionnaires distributed between every subject and two of his/her acquaintances. Results: The results suggest that spiritual intelligence and other related variables explained 41 per cent of the variance in the rate of hospital-makers benefactors intentions (R2=0/41) that is a sizable amount in behavioral studies. Results provide strong support for the proposition that social mission and social responsibility fully mediate the positive effect of spiritual intelligence on intentions of hospital-makers benefactor. Conclusion: With existence of opportunities for merely finical investments, hospital-makers benefactors should have high levels of spiritual intelligence to gain motivation for social wealth creation. Policy-makers of health system, to increase charitable activities, should focus on heightening spiritual intelligence in health and care sector.

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

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Background: Priority setting and resource allocation are assumed to be the most important issues of health-sector and fairness thereof requires considering various criteria. This study was performed to identify the criteria used for priority setting and resource allocation in the world health systems through comprehensive review.
 
Materials and Methods: Cochrane, PubMed and SCOPUS database were searched systematically from Jan.1,2005 to Oct.10,2016. The English articles with codified and specified qualitative and quantitative criteria in the resource allocation context in health sector were included in the study. The obtained data were synthetized thematically.
 
Results: Overall, 9162 papers were extracted. At the beginning of review of the included articles, 9089 papers were removed due to duplication and also based on the title. The abstracts of the remained papers were reviewed and 17 papers were removed. Full text of 59 remained papers were reviewed and based on matching with the inclusion criteria, 34 other papers were removed, too, and ultimately 25 papers were included in the final phase of the study. Extracted criteria were categorized into four dimentions based on economic, management, structural and contextual, out of which the most frequent ones were related to cost, health system goals, local capacity and disease status, respectively.
 

Conclusion: In this study, the most important criteria used by policy makers and decision makers of health system in the world were extracted for priority setting and resource allocation. The results indicated that in the world, priority setting and resource allocation in the health system is made mainly based on criteria such as cost-effectiveness, disease status, equity/equality and the need. 

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Background:  Need to assess the health system performance, various models and frameworks have been developed by different groups and organizations. This study explores health system performance assessment frameworks using the comparative-analytical study.
 
Materials and Methods: This is a comparative-descriptive study conducted using descriptive-prescriptive method based on comprehensive comparative analysis. The scope of research includes health system frameworks. The study results compared and interpreted based on identified factors in comparative tables.
 
Results:  Overall, 11 frameworks out of 16 ones described, analyzed and compared to each other. Some of the frameworks in addition to providing insight about the health system have focus on assessment of health system performance. Each framework follows especial goals which focus on importance the health systems assessment.
 
Conclusion: During the time, health system frameworks have changed and developed according to the health systems changes. Developed Frameworks in recent years are more comprehensive than others which have been presented at first. Utilizing these frameworks in order to identify health system goals, assess based on responsibility (organizational actions or outside the organizations) and ways to reach them can be effective. Using the developed frameworks based on their domains and objectives can be considered in health system performance.
 

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Background & Aims of study: Hospital care and paramedical services has become one of the most important and problematic issues in the field of health and critical concern of health planners and policymakers. In current study, contribution of various paramedical services costs were extracted from the total household health expenditure.
Materials and Methods: The current study is a descriptive study that was conducted in a 5-year study period from 2011 to 2015. The annual income-based survey data of the household provided by Statistics Center during 2011-2015 was used to achieve the study aims. Excel_2013 software was used. Contribution of household and paramedical services cost were calculated from household health expenditures per year in urban and rural areas.
Results: Regarding the results of the current study, on average, 20 % of total household health expenditure is allocated to paramedical services in urban and rural areas. The cost of radiology, sonography, radiotherapy, scan, echo cardiac stress test, endoscopy, electrocardiogram (ECG) etc, accounts for the largest contribution of hospital and non-hospital paramedical services costs, which include an averagely about 50 %t of paramedical services costs.
Conclusion: Understanding paramedical services costs can guide policymakers and decision-makers in the field of paramedical services to decide better. Moreover it helps them to reduce direct payments from the pocket of household health expenditures. Therefore, considering the laboratory sector and radiology, sonography, radiotherapy sectors and so on are very important to reduce paramedical services costs.
 

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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.

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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.

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Background: The development of the health system increases the health level of the society. The present study was carried out with the aim of development of "Health System Development Scale".
Methods: The study was qualitative-quantitative. For qualitative part, a semi-structured interview with 11 experts was conducted in a targeted manner with maximum diversity and the results were analyzed by open, central and selective coding method. For quantitative part, first the validity of the questionnaire was carried out through interviews with 10 experts. Finally, the construct validity was conducted according to the opinion of 220 experts by exploratory factor analysis (with the Kaiser-Meyer-Elkin scale) and confirmatory factor analysis (in the form of divergent, convergent validity and fit indices) using SPSS and Lisrel software. Reliability was also measured by calculating Cronbach's alpha coefficient and composite reliability.
Results: The scale was designed with 40 statements obtained from the findings of the qualitative study. In the quantitative part, the appearance and content validity ratio of the dimensions of the questionnaire was qualitatively confirmed (for all statements between 0.80 and 0.1). Construct validity was done by exploratory and confirmatory factor analysis and convergent validity was between 0.53 and 0.75 and divergent validity was between 0.54 and 1. The internal consistency of the tool was approved with Cronbach's alpha coefficient between 0.75 and 0.86 and composite reliability coefficient was between 0.72 and 0.80.
Conclusion: The validity and reliability of the scale was confirmed. It is suggested to use it to measure the level of development in the health system by experts in this field.

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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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The provision of virtual health care has currently received ample attention from health systems worldwide, due to the recent conditions and events. Many countries are trying to provide their preliminary visits and a relatively wide range of other care virtually, paving the way towards the introduction of virtual clinics. However, in many countries, this concept has not been clearly defined, and the characteristics that are necessary to use the virtual clinics are still unknown. This perspective has sought to explain the concept of virtual clinics and their characteristics with a brief review of related literature.

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Background and purpose: As health resources face increasing constraints, the use of medical imaging services has risen significantly. On average, diagnostic services account for approximately 10% of total healthcare expenditures, and this figure is steadily increasing. This study aims to identify the causes of irrational utilization of medical imaging services and propose corrective measures.
Methods: This descriptive-survey research was conducted in two phases. In the first phase, a comprehensive literature review was performed using both international and national databases, covering the period from 1990 to November 2021. Relevant studies were identified using specific keywords. In the second phase, a semi-structured questionnaire was developed, and a series of in-depth interviews with experts and professionals were conducted. Data were analyzed using the six-step thematic approach by Braun and Clarke, utilizing MAXQDA software.
Results: A total of 605 studies were initially identified, of which seven met the inclusion criteria after rigorous screening. In the second phase, 12 in-depth interviews were conducted, yielding 65 codes, which were organized into 12 themes. The identified themes included legal issues, conflict of interest, monitoring challenges, poor governance and stewardship, inappropriate policymaking and planning, financial incentives, inadequate service provision infrastructure, health culture, education and continuous training systems, financing and purchasing services, political factors, and inadequate insurance systems. Various strategies for controlling the inappropriate use of diagnostic and therapeutic services were proposed, including policy interventions, monitoring and evaluation, and training.
Conclusion: The irrational use of healthcare services is a significant challenge in many countries. Key contributing factors include incomplete insurance coverage, out-of-pocket payments by patients, defensive medical practices, and gaps in knowledge. Addressing these issues requires targeted interventions and reforms.