Journal of

Background: If a managers try for further income or productivity so they must attentive their staff incentive. One of the most issue in the management process is that managers can distinguish strength of staff but they can't determine their weakness . ACHIEVE model present seven factors ( ability, clarify, help, incentive , evaluation, validity , environment ) that effective to staff performance . and this model help manager to determine cause of performance problem. And create change strategy for solving those problem .
Material & Methods: It is descriptive , survey and inferential study , the population is university hospital managers in Esfahan university. data is gathered through achieve questionnaire that supported by member of management faculty.The reliability is supported based on α koren bakh . for analysis of data use spss soft ware .
Results: Finding show that : Average number of ability factor is (87/5+12/2) , clarify factor (82/3+14/8), help factor (82/6+15/7) , incentive factor ( 81/4+ 15/4), evaluation factor (77/2+15/6) , validity factor (82/7+ 17/3),and environment factor is (85/2+12/8). and base on Pierson test (p<0/05) all of the factor are effective on staff performance.
Conclusion: Today the important problem in health care organization is staff effectiveness . in fact , performance improvement is the most step for organization improvement.

Background: Achieved results from this research shows that despite in health system in country efficiencies such as work force efficiency(doctors and nurses) is not incomputable  and percentage of bed occupation and regulating shift work program prepare manually and with paper, this issue results in time consuming of managers and wasting costs and errors in carried out computations. Therefore with technology improvement and automation system there is possibility of making such automatic data is provided. Using of intelligent system consider essentially for preparing optimal program. Studying of Data showed that the present situation of planning and determination of efficiency in Iran Hospitals is not desirable. In this research, Markov methods and Petri net and genetic algorithm as modeling method and developments of model and intelligent optimization for solving problems, reducing costs and planning for work force was used successfully and there is the possibility to generalize it with changes and reforms in programming. In Achieved results of studies show that, the present research is a suitable base for expanding researches in future in field of system designs in a way that can be used in different wards and can provide more facilities to approach the real world

Material & Methods: the present study is applied and descriptive-analysis one which had been as the software design and data collection tool was the checklist of Booali Hospital's patients' files which its admissibility confirmed by the related experts and studied after observation, chronoscope and also time of manpower servicing to several patients and study of the nurse and doctors working scheduling with use of intelligent system's designing. Data analysis and planning is carried out with the method of Petri net and Markov and genetic algorithm with use of Matlab and Hpsim software

Results:42 % improvement in expense decreasing and 87% time saving in servicing time to patients can be seen from comparing prepared program and designed system.

Conclusion: Research various models can be used as a suitable tool for scheduling and determination staffs optimized number needed in several parts of a hospital which has a vital role. In case that the designed system in the current project is limited to the achieved and collected data from educational center of Booali attached to Tehran Islamic Azad university, it is need to make changes in programming based on data for generalizing it and optimized utilization in other hospitals. So it is recommended to make the prepared program close to the real world for make these systems utilizable in other hospitals and increasing restrictions.

Background: Performance evaluation could provide information to managers that they need to evaluate and monitor of the current status and activities in hospitals. The PABON LASSO model was applied to evaluate performing of hospitals affiliated with Ahwaz Jundishapour University of Medical Sciences to produce the information that used by policy makers in their attempt to make more productivity health care system.
Materials & Methods: This cross-sectional & descriptive study involved in 26 hospitals, with 3824 available beds. Data for this study extracted from computerized databases within statistical department of vice- chancellor for clinical affairs. This study used the PABON LASSO model combining with three major indicators of hospital performance named as average length of stay, bed occupancy rate, and bed turnover which analyzed in PABON LASSO model. The statistical software SPSS-13 used to derive three basic performance indicators.
Results: Based on 10 hospitals in Zone 3 of the model the satisfactory level of efficiency indicated. Results in 2 hospitals demonstrated the inefficiency and underutilization of resources by falling into Zone 1 and 7 hospitals in zone 2 and 7 hospitals placed in Zone 4. The overall average length of stay, bed occupancy and bed turnover rates were 3.57 days, 63.13% and 79.37 times respectively.
Conclusion: The performance of hospitals affiliated with Ahwaz Jundishapour University of Medical Sciences was in a relatively desirable level. Future research should be focused on why and how this situation could be improved in the hospitals with low efficiency.

Background: The first step of developing a proper model for delivering nursing care in hospitals will be identifying relevant components to apply a model. The aim of this study was identify relevant components to apply nursing care models in Shahid Beheshti University of Medical Sciences training hospitals.
Materials & Methods: This study was a qualitative research which was conducted by using content analysis approach. Participants were 6 faculty members and nurse managers of Shahid Beheshti University of Medical Sciences selected by purposeful sampling frame. Data gathered via semi-structured interviews and analyzed by thematic analysis.
Results: In this study, extracted themes included caring based on client satisfaction, nurses' knowledge and skills, importance of cooperative care, quantity and expertise of nurses, efficient supervision on nurses' performance, and strategies of health system in higher level. These themes were categorized in three dimensions including structure, process and outcome.
Conclusion: Findings of this study would be used for developing a nursing care models in Shahid Beheshti University of Medical Sciences hospitals in future research.

Background: Deciding on the number of hospital beds is one of the most serious challenges managers face. More hospital beds result in higher running cost although less hospital beds might cause disorder in patients flow.  Minimizing total cost besides maximizing the patients flow in a hospital network, considering the practical limitations is the main objective of this survey.

Materials & Methods: This study had main steps to investigate following: identifying current limitations of changing capacity of each ward, by conducting interview with hospital managers and other personnel of Modares hospital, analyzing cardiac patient flow analysis, simulating current flow, determining practical scenarios and choosing the best among them by mathematical modeling could minimize total cost and maximize patient flow.

Results: 31 practical scenarios have been determined and analyzed by surveying limitations among all existing scenarios. Finally, eight best scenarios had been selected. Results showed that decreasing the number of beds in CCU and increasing the number of beds in Post-CCU can improve patients flow, considering cost limitations.     

Conclusion: A recommended approach in this study can be a general guide for capacity planning with taking practical limitations into consideration. This survey could be useful for the managers who are against the benefits of post CCU  by comparing the patient flow with and without this ward.

Background: in recent decades, Medical Tourism Industry has been mentioned by local countries because of its benefits such as high profits, more jobs creation and other benefits. High medical services quality is one of the most important factors developing this industry in health care centers. Therefore, concerning this issue this study assesses the provided medical services quality to the foreign patients by Medical Tourism Centers in Tehran city.

Materials and Methods: This study was an applicable and descriptive in term of purpose and nature repectively. This study conducted to assess provided services quality by Medical Tourism Centers evaluating 154 impatient foreign patients using SERVQUAL approach in ten swlwcted hospitals during March to April in 2014. Graded Integration method and terms of fuzzy set were performed considering complexcity and ambiguity in conceptualizing and weighting dimensions and indices.

Results: there was a negative gap and dissatisfaction in all dimensions and indices among foreign patients in the significant level p<0.05 except physicions and profession medical staff.

Conclusion: Considering the moderate situation of physicians and profession medical staff, modern medical facilities and equipment and appropriate medical costs comparing to services are the main factors of Medical Tourism Industry development, it is possible to enlarge Iran’s bazar portion of Medical Tourism Industry. 

Background: The Pabon Lasso graphical Model is a method to determine hospital efficacy as one of the most important part of health system in developing countries. This study aimed  at assessing the efficacy analysis using Pabon Lasso Model and comparing with national standards of educational hospitals affiliate to Qom University of Medical Sciences.

Materials and Methods: This descriptive study conducted in educational hospitals of Qom University of Medical  Sciences in 2011 - 2013. Data collected by approved forms of Health Ministry and three indicators including bed occupancy percentage, bed turnover rate, and average length of Stay were calculated for each hospital using Pabon Lasso model. One sample t-test conducted to data analysis.

Results: The mean of bed occupancy and bed turnover was 76.9±9.8 and 100.6±35.4 respectively which were significantly higher than national standards. In addition, the average length of Stay was 3±1.1 days that were similar to standard. The Highest efficacy calculated for IZ hospital and lowest efficacy observed in KA and NE hospitals. Moreover, ZA Hospital can achieve excellent efficacy in 2013.

Conclusion: The mean of bed occupancy and bed turnover assessed  very desirable  and higher than national standards. Moreover, only IZ and ZA hospitals had excellent efficacy based on Pabon Lasso model. 

Background: The present study performed with the purpose of nursing care quality assessment and its association with process management in Shahid Beheshti hospital of Kashan in 2014.

Materials and Methods: In this applied, cross sectional and correlation study with the purpose of assessing the nursing care quality, 200 hospitalized patients who had more than 48 hours length time selected randomly conducting modified four parts SERVQUAL questionnaire in likert scale. In order to evaluate hospital performance based on process management model (EFQM) Excellence model questionnaire was utilized. Data analyzed using SPSS software version 16 by descriptive statistics and multivariate regression tests at a significance level of less than 0.05.

Results: Data extracted from 200 completed questionnaires analyzed. Respondents included 104 women and 96 men. The mean duration of hospitalization was 6.9 ±12.9 hours and the mean age of patients was 37 ± 12.02 years. Total nursing quality services were more than average and it assessed good (3.8 ± 0.92).Scores of Shahid Beheshi hospital were 215.66 and 217.64 in empowerment and results EFQM dimensions respectively. Multivariate regression coefficient was assessed 0.57.

Conclusions: Based on study results, it is necessary to make use of new management system and professional training to nurses in order to improve nursing quality services in hospitals. 

Background: Considering the importance of hand hygiene in nosocomial infections prevention and the low outcomes of performed researches in hand hygiene, this study aimed at assessing the effective factors on hand hygiene using planned behavior model among nursing and midwifery staff in atea hospital of Hamadan in 2015.

Materials and Methods: This study was a descriptive and cross-sectional study in which all nursing and midwifery staff of the Atea hospital selected through census sampling. Hand hygiene behavior was observed and all participants filled out a questionnaire based on Planned Behavior Model. Data was analyzed   using descriptive and inferential statistics.

Results: only 31 participants (21.1%) had hand hygiene behavior higher than average and 123 (79.9%) had lower than average. Hand hygiene was in the lowest rate, 21.3% and 13% after patient contact and prior to action aseptic respectively.  Knowledge (84%) and attitude (90.4%) about hand hygiene was high, but the level of perceived control, (53.35%) was at the low level. Also, there were significant statistical differences between perceived control and hand hygiene between subjective norms and hand hygiene (p<0.05).

Conclusions: The knowledge and attitude to adopt hand hygiene behavior is not enough alone. Along with staff training, it is necessary to have hospital managers and physicians training, providing appropriate context and omitting barriers to have suitable hand hygiene behavior in practice.

Background: medical centers location is one of the most important problems, which should be considered in different dimensions to improve the services. In this paper, we consider the hierarchical maximum covering problem for bi-level healthcare systems including Clinics and hospitals, by taking the service rates into account. In this problem, the initial objective is minimizing the uncovered demand nodes, and secondary objective is the minimizing the lost demand rate as a measure of potentially patients’ retention in coverage radius.

Methods: In this paper, the serving system in the Tehran heart center hospital is considered for queue analyses. The proposed method is a mathematical optimization model called probabilistic two-stage programming model. To evaluate this model, a number of numerical problems are solved through GAMS software.

Results: according to the results, we have found that the best condition for locating the medical centers is that the clinic are located adjacent to a hospital. Decision making about the location problem by considering the service rate in each healthcare centers, increases the reliability to the result of the optimization model.

Conclusion: The proposed model is able to help the decision makers to attain an optimized decision for locating the medical centers in deprived areas, inspired by the medical centers in areas with similar population. Therefore, if the clinics and hospitals are located by considering the hierarchical mode and their service rates, the patients’ welfare will be enhanced.

Background: Considering the importance of standard precautions to prevent needle stick injuries and health care staff, this study aimed to determine the effectiveness of educational interventions to improve adherence to standard precautions, health belief model based on professional clinical staff needle stick two hospital "yaftabad" and "Ghiyasi" done.

Materials and Methods: This study was an experimental study of two group. The study population was 90 persons of professional clinical staff Shohada Hospital Yaftabad as the intervention group and 90 patients from the hospital Ghiyasi as compared to randomly selected and three part questionnaire including demographic, structures, health belief model , and practice questions were completed. In analyzing the data, descriptive and inferential statistical methods were used.

Results: At baseline, the two groups regarding demographic variables, health belief model structures and functional do not different between them. After intervention structures perceived severity, perceived susceptibility, perceived barriers, self-efficacy and performance of the experimental group showed statistically significant change (p< 0.05) that the effect of education based on health belief model.

Conclusion: education based on health belief model, you can increase the level of knowledge and capacity building and efficacy in clinical staff needs people to observe standard precautions

Background: Because of the current population policies adopted in Iran followed by increasing the number of births, this study aimed to investigate the current situation of safe delivery and proposed a model based on clinical governance.

Materials and Methods: This study is a combinatorial-exploratory research (Mixed Method) conducted in four hospitals in Qazvin and Semnan provinces including two stages in 2014.  The first stage was the assessment of current situation; clarifying safe delivery, reviewing literatures, providing two checklists, assessment of current situation based on assessment of continuous quality improvement and assurance of the quality and the second stage was presenting the model including codification of safe delivery model in seven axes of clinical governance, the approval of the model on the panel using nominal group technique.

Results: In quality assurance, hospital (4) and hospital (2) obtained the maximum score (1431) and minimum score (1237) respectively. All hospitals in continuous quality assessment, admission in the intensive care unit (P < 0.001), mothers with severe consequence of pregnancy (P = 0.004) and 16 cases out of 27 errors had significant statistical difference.

Conclusions: In order to improve the quality of Maternity ward, hospitals' accreditation also should be based on the principles of clinical governance. In addition to evaluations based on quality assurance and annual accreditation, assessment using continuous quality improvement methods based on clinical governance is essential. The proposed model includes seven axes of clinical governance.

Background: Considering the key role of human resource management in health care organizations, assessing human resources and its pathology are essential. Therefore, this study aimed to evaluate human resources pathology in Imam Khomeini Hospital complex in Tehran.
Materials and Methods: The present study was conducted using descriptive-analytical method in 2016. In this research, 342 employees of Imam Khomeini Hospital complex were selected. The data were collected using a standard three-dimension questionnaire, then, descriptive (frequency, percentage, mean, standard deviation) and analytical statistics (Pearson Correlation Coefficient) were used to data analysis.
Results: Study results revealed that the highest and the lowest mean and standard deviation were obtained for the variable of motivation and job satisfaction (3.51 ± 1.02) and improvement methods (2.81 ± 0.84), respectively. Among all studied variables, behavioral (3.29) and contextual (2.91) factors scored the highest and lowest points respectively. Correlation between structural, behavioral and contextual with demographics revealed a statistically significant association with sex.
Conclusion: According to study findings, considering the importance and role in providing the desired services, human resource managers should pay special attention to identify all organizational factors, especially organizational culture, motivation and job satisfaction, employee training, job security and customer orientation.

Background: Today, one of the most important issues in hospital site selection is to consider the equity. This study aimed to provide a multi-objective model for fair Hospital site selection considering cost and use for hospitals construction in the future.
Materials and Methods: This study was an analytical-descriptive one conducted to determine the best locations for hospitals construction with respect to criteria of equity in Rasht city. For this purpose, after literature review, a three-objective model consist of p-median, p-envy and equitable loads objects was proposed; and the Rasht city was analyzed by model using the real data. In order to achieve the results and comparisons, the total weighting technique from the multi-objective decision-making techniques was used and solved with GAMS 24.1.1 software.
Results: This research can assist the decision-makers to consider the equity criteria to Hospital site selection in addition to the costs. Citizenship equity establishment and increasing in hospitals efficiency along with cost considerations can be regarded as the major achievements of this research for decision-makers in the health field.
Conclusion: Lack of proper attention to equity criteria hospital site selection, the results can be very unfair and can lead to irreparable consequences. This case study indicated the desirable function of the proposed model in hospital site selection with respect to the citizenship equity criteria in Rasht city. This study results can be given to managers as the proper basis for decision-making.