Journal of

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Background: However nurses are responsible for patients quality care legally and ethically, in other side, patients have rights to receive appropriate and quality care. The aim of this descriptive study was to explore SERVQUAL dimensions (Reliability, Responsiveness, Assurance and Empathy) of Nursing Service Quality (NSQ) at Tehran Social Security Organization (SSO) Hospitals.
Material and Methods: This study was carried out as an applied, descriptive and cross- sectional study during the summer and autumn of 2009 in Tehran SSO hospitals. Study tool was prepared on the basis of the standard and modified questionnaire of SERVQUAL based on Parasuraman, Zeithaml and Berry questionnaire (1988) for NSQ and consisted of 4 dimensions which were Reliability, Assurance, Empathy, and Responsiveness. The population for this study included of all inpatients of selected Tehran SSO hospitals who were selected by random sampling (N=200). For accounting Means, Standard Deviations and percents SPSS (ver. 16) have been used.
Result:The total percentage of NSQ was upper middle (66), prescriptively Reliability (74), Assurance (69) and Empathy (64) were the most ones and Responsiveness (58) was the lowest.
Conclusion: The results of this study showed that NSQ was in desired degree from patients` perspective in selected hospitals. The health care managers should have been attention to nursing as an important workforce of a hospital for raising the service quality of their organizations .Nurses are main role in quality care improvement and patients satisfaction. So, actions regarding to improve their performance are useful and necessary. Due to lowest score of Responsiveness among nursing staff, we suggest training courses for improving organizational culture on responding and effective communication to achieve high quality performance of all nursing group staff.

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Background: Payment method is one of the most important control knobs in the health system. All organizations that mobilize funds for health sector must be decided: who should be paid? Why this money should be paid to them? And how much should be paid? So the main purpose of this study is to identify different methods of paying to the doctors in referral system of selected countries, and ultimately providing some suggestions for Iranian social security organizations- direct medical service provision.
Materials & Methods: This was a comparative study designed in 2008. First we studied theoretical issues and analyzed them within the framework of the current situation. Then we conducted a comparative study to find some solutions for it. Then we validated selected suggestions using by Delphi technique.
Results: Most selected countries use a combination of methods to pay to the physicians. Usually for employed physicians in insurance organizations, salary makes a large part of doctor`s income. In countries where GPs play the role of gatekeeper, the per capita payment method has a special room. In American Health Maintenance Organizations (HMOs), based on employment or contractual relationship, they pay physicians by one of three methods: "Per Capita", "Salary Monthly" or "Prepayment". In addition to Salaries (if any employment relationship), specialists usually receive some fees for their Services widely.
Conclusion: Bonus payment in exchange for quality indicators is considered as a recently developed payment method for both GPs and specialists, but due to wide infrastructures, it needs accurate designing and plenty of arrangements.

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Background: In the absence of medical facilities in Social Security Organization (SSO) hospitals in provinces, the patients will be dispatched to Tehran. This will dissatisfaction and intellectual and emotional tensions and imposes a lot of costs upon SSO for dispatching the patients . The objective of this study is to compare franchise elimination of medical services in hospitals in contract with social security organization in Provinces with costs of patients dispatching to Tehran .
Materials and Methods: The study was done as retrospective and analytical research. The neurosurgical patients dispatched to Tehran were selected for the study (using the census method). The data were collected in information forms. Research finding were analyzed by SPSS software.
Results: Among studied provinces, Khuzestan province ,with 233 cases, had the highest frequency of patients dispatched and Zanjan and Golestan provinces with 2 cases had the lowest frequency. There was a significant difference between average of dispatching costs paid by SSO and the average franchise paid by patients (p<0.001) such that patients dispatching cost was higher than the franchise paid by patients. There was also no significant difference between average dispatching costs and franchise margin among studied provinces.
Conclusion: Considering the fact that cost of studied dispatching patients was higher than the franchise paid by them in exchange of medical services from hospitals in contract with SSO, elimination of medical services` franchise and treatment of patients in their provinces could decrease in the SSO costs compared with dispatching them to Tehran.

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Background: Three aspects of health, responsiveness rate and equitable financing introduced as the main goals of health systems. In this study, responsiveness rate was assessed among private and social security hospitals in 2013.

Materials and Methods: The descriptive-analytical study conducted as a cross-sectional one among 10 hospitals in Tehran city (20 percent of total social security and private, 8:2 respectively) in 2013. Study population consisted of all inpatients and outpatients referee to eight private and two social security hospitals and 333 subjects selected to data gathering randomly. The valid and reliable World Health Survey questionnaire was utilized. Data was analyzed by SPSS₁₇ using descriptive statistic, Mann–Whitney and Kruskal–Wallis tests.

Results: In points of view among inpatient and outpatient, the mean score of responsiveness rate were 4.1±0.71 and 3.7±0.60 respectively. These amounts estimated 4.4±0.46 and 3.2±0.82 for inpatient and 3.8±0.58 and 3.5±0.63 for outpatient in private and social security hospitals respectively. Also, the mean score of responsibility rate assessed 4.4 in private hospital which was higher than social security ones (3.2); and this difference was statistically significant (P<0.001).

Conclusion: Responsiveness rate dimensions were evaluated moderate to high among assessed hospitals. These results were enhanced in private hospitals rather than social security ones. It is recommended that hospital managers should pay more attention to client and mechanisms to improve responsiveness rate and providing more services quality. 

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Background: The organizational learning has been influenced in different theories and model based on theoretical and practical dimensions in organizations development and provides a favorable context for changing and development. Organizational learning capacity can play a main role in clinical governance implemention.
Materials and Methods: This study was a descriptive- analitical and cross-sectional one which performed during the first six months of 2014. Study population included staff of Ardabil Social Security hospital. One hundred and seventy participants selected using simple random sampling. A four dimensional standard questionnaire of Gumejeet et al  and a seven dimensional self administrated questionnaire were conducted to examine organizational learning capacity and clinical governance assessment, respectively. Data analysis was carried out using Pierson Correlation Coefficient and Mulivariate regression analysis. Data was analyzed by SPSS₁₈ software.

Results: Study results revealed that there was a positive and significant relation between organizational learning capacity and clinical governance implementation (R= 0.507). This correlation coefficient was 0.644 in management commitment, 0.498 in systematic approach, 0.446 in open climate and 0.261 in knowledge transfer.

Conclusion: According to the main role of organizational learning on implementing clinical governance, providing an essential background to enforce organizational learning capacity in four components especially management commitment and systematic approach to implement efficient clinical governance is recommended.

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Background: Considering the increasing growth in health care costs along with the resources finitude; therefore, improving the efficiency and efficient use of resources is considered as one of the main priorities of the health system. The aim of this study was to determine the efficiency of direct medical services affiliated with Iranian Social Security Organization using Stochastic Frontier Analysis (SFA) Method in 2008-2015.
 
Materials & Methods: In this descriptive- analytical study, performance of 30 units of direct medical services affiliated with Iranian Social Security Organization was analyzed using Stochastic Frontier Analysis (SFA) Method. The number of active beds, physicians, nurses and staff were used as inputs and combined variables obtained from factor analysis were selected as output. Frontier version 4.1 was used to determine the efficiency and Stata version 14 was used to study the effective factors on efficiency.
 
Results: The average technical efficiency of studied units was 0.816. Based on the value of index of likelihood ratio test ( LR = 100.45 ), Cobb-Douglas production function was selected as the best model.
 
Conclusion: Based on the findings of this study, adjusting surplus manpower, congenital planning for increasing efficiency and resource management should be the priority of the managers so that they can increase the level of efficiency of studied units and reduce the costs to the least possible.
 

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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: Effective management of human resources is crucial for improving healthcare services, as personnel are an organization's most valuable asset. This study aims to identify challenges in human resource management and propose solutions to enhance service quality in hospital settings.
Methods: This qualitative study employed semi-structured interviews with 53 managers and key decision-makers from Social Security hospitals in Tehran, using purposive and snowball sampling techniques. Thematic analysis was utilized to analyze the data. The validity and reliability of the qualitative findings were ensured through participant and expert review methods.
Results: The study identified numerous human resource challenges, categorized into five main groups and 20 subgroups. Key issues included flawed recruitment and hiring processes, unfavorable working conditions, weak human resource organization, inadequate staff training, and ambiguity in employment laws and regulations. Proposed solutions, classified into five main groups and 29 subgroups, encompassed: enhancing recruitment and hiring processes, fostering a dynamic organizational culture, improving human resource productivity and efficiency, transforming hospitals into learning organizations, providing comprehensive and effective training, and increasing transparency in rules and regulations, particularly in job descriptions.
Conclusion: Regular identification of human resource management challenges and implementation of evidence-based, scientific, and operational solutions can significantly improve human resource management and, consequently, hospital performance in Social Security hospitals.