Journal of

Background and Aim: The hierarchical and bureaucratic form of governmental administration is changing into a new type of flexible and market-based public management called Enterpreneurial Management Revolution. According to Stevenson, entrepreneurial management comprises a number of opportunity-based management activities for the maintenance of organizations in order to have their contribution in social value creation. This research study aims to study the organizational performance of medical sciences universities of Tehran based on Stevenson Model.

Materials and Methods: This research is a field study in which a structured questionnaire containing 22 main questions on the Likert Scale was distributed among the staff members of medical sciences universities in Tehran. The validity of the questionnaire was confirmed by experts and its reliability was estimated using Test- Retest Method. The Cronbach alpha coefficient was found to be 0.95. The data collection device was given to 379 staff members, of whom 325 filled it out. The data were completely recorded and then analyzed by SPSS software version 18.

Results: The results of the study show that regarding entrepreneurial management approach, medical universities are at an average level.
According to the present research and all related studies, this is the case in all other governmental organizations.

Conclusion: The results of the study indicate that organizational restructuring, decentralization, and continuous improvement in processes are the milestones of entrepreneurial revolution strategies in medical universities and all other public organizations.

Background and Aim: Over the past decade, the number of private centers providing health care services in Iran has had a continuous growth and the highly competitive market in private hospitals industry has caused increasing pressure on them to provide services with a higher quality. The purpose of this study was to assess the quality of services being provided in private hospitals of Tehran as judged by patients.

Materials and Methods: This cross-sectional study was conducted in 2010 in Tehran. The study sample comprised 983 patients, randomly selected from 8 private hospitals. The survey instrument was the standard SERVQUAL questionnaire. Wilcoxon, t-test, and Kruskal-Wallis tests were used for statistical analyses.

Results: The total mean scores of patients' expectation and perception were 4.92 and 4.02, respectively. The highest figures were related to the tangible factors dimension and the lowest ones to the empathy dimension. The differences between the perception and expectation for all the 22 items and the 5 dimensions were found to be statistically significant(p< 0.001).

Conclusion: SERVQUAL is valid and reliable in hospital settings as a standard tool for the assessment of quality. The results of the present study have revealed the areas that need to be improved as far as the patients are concerned. Measuring the opinion of patients can help facilitate the provision of hospital services, and improve the quality of such services and patients' satisfaction.

Background and Aim: This study aimed to assess the factors affecting organizational innovation and entrepreneurship at medical sciences universities in Iran. Such universities provide a wide range of services and products including prevention (hygiene), treatment (medical care), rehabilitation and palliative care, as well as their important mission, i. e., higher education and research in related fields.

Materials and Methods: In this study, the researchers developed and examined a model for organizational innovation and entrepreneurship, including 16 factors classified into structure, content (behavior) and context (periphery) of the subject.
The data collection instrument was a pre-structured questionnaire containing 58 core questions on the Likert scale. The validity of the questionnaire was computed by elites, and its reliability was estimated using Cronbach's Alpha (94%). Of 389 questionnaires, 325 were collected and their data were analyzed by SPSS software, version 18.

Results: The three factors -- structural (structure), behavioral (content) and peripheral (context) -- which affect innovation and entrepreneurship are not favorable at medical universities.

Conclusion: This study shows that structural, behavioral and peripheral factors are the most important, which affect innovation and organizational entrepreneurship at medical sciences universities.

Background and Aim: In strategic planning, there are several procedures to perform internal assessment or strength and weakness of organizations. Among other methods created for this purpose, Wiseboard model is the one in which the following six internal dimensions are considered: Organizational Structure, Leadership, Coordination, Reward System and Communication. This study measures three of these variables in hospitals of Tehran University of Medical Sciences (TUMS).

Materials and Methods: This survey is a descriptive, analytical and cross-sectional study conducted during 2010 and 2011. The research population comprised all those working at TUMS hospitals from which a random sample of about 580 people was selected. The questionnaire's reliability was estimated to be 91% and the data were analyzed by the SPSS software.

Results: Of the subjects, 75.4% were below diploma level, 13% above diploma, 7.8% higher diploma, 66.4 bachelor holders, 2.6% master holders, and 5.4% had a doctoral degree or higher. Some 72.6% of the subjects were in Clinical and 19.8% in Nonclinical fields. The mean values of Goal Setting, Organizational Structure, and Leadership came out to be 24.47, 20.37, and 22.06, respectively.

Conclusion: Based on the findings of this research study, TUMS hospitals have weaknesses in some aspects and they need improvement in some areas in the following order: Organizational Structure, Leadership, and Goal Setting.

Background and Aim: Female pattern hair loss(female androgenic alopecia) is a common but puzzling condition in women which increases by aging. Female hair loss is strongly linked to hormones and hormonal imbalances. The aim of this study was to determine the serum level of hormones such as T4, TSH, free testosterone, Prolactin(PRL) and Alb, SHBG in women(15-50 years old) with hair loss versus those without hair loss.

Materials and Methods: In this cross-sectional case-control study, 71 women with hair loss and 70 normal women were selected from skin and hair care day clinics. The level of hormones and SHBG were measured by ELISA, and Alb was measured by spectrophotometery. Data were analyzed by independent t-test.

Results: After analyzing the data and determining the levels of TSH, T4, Prolactin, Alb, SHBG, no significant difference was found between the case and control groups. However, free Testosterone level was significantly different between patients and controls(P= 0.000), with a higher mean level in the case group(patients).

Conclusion : Since androgens have a major role in regulating the biological cycle of hair in women and since there was a significant difference between free testosterone in patient and control groups, we suggest that the serum level of free testosterone should be measured in women with androgenic alopecia .

 Background and Aim: Information literacy is a set of skills required to identify rightful information resources and access to them. These skills are empowering goal oriented use of information resources. This study aimed to determine the ability rate of information literacy among health services administration students in Jundishapur University of Medical Sciences based on SCONUL seven pillars model.  

 Materials and Methods: This cross-sectional descriptive-analytic study was conducted using a questionnaire developed based on SCONUL information literacy seven pillars model. Validity of the questionnaire was confirmed through content analysis and coefficient of Chronbach’s alpha was 0.93. The study population included students of health services administration in Ahvaz Jundishapur University of Medical Sciences in 2013. The sample size included 40 cases collected randomly. Data analyzed through SPSS descriptive statistics and non-parametric statistical tests.

 Results: The mean score for the studied components of information literacy abilities among the study population was 0.5±0.43. Information Literacy score among freshmen was significantly different from other students (P<0.03). Students who passed Computer Basics and Research Methodology educational courses showed significant differences from other students in the information management (P<0.01).

 Conclusion: Given the increasing development in information technology, the need to develop information literacy skills is considerable especially among those who are going to be engaged in the health sector. Although studied students’ information literacy estimated relatively well, it seems necessary to take measures to improve their information literacy in all components.

Background and Aim: Today universities admit International Students as well as national students. Tehran University of Medical Sciences has been also started admitting International Students in regards of its Internationalization aims. Student’s satisfaction is of high importance in order to gain the given goals. The purpose of this study was to evaluate the satisfaction of International students of TUMS.

Materials and Methods: This was a descriptive study. The target group was international students of TUMS, the participants were selected through availability sampling. The research instrument was researcher-made questionnaire which the reliability calculated as 0.97 by Chronbach’s alpha. The data was analysied by Microsoft Excell version 2010.

Results: The overall satisfaction of the students was 70% (satisfied and completely satisfied) while the overall dissatisfaction was 10% (dissatisfied and completely dissatisfied).

Conclusion: Given satisfaction of more than half of the International students, TUMS has performed reasonably. Based on the results obtained in this research the university may pay attention to the fields reported as dissatisfied.

Background and Aim: To improve the implementation of clinical governance (CG) in Iran's hospitals, awareness of various aspects of its implementation and assessment is important. The aim of this study was to find out the obstacles and challenges of clinical governance implementation and assessment in Qazvin teaching hospitals. Materials and Methods: Semi-structured interviews with 17 senior managers, clinical staff and clinical governance experts were conducted in six hospitals of Qazvin University of Medical Sciences (QUMS). To analyze the collected data, framework analysis was used. Results: The challenges and obstacles of CG implementation in Qazvin teaching hospitals were explained using three themes of (1) challenges of CG implementation, (2) improvement in seven dimensions of CG, and (3) challenges of CG implementation assessment. Conclusion: The results of this study show that CG implementation needs to address three issues: improving clinical staff awareness about CG, changing organizational culture so as to make it more receptive to CG, and creating higher levels of cooperation among physicians, managers, patients, specialists, and professionals. The supportive role of top management in addressing the three issues and in providing resources and other infrastructures is obviously essent

Background and Aim: Nearly a decade has passed since the use of computers to record patients' medical records in Iran. Despite the advantages of computer systems, healthcare providers are reluctant to use them therefore, parts of computerized records will be incomplete, which lead to information gaps. The purpose of the present study is to investigate the completion of electronic reports and its reasons from employees' viewpoint.

Materials and Methods: In this descriptive study, 2499998 electronic reports were evaluated using a checklist that examined types of identity and clinical data meanwhile, staff’s attitudes were investigated by a researcher-made questionnaire. The validity of the questionnaire was confirmed by experts and its reliability was estimated through test-retest method.

Results: The results showed that 100% of some clinical and identity data were not recorded. Some 58.7% of staff members reported the absence of clear regulations and 54.7% reported inappropriate electronic forms as the reasons. Some 24.1% of staff members suggested the codification of clear guidelines and 15.6% offered surveillance programs as solutions to completing electronic reports.

Conclusion: The staff reported human and organizational factors as the most important elements influencing the quality of electronic reports. It seems that the following are among the solutions which can remove many defects of electronic reports: investment in education, management support for the codification of relevant policies, health information technology professionals' participation in designing electronic forms, and the use of high technologies to record data for busy employees.

Background and Aim: Given the increasing growth of new technologies in health care and their rising cost, the necessity of concentration on assessing new technologies and their potential role in quality of health care is more crucial. The aim of this study was to investigate the role of health technology assessment (HTA) in improving healthcare quality and offer the best evidence for decision makers.

Materials and Methods: The study was based on systematic review of papers in health technology assessment via searching in databases such as Pubmed, Cochrane and other HTA related databases. The search has covered the period between years 2000 to 2013. Studies analyzed by narrative synthesis method.

Results: Related studies show that assessing new technologies has potential role in quality improvement of healthcare. HTA can boost the competition among companies which this in turn increases the quality of technologies and ultimately enhances the quality of health services and stakeholders satisfaction.

Conclusion: HTA may increase quality of healthcare services through facilitating a move towards evidence-based decision-making, providing safe health care and increasing patients’ trust and satisfaction to clinical procedures and team members.

Background and Aim: Patient safety is a critical element of health care quality, and is a priority of health system that pursue to improve the quality of health services. This study aims to determine the attitude the nurses about patient safety in hospitals of Tehran University of Medical Sciences.

Materials and Methods: Nurses employed in 7 emergency and intensive care ward specialty and subspecialty hospital affiliated with Tehran University of Medical Sciences was invited to anonymously complete safety attitudes survey. Reliability of the questionnaires was evaluated by calculating Chronbach’s alpha. ANOVA were used to compare the score means between the wards. Spearman correlation test was used to analyze the correlation between the safety dimensions and the outcome variables.

Results: The results showed that the highest score was dedicated to stress recognition, and the lowest score was related to management perception and working conditions. No significant difference was between the perceptions of emergency department nurses and intensive care nurses with various aspects of safety culture in hospitals.

Conclusion: Patient safety status described as acceptable in emergency and intensive care wards. There is a need to understanding of the atmosphere and the culture of safety by hospital executives deeply.

Background and Aim: Evaluating and improving the employees’ quality of work life is one of the most important responsibilities of managers in each organization. The aim of this study was to design and prepare a questionnaire for evaluating the residents’ quality of work life and checking the validity and reliability of this tool.
Materials and Methods: We collected the questionnaires which were used for the employees’ quality of work life, and designed by Delphi method a comprehensive questionnaire for measuring residents’ quality of work life. This questionnaire was distributed two times with one-week interval between 14 residents of Tehran University of Medical Sciences and then the validity and reliability was assessed by α cronbach model. We used the 5 experts in the field of health care management, medical education and health economics to determine the validity of quality of working life questionnaire. The classification of cronbach's α for intra-rater reliability was: very good (0.9-1), good (0.8- 0.89), average (0.7- 0.79), bad (0.6-0.69) and very bad (under 0.59).
Results: The results of  αcronbach test for questions reliability and the result α cronbach test for internal consistency of each class of question indicated the rather high reliability and validity of these questions.
Conclusion: Regarding to the results of α cronbach test, we can deduce that our designed questionnaire encompass have satisfied validity and reliability and it can be used for future studies.

Background and Aim: Diabetes is a metabolic disorder, in which either there is no sufficient insulin in the body or the available insulin is not capable of acting properly. Defining the effects of trace elements can help to make use of these elements in control or preventing diabetes.

Materials and Methods: Forty-eight Wistar male rats were equally divided into eight groups. Three different control groups and five test groups. Test groups was treated with streptozotocin (60 mg/kg intraperitonieal) to induce diabetes, then supplemented with specific trace elements: Zinc, Chromium, Magnesium, Manganese and Copper. After one week, glucose, triglyceride and cholesterol levels in serum of all groups were assayed with routine methods. Then mentioned trace elements were gavaged to each groups with proper dosages. Gavage was performed during 3 weeks, then the blood tests were repeated. Median values were taken, the results were analyzed by SPSS software and p<0.05 was considered statistically significant.

Results: Levels of glucose in the serum of experimental group were found to be significantly higher than in the control group (p=0.0009). Oral administration of trace elements for 23 days exhibited a significant reduction of serum glucose (P=0.0009) and cholesterol level (p=0.019) in streptozotocin-induced diabetic rats but not in control groups.

Conclusion: The present study indicated that treatment of diabetic rats with some trace elements to attenuate hyperglycemia until reaching the normal range. Between different trace elements which were used, Cr is suggested for its great ability in decreasing the glucose, cholesterol with no effect on triglyceride levels as compared with normal rats.

Background and Aim: With the assumption that health is as one of the luxury goods, therefore making efforts in reducing health spending and inflation in this section will be ineffective.
But if health is an essential service, then in the national level for better redistribution of the resources and financial protection of the households against the health expenditures will be needed. The main objective of this study was determination of income impact of health care expenditures in Tehran household in years 2011-2012.
Materials and Methods: This study was a population based survey. The instrument of data gathering was a "WHO questionnaire" which was integrated by interview with an acquainted person in each one of the 792 families who live in Tehran. The least ordinary squares, Granger causality test, Breusch-Pagan-Godfery and White heteroskedasticity test were used for data analysis. Eviews 8 software was used for running the tests. 
Results: The results showed that heath is a cause for increasing income but the converse is not true. Otherwise, Health with income elasticity equal to 0.25 is an essential service, and is not perceived as luxury goods. Moreover results represented that income is not a good variable for rationalizing the variation of health expenditures.
Conclusion: Health was an essential good, and although income changes affect the expenditures of health care, but the sensitivity is not high and recommended that health policy-makers should in adoption policies such as tariff increases do a comprehensive survey because prices increase are borne by the consumers.