Journal of

Background & Aim: One of the most important and useful models for assessing hospital performance is the Pabon Lasso Model, a graphical model that determines the relative performance of hospitals using three indicators: 1. Bed Occupancy Rate (BOR); 2. Bed turnover (BTO); 3 Average Length of Stay (ALS). The aim of this research is to investigate the performance of the hospitals affiliated with Tehran University of Medical Sciences in Iran during the year 2011 based on the Pabon Lasso Model.

Materials & Methods: This descriptive and cross-sectional study conducted in 2011.  All the 16 hospitals affiliated to Tehran University of Medical Sciences formed the study population. Data was analyzed by Excel software and Pabon lasso model.

Results: The following average results for each performance indicator were obtained: Average Length of Stay (ALS) = 6.55 days. Bed Occupancy Rate (BOR) = 74.151% and Bed Turnover (BTO) = 70.24 times per year18.75% hospitals were located in the Pabon Lasso Model zone 1.25% hospitals in zone 2.25% of hospitals in zone 3, and 31.25% hospitals in zone 4 of the model.

Conclusion: The study showed that 75% of the studied hospitals were inefficient. Applying Pabon Lasso model compared hospital's performance. Thus, using one of the active ways of problem recognition in hospitals and perceiving the relation of performance indicators will be helpful in establishing new policy and reviewing current policy in order to maximize performance capacity.

Background and Aim: In health sector, improving quality of treatment services and patient safety are considered as vital. The objective of this study was to determine the relationship between the quality improvement and patient safety (QPS) and the hospital performance indicators. 
Materials and Methods: In this descriptive analysis research, the statistical population included managers, matrons,  one of the members of the quality improvement committee and one of the clinical governance office members of Shahid Beheshti University of  Medical Science teaching hospitals (N=44). In order to evaluate QPS, data were gathered through questionnaire and the hospital performance indicator data were gathered through interview and observation. Also independent T test was used to determine the relationship between the quality improvement and patient safety and performance indicators.
Results: All five areas of (QPS) including leading and planning, designing clinical and managerial processes, collecting the data, analyzing the data and improvement were significant in QPS score and   according to independent T-test, the relationship between (QPS) and bed occupancy percentage, average length of inpatient stay, bed turnover interval, bed turnover rate and gross death rate was significant (p-value<0/05).
Conclusion: Considering (QPS) standards can improve hospital performance indicators.

Background and Aim: Health communicators with volunteer activities meet many people’s educational and informational needs in different aspects of health without additional costs. Despite the importance of communicators in health programs, the level of their cooperation or connection with our health centers has been reduced in recent years. So, this study was performed with the aim of affective factors on recruitment and retention of health communicators.
Materials and Methods: This study was an applicable study with the use of phenomenological qualitative methods. Data gathering tool was focus group discussions that were done in year 2014. A total of 39 health communicators, coaches, and experts of health communicators plan were selected using purposive sampling in Kerman city health center. Data achieved by focus group interviews were analyzed using framework analysis.
Results: Three main concepts were extracted as the results of the analysis of the qualitative data. Factors related to the health care system weaknesses of the communicator's plan, weakness of human factors (coaches and communicators), and factors related to society were the three main concepts of recruiting and retaining the health communicators.
Conclusion: Setting up the supportive and supervisory regulation by the Ministry of Health and Medical Education in conjunction with this program, allocating the appropriate budget to this program, documenting achievements and appreciating the better volunteers and their coaches in the country, and planning for education of volunteers according to the health needs of the society are the solutions proposed in this study.

Background and Aim: Electronic Medical Record system collects and stores laboratory data, digital images and electronic versions. It plays a major role in reducing medical errors and duplication and health care providers immediate access to patient medical records. This study aimed to examine the viewpoints of Hormozgan University of Medical Sciences' administrators on the role of electronic Medical records system.  
Materials and Methods: The study was a descriptive-analytical research to examine the viewpoints of Hormozgan University of Medical Sciences' administrators and physicians on the role of electronic medical records system. The study population consisted of 61 managers, matrons and health information managers of Hormozgan hospitals and 121 faculty physicians and residents. Data collection tool was a researcher-made questionnaire. The validity was determined and verified by content validity method and experts' views. Cronbach's alpha coefficient was used for assessing reliability, which was 83%. Data collected from the questionnaires was analyzed using SPSS software and descriptive statistics and analytical statistics.
Results: Results indicated that "data management" (N=146) with 77.5%, "job objectives and processes" (N=160) with 87.9%, "communication" (N=163) with 89.6%, "data privacy and security" (N=152) with 83.1% had the most important roles in the health system. 
Conclusion: Generally, managers and physicians attitudes about the role of electronic medical records system in the health system was evaluated satisfactorily. According to the advantages of the system and removing major obstacles in its implementation, a new step would be taken in order to promote health.

Background and Aim: Due to social development, population growth, industrialization of countries and require some work, most of the employees are working with program shift. The purpose of this study was determination of relationship between nurses shift rotation and personality characteristics and coping strategies in selected private hospitals in Tehran, Iran.
Materials and Methods: In this descriptive and cross-sectional study standard shift work questionnaire and Eysenck personality questionnaire was used. After confirming the validity and reliability (Cronbach's alpha 0.73), the questionnaire was distributed among 305 nurses and 6 non-governmental hospitals in Tehran on the cluster random sampling method. Descriptive and analytical methods were used for data analysis using SPSSv.22 software.
Results: 43.6 percent of nurses participating in the study were introverted and 56.4 percent were extroverted. The results showed that there was a meaningful statistical relationship between age and health (p=0.008), gender and physical health (p=0.015), education level and physical health (p=0.014), gender and physical-cognitive anxiety (p=0.006), age and family- socioeconomic status (p=0.001), marital status and family-socioeconomic status (p=0.001), second occupation and family-socioeconomic status (p=0.001). 
Conclusion: Planning according to nurses working hours standard and to avoid overtime, especially nurses who have more experience can prevent severe complications of shift work and improve health and the quality of care. 

Background and Aim: Modeling of organizational knowledge creation process is one of the key areas of research in knowledge management. The aim of this paper was to determine solutions for developing and improving evolutionary knowledge creation model based on the model validation results in real world.
Materials and Methods: This study was an analytical and empirical research that was done by multi case study and simulation strategy. The committee was formed to collect information from various source of data including organizational documents and interview with senior managers about knowledge creation history for 5 years in Development and Planning Management department of Tehran University of Medical Sciences. Data analysis was done using descriptive statistics and qualitative analysis. Also, the mathematical formulation was analyzed using simulation in Excel.  
Results: In most of analyzed knowledge creation cases, knowledge absorption from external source through changing managers or employing consultant following integration with exist knowledge was occurred. Also, simulation results show that, mathematical relations were not well defined and changing them makes results more acceptable. 
Conclusion: Knowledge grow in organization has occurred through three ways including planned knowledge creation based on managerial decisions, planned knowledge absorption based on managerial decisions, and random knowledge creation mechanism, and all of them have impact on essential knowledge contents. 

Background and Aim: Bacterial meningitis detection is a complicated problem because of having several components in order to be diagnosed and distinguished from other types of meningitis. Fuzzy logic and neural network, frequently used in expert systems, are able to distinguish such diseases. The purpose of this paper is to compare Fuzzy logic and artificial neural networks for distinguishing bacterial meningitis from other types of meningitis.
Materials and Methods: In this study to detect and distinguish bacterial meningitis from other types of meningitis, in the first step 6 attributes were selected by infectious disease specialists. In the second step, systems were designed by Matlab software. The systems were evaluated by 26 records of meningitis patients, and results were analyzed by SPSS software.
Results: The evaluation showed that the accuracy, specificity and sensitivity of fuzzy method were 88%, 92% and 100% respectively and those of neural network methods were 92%, 94% and 88% respectively. The Kappa test result in fuzzy and neural network methods were 0.83 (p<0.001) and 0.83 (p<0.001). The areas under the ROC curves were 0.94 and 0.91 respectively.
Conclusion: The sensitivity, the Kappa test results and the areas under the ROC curve of the fuzzy logic method were better than neural network method. However the fuzzy logic method is more reliable to distinguish bacterial meningitis from other type of Meningitis, the evaluation result were obtained from 26 records of meningitis patient which were hospitalized in the same center leads to the study be still open.

Background and Aim: Diagnosis is an implement of organizational development. The main objective of this study was to diagnosis the TUMS by using Six Box Model of the Weisbord to identify in which areas of this model Purposes, Structure, Leadership, Rewards, Relationships, Helpful Mechanisms and Attitude toward Change is more vulnerable.
Materials and Methods: The research was descriptive and the statistical population included five hospital staff subset of TUMS. Out of 280 questionnaires we received 220 completed ones. For data gathering we used standard questionnaire of the Weisbord which was estimated as both reliable and valid. By the use of Cronbach alpha coefficient, reliability coefficients was obtained equal to 0.85. Also, questionnaire was confirmed by 5 faculty members in terms of nominal and content validity. The data were analyzed by SPSS software.
Results: All the variables except rewarding and Attitude toward Change had significant changes p<0/05 thus the H0 for Purposes, Structure, Leadership, Relationships and Helpful Mechanisms were rejected. These variables stay in acceptable condition. However there was a significant difference between Relationships and rewarding; considering their T-Value it could be concluded that Relationships situation was desirable (T=3/62) but rewarding situation was undesirable (T=5/70).
Conclusion: The findings conclude that TUMS, currently the most appropriate situation was in communication and the most inappropriate situation was rewarding. Also other aspects are between these two conditions. Also, rewarding area needs planning to increase employee satisfaction.

Background and Aim: More than 80% of patients need to take x-rays during their diagnosis and treatment stages. Due to the biological effects of ionizing radiation, observance of radiation protection principles are necessary. The observance of radiation protection principles in intensive care units at Imam Reza hospital of Kermanshah in 2014 was evaluated in this study.
Materials and Methods: In this cross-sectional study which was performed by census method, performance of 38 radiographers working in target center was investigated regarding the following of the principles of radiation protection in respect of patients, nurses, radiographers, and other clients in intensive care units. Data collection tool included a questionnaire and a checklist of 31 principles of radiation protection. 
Results: The overall level of observance of radiation protection principles in intensive care units was at an appropriate level (94.7%) in 36 radiographies. The highest and lowest levels of principle observance of radiographers were in respect to themselves (94.7%) and nurses in the intensive care units and other clients (26.3%), respectively.
Conclusion: According to results in this study, radiation protection principles observance by radiographers during portable radiography examinations respect of themselves is appropriate but respect of other nurses is not satisfactory. It seems that it can be improved to 100% of the optimum level by equipping intensive care units to protective equipment, setting some obligations to use them, and controlling and continuous monitoring of protective measures of radiographers.

Background and Aim: In attention to pressing need to cost containment and service efficiency, laboratory services serve as a central locus for controlling health care expenditure. This study intents to investigate proportion of laboratory utilization in Iran to pave the way for future interventions.
Materials and Methods: A cross-sectional study was conducted to investigate the proportion for laboratory utilization through the retrospective analysis of 384 medical records at the tertiary care Kashan University Hospital Shahid Beheshti. To pave the way for future intervention, over utilization tests were classified into two categories, inappropriate and resulted in laboratory errors.
Results: Nine thousand five hundred forty one laboratory tests were ordered, 2522 (26.40%) of the tests were inappropriate and 143 (1.5%) of the over utilization tests have occurred due to laboratory testing cycle errors. According to reviewers’ judegment relevancy to medical intervention was considered as the most accepted appropriateness criteria 5012 (52.53%) for laboratory tests 
Conclusion: Since, the laboratory tests over utilization is multifactorial, forming a multidisciplinary team including physicians, nurses, laboratory staff, medical education experts, health care management and health information technology staffs in terms of Utilization Committee to develop more targeted strategy based on root cause analysis of over utilization behavior seems necessary. 

Background and Aim: Research in the medical field requires large budgets, specialist human resources and modern equipment and instruments. Scientific collaboration is a way to overcome such problems. Main goal of this study was analyzing scientific collaboration of universities of medical sciences in different aspects.
Materials and Methods: In this research, by using scientometrics methods and social network analysis techniques, the Universities of Medical Sciences co-authorship network was mapped. Source of collecting Data, was Web Of Science database. For mapping and analyzing of scientific networks, we used Bibexcel, VOSviewer, Pajek and UCINET software.
Results: Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences, with 933 co-authorship papers are in the first place in scientific collaboration among Iranian Universities of Medical Sciences. And at the international level, Shahid Beheshti University of Medical Sciences has more scientific collaboration than other Iranian universities with the University of Malaya. Tehran University of Medical Sciences, Shahid Beheshti University of Medical Sciences, Isfahan University of Medical Sciences, Tabriz University of Medical Sciences and Shiraz University of Medical Sciences, have significant position in terms of centrality index in co-authorship network.
Conclusion: Medical sciences researchers have very strong tendency to make scientific collaboration with Tehran University of Medical Sciences researchers. For this reason, scientific collaboration network has become a monopoly network around Tehran University of Medical Sciences. This form of collaboration prevents creation of opportunities for collaboration.

Background and Aim: Organizations must collect, process and analyze different types of necessary information and give them to managers and other individuals. Such information includes the management of medical records and documents in insurance companies. This study aims to evaluate the potentialities of medical records management electronic systems in such companies.
Materials and Methods: In this cross-sectional applied research, the systems existing in insurance companies were checked using researcher-made checklists to study the capabilities of medical records management electronic systems in all governmental and private insurance companies of Gorgan. For data-analysis, descriptive statistics (frequency, percentage) was used.
Results: In data register and entry, the share of insurance companies as well as the amount of deductions was 92%. In the ability to search, store and retrieve, the search based on the names of persons had the highest percentage (100%). Security was one of the features considered in the software of insurance companies. In the reporting section, the possibility to report the titles of medical documents was 92%. Lack of physical and electronic documents manageability through check-out method was 14%. 
Conclusion: In terms of functional capabilities, softwares observed in insurance companies have both strong points (security feature) and weak points (classification and indexing capabilities). The management of medical records and documents can be enhanced in the softwares of insurance companies by using the mentioned capabilities of the existing softwares. 

Background and Aim: The present study aimed to assess the impact of trade openness and vaccination on child mortality under five because the mortality of under-five-year-old children is one of the most important indexes of health and development. 
Materials and Methods: Using an Eviews6 software, this study is doing a causal-analytic approach by exhausting a Johansen-Juselius method over the period of first quarter of 1984 to forth quarter of 2013, in Iran.
Results: Coefficients for each of the variables in the model were consistent with the theoretical bases. Based on the findings of the study, the increase of one unit in each of the variables of DTP vaccine and trade openness leads to the decrease of child mortality as much as 0.23 and 4.36 units, respectively. Also, the results based on error correction model indicate that in each period, about 0.04 of short-run imbalances is adjusted to achieve a long-term balance.
Conclusion: Since the increase of vaccination and trade openness reduce the mortality of under-five-year-old children, it is suggested that the immunization of children be trained in all parts of the country so that we can achieve high rates of growth and development by the delivery of healthy factors of production to the society. Moreover, by increasing trade relations and dealings with other countries, we can prepare the grounds for the entry of new knowledge and medical equipment as well as health promotion and human development. 

Background and Aim: The issue of organization fit is an important factor for attracting expert individuals within the organization and get their loyalty and commitment. Therefore, this study aimed to investigate and determine the relationship between person–organization fit with organizational commitment of managers of Alborz University of Medical Sciences.
Materials and Methods: This cross-sectional study was done on all managers who employed in Alborz University of Medical Sciences. Data collection conducted using a questionnaire which had two parts: person – organization fit and organizational commitment. The validity and reliability of the questionnaire was confirmed and about 180 questionnaires had been collected. And for analyzing data, Mann-Whitney and Kruskal-Wallis methods were used. 
Results: The average score of person – organization fit was 5.16 with 0.28 standard deviation and the average score of organizational commitment was 4.91 with 0.44 standard deviation. The results showed statistically significant relationship between person – organization fit and organizational commitment (r=0.63, p=0.000).
Conclusion: Managers of Alborz University of Medical Sciences had average fit with their organization and high organizational commitment. So it is suggested that managers should be oriented about the goals and values of the organization. Moreover, policy makers and leaders of this university should be aware about the characteristics and values of the manegers. In addition, they must  pay more attention to the issue of person–organization fit.

Background and Aim: The study of relationship between entrepreneurial orientation and performance leads to the improved competitive performance of organizations. The purpose of the present study is to determine the relationship between entrepreneurial orientation and occupational performance.
Materials and Methods: This study is a descriptive-analytical applied research. As regards the type of collected data, the present study is quantitative with the standard questionnaire of Lumpkin and Dess for the measurement of entrepreneurial orientation and the standard questionnaire of Byrne and Conway for the measurement of occupational performance. One hundred and eight employees at Tehran University of Medical Sciences (TUMS) Student Health Center formed the sample of the study. Data analysis was done by using SPSS and SMART PLS in two parts: part of measurement model and structural part.
Results: The results indicate a positive and meaningful relationship between entrepreneurial orientation and its dimensions (innovation, risk-taking, and proactivity) and the staff members’ occupational performance. Also, the dimensions of entrepreneurial orientation have a high correlation with each other, but they do not have the same effect on occupational performance. Regarding the importance of each entrepreneurial orientation dimension, it is proposed that facility managers define activities that lead to the increase of occupational performance. 
Conclusion: Considering the results of this study, taking measures to enhance the staff’s entrepreneurial activities in health centers can lead to the increase of job performance in these centers.

Background and Aim: To fulfill its mission, the health system needs reform in various sectors including supervisory areas. That is because the quality of supervision can have various consequences such as increase or decrease of innovative self-efficacy through various factors. Therefore, the aim of this study was to explain the mediator role of perception of organizational justice in the relationship between abusive supervision and innovative self-efficacy.
Materials and Methods: This is a correlational descriptive-analytical study. The sample included 225 employees of Shiraz University of Medical Sciences, who were selected through random sampling. The research instruments were questionnaires of abusive supervision, innovative self-efficacy and perception of organizational justice, which were distributed among the sample after calculating their reliability and validity. 
Results: The results showed that abusive supervision had a significant negative impact on the perception of organizational justice and employee’s innovative self-efficacy. Also, the perception of distributive justice has a significant positive impact on innovative self-efficacy and a mediation role in the relationship between abusive supervision and innovative self-efficacy.
Conclusion: In order to enjoy innovation, health-oriented organizations should reduce abusive supervision in managers’ and supervisors’ behavior; therefore, with the increase of employees’ feeling of innovative self-efficacy, they can lead to the realization of the mission of these organizations.

Background and Aim: To improve the quality of laboratory services, World Health Organization (WHO) introduced ISO15189 standard. So, this study aimed to investigate implementation of the standard at Mycobacteriology Research Center (MRC) and determination of its adaptation.
Materials and Methods: At the first step, 12 organizational blocks of the laboratory was assessed by completion of the standard questionnaire. By implementation of the software and audit surveillance the second step was completed. Consequently, the given results were analyzed using SPSS Version 16. 
Results: By implementation of Quality Management System (QMS) at the three known focal points (pre analytical¸ analytical and post analytical), MRC was scored 80–100% points during 2013-2014; whereas previous QMS of the national reference TB laboratory (NRL) ranged from 48% to 79%
Conclusion: This study was the first of our knowledge in stepwise implementation of ISO15189 standard in Iran. Internal evaluation of the standard, our NRL ranked as a 5 star laboratory. We seeked international evaluation to accreditation of the national reference TB laboratory.