Journal of

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Background and Aim: Health tourism is considered a national strategy to increase the income of the country and also is considered one of the pillars of national security. This aim of this study was to determine the impact of observing the standards of Joint Commission International (JCI) related to Patient-oriented on attracting health tourists. Materials and Methods: This research is an applied descriptive- analytical study that is conducted cross-sectional in selected hospitals in Tehran during year 2012. Five hospitals with using purposive sampling were selected as the sample size in this study. The instrument of data gathering is Commission standard checklist JCI which has seven patient-oriented areas. Reliability and validity of this checklist have demonstrated in previous studies. Data was collected by observation, interview and document review. After collecting the data, data analysis using descriptive and inferential statistics such as mean and Pearson correlation coefficient were used in the statistical software SPSS 16. Results: The rate of observance of the Patient-oriented standards in hospitals was different in this study. The overall average of standard observance was 3.16 .Anesthesia and surgical care areas and also standards of Patient and family rights have highest (3/60) and lowest (2/93) mean scores respectively. Results of this study showed a positive correlation (r=0/341) between the observance of JCI standards with attraction of health tourist. Conclusion: Establishments of mechanisms for accreditation of care centers such as JCI standards enhance the quality of health services and will attract more Health tourists.

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Background and Aim: Nurses’ knowledge and awareness about religious orders is undoubtedly so important in their relationship with patients in hospitals. So, the aim of this study is to compare the knowledge and attitude of nurses before and after their participation in religious orders workshop. Materials and Methods: In this cross-sectional study, religious knowledge and attitude of 480 nurses working in the hospitals of Tehran University of Medical Sciences (TUMS) were evaluated. The research tool was a questionnaire and such factors as nurses’ age, sex, educational level, and type of employment were considered. The data were collected by a questionnaire and analyzed by SPSS software version 19. Results: Nurses demonstrated a higher level of knowledge and attitude in hospitals where Islamic orders workshop was held than the ones in other hospitals. In total, there was no significant difference among nurses regarding their age, sex, educational level, and type of employment however, nurses working in surgical wards and those with a postgraduate degree showed a higher level of knowledge and attitude than others. Conclusion: It is necessary to provide nurses with knowledge about religious orders because such knowledge may increase patients' satisfaction with the care they receive.

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Background and Aim: Medication errors make up a large portion of medical errors that mostly happen in hospitals. To prevent medication errors, it is essential to reach an appropriate understanding regarding with their causes and reporting especially among nurses. The purpose of this study was to determine the reasons of medication errors and the causes of not error reporting from nurses’ viewpoints. 

Materials and Methods: This is a descriptive analytical cross-sectional study conducted in year 2013. The study population were nurses working in different working shifts in special and sub-special pediatric hospitals in Tehran. A sample of 294 nurses recruited using a stratified non randomized sampling approach. The corrected Gladstone questionnaire with appropriate validity and reliability was used. The data were analyzed by descriptive (frequency, mean and standard deviation) and analytical statistics (Mann-Whitney and Kruskal-Wallis) using SPSS version 16.

Results: The most important reasons of medication errors were tiredness of nurses, wrong dose prescription by the physicians and illegible prescriptions. Fear of the nursing manager's reaction was the main obstacle to reporting medication errors in the view of 74.9% of nurses. The nurses estimated that only 42.52% of all the medicinal errors were reported.

Conclusion: Raising awareness regarding with the types and causes of medication errors and their reporting and implementing the relevant intervention to address these causes should be established in hospitals in particular in pediatrics wards.

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Background and Aim: The main purpose of all organizations is improving efficiency and effectiveness. One of the barriers of reaching effectiveness is burnout which can be seen as the final outcome of job stress in many professions including nursing. This study aimed to evaluate the correlation between effectiveness of nurses and burnout in Shiraz Nemazee hospital.

Materials and Methods: This descriptive-analytic and cross-sectional study was done among all of the nurses in the Shiraz Nemazee hospital. Two hundred and forty five nurses were selected using random classified sampling method. The data gathering form was standardized questionnaire. Data were entered into SPSS 15 software and the Pearson correlation test was used for data analysis.

Results: The study nurses were at moderate level according to burnout and effectiveness variables. There were positive correlation between “effectiveness” and “target acquisition” and “preservation of the cultural model” dimensions with “lack of individual success” dimension (P<0/05). Also, there was a negative correlation (P<0/05) between burnout in nurses and their effectiveness.

Conclusion: It seems that nurses’ burnout can affect their effective performance so managers can enhance effectiveness of staff performance by providing programs to reduce burnout and its dimensions.

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Background and Aim: Employee involvement and organizational adaptability are two key factors towards success in almost all organizations. Hospital managers must pay special attention to these two variables and always try to improve them. The present research, therefore, studies the relationship between employee involvement (empowerment, team orientation, and capability development) and organizational adaptability (creating change, customer focus, and organizational learning) in the educational hospitals of Kerman.

Materials and Methods: The population of this quantitative study includes all staff members of Kerman’s educational hospitals, estimated about 1370 individuals. A sample of 302 subjects was systematically selected based on Krejcie and Morgan’s table of sample size. The data collection tool was a questionnaire and the data were analyzed by Pearson correlation coefficient, ANOVA, and Schefe post hoc test.

Results: According to the findings, employee involvement and organizational adaptability -- and their related indices -- were at an acceptable level and were almost equal to those of international organizations. Moreover, there was a positive and significant relationship between these two main variables and their related indices.

Conclusion: The results of this study can help hospital managers to verify the present situation of organizational adaptability and organizational involvement and their relationship. These findings could help hospitals to predict change priorities and select better strategies.

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Background and Aim: The study of human resources flexibility impact on hospitals performance indicators can be effective on hospitals performance improvements. The main purpose of this research is to investigate the relationship between human resources flexibility and hospitals’ performance indicators of Islamic Azad University.

Materials and Methods: The present research was a descriptive-analytical research that has been induced cross-sectionally in 2013. The statistical sampling has been selected randomly, and class assignment among 108 nurses, and supportive employees in five hospitals of Islamic Azad University. Data collection tools was hospital’s performance indicator forms, and flexibility questionnaire based on Right and Esnel. The process of data analysis has been done using SPSS software and by descriptive statistical indicators and correlation tests.

Results: The studied employees had low flexibility. The total studied hospitals were in undesirable situation from the perspective view of bed occupying and bed rotation ratio. Finally, there were not any meaningful relationship between human resources flexibility and hospitals performance indicators.

Conclusion: According to low flexibility of human resources of Islamic Azad University hospitals, the policies should be made in order to coordinate human resources process  with human  resources  flexibility strategies. Furthermore, human resource for the purpose of creating flexibility and hospital subsidiaries of Islamic Azad University performance improvements could be clearly effective in such hospitals situation promotion.

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Background and Aim: Nurses’ main tasks include the provision of healthcare services at the highest levels of quality and quantity standards, and based on the findings of scientific research. The aim of the present study is to identify and determine the barriers of evidence-based practice among nurses of Qazvin hospitals, in Iran, at 2013.

Materials and Methods: The present cross-sectional research was a descriptive- analytic study conducted among 260 nurses practicing in six hospitals of Qazvin in 2013. The barriers scale questionnaire developed by Funk, et al. was used to examine the four dimensions of evidence-based practice (EBP) barriers including adopter, organization, innovation and communication characteristics. To analyze the data, descriptive and analytic statistics were used.

Results: The mean score of EBP barriers among subjects was 3.07 out of 4. Among the barriers, "organization" and "adopter" dimensions had the highest and lowest mean scores, respectively. There was no significant statistical relationship between gender and EBP performance, But a significant relationship was observed between organizational dimension with age, employment type and work experience.

Conclusion: Since “organization” was found to be the main  barrier to  the use of research in nursing performance, policy-makers and administrators should pay attention to the use of research in performance, the establishment of a research culture in organization, the creation of appropriate infrastructures, and the allocation of sufficient time to the nursing personnel to have access to evidences.

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Background and Aim: Nowadays, hospitals believe that applying the principles of management improve quality, and enhance competition and development. One of the ways to achieve these goals is the use of 5S. This study is aimed to determine and compare  supporting departments of Amir Alam Hospital before and after the implementation of 5S.

Materials and Methods: This descriptive analytical and cross-sectional study was conducted within three departments: Kitchen, laundry and the maintenance & repairs departments  of Amir Alam Hospital. Five checklists were designed for collecting information before and after the implementation of 5S within each department. Data analyses was performed using Wilcoxon test and SPSS version 19.

Results: Average rating after running 5S was more than before within the kitchen Section. However, there was a significant relationship before and after running 5S in only stage one and five. Within maintenance & repair and the Laundry departments, average rating after implementation of 5S was higher than using it before. In addition, all purposes with the exception of employees’ adornment, were statistically significant in all of five stages.

Conclusion: Implementation of 5S systems will contribute to increase in employees & patients’ efficiency and satisfaction, which in turn will lead to achieving higher productivity and economic growth. Therefore, we recommend other hospitals and departments to apply the concept of 5S.

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Background and Aim: Diagnosis of preeclampsia has an essential role in applying appropriate treatment plan for the patients. The aim of this study was to design an expert system in order to diagnos preeclampsia in order to assist the clinicians.

Materials and Methods: This was a cross-sectional study which resulted in developing a new system. The study population consisted of all patients admitted to three Maternity hospitals affliated to Tehran University of Medical Sciences (TUMS). Sample size included 215 medical records which were randomly selected. The results obtained were compared with the diagnosis from experts by kappa test using SPSS software.

Results: First of all, input parameters fuzzificated and entered into inference engine. Outputs were categorized in two groups as patients and healthy, with the final diagnosis and clinical explanation. The results obtained from system evaluation showed that accuracy, specificity and sensitivity of the system were 98.2 percent, 100 percent and 96.4 percent respectively.

Conclusion: Based on evaluation results, it could be concluded that fuzzy logic is an efficient method for designing of expert systems in the field of obstetrics and gynecology. Also, due to the similarity of the logic used in the proposed system with workflow and medical decision making, it will be accepted by the physicians.

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Background and Aim: The analysis of patients’ safety clinical indicators is considered as one of the safety improvement instruments. Therefore, the present study is aimed to analyze the indices of safety clinical services in selected hospitals of Tehran University of Medical Sciences (TUMS).

Materials and Methods: The present descriptive-analytical study was conducted in 11 TUMS hospitals in 2013. The study tool was the patient safety evaluation protocol of the World Health Organization (WHO). A checklist was completed following interviews, observations, and documentation reviews. The data were analyzed with descriptive and analytical tests, and SPSS software version 13.

Results: The average scores of the studied hospitals were 96.6, 85.6 and 66 for the required, basic and advanced indices, respectively. The figure was not acceptable in required standards, but it was acceptable in basic and advanced ones. In the studied hospitals, numbers 7, 2, 4, 11, and 9 enjoyed the highest amount of conformity with standard, and were placed in rank 2 according to the ranking protocol. Finally, there was no meaningful statistical difference among hospitals in their observance of standards.

Conclusion: Conformity with necessary standards was low in 6 studied hospitals, but in 5 hospitals, it was acceptable in basic and advanced standards. Hospitals need enhancement programs in statements of information management system, drugs management system, infection reduction system, and effective clinical system.

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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.

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Background and Aim: Hospital complaining is an important dimension of clinical governance. This study aimed to determine the impact of clinical governance program on patients’ complaint in Shiraz public hospitals.

Materials and Methods: This applied study was conducted as descriptive-analytical in 2012 in Shiraz. The population studied was 10 public hospitals in Shiraz and the patients complaints were studied during 5 years. Data collected through Iranian Ministry of Health standard checklist of clinical governance. The data entered to SPSS version 21, and analyzed using descriptive statistics and analytical tests such as Chi-square.

Results: Registered complaints had increasing trend during the execution of the program  and were 1905. Moreover, 60.5% of the complaints have been made by family members. There was significant relationship between complaints registered with the hospital wards (P=0.000) and gender (P=0.000). Therefore, both genders and in all departments of the hospital complaints of poor quality and inappropriate behavior of the staffs was greater than other complaint.

Conclusion: The number of complaints has increased in recent years. It is proposed to reduce the number of complaints attention to improve  communication between physicians and patients, medical ethics, cut non-conventional financial relationaship between physicians and patients, and increased scientific and technical knowledge and skills.

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Background and Aim: Organizational productivity and efficiency depends on staff members’ job satisfaction and performance. Without the participation of staff members, hospitals cannot play an important role in promoting the society’s health. This study aimed to determine staff’s job satisfaction in a teaching hospital of Tehran university of Medical Sciences (TUMS).
Materials and Methods: This descriptive, analytical cross-sectional research was conducted on 172 staff members of a teaching hospital, who had been selected through random sampling. The data-collection tool was a researcher-made questionnaire. The validity of the questionnaire was confirmed by the clinical governance department members and Cronbach’s alpha reliability estimate turned out to be 0.88. 
Results: Para-clinical and service employees getting the mean scores of 72.55 and 70.71 demonstrated desired job satisfaction; nursing and administrative-financial staff members, however, showed a relatively desired job satisfaction with mean scores of 60.04 and 53.52, respectively; and the difference between job groups was significant (p=0.02) regarding job satisfaction. The highest job satisfaction figure was related to job success and the lowest pertained to the nature of the job. There was a meaningful relationship between job satisfaction on the one hand and staff members’ gender, marital status, and type of employment on the other.
Conclusion: Staff’s job satisfaction in the studied hospital has increased due to the establishment of Iran’s Healthcare Reform Plan at the beginning of 2014. However, compared with other job groups, nurses are less satisfied; therefore, it is necessary to improve nursing job satisfaction through timely payments based on job performance and difficulty level.

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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.

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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.

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Background and Aim: Hospital is a complex ecosystem in terms of diversity of services, clients, personnel, equipment, technologies, data and information which are generated. Since the ultimate goal of a hospital is to improve quality of care along with reducing cost, using intellectual tool such as dashboard can create strategic value.

Materials and Methods: This review article was performed based on a literature review and internet search through such scientific databases as PubMed, EBSCO host research, Proquest, Emerald, Web of science and search engine such as Google, Google Scholar. In this study, the articles about intellectual capitals as well as the application of dashboard in healthcare between year 2009 and 2013 were reviewed.

Conclusion: Application of dashboard in hospital can create strategic values such as respond to environmental changes rapidly, identify new market opportunities, become a learning organization by discovering new patterns and relationship among data, achieve best practices by analyzing patterns of treatment and results and achieve the highest efficiency.

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Background and Aim: Safety is an important component in the quality of health care that lack of attention to it leads to harmful results. This study was conducted to estimate the safety management status in selected hospitals affiliated with Tehran University of Medical Sciences. 
Materials and Methods: This analytical-descriptive cross-sectional study was conducted in four selected hospitals affiliated to Tehran University of Medical Science in 2012. Data collection was performed through a valid and reliable questionnaire (Safety management) involved 112 questions in 3 parts: organization, safety and event committee’s management, investigation of organization and hospital’s structure and evaluation standards for surgery rooms by safety management views, in 5 options of Likert criteria. SPSS software frequency, mean and standard deviation and Kruskal–Wallis were used for statistical analysis of data’s.
Results: In the evaluation of the hospital organization factor and its structure from safety management approach, each hospital’s organizational structure form safety management view was in a suitable condition (72.50). The result also showed that in respect to evaluation of surgery rooms for safety management, the highest average of calculated score was for hospitals number 1 (90.00) and the lowest was related to hospital number 4 (69.09). 
Conclusion: According to the results, safety in hospital was in an acceptable level. But it seems that continuous monitoring and safety management training courses is essential.

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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. 

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Background and Aim: Job Burnout syndrome consists of emotional exhaustion, depersonalization, and reduced personal accomplishment. The health system personnel to deal with stress because of physical, mental, and emotional intensity are at risk of burnout.
The aim of this study was to determine the relationship between burnout and general health of the financial staff hospitals of Tehran. 
Materials and Methods: In this cross-sectional study, the sample size consisted of 150 financial administrative personnel employed by university hospitals of Tehran University of Medical Sciences which were selected by random sampling.
The instrument was included demographic information, general health questionnaire and the Maslach Burnout questionnaire, which was already confirmed for its validity and reliability.
Results: The results showed a significant correlation (p<0.001) between burnout and general health therefore public health was reduced with increased burnout.
There was also a significant relationship (p<0.05) between burnout and satisfaction with work and partners. But there was no significant relationship between age, gender, work experience, marital status and income.
Conclusion: Regarding the significant relationship between burnout and public health in this study, the use of improved working conditions and the promotion of mental health personnel is recommended.

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Background and Aim: Growing the number of private institutions offering health care and fierce competitive market conditions in the private hospitals industry cause to pressure these hospitals to provide high-quality services. The purpose of this study was to examine the effect of service quality on patient satisfaction in private hospitals of the Guilan province. 
Materials and Methods: Based on standard model of Büyüközkan et al (2011) a new dimension professionalism to SERVQUAL model was added that has used six dimensions including tangibles, reliability, responsiveness, assurance, empathy and professionalism as the dimensions of service quality. The number of samples was 360 patients hospitalized in four private hospitals and a standard questionnaire was used to assess the quality of services. Pearson Correlation Coefficient and Simple and Multiple Linear Regression was used to analyze the data and then by using ANOVA and Duncan’s and by Fuzzy Analytical Hierarchy Process technique, ranking of private hospitals was performed.
Results: Four dimensions: tangibles, responsiveness, empathy and professionalism on patient satisfaction have been found to be effective while Components of trust and assurance in private hospitals of the Guilan province had no significance effect.
Conclusion: Based on the effects of service quality dimensions except trust and assurance recommend that hospitals can increase patient satisfaction if they pay special attention to patient in empathy, updating facilities and technology in tangibles, fast response to patient in responsiveness, employing professional and skilled human resources in professionalism dimensions.