Journal of

Background and Aim: In recent years, the family physician plan has been implemented as a main strategy of the health system in Iran. Therefore, the necessity to reform organizational structure based on new goals and strategies is felt more than before. The aim of this study is to review and summarize all cases about Iran’s organizational structure and its challenges in primary healthcare system.

Materials and Methods: This study is a systematic review. All relevant databases, bibliography of related papers, and laws were searched using appropriate search strategies and keywords. To evaluate the quality of selected papers, CASP tool was applied by two experts, and their choices were discussed to reach a final decision.

Results: Fourteen final cases were categorized in two groups: papers and upstream policies and laws. The results revealed the ineffectiveness of current organizational structure at different levels. The majority of the findings suggested proper reforms in the system. Centralization and delegation processes were the main dimensions studied.

Conclusion: Due to fundamental changes in goals and strategies, certain reforms in the organizational structure of health system in Iran are indispensable, especially at peripheral levels.

Key words: Primary Health Care System, Organizational Structure, Iran

Background and Aim: In recent years, the family physician plan has been implemented as a main strategy of the health system in Iran. Therefore, the necessity to reform organizational structure based on new goals and strategies is felt more than before. The aim of this study is to review and summarize all cases about Iran’s organizational structure and its challenges in primary healthcare system.

Materials and Methods: This study is a systematic review. All relevant databases, bibliography of related papers, and laws were searched using appropriate search strategies and keywords. To evaluate the quality of selected papers, CASP tool was applied by two experts, and their choices were discussed to reach a final decision.

Results: Fourteen final cases were categorized in two groups: papers and upstream policies and laws. The results revealed the ineffectiveness of current organizational structure at different levels. The majority of the findings suggested proper reforms in the system. Centralization and delegation processes were the main dimensions studied.

Conclusion: Due to fundamental changes in goals and strategies, certain reforms in the organizational structure of health system in Iran are indispensable, especially at peripheral levels.

Background and Aim: Learning is essential in healthcare environments, where knowledge and skills are quickly outdated due to continuous advances in medical science. Organizational learning is a dynamic process that enables learning organizations to be campatible with change in good time. The aim of this study was to determine the status of organizational learning in an Iranian healthcare organization in Tehran, and to assess the extent to which this organization could be considered as a learning organization.

Materials and Methods: In this cross-sectional and descriptive study, 200 nurses were selected in an Iranian healthcare organization. Dimension Learning Organizational Questionnaire (DLOQ) was used to collect data to be analyzed using descriptive statistics methods by frequency, percentage, mean, and standard deviation.

Results: The mean overall score for organizational learning was 3.36±0.69. Among the various dimension of organizational learning, continuous learning had the highest average (3.44±0.39), and the empowerment had lowest amount (2.72±0.06).

Conclusion: The findings from this study provide useful information for these organization's managers regarding the areas where there is a need for improvement in OL and to make it a more LO.

Background and Aim: Today, customer perception assessment as a way to measure satisfaction and expectations has an important role in improving the quality of services and organizational excellence. This study aims to measure customers’ perception at the Health Deputy of Iran’s Ministry of Health and Medical Education (MOHME).

Materials and Methods: This cross-sectional study was performed in 2012-2013. The population comprised the health deputies of medical universities, among which 13 of the universities were randomly selected. As the main customers of MOHME health deputy, these universities’ managers and experts were asked questions like a census. The data collection device was the national award standard questionnaire consisting of 2 sections and 26 questions. The data were analyzed by SPSS 18 with level.

Results: Of the 267 managers and experts, 147 (56.1%) were male. Many of them (57.3%) had a bachelor's degree. Most of them (91.6%) were employed in technical units. The average perceived level of managers and experts regarding their reputation and image was 3.3±0.7, production and service 3.1±0.7, support while and after providing services 3.0±0.7, and loyalty and honesty 3.3±0.8 out of a maximum 5 points, respectively. There was no significant relationship between administrators and experts’ perception level on the one hand, and individual and organizational factors on the other (P>0.05).

Conclusion: The study showed that customers’ perception of indices related to the quality of relationships, services and measures was at a moderate level. Therefore, it is recommended that the department of health should design and implement an appropriate intervention program for organizational excellence.

Background and Aim: With regard to the effect of environmental health for employees, and with regard to the lack of a proper plan for identifying and controlling harmful occupational factors, it is necessary to create workplace health identification cards. The aim of this research is to design an identification card, which includes all the information about the workplace health of the employees of administrative section of a ministry, which could be updated in specific time intervals.

Materials and Methods: The present research was an applied, descriptive and  observational study which was conducted in 2015 in 100 work stations which were randomly selected in a governmental ministry through designing of two forms, including the information about workplace building, and the health information of the work station. The employees were also interviewed in order to collect data about each workstation regarding the machines for measuring the light, sound, temperature, ventilation, and rays. The opinions of four experts in the fields of environmental health, public health, occupational health, and civil health was used to analyze the data.

Results: A workplace health identification card was designed and determined through using the data obtained in this research. The following issues from this identification card, including standardizing the workplace of administrative employees, creating a data bank from the information, related to workplace health.

Conclusion: Workplace health identification card will be created and the standard management procedure will be designed for the purpose of health inspections of the workplace of administrative employees through the data extracted from this research.

Background and Aim: For more than forty years, telemental health services have been used as a successful mean in various fields such as treatment and preventive interventions. This study was aimed to determine the viewpoints of health information management (HIM), and mental health professionals about telemental health services for veterans with mental disorders.

Materials and Methods: This cross-sectional survey was conducted in 2013. The study population consisted of two groups: the first group included mental health professionals working in psychiatric hospitals in Tehran and the second group comprised HIM professionals. The data were collected using a questionnaire that its validity was confirmed by experts and the reliability was estimated through test-retest method. The data analysis was performed using SPSS 17.0 and descriptive statistics.

Results: The findings showed that from the mental health experts' viewpoints, highest impact of the use of telemental health services related to medical travel costs with average 4.37 and the lowest impact replacement with the face to face treatment with average 2.68.

Conclusion: In general, the groups participating in this study stated that in situations where access to care was difficult, telemental health services could be used as a reliable alternative for the war disabled care needs. Therefore, it is suggested that Iranian foundation of Martyrs and Veterans Affairs and the health system administrators take more serious measures for the implementation of telemedicine for veterans.

Background and Aim: Caring about workers is important due to protect human capital and economic growth. Understanding health priorities is one of the main challenges of health management. The aim of this research was to priorities health promotion behaviors of female workers.

Materials and Methods: This study was conducted in 2012 and had a triangulation design with sequential qualitative-quantitative method based on "integrated model of planned behavior and self-efficacy". In the qualitative phase of the study, a content analysis approach was done  to develop the questionnaire, based on the model and psychometric properties were assessed. Then, the educational intervention was conducted in an experimental study with randomized sampling in 70 female workers (35 intervention group, 35 controls). The pretest and posttest was compared.

Results: Content analysis demonstrated 6 main themes, including the main constructs of the research model: attitude, subjective norm, perceived behavioural control, self-efficacy, intention and behaviour in 4 domain (nutrition, exercise, cervical and breast cancer screening, cope with stress). Scale level content validity index was 0.93. Confirmatory factor analysis showed CFI=0.97, GFI=0.95, IFI=0.96, NNFI=0.98, NFI=0.97, RMSEA=0.05. Concurrent validity versus the Health-promoting lifestyle profile II showed r=0.60. Cronbach alpha was 0.75–0.93 across the subscales. Test–retest reliability revealed no significant differences.After educational intervention there was a significant increase in attitude, subjective norm, perceived behavioral control, self-efficacy, intention and behavior of female workers in intervention group. Also, effect of intervention program was mostly in self-efficacy construct.

Conclusion: With regards to working conditions economic and socio-cultural barriers in female workers, health policy making is essential in this group to promote health

Background and Aim: Cosmetic surgery rhinoplasty, has dramatically been increased during the last two decades. This study aims to explore its effects on the quality of life of individuals gone under the surgery.

Materials and Methods: This was a descriptive and analytical study which was performed as a cross-sectional study. From all plastic surgery clinics in Teheran, 25 clinics were selected randomly as the site of study. In the next step 110 patients undergone rhinoplasty were selected randomly from these clinics. Collected data was analyzed by Spss17.

Results: Findings revealed that, the mean score of quality of life before and after surgery was statistically significant. While mean score of general benefits increased the score of social support and physical health was decreased after the surgery. The most motivating factors for surgery were external factors. In addition there was a positive correlation between quality of life and the time of interview. Also the mean cost of surgery was increased.

Conclusion: Overall quality of life among study population was decreased. It could be because of unnecessary surgeries, medical errors, and etc. The reduction for social support may be resulted from unacceptable consequences of rhinoplasty particularly in terms of appearance. Physical health of respondents was negatively affected by rhinoplastiy surgery. Malfunctions of upper respiratory system after rhinoplastiy surgery is known as the main reason for it. Correlations between the times of surgery and interview suggest a long term assessment of impacts of such surgeries.

Background & Aim: Because of extension of health services and comprehensive receivers, the need for health services management is inevitable. Despite the availability of health care services, people do not embrace the full range of these services. This study was conducted to determine the reasons for unwillingness to use health care services presented to age group under 9 years from perspective of health workers in Qom province, during 2013.

Materials and Methods: This cross-sectional study was done to evaluate the perspective of health personals about services that presented to population with age group less than 9 years. This study was done with a questionnaire as a matrix evaluation of health services. Data were analyzed by Spss 15 Software. Chi square test were used for the evaluation of the hypothesis.

Results: The main reasons for the lack of interest to receive the health care services from perspective of health workers were: lack of health knowledge in recipients of services, inadequate information, poor methods of health care delivery, quality of health care and unsuitable access to health care.

Conclusion: To encourage people to get the health care services provided at health centers in Qom province should hold training meetings, to enhance the knowledge of health care recipients. About presentation of services and methods of service delivery in health centers, we should give enough knowledge to people. Also we should try to promote the level of services, while people motivate to get the services.

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: The objective of this study was to design electronic card of health for schizophrenic patients to better manage their clinical information.
Materials and Methods: The study was conducted year 2014. The population of the study included 40 psychiatrists. The information, based on minimal clinical and demographic data, was gathered through field study and survey using a questionnaire. Referential and inferential statistics techniques were used to analyze the data.  To schizophrenic patients' electronic health cards, various software were studied to design database, card and card reader.
Results: According to the results and observed frequencies, it was confirmed that the components of demographic and clinical information be inserted in the electronic card of health. The project includes hardware of card reader machine, card and visual studio software. Microsoft SQL Server, 2008, was applied to design database. 
Conclusion: The electronic card of health for schizophrenic patients helps the treatment team to provide effective health care as well as medical records and hospital admission's staff in better management of patient information. It also reduces the problems of relatives and family members of the patients in the medical centers and facilitates, and the process of treatment of schizophrenic patients significantly. Using schizophrenia patient’s electronic health card, hospital in better management of patient information puts in good condition. 

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.

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.

Background and Aim: The most important issues that always absorb accuracy and effort of hospital, is the mastery and control over the financial status for the hospital resources management. In all countries, the medical centers are considered as a vital community resource and must be managed in line with the interests of society. Hence, these studies aimed to investigate the causes of insurance deductions and were made to assist hospital administrators in reducing the deductions against them. 
Materials and Methods: This descriptive research is retrospective study in year 2012. The study population consisted of 100 insurance experts deployed in insurance centers (including Health care’s, Social security, Armed forces, Help Committee) from which 25 experts were randomly selected from each Insurance Center. Researcher madden questionnaire was used to collect data. For validating of questionnaire justifiability, questionnaire was provided to insurance expert, professors and ambiguities were resolved. Test-retest procedure was used to ensure the Stability of the questionnaire. The collected data was analyzed and classified using Excel software.
Results: These findings indicate that between all parts of surgery wards deductions are the highest (%45/55), and between surgery wards, orthopedics surgery had the highest amount of deductions (%40/75).
Conclusion: Healthcare provider should be more careful and minimize documentation errors in reporting and documentation. Also the hospital administrators for reducing deductions against patient records must provide educational course for correct documentation.

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.

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.