Journal of School of Public Health and

---

  Background and Aim : It is impossible to deny the threats and risks endangering the process of health care when offering the services. Confirming this fact does not mean ignorance the risk, or allowance to medical and nursing mistakes to happen however, it can mean approaching the problem to come up with practical solutions and minimize the risks in the process of providing health care services. The present study was conducted periodically as an applied multi-stage research.

  Materials and Methods : To do a model of clinical risk management, different authentic texts on risk management in health sector were reviewed focusing on the models available. All such models were tabulated, analyzed and compared together which resulted 62 primary variables. The variables were, then, validated being used in a questionnaire responded by 20 nurses and doctors which, this time, produced a confirmed questionnaire of 40 variables. After that, 215 subjects chosen through a random and a stratified sampling were asked to respond to that questionnaire, making an exploratory factor analysis as well.

  Results : This study was done, using principal components analysis as with a rotation of Varimax loadings showed a variety of factors (19 factors) available in the models of clinical risk management were loaded as "organizing and policy-making" factor. This factor illuminated a sum of 25.3% of variances in the model of clinical risk management. The results also showed the loading factor of variables as among 0.5 and 0.7 which indicated a fine correlation among them and the participants' view.

  Conclusion: It was concluded that "the best care of the patient is accepted as a common perspective in organization" and "the effect of the treatment team's clinical performance on their financial payments" are the most and the least important variables respectively with 0.739 and 0.548 as factor load.

---

Background and Aim: Since health is a multidimensional issue and several factors affected on it, forming a structure which can manage these factors at provincial level is difficult but possible. Analysis of Stewardship function of Iranian Health system showed that an effective platform for operationalizing the national policies has not been provided in provinces yet So, study the current situation of policy making and planning process and designing a model for provinces was necessary. Materials and Methods: This is a descriptive and analytic study which used system designation mathod. Information were gathered by reviewing scientific literatures of policy making systems, critical review of documents related the policy making and planning structures in universities of medical sciences(UMS) in the country and written survey of the chancellors. Synthesized information presented to steering committee, that had been selected after stakeholder analysis, and the principles and requirement of designation were agreed by them. Based on the principles, Components of the proposed system as "Provincial Health Policy Secretarite(PHPS)" including mission and goals, system process, procedures and standards, management style and financial, human and information resources prepared and finalized by running several focus group discussion sessions, presenting selected health experts and steering committee. Results: Scattering of policy and decision making centers in UMSs, weakness of monitoring and evaluation of provincial health policies and programs, weakness of coordination of education, research and health services policies, weakness of evidence based policy making system in 3 levels of UMS, board of trustees and health and food security technical taskforce of the province, weakness of presence of key stakeholders in preparing policies in UMS are the most important improving opportunities of provincial health policy and planning system. Considering existing gaps, PHPS could operationalize brokering, supervising and surveillance roles of the chancellor (Vice Minister of Health at Province) and ensure the attainment of the three streams: following the standards of academic and community engagement, evidence based policies and plans and monitoring progress of provincial health indices improvement policies and plans among executive organizations. Conclusion: Several units effective on policy and planning in province should be coordinated. PHPS not only prevent the parallel structure but can improve the other structures functions as well. Formal implementation of PHPS in top chart of UMSs and training experts of the unit will help integrated policy and planning and facilitate to achieve the best health indices in the province and the country.

---

  Background and Aim: The aim of the present study was to investigate the views of policy makers and key persons about national AIDS control politics.

  Materials and Methods : This qualitative study used purposive sampling. To collect data, the perspectives of six experts about AIDS were inspected. Framework analysis was used to analyze the data.

  Results: The results of this study showed that beside the strengths there are also significant weaknesses in making the policies, administering the existing policies, executing the programs in organizations, and planning new policies to control AIDS hence these problems and weaknesses must be identified to achieve the main goals of AIDS control program.

  Conclusion: AIDS is not only a health problem but a social, economical and cultural problem, which requires more attention from authorities and related organizations for developing and implementing policies in accordance with international guidelines. To achieve Millennium development goals (MDGs) in the context of AIDS it is essential for policy makers and key figures to consider more effective activities and measures in their agenda.

---

Background and Aim: Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.
Materials and Methods: This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.
Results: The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.
Conclusion: Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.