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Background and purpose: This study aims to examine the challenges within the management structures of public hospitals, particularly how these challenges impede the achievement of executive goals. If the consequences of these challenges are not adequately addressed, they may result in significant issues in the management of medical and hospital services. These issues could have a detrimental impact on various stakeholders, including patients, hospital staff, and administrators. Therefore, this research identifies the key administrative challenges faced by public hospitals from the perspective of multiple stakeholders and proposes potential solutions to improve hospital management and service delivery. Materials and methods: This mixed-method study (quantitative and qualitative) involved two primary groups: healthcare providers and hospital managers/senior professionals, including 14 senior staff from a public hospital. In the qualitative phase, semi-structured interviews were conducted to identify the challenges in public hospitals. In the quantitative phase, a questionnaire was developed based on the qualitative findings and the opinions of 363 experts. Exploratory factor analysis was performed using SPSS and AMOS software (version 24). Results: According to stakeholders, the challenges in managing public hospitals were identified across four key categories: financial, procedural and decision-making, human resources, and infrastructure. The results of the data analysis revealed that procedural and decision-making challenges had a coefficient of 0.89 with a significance level of 7.881; financial challenges had a coefficient of 0.79 with a significance level of 6.994; human resource challenges had a coefficient of 0.75 with a significance level of 6.641; and infrastructure challenges had a coefficient of 0.43 with a significance level of 3.807. Conclusion: The study results indicate that procedural and decision-making challenges in public hospitals are key factors significantly affecting the achievement of hospital operational goals and have a broad influence on other critical aspects of public hospital services, including patient satisfaction and service efficiency. Additionally, financial constraints, human resource limitations, and infrastructure challenges diminish hospitals' capacity to effectively meet patients' needs and organizational goals in both quantitative and qualitative terms, posing serious barriers to healthcare quality and accessibility. [ABSTRACT FROM AUTHOR]

Introduction: Resilience is a component that plays a meaningful role in enduring the hardships of the work and marriage environment. Therefore, it is identified as the main structure of personality, so it is influential to identify variables that can predict resilience. Methods: The current research is based on the fundamental goal and the descriptive data collection method of the structural equation model correlation. The statistical population of the research consists of all married female nurses of hospitals and government treatment centers in Alborz province in 1401, who were selected by a multi-stage cluster sampling method of 400 people from different treatment units and departments. In this research, the Conner and Davidson resilience questionnaire (2003), Dennis and Vanderwaal cognitive flexibility scale (2001), and Bagaroozi marital intimacy scale (2001) were used to analyze data from Amos version 24 software. Results: For cognitive flexibility leading to marital intimacy, the value was 2.023. The value for the path of mental flexibility to resilience was 0.986, and for marital intimacy to resilience, it was 0.909. The critical ratio between cognitive flexibility (r= 0.767) and marital intimacy (r = 0.796) had a positive and significant relationship with resilience at a significance level of 0.01. Conclusions: The results showed that the data fit the conceptual model of the research. Also, the mediating role of marital intimacy between cognitive flexibility and resilience was confirmed. According to the results obtained, to increase the resilience of married female nurses, it is suggested to health officials to Different cognitive, emotional and emotional variables of this group should be given special attention. [ABSTRACT FROM AUTHOR]

Background. Designing a payment system for healthcare workers- doctors and nurses, in particular- in the hospitals is more intricate than that for other organizations. Beyond the legal compliance, the unique features of the medical professions and nursing work environment should be considered. Due to the lack of adequate researches on payment methods for doctors and nurses in Iran, especially regarding the recent changes in "fee for services" (FFS) payment, the present study aimed to investigate the payment challenges faced by the doctors and nurses in Iranian public hospitals. Methods. Challenges were identified by interviews, and prioritized by adopting the MARCOS method. The study population included the hospital managers, healthcare payment method experts, and doctors and nurses in the public hospitals. Targeted sampling and semi-structured interviews were conducted to collect the data. In the MARCOS method, criteria determination, weighting, and scoring of the challenges were performed by five experts in the field of healthcare payment. Criteria included decreased motivation (25%), reduced productivity (15%), correction cost (40%), and implementation difficulty of the correction (20%). Calculations were performed using Excel software and determining the relevant priorities. Results. A total of 16 interviews were conducted in this study, with 10 interviews about the academic faculty and hospital managers in Isfahan University of Medical Sciences, three about the nursing experts in Tehran, and three about the Ministry of Health experts. According to MARCOS method calculations, the top 4 challenges in compensating doctors were identified as: low FFS ceiling, lack of job difficulty incentives, the inadequate impact of full-time work, and the progressive taxing. Additionally, the 2 primary challenges in compensating nurses were: irregular payment of FFS, and collective payment of FFS instead of individual payment. Conclusion. At the time of this study, Iranian public hospitals provided the doctors with individual rights, benefits, and allowances, while it provided the nurses with collective rights, benefits, and overtime pay. Although these compensation methods often posed different challenges, most of the issues were associated with the allowance payments. By prioritizing key challenges, authorities may have developed the necessary solutions for addressing the challenges as well as enhancing the satisfaction of doctors and nurses in Iranian public hospitals.

This research develops and tests a mediation model regarding the effectiveness of internal control on hospitals' performance via the mediating role of intra-organizational information quality and organizational ethical behaviors. The proposed model and its hypotheses were tested using partial least squares structural equation modeling (PLS-SEM) in SmartPLS-3 with survey data from 384 public hospital managers in Iran. This study found that internal control effectiveness positively affects hospitals' performance. Also, the effect of internal control effectiveness on intraorganizational information quality and organizational ethical behaviors is positive and these, in turn, improve the hospitals' performance (mediating role). In general, these findings suggest that public hospitals seeking to improve their performance need to improve internal control systems. [ABSTRACT FROM AUTHOR]

Introduction: The dentist's level of knowledge and abilities is one of the determining factors in the correct selection and application of dental cements. This study aimed to investigate the level of knowledge, attitude, and practice of general dentists and specialists about the application of different dental cements. Methods: This descriptive-analytical study was cross-sectional one which conducted on 150 specialist and general dentists in governmental and private centers in Kurdistan province (2019) who performed fixed prosthetic treatments, was done through census and available sampling. The data collection tool was a questionnaire. To analyze data, T-test and ANOVA tests were used in SPSS-22 software. A significance level was considered less than 0.05. Ethical considerations: This study was conducted after the approval of the protocol in the research ethics committee and receiving the ethical code number IR.MUK.REC.1398.302 and according to the Declaration of Helsinki. Results: The overall average score of dentists' knowledge was 6.5, which was close to and higher than the average scores and had a significant relationship with the grade and place of employment (P<0.05). The overall average score of attitude was 3.4, which was almost equal to the average scores. There was a significant relationship between grade and gender with attitude score (P<0.05). The overall average score of the dentists' practice was 5, which was higher than the average scores, and the practice score had a significant relationship with gender, place of employment, and grade (P<0.05). Conclusions: The average score of knowledge, attitude, and practice of dentists was average, and in general, the scores of specialists were higher than general dentists. Women had a higher attitude and practice score. People working in the private sector had a higher knowledge score. To increase the knowledge, attitude, and practice of general dentists, there is a need to hold training courses. [ABSTRACT FROM AUTHOR]

Introduction: The nursing profession is one of the most challenging jobs in health care, and many of these challenges can lead to a decrease in efficiency and burnout among nurses. Therefore, the present study aimed to investigate the structural model of organizational commitment, job stress, psychological capital, and job burnout among nurses in Kermanshah, Iran, in 2021. Material & Methods: This descriptive correlational study was conducted using structural equation modeling. The statistical population of the research included nurses who worked in public and private hospitals in Kermanshah in 2021. The sample size was calculated at 300 cases who were selected via random and stratified sampling methods. Data were analyzed in SPSS (version 19) and AMOS software packages using descriptive statistics, Pearson correlation coefficient, and structural equations. The significance level was P<0.05. Findings: The mean scores of job burnout, organizational commitment, psychological capital, and job stress were reported as 63.17±17.72, 78.09±17.26, 115.452±22.28, and 38.63±12.89, respectively. Data analysis indicated a good fit of the model. The research results pinpointed that that organizational commitment (β=- 0.35, P=0.02), job stress (β=-0.39, P=0.02), and psychological capital (β=-0.64, P=0.001) had a significant direct effect on job burnout. Moreover, organizational commitment (β=0.31, P=0.001) and job stress (β=0.75, P=0.001) had a significant direct effect on psychological capital. Psychological capital had a significant indirect effect on job burnout through organizational commitment and job stress (β=0.18, P=0.001). That is, the results of the Sobel test for organizational commitment (1.9) and burnout (3.56) were significant at the P<0.05 level. Job stress exerted a more marked effect on the relationship between psychological capital and job burnout. Discussion & Conclusion: Nursing managers can implement interventions to improve nurses' organizational commitment and psychological capital. Furthermore, effective steps can be taken to reduce the stress and burnout of the nursing community by strengthening the components of organizational commitment and psychological capital. [ABSTRACT FROM AUTHOR]

Background & Aims safe nursing care is the use of knowledge and skills by nurses to provide quality patient care and it is considered one of the health goals in intensive care units. The feeling of being supported by the hospital play a key role in achieving this goal; it can lead to job satisfaction, good job performance, and patient satisfaction. This study aims to determine the relationship between perceived organizational support and safe nursing care in nurses working in the intensive care units (ICUs) of public hospitals in Tabriz, Iran. Materials & Methods This is a descriptive-correlational study with a cross-sectional design that was conducted on 200 nurses working in the ICUs of hospitals affiliated to Tabriz University of Medical Sciences in 2021-2022, who were selected using a quota sampling method. Eisenberger et al.’s perceived organizational support scale and Rashvand et al.’s safe nursing care questionaire were used to collect data. Data analysis was done in SPSS v.16 software using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent t-test, analysis of variance, and Pearson correlation test). Results The mean score of perceived organizational support was 23.20±9.57, which was lower than the cutoff point. Safe nursing care was at a favorable level with a mean score of 322.89±34.1. The perceived organizational support had no statistically significant correlation with safe nursing care and its dimensions. Conclusion Despite the unfavorable perceived organizational support of ICU nurses in Tabriz, their safe nursing care is favorable. There is no statistically significant relationship between their perceived organizational support and safe nursing care. This finding is probably due to the prevailing rules and professional beliefs in the work of nurses, which has caused the care provided to be safe despite the perception of low organizational support. [ABSTRACT FROM AUTHOR]

Background and purpose: Equitable access to health services and their fair distribution in the country, especially in deprived areas, are among the major goals of health systems. The aim of this study was to investigate the amount of health insurance subsidies in different socio-economic classes in public hospitals in Babol, Iran. Materials and methods: This cross-sectional applied study was performed in hospitals affiliated with Babol University of Medical Sciences in 2018. The statistical population consisted of 700 patients selected by simple random sampling. Data were collected using a checklist based on patient statements and a researcher-made questionnaire. SPSS V22 was used to analyze the data applying Mann Whitney and Kruskal Wallis test. Results: The amount of health insurance subsidies for patients of middle social class was higher than other two groups (good and lower social classes). The most discount on medical bills were offered to good-social class patients and then to patients of middle and lower classes (P

Background and Objectives: Bureauphobia in the public sector doubts the direct effect of good services on people’s trust. Addressing bureauphobia in public hospitals can be an attempt for increasing trust in the public sector, in addition to improving the health of the society. Therefore, the current study aims to survey bureauphobia in public hospitals of Qom Province in Iran. Methods: A quantitative method was used in this study. A researcher-made questionnaire was used to survey bureauphobia. Logistic regression analysis was used to find the related factors. Results: It was found that 24% of participants had bureauphobia. Age and gender had a positive significant relationship with bureauphobia. Employment in the public sector and citizenship had a negative significant relationship with bureauphobia. There was no significant relationship between educational level and bureauphobia. Conclusion: The results of the research showed that increasing age has increased the attitude of bureaucracy-phobia among the clients of government hospitals. The attitude of bureaucracy-phobia is higher among male clients than among female clients. On the other hand, people working in other government sectors have less fear of bureaucracy than the staff of government hospitals. Also, clients from other countries (Afghanistan, Iraq and Pakistan) have less fear of bureaucracy than government hospital personnel. There is no relationship between education level and bureaucracy-phobia.

Introduction: The COVID-19 pandemic has caused job burnout in nurses, followed by a decrease in the quality of life and the quality of care services provided to the patients. Regarding the prevalence of the COVID-19 pandemic and the researcher's experience, the present study aimed to determine the relationship between job burnout and the quality of life of nurses in intensive care units during the COVID19 pandemic. Material & Methods: This descriptive-correlational study was conducted on 140 nurses working in the intensive care units (including ICU and CCU) of public hospitals in Ilam province from February 10 to March 10, 2021 (the sixth peak of COVID-19). The participants were selected using the total population sampling method. The required data were collected through demographic characteristics form, Maslach Burnout Inventory (1985), and the World Health Organization Quality of Life Instrument (2004). The collected data were then analyzed in SPSS software (version 26) through Pearson's correlation coefficient and regression at the significance level of P<0.05. Findings: In this study, the mean±SD values of job burnout and quality of life were obtained at 76.1±11.4 and 72.9±5.9, respectively. There was a significant inverse correlation between job burnout and quality of life (r=-0.296, P<0.001). Furthermore, the linear regression test of the components of personality distortion and individual performance did not show a significant effect on the quality of life of nurses. The component of emotional exhaustion (P=0.001) had a significant negative effect on the quality of life of nurses working at intensive care units. Discussion & Conclusion: Managers must adopt support, encouragement, and educational programs to prevent adverse effects on nurses during the outbreak of health crises. [ABSTRACT FROM AUTHOR]

Background and Aim This study aimed to investigate the clinical and laboratory characteristics of hydatid cyst disease in patients admitted to Imam Reza, Imam Hossein, and Bisotoon hospitals in Kermanshah City, Iran, from 2014 to 2018. Methods & Materials In this descriptive study, we studied and analyzed the medical records of 350 patients with hydatid cysts who were hospitalized and underwent surgical treatment in Kermanshah hospitals from 2014 to 2018. Also, the demographic characteristics of patients, including gender, age, occupation, place of residence, and affected organs, were extracted and recorded. Ethical Considerations The Ethics Committee of Kermanshah University of Medical Sciences approved this study (Code: IR.KUMS.REC.1398.366). Results In total, 350 patients with a Mean±SD age of 43.2±19.7 in women and 43.3±20.7 in men were admitted with a diagnosis of hydatid cyst. The highest and lowest prevalence of hydatid cysts were in the age groups of 41-50 (16.5%) years and 1-10 (4.8%) years, respectively. The prevalence was 181 (51.7%) in women and 169 (48.2%) in men. The organs mostly infected with hydatid cysts were the liver, lung, and brain, with 241 cases (68.8%), 55 (15.7%), and 24 (6.8%), respectively. Conclusion This study shows that hydatid cyst disease is an important disease, especially in rural areas of Kermanshah Province, Iran. [ABSTRACT FROM AUTHOR]

Context: The intention to quit is a step before the actual leaving the job. The complex conditions of treating covid 19 patients, nurses physical pressures and mental tensions during the covid-19 pandemic, encourage them to quit their jobs. The present study was conducted to determine the factors related to the willingness of nurses to quit during the covid-19 pandemic in the hospitals of Isfahan city. Method: 416 nurses working in the hospitals of Isfahan participated in this cross-sectional descriptive-analytical research in the form of quota sampling and systematic random stratification. The data collection tool was a researcher-made questionnaire with high validity and reliability (0.95) that measured the intention to quit of nurses during the covid-19 pandemic in 4 dimensions of individual, occupational, organizational and transorganizational factors. SPSS version 25 software was used for data analysis. Findings The average score of nurses' willingness to leave during the corona pandemic in Isfahan hospitals was 2.98 out of 5. The average of Transorganizational factors (3.30) was higher than the average of organizational factors (3.05) in driving the intention to leave of nurses. A relation was seen between demographic information such as; received compensation, secondary job and total income and intention to quit. Conclusion: During the covid-19 pandemic, several factors lead to the quit in the group of nurses. Since the willingness to leave the job in public hospitals is higher than in private hospitals, managers of these organizations should pay more attention to evaluating factors, determining their impact and making effective decisions. [ABSTRACT FROM AUTHOR]

Background and purpose: Equitable access to health services and their fair distribution in the country, especially in deprived areas, are among the major goals of health systems. The aim of this study was to investigate the amount of health insurance subsidies in different socio-economic classes in public hospitals in Babol, Iran. Materials and methods: This cross-sectional applied study was performed in hospitals affiliated with Babol University of Medical Sciences in 2018. The statistical population consisted of 700 patients selected by simple random sampling. Data were collected using a checklist based on patient statements and a researcher-made questionnaire. SPSS V22 was used to analyze the data applying Mann Whitney and Kruskal Wallis test. Results: The amount of health insurance subsidies for patients of middle social class was higher than other two groups (good and lower social classes). The most discount on medical bills were offered to good-social class patients and then to patients of middle and lower classes (P<0.05). Also, health insurance subsidy paid to patients with good economic status (450,000 Tomans) was higher than patients with poor economic status (430,000 Tomans) (P<0.05). Conclusion: Current study showed that health subsidies and medical bill discounts were not commensurate with patients’ social and economic status. In fact, patients who had good conditions in terms of these characteristics, benefited more than other groups. [ABSTRACT FROM AUTHOR]

Background & Aims: Acinetobacter baumannii is an opportunistic pathogen and a component of gram-negative, aerobic, and non-fermentative gram-negative bacteria, which is found in the form of cocci or coccobacilli. Because these bacteria have few nutrients to grow, they can survive long periods in adverse conditions, on dry surfaces, as well as in aquatic environments. Acinetobacter is probably known as gram-negative bacteria on the surface of the genus. These organisms are difficult to stain and are often mistaken for gram-positive. Among the gram-negative bacteria that cause nosocomial infections (especially in the intensive care unit of the ICU), Acinetobacter species have received a great deal of attention over the last three decades (1-3). Acinetobacter baumannii OmpA binds to the host epithelium and mitochondria, causing mitochondrial dysfunction and swelling that is followed by the release of cytochrome c, leading to the formation of apoptosis, all of which contribute to cell apoptosis. OmpA, the most abundant surface protein in the pathogen, is also involved in complement resistance and biofilm formation. Key stress survival strategies and the potential for important virulence factors help increase bacterial survival inside and outside the host (1, 4). Most chromosomal AmpC beta-lactamases are found in Enterobacter, Serachia, Pseudomonas, Acinetobacter and, Citrobacter species. These enzymes belong to the C ambler classification and include the genes cmy, fox, mox, dha, acc, mic, family / related bil / lat (cit and act, mir (related to the ebc family)). They are (5). It is noteworthy that at tigecycline resistance levels in Acinetobacter baumannii isolates, its efficacy may be increased during treatment with tigecycline if the drug is exposed for a short time. Recently, mutations in the trm gene, encoding methyltransferases, have been associated with decreased tigecycline sensitivity in one Acinetobacter baumannii strain (6). Most strains of Acinetobacter baumannii are resistant to ampicillin, amoxicillinclavulanic acid, anti-staphylococcal penicillins, broad-spectrum cephalosporins (except ceftazidime and cefepime), tetracycline,and, tetracycline. MDR resistance in Acinetobacter strains has become a global and growing problem. In previous studies in Iran, the rate of multidrug resistance has been more than 60% (7). Methods: A total of 240 clinical samples (including blood, urine, sputum, respiratory secretions, urine, wounds, skin, etc.) were collected from patients admitted to different wards of Dey Hospital in Tehran. Samples were collected from patients who had been hospitalized for at least three days and had acquired the infection in a hospital setting and were transferred to a microbiology laboratory for evaluation. For initial isolation, clinical specimens were cultured linearly in McConkey Agar and Bloodagar media containing 5% sheep blood and incubated at 37 ° C for 24-48 hours (9). After the incubation period, the cultures were examined for macroscopic characteristics (appearance of the colonies) and microscopy using a hot staining technique. Then gram-negative bacilli were analyzed using biochemical tests. In order to extract the plasmid, the extraction kit made by Sina Clone Company, Iran was used. First, a colony of each isolate cultured on Müller-Hinton agar medium (manufactured by Merck, Germany) was inoculated with 5 ml of Luria Bertani Broth culture medium (manufactured by Sigma-Aldrich, USA) and stored for 13 hours in Incubated at 39 ° C. Then, the plasmid extraction steps were performed using the Cinnagen kit protocol. It should be noted that the resulting plasmids were stored at -20 ° C until PCR. Results: According to the results in Table 6, the higher the number of isolates containing mox gene, the more antibiotic resistance is observed. In fact, a significant relationship was found between the presence of this gene and antibiotic resistance. For colistin, which had the lowest resistance ratio of this antibiotic, fewer isolates had this gene. (Significance level 0.563) A semi-sensitive to colistin isolate containing both ox mox. Genes. One of the semi-sensitive isolates containing cefpeme contained only dha and no semi-susceptible isolates contained cit gene (significance level 0.853). With 1, 5 and, 14 isolates containing dha, cit and mox genes (significance level 0.802) (Table 6). Conclusion: Previous studies have shown that resistance to various antibiotics is on the rise. For example, studies by Wang et al. (23) and Esmoliako et al. (24) in recent years have shown that most strains were sensitive to amikacin, ampicillin, sulbactam, ceftazidime, cefpime, gentamicin, imipenem, meropenem, piperacillin, tazobactam. . In contrast to the present study, which found a 98.3% resistance to ampicillin and the highest resistance among all antibiotics studied, Karimi et al. reported a sensitivity of 91.6% to ampicillin in 2020. Consistent with the results of the present study, the results of the study of money changers and colleagues (2019) in Shahrekord have also shown a high prevalence of resistance to carbapenems, impenem 78% and meropenem 44%. In this study, Acinetobacter baumannii had the highest resistance to cefipime and ceftazidime (100%) and the lowest resistance to tobramycin and meropenem (22). In the study of Karimi et al., The resistance to meropenem was 83.3% and to ceftazidime was 93.3%. (19) Salehnia et al. In their study showed 100% resistance to cefpeme (7). According to the antibiogram results of the present study and also the results of the mentioned studies, to date, some strains of Acinetobacter baumannii have become resistant to all common antibiotics used, which greatly limits the treatment of these infections. The only effective antibiotic used to treat infections associated with this bacterium is colistin, which is also increasing its resistance. In general, the findings of the present study indicate an increase in antibiotic resistance compared to previous studies. This high prevalence of resistance is due to the unnecessary prescription of antibiotics and the lack of appropriate infection control tools. This is very important in identifying antibiotic resistance genes. In addition, the selection of appropriate antibiotics based on antibiogram plays an important role in treating and preventing the spread of drug resistance. The results show a high percentage of MOX genes that are directly related to antibiotic resistance, however, the presence of these genes and their relationship with antibiotic resistance need further investigation. The high resistance of Acinetobacter baumannii to antibiotics was very worrying because it is difficult to control and treat this bacterium. The only effective antibiotic used to treat infections associated with this bacterium was colistin, which is also increasingly resistant. [ABSTRACT FROM AUTHOR]

Introduction: Health tourism is a new form of tourism industry that aims to maintain recovery and regain physical and mental health and has grown in recent years. Therefore, the present study was conducted to investigate the factors affecting the marketing of health tourism in hospitals affiliated to Iran University of Medical Sciences . Methods: The present study is descriptive -analytical and was conducted on 270 individuals at some point in 2021. The study population consisted of all heads, managers, matro ns, quality managers and heads of international patients of public and private hospitals affiliated to Iran University of Medical Sciences. The data collection tool was a researcher -made questionnaire. Data were analyzed by using SPSS software version 23 . Results: The results of study showed a significant difference between the components of price, place, promotion and people in the two types of hospitals (P -value <0.05). While no significant difference was observed between other components ( product, physical evidence and process) (P -value <0.05). Conclusion: Providing the needs of medical tourists will increase their satisfaction. Therefore, paying attention to the effective factors in marketing and trying to solve the shortcomings of this field can be very effective in attracting health tourists and turning Iran into a medical tourist destination. [ABSTRACT FROM AUTHOR]

Introduction: Sustainable innovation is recognized as one of the influencing factors in the performance of the health sector because the dynamic and complex nature of the health care industry requires innovative methods and solutions to achieve sustainability. The aim of this study is to determine factors influenced by and influencing sustainable innovation in public hospitals in Tehran. Methods: The present applied research was conducted in two stages according to mixed methods research (qualitative and quantitative). In the first stage, in order to extract the factors influencing sustainable innovation in public hospitals, 11 people were selected from among the experts of public hospitals in Tehran by the snowball sampling method, and in-depth interviews were conducted with them. In the second stage, through a questionnaire and the fuzzy dimatel method using Excel software, the internal relationship between these factors and the influenced and influencing factors was determined. Results: 72 codes were extracted from the interviews and categorized into 17 factors. Out of 17 factors, 8 factors were influencing ones and 9 factors were influenced ones. According to the results of the research, the manager's familiarity with current knowledge was the most influencing factor and the observance of stability was the most influenced factor in all aspects of the hospital. Conclusion:Considering the benefits of sustainable innovation, it is recommended that hospital officials should provide a suitable platform for the development of sustainable innovation in hospitals with practical and up-todate training and human resource development and the use of systems that create transparency in hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Skin diseases, not only may have physical consequences but also costly psychological consequences in one’s life. The present study was conducted to compare the effect of group counseling with the approaches of Compassion-Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT) on the internalized shame of patients with vitiligo. Material & Methods: This was a quasi-experimental study with pre-test and post-test design and follow-up and control groups. The study population consisted of all women with vitiligo who were referred to Razi Hospital, in Tehran, in 1399. A total of 45 persons who met the inclusion criteria were purposefully selected and randomly divided into 3 groups of 15 people each (two experimental groups and one control group). The study tool included Cook's Internalized Shame Scale (1993). Descriptive statistics and repeated measures analysis of variance was used to test the research hypotheses. The data were analyzed using SPSS software (version 20). (Ethic code: R.IAU.SRB.REC.1399.125) Findings: Both CFT and ACT therapeutic approaches were effective in reducing internalized shame in patients with vitiligo, compared to the control group. A comparison of the two approaches showed no significant differences between the two experimental groups of CFT and ACT in terms of all components of shyness, self-esteem, and internalized shame. Discussion & Conclusion: Based on the obtained results, the abovementioned treatments can be used to improve the psychological status of patients with vitiligo. [ABSTRACT FROM AUTHOR]

Background and Objectives: Health System Reform Plan was implemented with the aim of modifying the health system structure with the overall aim of responding to the needs of society, improving and promoting the health system and a fundamental step in solving community health problems in the country. The purpose of this study was identifying and ranking the barriers to implementation of health system transformation plan by AHP method. Material and Methods: This study was an applied descriptive-survey study conducted Public Hospitals in Ahwaz. Statistical population was hospital managers, 12 of whom were selected by purposeful sampling. Open and closed questionnaires used for data collection. The t-test used to weight the indices, the AHP technique was used to rank the indices by paired comparisons based on the 9 ° hourly spectrum and also SPSS and the statistical software, Expert Choice, were used. Results: Findings showed that 4 factors (financial, infrastructure, planning and human) with 22 d subfactors were identified as barriers to implementation of Health System Reform Plan that financial barrier with weighted average (0.381), infrastructure weighted average (0.332), Planning with Weighted Average (0.162) and Human with Weighted Average (0.120) gained first to fourth rank, respectively. Conclusion: The results of the study showed that for the successful implementation of the Health System Reform Plan, it is necessary concetrate on the financing of the project, providing the necessary infrastructure, correct monitoring of the implementation, motivation and participation of human resources.

Introduction: Supply chain management in healthcare sector is of utmost importance due to its effect on individuals’ health status compared to other industries. In the current world economic situation wherein logical thinking should be based on lifetime costs of products ,as well as supply chain sources and processes, it is essential to have an agile supply chain to have a socio-environmental performance creating competitive advantage. Materials & Methods: This study was a survey with a correlational design considering its methodology and purpose. The statistical population of this study included the staff of public hospitals in Ilam province, Iran; of which, 340 individuals were selected as the participants based on Krejcie and Morgan’s sample size determination table. Moreover, the SPSS Statistics Software and LISREL Software were used to analyze the data in this study. Findings: The statistic of the Kaiser-Mayer-Olkin (KMO) index was equal to 0.844 implying sampling adequacy. Moreover, all the factors affecting supply chain agility had a normal distribution and the test statistic was larger than 1.96 for all the factors, suggesting their relationship with supply chain agility. The positive correlation between supply chain agility and competitive advantage was further confirmed based on the research findings.Additionally,the value of the goodness of fit index (GFI=0.96) showed the fit of the model and the test statistic of the model (T=9.60) revealed the significant impact of supply chain agility on creating the competitive advantage. Discussion & Conclusions: The results of the present study demonstrated that the seven dimensions of computer-based technologies, flexibility, relationships with suppliers, use of modern technologies, collaborative partnerships, sensitivity to market, and responsiveness of demands had effects on supply chain agility in hospitals. Moreover, public hospitals in Ilam Province were endowed with competitive advantage in three dimensions of durability and permanence, retention, and opportunities; however, they lacked competitive advantage in the dimension of individuals’ unique capabilities.

Background and Objectives: Given the complexity of the ruling in organizations, currently knowledge management can be considered as a guide for management practices. Complicated conditions have caused sweeping changes in management of organizations, especially in hospitals, which should be responded to these changes. The knowledge-oriented leadership can be a good answer to these. So, the impact of knowledge-oriented leadership on knowledge management practices in public hospitals was the main objective of this research. Material and Methods: This study was a descriptive survey, and an applied research by the objective, and according to the research goals that measure the effects of variables, it is a hypothetical-deductive type. Study population consisted of 631 health sectors of public hospitals in Tabriz. In this research, sampling was done by multi stage cluster method and the views of the managers of 169 health departments were used to collect data. Data analysis was conducted by structural equation modeling. Results: Software outputs indicate a positive and significant impact between knowledge-oriented leadership and knowledge management practices. Also, knowledge-oriented leadership has the greatest impact on knowledge application. Conclusion: The results show that practices of creation, storage, transfer and application of knowledge management has strong relation with knowledge-oriented leadership. In other words, attention to existing knowledge will improve the knowledge of hospitals.

Background One of the essential factors affecting the conditions of primigravid women is fear of childbirth that may be influenced by factors such as experiential avoidance, cognitive fusion, and difficulty in emotional regulation. Objective The present study aimed to investigate the relationship between experiential avoidance, cognitive fusion, and emotional regulation difficulties with fear of childbirth among Iranian primigravid women. Methods This cross-sectional analytical study was conducted on 300 primigravid women. The data was collected from a government hospital in Rash, Alzahra hospital. The research tools included demographic information form, the questionnaire of experiential avoidance (AAQ-II), Difficulty in Emotional Regulation (DES), Cognitive Fusion (CFQ), and fear of childbirth (CAQ). SPSS v. 16 was used to analyze the data. Descriptive statistics, Pearson correlation coefficient, and multivariate regression were performed. The significance level was considered 0.05 Results The present study's findings showed a significant reverse relationship between income and fear of childbirth (R=-0.22, p<0.05). Experiential avoidance, cognitive fusion, and difficulty in emotional regulation generally had a positive and significant relationship with fear of childbirth and could also predict it. Conclusion The score of fear of childbirth in primigravid women was high, and women with lower income had a higher score in fear of childbirth. Further problems can be prevented by supporting women who are more likely to be affected by fear of birth, holding psychology courses, and controlling emotions. [ABSTRACT FROM AUTHOR]

Introduction: In the present era, the implementation of open innovation process is necessary for any organization, and hospitals as the main medical centers are no exception. In fact, hospitals, as health operational units, are always directly exposed to changes in the field of health services. Therefore, the present study has investigated the factors affecting open innovation in public hospitals in Guilan province. Methods: From the point of view of purpose, this research is an applied study and in terms of data collection, it is in the category of descriptive research, which was conducted cross-sectionally in 1400. The statistical population of the study was 1600 senior managers and staff of public hospitals in Guilan province. For sampling, a non-randomized judgmental sampling method was used to access community members (senior managers and employees with at least a bachelor's degree). 250 questionnaires were used to perform the test. Data collection tools are standard questionnaires. The reliability of the questionnaire was confirmed through Cronbach's alpha, and the validity of the questionnaires was confirmed through the face and content validity, convergent and divergent validity. The structural equation modeling method has been used to test the research hypotheses. The software used in this research is SPSS 26 and Smart PLS3. Results: The results of the structural equation modeling test showed that among the external factors, cooperation with partners and the user, among the internal organizational factors, organizational structure, exploratory learning, and organizational culture, and finally among the individual internal factors, organizational motivation affects the open innovation of public hospitals in Guilan province. The impact of trust between partners, technology, personality traits, and knowledge on hospital open innovation has been rejected. Conclusion: In collaboration with other health care services, universities, and users, hospitals should develop appropriate policies to transition from a closed innovation system to open innovation, and support effective measures in this regard. [ABSTRACT FROM AUTHOR]

Background & Aims of study: Service delivery is known as the most tangible function of the health system and hospitals are the most obvious manifestation of this function. Also, one of the most important factors in creating catastrophic health expenditures is the use of hospital services; therefore, in the present study, an attempt was made to describe the share of hospital service costs from total household health expenditures. Materials and Methods: The present descriptive study was performed retrospectively for the period of 2011 to 2015. The study was done using the Household Expenditure and Income Survey (HEIS) which is conducted annually by the Statistical Center of Iran (SCI). Based on the designed model, the share of hospital costs from household health expenditure was determined by year and type of services in urban and rural areas. Results: On average, 18.5% of households used hospital services and about 28.7% of household health expenditure had been spent on receiving health services from hospitals. The average cost of household hospital medical services was 92.4% in urban areas and 91.4% in rural areas. On average, 51% of the cost of household medical services in hospitals was related to public hospitals, and the highest cost spent by households in public hospitals was allocated to surgery. Conclusion: The share of hospital services costs and the rate of use of these services among Iranian households are significant, which may lead to poverty and catastrophic health expenditures. Therefore, it is necessary for health decision makers to design and implement evidence-based policies to manage and control this part of health costs. [ABSTRACT FROM AUTHOR]

Introduction: There are many ambiguities and contradictions in the economic consequences of outsourcing services in public hospitals. Therefore, the aim of the present study was to systematically review the economic consequences of outsourcing in public hospitals in Iran. Methods: The information required in this systematic review study was collected using relevant keyword searches in the databases of PubMed, ProQuest, Scopus, Web of Knowledge, Google Scholar, SID, and MagIran without time limit. Textual data were analyzed manually by the content analysis method. Results: Finally, 20 articles were included in the study. Three types of rental outsourcing, managerial, and public-private partnership were reported in the studies. In five studies, the whole hospital was outsourced. None of the studies had a control group. A total of 51 indicators were used, most of which were total revenues, total costs, and personnel costs. The mean study time of the outsourcing effects was 24.2 months. The results of most studies showed the positive effects of outsourcing in economic terms. The most important achievements of outsourcing included reducing costs and increasing profitability, and the most important obstacles included the existence of hidden costs, imposing additional costs on patients, lack of economic stability, and lack of economic evaluation. Conclusion: The results showed that outsourcing has been economically successful in many wards and services of public hospitals; however, in some cases, outsourcing has led to increased costs. Therefore, more attention should be paid by hospital managers and health policy makers to identify the influencing factors and negative consequences of outsourcing. [ABSTRACT FROM AUTHOR]

Background and Aims: The National Program for Hospital Preparedness is a comprehensive and unified model for planning and responding to accidents and disasters in hospitals and health centers of the country. The present study aimed to assess the effectiveness of training nurses on The National Program for Hospital Preparedness in their preparedness for disasters and accidents. Materials and Methods: The randomized controlled intervention study was performed on 62 nurses who were selected by the simple non-randomized sampling method. The research instrument was the Disaster Preparedness Questionnaire (READI). A one-day workshop was organized for nurses' preparedness for disasters in accordance with Hospital Preparedness National Program. The questionnaire was administered to case and control groups in three stages: before, immediately, and two months later. Data were analyzed using Chi-square, Fisher, independent t-test, and Bonferroni, and repeated measures ANOVA. A p-value less than 0.05 was considered statistically significant. Results: As evidenced by the obtained results, the scores of clinical competence, managerial support, team cohesion, environmental competence, and survival skills increased after the educational intervention. Moreover, the total score of nurses' preparedness for disasters was improved from 191±28.4 to 193.4±36.3 and 208.4±35.4 immediately after the program and two months later, respectively (P<0.05). Conclusion: Training on the National Program for Hospital Preparedness will further enhance nurses' preparedness levels. Due to the peculiar role of nurses in accidents, it is recommended that this program be integrated into nurses 'training courses and students' courses. [ABSTRACT FROM AUTHOR]

Introduction: Benchmarking is one of the superior methods and processes for performance and organizational improvement. This study was conducted to determine benchmarking rate of disaster management committee members in Iranian public hospitals in effective disaster response. Methods: This cross-sectional study was conducted in 2018. The research community was Iranian public hospitals that were randomly selected based on spatial planning. The data were collected using a researcher-made questionnaire including two parts of individual variables, and amount and technique of benchmarking using 14 open-ended and closed-ended questions. The data were analyzed by SPSS-23 software. Results: Out of 410 members available from the hospital crisis and disaster management committee who were studied, 103 persons (25.1%) had from 1 to 8 benchmarking cases during the period of cooperation with this committee, and a total of 237 cases of benchmarking were recorded. Thus, the mean number of benchmarking cases was 0.58±1.2. Thus, the mean score of benchmarking was 0.58±1.2. There was a significant relationship among the number of benchmarking cases and the duration of cooperation in the Disaster Management Committee (P=0.001 & r=+0.177), the number of active beds in the hospital (P=0.024 & r=+0.117), educational level (P=0.029 & r=+0.109), and the city of hospital (28.4% in metropolitan areas and 15.9% in non-metropolitan areas) (P=0.010). Conclusion: This study showed that benchmarking rate per capita among the studied members was in a lower level compared to other similar studies. Therefore, it is suggested that appropriate intervention programs be designed and implemented. [ABSTRACT FROM AUTHOR]

Background: External laryngeal trauma is rare. It has a population incidence of 1 in 137,000 in adults. In developing countries blunt trauma is more common than penetrating trauma. Blunt trauma may occur due to accidents, sports injuries or hanging. Laryngeal trauma manifests as a spectrum of symptoms and signs ranging from cardiopulmonary arrest to subtle changes in voice quality. The most common presenting feature of laryngeal trauma is hoarseness, followed by dysphagia and pain. Although blunt laryngeal trauma is rare, but it can be life threatening. So, its early and proper management will remarkably affect the immediate probability of patient’s survival and their long term quality of life. Methods: In this cross-sectional and descriptive study, medical records of 30 patients with blunt laryngeal trauma, who were admitted in ENT ward of Imam Reza hospital over a 10-year period, were evaluated. Results: 30 patients, including 27 (90%) males and 3 (10%) women were studied. Mean age of patients was 36.13±10.53 years. The most common cause of blunt laryngeal trauma was vehicle accidents. The most common presenting symptoms were neck pain and tenderness. Subcutaneous emphysema was the most common radiological finding. The most common laryngoscope findings were swelling and hematoma of true vocal cords. Treatment modalities were supportive therapy performed on 26(86.7%) patients, tracheotomy on 3(10%) patients and open surgery on 1(3.3%) patients. Also 2 (6.7%) patients required intubation. Conclusion: In most patients suffering from mild trauma, conservative therapy is mostly administered. Any delay in early and proper diagnosis and treatment may be life threatening. So in such situations the patient's airway should be evaluated by skillful experts and emergency procedures have to be applied. Also any changes in patient's signs should be monitored frequently and the required diagnostic and therapeutic procedures must be applied. [ABSTRACT FROM AUTHOR]

Background and Objectives: Health System Reform Plan was implemented with the aim of modifying the health system structure with the overall aim of responding to the needs of society, improving and promoting the health system and a fundamental step in solving community health problems in the country. The purpose of this study was identifying and ranking the barriers to implementation of health system transformation plan by AHP method. Material and Methods: This study was an applied descriptive-survey study conducted Public Hospitals in Ahwaz. Statistical population was hospital managers, 12 of whom were selected by purposeful sampling. Open and closed questionnaires used for data collection. The t-test used to weight the indices, the AHP technique was used to rank the indices by paired comparisons based on the 9 ° hourly spectrum and also SPSS and the statistical software, Expert Choice, were used. Results: Findings showed that 4 factors (financial, infrastructure, planning and human) with 22 d subfactors were identified as barriers to implementation of Health System Reform Plan that financial barrier with weighted average (0.381), infrastructure weighted average (0.332), Planning with Weighted Average (0.162) and Human with Weighted Average (0.120) gained first to fourth rank, respectively. Conclusion: The results of the study showed that for the successful implementation of the Health System Reform Plan, it is necessary concetrate on the financing of the project, providing the necessary infrastructure, correct monitoring of the implementation, motivation and participation of human resources. [ABSTRACT FROM AUTHOR]

Introduction: Salivary gland reactive lesions are acquired, non-infectious, and non-neoplastic lesions. Often, direct trauma and salivary flow obstruction are reported to be the etiologic agents for these lesions. This study aimed to determine the frequency of salivary gland reactive lesions recorded in Isfahan Ayatollah Kashani and Al-Zahra Hospitals and Dental School during a 10-year period (2007-2016). Materials & Methods: In this descriptive cross-sectional study, patients' records (n = 435) with a diagnosis of reactive lesions (mucocele, ranula, adenomatoid hyperplasia, necrotizing sialometaplasia, sclerosing polycystic adenosis, obstructive sialadenitis, mucus retention cyst, cheilitis glandularis) were investigated in Isfahan therapeutic centers from 2007 to 2016. Data analysis was performed with SPSS 22, using ANOVA and chi-squared test (α = 0.05). Results: A total of 435 samples of salivary gland reactive lesions were seen that accounted for 4.74% of oral biopsies, 28.5% of the whole oral reactive lesions, and 29.45% of salivary lesions. Mucocele (60.7%) had the highest frequency among salivary reactive lesions. Patients with mucocele and ranula were significantly younger than those with other salivary gland reactive lesions (p value < 0.001). The highest incidence of salivary glands reactive lesions was observed in the lower lip (56.6%). Conclusion: Considering the prevalence of salivary gland reactive lesions among all the oral and salivary biopsies, recognizing the epidemiological characteristics of these lesions leads to better differential diagnosis of them from other oral and salivary lesions, such as salivary gland tumors, leading to their appropriate treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives This study aimed to investigate the management of the consumption of blood bags in the elective procedures in the public and private hospitals in Iran. Due to the issue of blood shortages caused by unpredictable demand besides immediate requirements for blood units in particular conditions, the strategic management of consumption of this vital source is necessary. Materials and Methods In this study, we evaluated 30 articles published from 2005 to 2017 which included the most important observational and interventional researches in Iran. These articles had investigated the consumption procedure and the likely wastage rate of blood bags in the operating rooms of Iranian hospitals. Results The results of this review showed the over-reservation of the blood units due to the lack of standard protocols for blood ordering, and the negligence of relevant staff toward expiry date and reserved/returned units as the most prevalent reasons for blood component wastage in operating rooms. The results of the studies carried out showed that conducting some effective interventions led to reduction of the rate of blood wastage and improvement of the standard blood transfusion indices such as cross-match to transfusion ratio (C/T ratio), Transfusion Probability (TP), and Transfusion Index (TI). Conclusions According to previous studies, the organization of a committee on the principles of managing blood supply at the national, local and hospital levels, implementation of standard blood transfusion guidelines, and establishment of training programs for physicians and nurses on the process of optimizing blood usage will be effective. [ABSTRACT FROM AUTHOR]

Introduction: Social responsibility is a concept in which organizations pay particular attention to environmental and social issues in its business processes. The purpose of this study was to investigate social responsibility dimensions in public hospitals affiliated to Mashhad University of Medical Sciences in 2019. Methods: In this cross-sectional and analytical study, social responsibility and its dimensions in 13 public university hospitals of Mashhad were examined using a questionnaire based on 273 samples of staff and customers. Data were analyzed using descriptive statistics (frequency, mean, and standard deviation) using SPSS software version 11. Results: The highest mean score (2.40) was related to leadership and internal processes, and the lowest mean score (1.83) was related to workplace dimension. The other average scores from highest to lowest were: environmental dimension (2.08), market dimension (2.01), and community and country dimension (1.92). Overall, the social responsibility of the hospitals under study was significantly different from the mean level of 2 (2/05), and considering the positive t-statistic for comparing a sample, it can be concluded that social responsibility was significantly higher than the average level (p-value ≤ 0.05) Conclusion: Improving the employment status of employees as the most important social capital is very important, which had the lowest score in this study. According to the results of the research, the existence of discrimination and work shifts reduced the satisfaction in this dimension. Lack of employee awareness has been the most important reason for the decrease, which can be promoted by increasing the awareness of employees in this dimension. [ABSTRACT FROM AUTHOR]

Introduction: Today, managers in the field of health and care, especially in hospitals, need to address not only the internal issues but also the social and environmental issues of their decisions and actions to improve financial performance and increase productivity. The purpose of this study was to improve the financial performance of hospitals through social responsibility future study. Methods: The method of this research was applied in terms of purpose, and according to the research methodology, it was a mix of quantitative and qualitative methodology consisting of phenomenology, content analysis, and future study. In the first step, phenomenological methods and interviews with experts were used to extract hospital financial performance indicators. In the second step, the content analysis method and systematic review on selected articles, dimensions, and indicators of social responsibility were extracted. Finally, as for the future study, the variables related to social responsibility were extracted through fuzzy delphi technique and analyzed using structural-interpretive model . Results: In the first step, 16 financial performance indicators were extracted. In the second step, the results of this phase showed the extraction of 35 proponents and four dimensions of economic, social, employee, and environmental social responsibility. In the last step, 20 variables related to social responsibility were extracted using the structural-interpretive model. The power of penetration and the degree of the dependence of the variables were determined. Conclusion: The research results showed that all the variables associated with social responsibility had a great deal of influence and instability powers. That is, any change that occurs on them affects both them as well as other variables. Since the main purpose of public hospitals is to provide quality services to all segments of society and satisfy them, Therefore, considering all dimensions and components of social responsibility increases productivity and consequently improves the financial performance of hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Hospital websites have a high potential for providing information and services to customers. The assessment and comparison of hospital websites determine the extent of their utilization and contributes to the formation of constructive competition between hospitals. Therefore, the present study was conducted with the aim of comparative assessment of the websites of public and private hospitals. Methods: This applied research is an analytical-descriptive study and was conducted in 2017. The study population included 13 public hospital websites and 3 private hospital websites in Isfahan, Iran. The data were gathered through a checklist based on 11 main and 69 sub-criteria and analyzed by inferential statistics. Results: There was a significant difference between the average of scores obtained from public and private hospitals’ websites in terms of the 4 main criteria including contact information and access methods, admission service and reservation, features, design and updating of pages and public relations. However, there was no significant difference between the average of scores obtained in terms of 7 other criteria and the overall score. Conclusion: The assessed websites did not fully utilize web capabilities and did not have a favorable status. Therefore, according to the results of this research, the authorities in this area must provide the information and services to the customers in a desirable way so that they can compete with other hospitals in order to attract more customers and improve customer satisfaction.

Introduction: Hospitals are among the service centers that cause the greatest environmental pollution. Green Hospital refers to a hospital that views the environment as part of its service quality processes and seeks to avoid harming itself and others by employing effective approaches in each of its dimensions including management, water, energy, buildings, waste, medicine, and shopping. Objective: This study aims to determine the extent of medical services centers readiness for the establishment and implementation of Green Hospital standards in Rasht. Materials and Methods: This is an applied research, and a descriptive cross-sectional method is used. Also, survey method is implemented. The statistical population of this study included all public and private hospitals in Rasht. Among them, 8 hospitals were selected as the sample using convenient sampling method. The data collection tool was the hospital checklists, obtained through observation and interviews. The checklist information consists of two parts, demographic information and information about seven variables in the green hospital, in which respondents should state their hospital readiness in each part of the green hospital checklist. SPSS statistical software was used to analyze the data. Also, descriptive statistics (Frequency distribution and percentage and mean) and analytical statistics (t-test, Kolmogorov-Smirnov, etc.) were used. Results: The results indicated that the 8 under studied hospitals were not in good condition regarding the relevant standards of the green hospital (the rate of meeting standards was 36.8%). Also, these hospitals are not prepared to implement green hospital standards. Only given the drug use (score 65.6), they meet green hospital standards; however, they are not in the right position for the establishment of a green hospital in terms of energy management; waste management; water conservation (score 34); use of chemicals (score 43); green architecture (score 35)and purchasing Hospital Requirements (23.2 points). Conclusion: Green hospital standards are of critical importance in sustainable management and cost saving for hospitals. Apart from the general discussion of green buildings, meeting these principles in hospitals, in addition to its sustainability aspects, has a significant role in improving the patient's therapeutic quality. Implementation ofsuchstandards in the province requires a comprehensive planning of the 7 under-studied variables and clarification of relevant guidelines and rules, training and documentation of actions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the process of establishing a non-governmental and nonprofit hospital, as a corporate infantry, and a model for the establishment of autonomous and corporate hospitals. Materials and Methods: This was a qualitative case study. The data were collected by interviewing the founders of Moheb Mehr Hospital, staff and some university officials and charity organizations. The data analysis was conducted based on grounded theory principles and data were coded in three stages of open, axial and selective coding. Results: The primary factors behind the establishment of Moheb Hospital were the low level of physicians' fees and the physicians’ dual practice in the public and private sectors. The existence of unused spaces at Hashemi-Nejad Hospital and the possibility of contracting supplementary insurance were the secondary factors. The reaction included welcoming from hospital physicians and opposition from the government and the Ministry of Health. A good patient access was created due to the lower charges, in comparison to the private sector, and having contract with the supplementary insurance. The negative comments from the government and the Ministry were gradually adjusted. Conclusion: Instead of turning government hospitals into independent or corporate, it is better to reestablish them in an autonomous or corporate form. Also, before any decentralization action, financial and managerial stability must be created in the organizations. Morevoer, employee benefits must be preserved. Instead of receiving government funding, it is better to use the capacity of the endowment and receive bank loans. [ABSTRACT FROM AUTHOR]

Introduction: The importance of management's role in any organization is obvious. Selection and appointment of competent managers in healthcare organizations -given the importance of their services- will also have a significant impact on health systems and communities. Therefore, it is necessary to identify and validate key management skills and competencies to design educational programs and identify and employ the best managers. Methods: This descriptive study consisted of two phases. First, a literature review was performed to identify the required competencies and skills for healthcare management and leadership based on which a five point likert-scale qestionnaire was developed. In the second phase, a Delphi technique was used to collect 20 experts' opinions about the extracted criteria in the questionnaire. Results: Based on the experts' opinions, eight key criteria including: personality traits, values, basic management knowledge, hospital management knowledge, planning skills, organizing skill and resource allocation, leadership skills, monitoring and supervision skills, and 46 sub-criteria were approved. Conclusion: Management knowledge is one of most important skills for managers; therefore, it is necessary to revise approaches for selecting managers and change the attitude of hospital managers form autocratic management to leadership and Intra-organizational collaboration and coordination. [ABSTRACT FROM AUTHOR]

Introduction: Hospitals are considered as critical health service providers. Taking the advantage of knowledge sharing and establishing trust between suppliers and hospitals, supply chain performance can achieve IT and supplier integration and pave the way for effective competition in the modern world, especially in health care services. Therefore, the current study aimed to analyze factors affecting knowledge sharing through supplier integration in hospitals in Mashhad. Methods: This applied research was conducted from 2018 to 2019. The population consisted of all hospital managers and employees among whom 273 people were selected through multistage sampling carried out in private, charity and public hospitals. Data were collected using a standard questionnaire addressing five variables: trust, supplier integration, IT integration, knowledge sharing and supply chain performance. The construct validity of the questionnaire was assessed and confirmed through confirmatory factor analysis, and the reliability was calculated as 0.871 using Cronbach's alpha. The data were then analyzed by the SPSS, and Liserl software. Moreover, regression tests were run. Results: According to the findings, the impacts of trust and IT integration on knowledge sharing were 0.33 and 0.48, respectively. The impacts of trust and IT integration on supplier integration were 0.33 and 0.35, and the impacts of knowledge sharing and supplier integration on supply chain performance were 0.36 and 0.71, in that order. The results also confirmed the mediating effects of trust, knowledge sharing, and supplier integration on supply chain performance. Conclusion: Supply chain performance requires the establishment of trust between hospitals and suppliers, leading to enhanced knowledge sharing, IT and supplier integration, reduced costs, increased speed, and improved quality. [ABSTRACT FROM AUTHOR]

Introduction: Designing a supply chain performance model for hospitals is one of the fundamental decisions in supply chain management which significantly affect the investment return and the overall performance in the chain. The purpose of this research was to design a model for assessing supply chain performance in hospitals while considering economic, social and environmental dimensions of sustainability. Methods: This qualitative research was conducted using grounded theory. In order to collect data, 14 experts in public hospitals in Yazd province were interviewed. The participants included five hospital managers, four heads of departments, three supplies deputies, and two administrative heads who had at least 8 years of work experience and were familiar with sustainability issues. A combination of purposeful and snowball techniques was used to collect data which were then analyzed using open, axial, and selective coding methods. Results: After the analysis of the data, 44 sub-codes affecting the sustainability of supply chain in public hospital were identified. The sub-codes were then classified into six main codes: intervening factors, causal factors, phenomenal pivot, performance strategies, background requirements and performance implications. Improving collaborative cooperation in different parts of hospitals, reducing the risk of medical errors, improving the quality of services, and enhancing the professional status of personnel were some of the implications of assessing the sustainable supply chain performance in hospitals. Conclusion: The proposed model can be used as a tool of prediction and policy making while assessing sustainability of supply chain performance in public hospitals. Planning and policymaking to enhance health and environmental management system can lead to collaborations between departments, reduction in medical errors (i.e., wrong diagnosis or medication), understanding the specific needs of each patient, the implementation of educational and health care programs, as well as a reduction of environmental pollutants. [ABSTRACT FROM AUTHOR]

Background: Physicians' full time attendance is related to increment of many hospitals performance. Regarding the present challenges, this study aimed to analyze this plan using SWOT technique and present TOWS model in Tehran University of Medical Sciences (TUMS). Materials and Methods: This study was a descriptive-analytical and cross-sectional one conducted during 2016-2017. Based on Cochran formula, 234 full time attending physicians randomly selected using simple randomization method. The research tool was a researcher made SWOT questionnaire which confirmed its content validity and reliability. Collected data was analyzed by SPSS software using SWOT technique and suggested TOWS strategic model. Results: The most valuable weaknesses of mentioned plan were inappropriate coordination of physicians; lack of compensatory system, and the most important strengths were employment of young physicians and better education for medical students. The most important opportunities and threads of mentioned plan were establishment of competitive work between public and private hospitals and burnout and dispensing of experienced physicians moving to private sector, respectively. Conclusion: Based on study findings, TOWS model strategies can be suggested for improvement of the plan. [ABSTRACT FROM AUTHOR]

Introduction: High quality health care service leads us towards a healthy society. Present paper aimed to use the service quality concept in health care sector based on service quality approach (SERVQUAL) in public hospitals. Methods: In present research a hybrid approach based on Analytic Network Process (ANP) and Fuzzy TOPSIS was used where the former was used for prioritization of healthcare service quality measures and the latter was used to operationalize the hospitals. Questionnaires and ANP and Fuzzy TOPSIS were used for data collection and analysis. Five public hospitals in Rash were evaluated. The time period of the study including data collection was 2014-2015. Results: The service quality criteria comprised of 6 main criteria and 19 sub-criteria in present study. Among five hospitals studied in present research, Rasoul Akram hospital obtained the first rank and other hospitals obtained the other ranks. All criteria and sub-criteria used in present study obtained some rank indicating their importance in the research context. Conclusions: With conducting present research, various criteria and sub-criteria related to service quality (SERVQAL) and their importance were identified and this may contribute to improved performance of health care services

Introduction: Fair access to health care services is every individual’s right in society and governments should ‎provide these services. The purpose of the present study was to prioritize strategic factors ‎influencing health care management using a hybrid approach in the context of public hospitals. Methods: The current research was an applied, descriptive survey. It was based on a hybrid approach ‎including a combination of Fuzzy Analytic Network Process (ANP) for prioritization of strategic ‎factors influencing health care management and Fuzzy Decision Making Trial and Evaluation ‎Laboratory (DEMATEL) for identification of the extent of the effects of strategic factors of health ‎care management. In addition, the studied hospitals were ranked using the Fuzzy Technique for ‎Order of Preference by Similarity to Ideal Solution (TOPSIS). Questionnaires were used for ‎collection of data from 6 public hospitals in 2014. Results: SWOT (strengths, weaknesses, opportunities, and threats) analysis criteria used in the present ‎research comprised of 4 main criteria and 16 sub-criteria which were ranked in the present study. ‎Among the 6 public hospitals studied in the present study, Poursina Hospital obtained the first rank ‎and Rasoul Akram, Amir-al-Mo’menin, Heshmat, Hefda Shahrivar, and Razi Hopitals obtained the ‎following ranks, respectively. Each of the Criteria and sub-criteria obtained a rank based on their ‎importance in the health care sector. Conclusion: The results of the present research can contribute to the improvement of the performance of health ‎care management by determining the importance of the criteria and sub-criteria associated with ‎SWOT analysis.

Background: ‌ Based on increasing the privatization in hospitals, conducting researches in various fields of private hospitals and comparison with public hospitals is greatly felt.This study aimed at investigating the relationship between job satisfaction and burnout among employed nurses in selected public and private hospitals in Shiraz city. Materials and Methods: This was a comparative-correlational study. The study population was composed of employed nurses in public and private hospitals in Shiraz city in 2012. sample size was estimated 320 using Cochran formula. The questionnaire of Spector job satisfaction” and “Maslach burnout” were used for data collection. Study conducted in two private and two public hospitals in Shiraz and data gathered randomly among nurses. In order to analysis descriptive and interfere statistics including mean and standard error, Pearson correlation coefficient, MANOVA and independent t- test. Results: There was a significant and negative relationship among job satisfaction and three dimensions of job burnout in both public and private sectors (p

Background: Hospital waste need a very sensitive and cautious attention due to holding hazardous, toxic, and pathogenic factors such as infectious, pharmaceutical, pathological, chemical and radioactive left-overs. Thus, this study aimed to evaluate the observance of safety measures by workers responsible for collecting hospital wastes in the public hospitals affiliated to Tehran University of medical sciences. Methods and Materials: This cross-sectional and descriptive-analytic study was conducted in 1391. Data were collected through using a questionnaire. According to the frequency distribution, total score for participants was divided into three weak (30) categories. Data were analyzed by the SPSS 18 software using T-Test, one-way ANOVA and regression analysis. Findings: Based on the results, 33.3% of hospitals received suitable, 55.5% received average and the remaining (11.2%) received a weak score regarding safety measures. Moreover, there was a statistically significant correlation between cleaning staff’s characteristics (education, age, work experiences and their training) with their safety status score. Conclusion: Implementing current national principles and standards and conquering shortages, proper planning, using young workers alongside with experienced ones, more training courses and respecting and paying enough attention to cleaning staff would help to improve the safety of collecting hospital wastes.

Background and Objectives: Given the complexity of the ruling in organizations, currently knowledge management can be considered as a guide for management practices. Complicated conditions have caused sweeping changes in management of organizations, especially in hospitals, which should be responded to these changes. The knowledge-oriented leadership can be a good answer to these. So, the impact of knowledge-oriented leadership on knowledge management practices in public hospitals was the main objective of this research. Material and Methods: This study was a descriptive survey, and an applied research by the objective, and according to the research goals that measure the effects of variables, it is a hypothetical-deductive type. Study population consisted of 631 health sectors of public hospitals in Tabriz. In this research, sampling was done by multi stage cluster method and the views of the managers of 169 health departments were used to collect data. Data analysis was conducted by structural equation modeling. Results: Software outputs indicate a positive and significant impact between knowledge- oriented leadership and knowledge management practices. Also, knowledge-oriented leadership has the greatest impact on knowledge application. Conclusion: The results show that practices of creation, storage, transfer and application of knowledge management has strong relation with knowledge-oriented leadership. In other words, attention to existing knowledge will improve the knowledge of hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Change in the health system is always considered as the main concern of governments which in turn may have many positive and negative effects. The health sector development plan is one of the programs aiming at improving the therapeutic and economic dimensions of families, given priority by the 11th government of Iran, and is expected to improve performance of the medical sciences universities and their affiliated hospitals, in addition to develop their educational, health, research and cultural systems. Objective: The aim of this study is to evaluate technical efficiency of 22 public hospitals of Guilan university of medical science before (April 2013 to March 2014) and after (April 2014 to March 2015) implementation of health sector development plan, using data envelopment analysis approach and in accordance with the production of undesirable factors. Materials and Methods The current research is a descriptive-analytical type and also a cross sectional one. The research population includes 22 public hospitals of Guilan University of Medical Sciences, with enumeration chosen as the sampling method and the data were collected from documents. Finally, the collected data were analyzed based on the coding the DEA weak disposability model in GAMS software. Results: The findings indicate that before implementation of health sector development plan (2013- 2014), 14 hospitals (63%) were efficient, while after its implementation (2014-2015), number of efficient hospitals increased to 16 units (73%). The average of technical efficiency also computed as 0.954 and 0.958, respectively. Conclusion: Although, observing the effects of changes in social systems often requires time lapse, however, one year after the implementation of the health system development plan, the average of performance in public hospitals of Guilan province was improved. [ABSTRACT FROM AUTHOR]

Background: Discharge against Medical Advice (DAMA) is a global problem with unpleasant consequences, mandating to conduct studies for its Predictors and outcome. This study aimed to investigate the reasons of DAMA from a general referral hospital. Methods: A cross-sectional descriptive study was conducted in Sina Hospital. A researcher-made questionnaire was used after determining its validity and reliability. All patients who wanted to DAMA, completed the questionnaire. The data was analyzed by SPSS 19, using descriptive and inferential statistics. Results: DAMA was more seen within men, married, native, and under diploma patients with age range of 19 to 39 years. Prolongation of hospital stay (13.2%), other hospital staff's suggestion (6.8%) and dissatisfaction with the facilities (12.3%) were among the main reasons for discharging. The reasons of DAMA had only significant relationship with hospital wards. Conclusion: Improvement of training, providing innovate facilities for young people, providing more advanced facilities and equipment, and continuing the necessary treatment as outpatient are important factors that must be prepared in order to decrease the rate of DAMA. [ABSTRACT FROM AUTHOR]

Background: Identification of development needs is a first important step in a systematic management development effort. This study aimed at assessing management development needs from the viewpoint of middle managers of hospitals affiliated to Tehran University of Medical Sciences. Material and Methods: This cross-sectional study was conducted in the hospitals affiliated to Tehran University of Medical Sciences. The population study was 227 of middle managers employed in 16 hospitals. Data were collected using a 42-items questionnaire which its reliability and validity was confirmed. Data were analyzed using main components analysis in software SPSS17. Results: designing and innovation indicator among managerial roles, human skills indicators in managerial skills, psychological abilities among managerial talents, social trust in personal characteristics, comprehensive thinking indicator in philosophic mindedness and leadership in managerial knowledge components were the most important from the perspective of the middle managers Conclusion: managers play the specific managerial roles in order to perform their managerial tasks. They need to develop administrative skills, abilities, knowledge, personality and philosophic mindedness to play the best managerial roles.

Background & Aims: Telepathology is one of the medical subdivisions that is specifically has been taken into consideration in recent years. Telepathology is the practice of digitizing histology and microscopic images to be transmitted by telecommunication for diagnosis, medical advice or continuing education. It includes electronic images production to be examined in one site or another site. At the present research, we have studied the possibility of telepathology implementation considering the presence or lack of presence of requirement and legal standards in medical centers of Western Azerbaijan province. Material & Methods: This study is a cross-sectional descriptive study which was conducted in 2013. All public and private hospitals were selected in the city of Urmia. The public sector hospitals in the other towns of West Azerbaijan province were chosen as well. The study population was included hospitals directors and administrators, pathologists, and informatics staff. The sample was considered as the study population. The data gathering tool was a questionnaire which was prepared separately for each group of the study population. Reliability was evaluated, and the data were analyzed by SPSS statistical software. Results: As a result, the average awareness of study population was 2/43 with 0/89 standard deviation about telepathology. There was a significant difference between the average awareness of the hospitals directors and administrators, pathologists and informatics staff, about telepathology. Also the possibility of telepathology implementation by considering the presence of requirement and legal standards was 2/18 with 0/51 standard deviation . Conclusion: Findings show that telepathology implementation can increase the quality of health care and the speed of patient handling, and it can lead to reduce the health costs. Also according to the rule of legal issues, confidentiality of information, sense of responsibility and accountability in telehealth systems, it is necessary to provide new rules and guidelines in this area. It is recommended that hospitals should take necessary proceeding for telepathology implementing. [ABSTRACT FROM AUTHOR]