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Abstract Background The Covid-19 pandemic has posed unprecedented challenges to healthcare systems worldwide, affecting routine medical services, including for cancer patients. This study investigates the impact of the Covid-19 pandemic on outpatient visits for patients with cancer in Iran. Methods We conducted an interrupted time series analysis (ITSA) on data collected from electronic medical records. The ITSA methodology was employed to analyze monthly outpatient visits for patients with cancer data from March 2017 to January 2023 in Lorestan University of Medical Sciences. Results Following the announcement of Covid-19 in Iran, outpatient visits for patients with cancer decreased immediately and sharply, with a mean of 247.08 visits per month, which has a 95% confidence interval of [-297; -197]. Subsequent waves in June 2020, September 2020, April 2021, July 2021, and January 2022 further affected outpatient visits. However, the initiation of Covid-19 vaccination, particularly for cancer patients, marked a positive turning point, leading to an increase of 156.39 outpatient visits between January and February 2022. Conclusion Our study provides critical insights into the dynamic relationship between the Covid-19 pandemic, patient behavior, and cancer care utilization. The observed decrease in outpatient visits underscores the multifaceted challenges faced by cancer patients during the pandemic, while the positive influence of vaccination signals a pathway towards recovery. The importance of vaccination is highlighted as a key factor in improving outpatient visit rates. As healthcare systems adapt to ongoing challenges, understanding the complex interplay between public health crises and patient behavior is crucial for shaping resilient and patient-centric healthcare systems.

Abstract Background The global emergence of the Covid-19 pandemic in 2019 posed unprecedented challenges to healthcare systems, disrupting routine services and necessitating swift adaptations. Harm reduction programs, vital for addressing substance use-related health risks, faced unique challenges during the pandemic, impacting vulnerable populations. This study focuses on the repercussions of Covid-19 on harm reduction policies in Iran, specifically examining the distribution of condoms, syringes, and methadone to high-risk individuals attending Triangle Centers. Aim The study aims to assess the impact of the Covid-19 pandemic on harm reduction services in Iran and provide evidence-based insights for policy adjustments. Using Interrupted Time Series Analysis (ITSA), the research analyzes trends in the distribution of condoms, syringes, and methadone before and after the official declaration of the pandemic in February 2020. Method ITSA, a valuable tool for evaluating program impacts, was employed to analyze data collected from Triangle Centers in Lorestan Province, Iran. Monthly records of harm reduction services (condoms, syringes, methadone) from January 2017 to February 2023 were extracted. The pre-intervention period spanned January 2017 to January 2020, with the post-intervention period extending from February 2020 to February 2023. Statistical analyses were conducted using the Newey-West technique, Combi-Huizinga autocorrelation test, and Ordinary Least Squares (OLS) regression, with a significance threshold set at P-value

Abstract Health Technology Assessment (HTA) is essential for evidence-based healthcare decision-making, yet its integration into Iran’s healthcare system faces political and logistical challenges. Despite HTA’s potential to improve resource allocation, limited awareness, data gaps, and competing priorities hinder its implementation. This commentary emphasizes the need for political support, advocating capacity-building, collaboration, and alignment with long-term health policies. Leveraging international partnerships and monitoring outcomes can enhance HTA’s role in improving healthcare in Iran and contributing to global health advancements.

In recent years, the complexity and diversity of health-related factors, changing disease patterns incommunities, the impact of socio-economic factors on health, and the multifaceted challenges ofhealth systems have increased the participation of nongovernmental organizations (NGOs) in healthactivities and programs.

Abstract Background The evaluation of health technologies plays a crucial role in the allocation of resources and the promotion of equitable healthcare access, known as health technology assessment (HTA). This study focuses on Iran’s efforts to integrate HTA and aims to gain insights into stakeholder perspectives regarding capacity needs, demand and implementation. Methods In this study, we employed the HTA introduction status analysis questionnaire developed by the International Decision Support Initiative (iDSI), which has been utilized in various countries. The questionnaire consisted of 12 questions divided into three sections: HTA need, demand and supply. To identify key informants, we conducted a literature review and consulted with the Ministry of Health and Medical Education (MOHME), as well we experts in policy-making, health service provision and HTA. We selected stakeholders who held decision-making positions in the healthcare domain. A modified Persian version of the questionnaire was administered online from September 2022 to January 2023 and was pretested for clarity. The analysis of the collected data involved quantitative methods for descriptive analysis and qualitative methods for thematic analysis. Results In this study, a total of 103 questionnaires were distributed, resulting in a favourable response rate of 61% from 63 participants, of whom 68% identified as male. The participants, when assessing the needs of HTA, rated allocative efficiency as the highest priority, with a mean rating of 8.53, thereby highlighting its crucial role in optimizing resource allocation. Furthermore, healthcare quality, with a mean rating of 8.17, and transparent decision-making, with a mean rating of 7.92, were highly valued for their impact on treatment outcomes and accountability. The importance of budget control (mean rating 7.58) and equity (mean rating 7.25) were also acknowledged, as they contribute to maintaining sustainability and promoting social justice. In terms of HTA demand, safety concerns were identified as the top priority, closely followed by effectiveness and cost-effectiveness, with an expanded perspective on the economy. However, limited access to local data was reported, which arose from various factors including data collection practices, system fragmentation and privacy concerns. The priorities of HTA users encompassed coverage, payment reform, benefits design, guidelines, service delivery and technology registration. Evidence generation involved the participation of medical universities, research centres and government bodies, albeit with ongoing challenges in research quality, data access and funding. The study highlights government support and medical education as notable strengths in this context. Conclusions This study provides a comprehensive evaluation of Iran’s HTA landscape, considering its capacity, demand and implementation aspects. It underlines the vital role of HTA in optimizing resources, improving healthcare quality and promoting equity. The study also sheds light on the strengths of evidence generation in the country, while simultaneously identifying challenges related to data access and system fragmentation. In terms of policy priorities, evidence-based decision-making emerges as crucial for enhancing healthcare access and integrating technology. The study stresses the need for evidence-based practices, a robust HTA infrastructure and collaboration among stakeholders to achieve better healthcare outcomes in Iran.

It has always been argued that countries should not be inactive about the quality of health services. Therefore, a clear policy needs to be created regarding how quality of health services should be. The present scoping review was aimed to identify and map the available evidence regarding the National Quality Policy and Strategy (NQPS) of the health services in health systems of developing countries, graphically and tabularly. We followed the published methodological guidance of the Joanna Briggs Institute reviews. Also, we employed a narrative thematic synthesis integrated with the systematic analysis using the World Health Organization’s approach of NQPS, and the multiple-streams framework of Kingdon. We included 33 records that met the inclusion criteria; these records were published between 2010 and 2019. Meanwhile, government documents were the most frequent records (61%). Zimbabwe, Indonesia, and Sudan were the most frequent locations (each one 8%). The Ministry of Health was in charge of the ultimate responsibility for developing the NQPS in all identified countries. Besides, 82% of the countries were in the development phase of NQPS formulation, and convergence of three streams was observed in Indonesia, Sudan, and Tanzania. It seems that the African countries were informed about their quality issues, and the need for having NQPS have been more popular with them. We recommend that future research focuses on examining NQPS in terms of prioritizing in the agenda-setting phase of the policy-making cycle, and also, document analysis of all identified NQPS based on the core eight interdependent elements related to the NQPS approach.

Abstract Patient and public involvement and engagement (PPIE) is critically important in healthcare research. A useful starting point for researchers to understand the scope of PPIE is to review the definition from the National Institute for Health and Care Research (NIHR) as, ‘research being carried out “with” or “by” members of the public rather than “to”, “about” or “for” them’. PPIE does not refer to participation in research, but to actively shaping its direction. The ‘Effectiveness of a decision support tool to optimise community‐based tailored management of sleep for people living with dementia or mild cognitive impairment (TIMES)’ study is funded through the NIHR programme grant for applied research. TIMES has thoroughly embraced PPIE by ensuring the person's voice is heard, understood, and valued. This editorial showcases how the TIMES project maximised inclusivity, and we share our experiences and top tips for other researchers. We base our reflections on the six key UK standards for public involvement; Inclusive Opportunities, Working Together, Support and Learning, Communications, Impact and Governance. We present our work, which had been co‐led by our PPIE leads, academics and partners including, together in dementia everyday, Innovations in Dementia, The UK Network of Dementia Voices (Dementia Engagement & Empowerment Project) and Liverpool Chinese Wellbeing. We have a Lived Experience Advisory Forum on Sleep, which includes people with dementia, family carers, representatives of the South Asian Community and the Chinese community.

Background: The pandemic of COVID-19 affect all healthcare systems globally, and its effect on different hospital performance indicators has been debated. The study aimed to compare the impacts of COVID-19 on hospital performance indicators using pre-and post-pandemic data from training hospitals.Methods: We conducted an observational cohort study of hospital performance indicators from two healthcare facilities affiliated with Qazvin University of Medical Sciences in the north-west of Iran. The R statistical software was used to analyze monthly data on three basic performance indicators, including bed turnover, average length of stay (LOS), and bed occupancy rate before and during the outbreak of Coronavirus disease-19 (COVID-19).Results: The pandemic had a remarkable effect on the level of bed turnover, the average length of stay (LOS), and the bed occupancy rate after one month from the COVID-19 outbreak (P

Abstract Background One of the most important challenges facing hospitals is inappropriate admissions and stays the reduction of which can contribute to a decline in healthcare costs without reducing the quality of services. The aim of this study was to estimate the rate and causes of inappropriate stays and their financial burden in a single specialty burns hospital. Methods This is mixed methods study conducted in 2021. In the quantitative phase, all medical records of patients admitted to a burn hospital were reviewed and 260 cases were randomly selected. The records were evaluated based on the Appropriateness Evaluation Protocol to estimate the rate and preliminary causes of inappropriate stays and their direct costs. Frequencies and logistic regression were used for the rates and the influential factors in causing inappropriate stay, respectively. In the qualitative phase, 13 senior and middle managers of the hospital were interviewed for their interpretation of the quantitative data and the main causes of inappropriate stays. Qualitative data were analyzed by using Graneheim-Lundman method. Results About 28.5% of the patients had at least 1 day of inappropriate stay and about 6% of the total hospitalization days were inappropriate. Marital status, insurance status, and the length of stay were significantly associated with inappropriate admission (p

In line with the global trend, the Middle East and North Africa (MENA) region has been growing vulnerable to the direct and indirect health effects of climate change including death tolls due to climatological disasters and diseases sensitive to climate change since the industrial revolution. Regarding the limited capacity of MENA countries to adapt and respond to these effects, and also after relative failures of the previous negotiation in Glasgow, in the upcoming COP27 in Egypt, the heads of the region’s parties are determined to take advantage of the opportunity to host MENA to mitigate and prevent the worst effects of climate change. This would be achieved through mobilizing international partners to support climate resilience, a major economic transformation, and put health policy and management in a strategic position to contribute to thinking and action on these pressing matters, at least to avoid or minimize the future adverse consequences.

Background Satisfaction with the salary and other payments and the way they are distributed are of the most important and effective dimensions of human resources management. The purpose of this study was to determine the level of employee satisfaction with the performance-based payment plan in 2021 across hospitals. Materials & Methods This was a cross-sectional study conducted in 2021 on 280 employees of teaching hospitals affiliated to Iran University of Medical Sciences. Data were collected by a questionnaire and analyzed by non-parametric tests and Spearman correlation in SPSS. Results The mean of total satisfaction in the staff was 2.95 ± 0.55 (out of 5). Among the various categories in the field of satisfaction, the highest mean of satisfaction was related to the physical conditions of the workplace with 3.3 ± 0.64 (out of 5) and the least was related to the payment system with 2.56 ± 0/86. The mean performance of all employees was 63.72 ± 8.82. (out of 100). In this regard, the mean score of staff attendance was 74.22 ± 6.97, job type was 30.97 ± 15.78 and the average quality coefficient of performance was 85.98 ± 11.12. According to the Spearman correlation test, there was a significant correlation between mean total satisfaction and attendance score (r = 0.19), job type score (r = 0.32) and performance quality coefficient (r = 0.21) (p-value

Abstract Background Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Abstract Introduction The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. Method For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. Results After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. Discussion This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system’s resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

Introduction: Root cause analysis is one of the most important tools in disaster management that aims to identify the real causes of an issue and find ways to eliminate them. Surgery is one of the areas in which the possibility of clinical error is significant. Therefore, the study aims to explain the weaknesses and challenges of root cause analysis in surgical events and identify the experience of staff around the technology. Materials and methods: This qualitative study was conducted through interviews in 2021. Twenty members of the root cause analysis team working in teaching hospitals affiliated to Iran University of Medical Sciences were interviewed. After conducting the interviews, MAXQDA software version 10 was used to analyze the thematic content and extract concepts related to the research objectives. Results: The majority of participants were female, head nurse, aged 30 to 40, work experience of 11 to 15, and employed in Hasheminejad Hospital. The most important weaknesses identified for root cause analysis included the lack of proper implementation of the root cause analysis process and the lack of participation of individuals, hospitals and universities in this process. Conclusion: Health managers and policymakers should address the weaknesses of root cause analysis by explaining the necessity of the process, root cause analysis immediately after each clinical event, evaluating the effectiveness of root cause analysis, and providing adequate feedback from the authorities. Upstream therapy, creating a culture of root cause analysis, providing the necessary facilities to perform these analyzes, providing clear instructions to encourage and punish employees.

Nowadays, the use of design thinking methodology in organization and management studies is increasing. In Iran within the field of organization and management, there is still a gap between thinking, formulation, and action, and the application of design thinking has been undeveloped conceptually and methodologically. The goal of this study is to explain discourses of design thinking, principles, models, and methods. The methodology of the study is based on a qualitative approach using secondary data content analysis and general qualitative research strategy. According to the study results, design thinking is rooted in two discourses of design and management, although with distinct applications. In this study, human-centered design, a combination of divergent and convergent thinking, co-creation, Iteration, and prototyping were identified as the five principles of design thinking in the field of the organization. In the following, the design thinking models of leading organizations were classified based on phases, stages and activities of design thinking and some of its most common methods were explained. Design thinking models are mainly process-based and can be summarized in four stages of exploration, creation, reflection, and implementation. Finally, research and operational suggestions for the use of design thinking in organizational and management problems with regard to the problem characteristics, level of analysis, and expected outputs are presented. These are unlimited to management science and will be used in other social sciences.

ObjectivesHospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally.MethodsWe conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted.ResultsThe rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22-0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women.ConclusionWe identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.

Introduction The increasingly ageing population is associated with greater numbers of people living with dementia (PLwD) and mild cognitive impairment (MCI). There are an estimated 55 million PLwD and approximately 6% of people over 60 years of age are living with MCI, with the figure rising to 25% for those aged between 80 and 84 years. Sleep disturbances are common for this population, but there is currently no standardised approach within UK primary care to manage this. Coined as a ‘wicked design problem’, sleep disturbances in this population are complex, with interventions supporting best management in context.Methods and analysis The aim of this realist review is to deepen our understanding of what is considered ‘sleep disturbance’ in PLwD or MCI within primary care. Specifically, we endeavour to better understand how sleep disturbance is assessed, diagnosed and managed. To co-produce this protocol and review, we have recruited a stakeholder group comprising individuals with lived experience of dementia or MCI, primary healthcare staff and sleep experts. This review will be conducted in line with Pawson’s five stages including the development of our initial programme theory, literature searches and the refinement of theory. The Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and reporting standards will also be followed. The realist review will be an iterative process and our initial realist programme theory will be tested and refined in response to our data searches and stakeholder discussions.Ethics and dissemination Ethical approval is not required for this review. We will follow the RAMESES standards to ensure we produce a complete and transparent report. Our final programme theory will help us to devise a tailored sleep management tool for primary healthcare professionals, PLwD and their carers. Our dissemination strategy will include lay summaries via email and our research website, peer-reviewed publications and social media posts.PROSPERO registration number CRD42022304679.

Due to the high value of human life, the occurrence of even one error that leads to death or complications is of great consequence and requires serious attention. Although significant efforts have been made to ensure patient safety, serious medical errors continue to exist. This study aimed to identify the factors associated with the recurrence of medical errors and strategies to prevent them through a scoping review.Data were gathered through a scoping review of PubMed, Embase, Scopus, and Cochrane Library databases during August 2020. Articles related to factors influencing the recurrence of errors despite the available information, as well as articles related to measures taken worldwide to prevent them, were included in study. Overall, 32 articles were selected out of the 3422 primary papers. Two main categories of factors were identified as influential in error recurrence: human factors (fatigue, stress, inadequate knowledge) and environmental and organizational factors (ineffective management, distractions, poor teamwork).The six effective strategies for preventing error recurrence included the use of electronic systems, attention to human behaviors, proper workplace management, workplace culture, training, and teamwork.It was concluded that using a combination of methods related to health management, psychology, behavioral sciences and electronic systems can be effective in preventing the recurrence of errors.

Objective People with disabilities are highly vulnerable during disasters and their mortality is higher than normal population. The causes of this vulnerability, in addition to the physical problems and movement limitations, can be lack of their knowledge in facing with disasters. Such deficiencies can adversely affect their preparedness surviving in the disastrous situations and cause adverse consequences. Hence, this study aimed to identify the educational needs of people with physical disabilities and related groups in earthquakes, through understanding their views. Materials & Methods The study was done in a qualitative method. Participants were selected from people with physical disability who had an experience of earthquake, literate, and in the age range of 18-60 years, through purposive sampling in two methods of maximum variation and snowballing. Semi-structured interviews were used for data collection and data saturation was reached with the entry of 18 eligible individuals. Thematic analysis was applied for data analysis assisted by MAXQDA software V. 10. Results According to the participants, education was an essential factor for improving their preparedness for earthquake. The educational needs were categorized as two main themes. The first main theme included two subthemes: 1. Basic educational needs such as saving life and prevention of secondary disabilities, keeping calm, stress management, and decision making; and 2. Empowerment educational needs such as coping with disabilities in critical situations, providing relief to other people in case of having enough ability, and educating other people with disabilities. The second theme included two subthemes: 1. General educational needs related to families and public, such as rescue of people with disabilities, saving self-life and prevention of disabilities, proper relief to public for prevention of disabilities, accompanying and psychological support of people with disabilities; and 2. The specialized educational needs for relief workers and disaster managers, including relief to people with disabilities, prevention of disability and injury while rescuing public, familiarity with different groups of people with disabilities and their needs, and considering the needs of people with disabilities in the response measures.. Conclusion Based on the findings, the educational needs of people with physical disabilities and related groups, emerged in the form of preserving life, health and disability prevention, empowerment and improving the quality of services in the earthquake. Fulfilling the educational needs can increase the preparedness of these people in facing with earthquakes, although it requires the development of standard and practical educational programs by obtaining their opinions and implementing it in the situations before the disasters. On the other hand, considering that no serious and principled action has been taken so far in the field of education of people with disabilities, it is necessary for the planners and policymakers to formulate specialized policies in accordance with the country's conditions. This measures can be effective in reducing mortality and improving the health of these people in disaster situations.

Abstract Background Serious consequences leading to the increase of infectious diseases and mortality of children justifies the importance of interventions for eradication of malnutrition. Thus, this study aimed to provide a model for the prevention of malnutrition among children under 5 years old (CU5) in Iran. Methods This paper is part of a bigger study, conducted in 2017 using a mixed methods approach. A model for prevention of malnutrition in CU5 was proposed based on the earlier steps, with the cooperation and consultation of experts and specialists. In the final step, a Delphi method was used to determine the validity of the proposed model. Results The main dimensions of the prevention model of malnutrition for CU5 in Iran included four level: basic causes, interventions, outcomes and impact. The proposed interventions are presented based on twelve areas: structural, intersectoral, political, economic, sanitary, health-oriented, research, educational/cultural, evaluation related, production, infrastructures and legal. Based on these areas, 118 solutions were finally selected for the final model. This model is designed based on the current conditions in different regions of Iran, the factors related to child malnutrition, affective context on policy making, the content of previous policies, the process of policy making in Iran, and key stakeholders and actors in policy making. Conclusion In order to prevent malnutrition, the causing factors should be identified and resolved. The adopted policies should be, more seriously, based on the presence of key stakeholders and actors. Most of the existing nutritional problems among children are because of inappropriate consumerism culture and habits in families and its transfer to children.

BACKGROUND: Despite great efforts to improve patient safety, serious preventable medical errors continue to occur. Accurate rooting causes of error recurrence are essential for reviewing methods to prevent them. This study aimed to identify the main causes of the recurrence of medical errors despite their previous occurrence.MATERIALS AND METHODS: This qualitative study was performed using the grounded theory method, with theoretical sampling from April to July 2021, through semi-structured interviews with 25 experts and treatment staff of hospitals under the auspices of four universities of medical sciences in Iran.RESULTS: Four main parts were identified: 1) primary and secondary factors leading to the occurrence of errors, 2) error prevention policies, 3) causes of error repetition, and 4) contextual factors.CONCLUSION: The attention, seriousness, and commitment of health system managers, from top to bottom, to patient safety are essential for preventing error recurrence. The institutionalization of patient safety education from universities and attention to individual, social, and cultural factors should also be given serious attention.

BACKGROUND: The public hospital preparedness is essential for epidemic disaster like COVID-19 pandemic. This study was conducted to present a hospital management preparedness model of Iran's public hospitals for the epidemic. MATERIALS AND METHODS: The method of this study was an exploratory sequential mix method study (qualitative–quantitative). In this study, qualitative and quantitative methods were used in four stages. (1) Interviews with hospital managers to identify hospital management experiences during the COVID-19 epidemic and categorize the results in themes and subthemes, (2) assessing the performance of public hospitals in managing the coronavirus epidemic in a quantitative method, (3) present the initial hospital management model for a public hospital in epidemic conditions using an expert panel, and (4) validation of the model using the Delphi method. RESULTS: Experiences of hospital managers and specialists were categorized into eight themes: information gathering and environmental analysis, general and operational planning, provision of equipment and physical and financial resources, training and empowerment of human resources, a compilation of instructions and job descriptions, review and ensuring maximum readiness, monitoring and follow-up of service provision and existing problems, evaluation and feedback of performance problems and level of preparation and 51 sub-themes. The quantitative study indicated that all the investigated indicators had a significant decrease in the first month and an increase in the epidemic's continuation. The results were categorized in nine themes and 59 sub-themes, and finally, the model was validated in one round by the Delphi method. CONCLUSION: In Iran, managers have valuable experiences in COVID-19 epidemy management, but these experiences are scattered and not organized. In this study, by a qualitative–quantitative, a model was presented that contains essential points obtained from the experience of hospital managers and experts in actual disaster conditions and is appropriate and fits hospital structure and infrastructure of the health system in Iran.

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 physicianschr('39') 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: The decentralization initiatives of the public sector in hospitals should be considered as a bottom-up process. Instead of turning government hospitals into independent or corporate, it is better to re-establish 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.

Evaluation of Human Resource Productivity Dimensions Based on ACHIEVE Model: a study on personnel of hospitals affiliated to Iran University of Medical Sciences Jafari Mehdi1, Hedayatirad Sedigheh2*, Aryankhesal Aidin3, Bordbar Najmeh4, Tavakoli Nader5 1. Professor, Department of Healthcare Services Management, Faculty of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 2. MSc Student of Health Services Management, Faculty of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 3. Associate Professor, Department of Healthcare Services Management, Faculty of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 4. Ph.D. Student in Health Services Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran 5. Associate Professor, Department of Emergency Medicine, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran *Correspondence: Sedigheh Hedayatirad Address: School of Health Management and Information Sciences, No.6, Rashid Yasemi St. Valie Asr Ave, Tehran, Iran Tel: 00982188794301 Email: hedayatirad1304@gmail.com Abstract: Background & Objectives: Productivity and performance improvement of human resource, as the most valuable asset and resource in the organization, have a greater impact on success and productivity of the organization than any other factors. The purpose of this study was to evaluate the dimensions of human resource productivity based on ACHIEVE model among personnel of hospitals affiliated to Iran University of Medical Sciences. Methods: This descriptive-analytical cross-sectional study was performed on 358 clinical and nonclinical personnel in 15 teaching hospitals of Iran University of Medical Sciences in 2019, selected by stratified relative randomized sampling. To collect data, the standard ACHIEVE questionnaire was used. Data analysis was done using one-way ANOVA, T-test and Tukey post hoc and through SPSS version 22 software. Results: Mean score of human resource productivity was 2.8 which was in a moderate condition. The highest and lowest mean scores of productivity were respectively related to environment (3.38) and motivation (2.30) dimensions. There was a significant difference in productivity based on gender, occupational group and educational level. Conclusion: It seems that creating performance-based management systems and fair rewards and benefits systems, as well as continuous performance appraisal sessions between employees and their supervisors could be effective in increasing motivation. Key­words: Evaluation, Productivity, Clinical personnel, Nonclinical personnel, Teaching hospital, ACHIEVE Model Citation: Jafari M, Hedayatirad S, Aryankhesal A, Bordbar N, Tavakoli N. Evaluation of Human Resource Productivity Dimensions Based on ACHIEVE Model: a study on personnel of hospitals affiliated to Iran University of Medical Sciences. Journal of Health Based Research 2019; 5(3): 273-86. [In Persian]

Introduction: Empyema is a respiratory disease that has increased seriously in the past two decades. The usual treatments for the stage III patients includes thoracotomy and video assisted thoracoscopic surgery. Hence a systematic review was conducted to compare the effectiveness and safety of the two procedures. Materials and Methods: In this search systematic review the databases of PubMed, Cochrane Library, Scopus, NIHR HTA, Embace, Magiran and SID were searched from 1990 until the end of June 2018. We used CASP checklist to evaluate the quality. Data analysis was performed in STATA software. The pooled effectiveness results were demonstrated in Forest plat. Results: Among initially 2228 retrieved records, four studies entered in the final stage of review, among which three were included in the meta-analysis. The findings showed that there was no significant difference between the two methods of thoracoscopic surgery and thoracotomy in the treatment of organizational empyema in terms of duration of surgical operation (MD = 1.33, %95 CI: -0.66 _ 3.31, p = 0.18). Postoperative hospital stay was not statistically different between two surgical methods (MD = 1.68, %95 CI: -0.20 _ 3.56, p = 0.08). In terms of safety, there was no particular risk for patients across the surgeries. Conclusion: There is no statistically significant difference in the operation of video assisted thoracoscopic surgery with thoracotomy in terms of effectiveness and safety. Nevertheless, the results should be considered cautiously due to the little number of included studies.

Introduction: Classroom management is leading the class by setting the class schedule, organizing the procedures, supervising the learners’ progress, and predicting and solving their problems. Students’ disruptive behaviors and classroom management are the most important challenges and concerns of the teachers. The current review aimed to analyze the classroom management techniques and strategies used to cope with the students’ disruptive behaviors. Methods: The present study was systematic review. The articles in Science Direct, PubMed and Scopus databases and Google Scholar search engine were searched using the keywords of classroom management, students’ disruptive behaviors, difficult students, and confrontation strategies during 2000-2017. A total of 31 articles were included in the study for analysis. Results: The results showed all the techniques and strategies used and teachers’ challenges in dealing with students’ disruptive behaviors were included in conflict management strategies, which were classified into three categories, i.e. cooperative and problem solving strategies, avoidance strategies and punishment strategies. Moreover, the studies mostly emphasized the use of cooperative and problem solving strategies, and the most highlighted methods were making effective mutual communication with students to correct their negative behavior, training and preparing the teachers for dealing with the students’ disruptive behaviors and using various teaching methods and approaches based on the classroom situation. Conclusion: To cope with the challenges of students’ disruptive behaviors, the teachers can use different strategies. Also, sufficient knowledge and skills about teaching, familiarity with the relevant and influential disciplines in dealing with students and making effective communication in the class can be helpful in developing and enjoying more effective skills in classroom management.

Background: Organizational efficiency should be continuously measured to plan for improvement, informing about organizational performance, and guiding the university toward its goals. In this study, the authors measured the efficiency of schools affiliated to Tehran University of Medical Sciences as one of the most important universities in Iran, in 2011 and 2012. Methods: In this research, the efficiency of schools was measured using Data Envelopment Analysis (DEA) technique in three dimensions of education, research, and development. Several indices in each dimension were assumed as input. Data were collected from university documents and analyzed by output oriented approach using Win Deap software. Results: Findings revealed that the efficiency scores of four schools including public health, pharmacy, nursing and midwifery, and advanced technologies were 100 in both years. In 2011, the efficiency scores for other schools were as follows: medicine 73.1, dentistry 57.6, rehabilitation 82.33, paramedical sciences 80.26, and management and medical information 60.26. These scores were respectively 73.76, 85.26, 71.63, 94.16, and 94.86 in 2012. Conclusion: This research could successfully measure the efficiency of schools. Moreover, it can help decision makers to improve the performance of schools by determining the optimized output.

BACKGROUND: Nongovernmental organizations (NGOs) as entities out of the health sector can play various roles and functions at different levels of the health systems. The present study was conducted to investigate NGOs' potential and actual functions in Iran's health system. MATERIALS AND METHODS: This exploratory study was carried out in two parts from April 2020 to December 2020 in Tehran, Iran. For the first part, the statute of 65 NGOs was used for document review, and in the second part, the required data were collected using semi-structured interviews with 26 key informants from the governmental sector and NGOs. Data were analyzed using the framework analysis method and MAXQDA software. RESULTS: According to data analysis, the results of this study were classified into two sections of NGOs' current functions and expected functions in Iran's health system. The current functions of NGOs in Iran's health system include service delivery, educational, research, and information activities, financing, supportive and facilitation activities, and advocacy. Other functions in which NGOs could play a role include health system management, education, and service providing and support activities. CONCLUSION: In this study, the various roles of NGOs in Iran's health system were explained. NGOs can act actively as the consulting and executive hand alongside the public sector in the lowest to the highest levels of Iran's health system. Hence, health sector managers and policymakers must facilitate NGOs' involvement in the health sector and use their capacities and capabilities to improve health and increase public access to health-care services.

Abstract Background Health-related quality of life (HRQoL) measurement in elderly people can provide appropriate information for an optimal management of physical/mental conditions. The main objective of the present study was to quantitatively assess the HRQoL among healthy elder Iranian individuals as measured by the Short-Form 36 (SF-36) questionnaire, both overall and at the level of each its single component/domain. Methods This study was designed as a systematic review and meta-analysis, following the "Preferred Reporting Results of Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, and Iranian databases such as MagIran, SID and Irandoc were mined from inception up to 1st September 2017. Also the grey literature (via Google Scholar) was mined. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data, and appraised their quality using the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) checklist. Results Twenty five studies were included. Mean overall HRQoL was 54.92 [95%CI 51.50–58.33], lower than the value found by studies done in other countries, especially in those economically developed. The sensitivity analysis indicated stability and reliability of results. Pooled scores of each HRQoL domain/sub-scale of the SF-36 questionnaire ranged from 49.77 (physical role functioning) to 63.02 (social role functioning). Conclusions HRQoL among healthy elder Iranian individuals is generally low. Health policy-makers should put HRQoL among the elderly as a priority of their agenda, implementing ad hoc programs and providing social, economic and psychological support, as well as increasing the participation of old people in the community life and use their experiences.

Background: Traffic incidents are of main health issues all around the world and cause countless deaths, heavy casualties, and considerable tangible and intangible damage. In this regard, mass casualty traffic incidents are worthy of special attention as, in addition to all losses and damage, they create challenges in the way of providing health services to the victims. Aim: The present study is an attempt to explore the challenges and facilitators in management of mass casualty traffic incidents in Iran. Methods: This qualitative grounded theory study was carried out with participation of 14 purposively selected experienced managers, paramedics and staff of aid organizations in different provinces of Iran in 2016. Semi- structured interviews were conducted in order to develop the theory. The transcribed interviews were analyzed through open, axial and selective coding. Results: Despite the recent and relatively good improvements in facilities and management procedure of mass casualty traffic incidents in Iran, several problems such as lack of coordination, lack of centralized and integrated command system, large number of organizations participating in operations, duplicate attempts and parallel operations carried out by different organizations, intervention of lay people, and cultural factors halt provision of effective health services to the victims. Conclusion: It is necessary to improve the theoretical and practical knowledge of the relief personnel and paramedics, provide public with education about first aid and improve driving culture, prohibit laypeople from intervening in aid operations, and increase quality and quantity of aid facilities.

Background: Special incidents are harmful events that can result in people’s death or injury. Despite registering special incidents’ data in Iran, no study has yet been conducted to identify the types, rates, mortality and morbidity of such incidents and their associated factors. The present study was conducted to assess the epidemiology of incidents and their associated factors during 2014 in Iran. Methods: In this cross-sectional study, all special incidents of 2014 were examined. Data were initially collected by universities of medical sciences nationwide and then sent to the Disaster and Emergency Management Center in the Ministry of Health and Medical Education. The collected data were analyzed in this study using statistical tests of Chi-square and Pearson’s correlation coefficient using SPSS ver. 14.5. Results: Out of 6,892 special incidents that occurred during 2014 in Iran, 6,781 cases were included, of which, the most prevalent were traffic crashes (71%), carbon monoxide poisoning (14%), drowning (3.5%), and other cases (11.5%) (which included suspicious deaths, explosions, group poisoning, quarrels, fires, falls from height, and building collapses). The incidents led to 37,313 injuries and 3,259 deaths, of which 78% of injuries and 75% of deaths were due to road traffic incidents. Conclusion: Given to relationship between occurrence of the incidents and special holidays; such incidents can be reduced through preventive planning and education. We recommend annual monitoring of special incidents and further studies on the associated factors.

AIM: This study aimed to identify models for the participation of the city council and municipality with the health system in selected countries. SUBJECTS AND METHODS: This is a descriptive comparative study conducted in 2020 qualitatively. The countries studied were examined in terms of the following characteristics: type of political structure, type of health system, level of cooperation between local government and health system, municipal financing, type of financial participation of local government and health system, method or institution for participation Created, level of participation, local government influence on health system decisions, advantages and disadvantages of a partnership between local government and health system. Data were collected through valid databases (PubMed, Scopus, Embase, and Google Search engine) and website of the World Health Organization, local government, and the Ministry of Health of countries concerned and analyzed in a framework of analysis. RESULTS: Countries were divided into two groups in terms of a partnership between the health system and local governments, which had a distinct partnership between the health system and local government and without their participation. Factors that contribute to the creating and strengthening of partnerships include beliefs of health authorities and local government, the need for participation, transparency in participatory programs, designing a specific mechanism for participation, local authority, and financing joint participation plans. CONCLUSION: In countries with planned participation, citizens have better access to services. Citizens' participation, as well as the private sector, is greater in health issues. In these countries, participation in health financing by the private sector and other related agencies has increased. Planning and service delivery increases according to neighborhood needs. The variety of services provided and the use of new methods of service are more, and in these countries, the focus of the Ministry of Health on the preparation of strategies and monitoring the quality of services is increasing.

BACKGROUND: Given the expanding range of health influencing factors, increasing expectations from the health systems, and general challenges such as insufficient resources, the health services needed by people cannot be provided completely by the governments alone. Therefore, nongovernmental organizations (NGOs)-government collaboration is considered a common approach in health-care provision for different communities. Since the NGO-government collaboration is complicated and usually influenced by many challenges and issues, the present study was conducted to identify collaboration challenges between the government and NGOs in providing health-care services. MATERIALS AND METHODS: Using a systematic review method and searching in ISI Web of Science, Scopus, PubMed, and Embase databases, using related keyword/terms, between March 2020 and June 2020, studies on NGO-government collaboration in the health area were collected without time limitation. After completing the article selection process, those articles that consistent with the research purpose were chosen for the final analysis. RESULTS: From 4236 initially collected studies, 16 studies were chosen for the final analysis. Based on the content analysis of the selected articles, 70 challenges were identified in the NGO-government collaboration to provide health-care services. These challenges were divided into five main themes: structural issues, process issues, issues related to roles and responsibilities, trust and communications issues, and control and power relation issues and 11 subthemes. CONCLUSION: The present study provides significant challenges by NGO-government collaboration in providing health-care services. Awareness of these challenges plays an important role in promoting such collaborations and enables these organizations to highly exploit the strengths of each other, resulting in a collaboration with win–win situation.

BackgroundMalnutrition is one of the main causes of death in children under 5 years of age and one of the most common factors threatening children's life and health. Nutrition policy analysis and solving existing problems in children can reduce the effects of malnutrition. This study aimed to analyze the current policies of malnutrition prevention in children under five years of age in Iran.MethodThis study was conducted in 2017 to analyze policies using the "policy triangle framework". In order to examine the policy-making process, the Kingdon's multiple streams model was used. A combination of two sampling methods, including purposeful and snowball sampling, was applied to select the interviewees. In relation to the implemented documents and policies, the country's most important policies were selected based on the suggestions of policy makers as well as searching scientific databases and electronic portals. A data collection form was used to identify the current policies and documents and a semi-structured interview guide form was used for the interviews. The framework analysis and MaxQDA software were applied to analyze the data obtained from the interviews.ResultsThe key factors affecting policies in Iran included the status of indicators as well as economic, social, structural-legal, policy and international factors. Among the most important policies and implemented programs, the following can be mentioned: growth monitoring, oral rehydration, breastfeeding, immunization, female education, family spacing, food supplementation, nutrition for children under five years of age, and control of nutritional deficiencies. Currently there is a need for a nationwide program and comprehensive document in the field of the nutrition in children under 5 years of age, which requires strengthening of the political process. Participants and stakeholders in nutrition-related policies for children under the age of five were divided into four categories of governmental, semi-governmental, non-governmental, and international organizations.ConclusionMore attention should be paid to the shortage of some micronutrients, accurate implementation of breastfeeding programs, supplementary nutrition, fortification and supplementation programs for children and mothers, utilization of the advantages of each region and its resources, and better coordination between organizations and their policies, and finally strong incentives are needed to promote macro nutritional goals for children under five years of age.

Response Letter to the Editor in Reference to Letter to the Editor about “Does Overall Catastrophic Health Care Expenditure Make Sense”?

Universal Health Coverage (UHC) in Iran

No Abstract####

Background: One of the main challenges of healthcare systems is to protect people from consequences of health expenditures. Such expenditures may lead to catastrophic financial loss in families so that many people deny demanding necessary healthcare services, which results in harms to their health status. The aim of this systematic review was to investigate the catastrophic health expenditures trend and its related factors in Iran. Methods: This systematic review and meta-analysis was conducted on studies conducted between 1984 and 2014. Data were collected through searching electronic databases and searching engines of PubMed, Scopus, EconLit, Google Scholar, Science Direct, MagIran, and Scientific Information Database (SID). The random effects were used with 95% confidence interval for the meta-analysis. Results: Out of 561 initially retrieved articles, finally 42 were included in the final analysis. The studies were conducted between 1984 and 2014. The overall proportion of exposure to catastrophic health expenditure in Iran was 7.5% (95% CI, 6.2 – 9.1). In the urban and rural areas, the proportion was 2.3% (95% CI, 1.8 – 2.9) and 3.4% (95% CI, 2.8 – 4.1) respectively. The overall proportion of exposure to the catastrophic health expenditure in hospitals was 35.9% (95% CI, 23.5 – 54.3). Conclusion: The catastrophic expenditures proportion of healthcare is relatively high in Iran and the government is expected to adopt effective measures in this regard, especially for the inpatient care. There are needs for special supporting policies for the financial protection of specific patients, the poor and villagers.

Background Nowadays task sharing is a way to optimize utilization of human resources for health. This study was designed to assess the effect of task sharing, mutually between midwives and Family Health Workforces (FHWs), on the number of needed staff across the Iranian Health Posts. Methods The workload and required number of midwives and FHWs in a Health Post were calculated and compared in two different scenarios of task division using a combined approach for estimating the number of required staff. In the first scenario, the midwives and FHWs provide their specialized services and in the second one, using mutual task sharing, a midwife provides all services traditionally delivered by FHWs and each FHW provides prenatal care in addition to the special tasks. Sensitivity analysis was performed to estimate the effects of different hypotheses. Results By applying mutual task sharing, the required number of staff for Health Posts was one midwife and two FHWs for a standard population of 12,500; one FHW less than that when no task sharing was applied. Sensitivity analysis illustrated that the number of needed staff is the same in both scenarios when different demographic, epidemiologic, cultural and organizational conditions were applied. Conclusion Task sharing can reduce the required number of health workers which increases efficiency and productivity at health facilities. However, apart from a need to consider quality, acceptability, and feasibility of care, increasing efficiency must be judged against the contextual circumstances.

Establishment of hospital accreditation programs is increasingly growing across numerous developing nations. Such initiatives aim to improve quality of care. However, such establishments, mainly incentivized by successful and famous accreditation plans in developed countries, usually suffer from lack of necessary arrangements which, in turn, result in undesired consequences. Indeed, the first priority for such nations, including Iran, is not establishment of accreditation programs, yet strict licensing plans.

Primary Health Care: An Important Approach for Health Sector, Missed in Iran’s Health System Evolution Plan

BACKGROUND: There is a growing global movement toward quality and safety in healthcare and quality improvement (QI) in general surgery. The first step in any QI initiative is identifying the challenges and barriers to achieve such goals and then to define appropriate actions. This study aims to provide an overview of the QI challenges in Iranian hospitals' surgery-related processes and suggest applied solutions accordingly. METHODS: This is a sequential (qual-quant) mixed-method study from November 2019 to January 2020, involving 21 face-to-face interviews with hospital managers, quality officers, and surgery-related clinicians and staff, followed by a Delphi consensus-seeking stage to finalize solutions. MAXQDA software was applied for organizing the concepts, and thematic content analysis was used for analyzing the data as an inductive approach to extract the emerging themes and sub-themes. RESULTS: The managerial problems were classified into four groups of (I) defects and delays in completing patient medical records, (II) irregularity and the lack of transparency in the direction of processes in the hospital, (III) inappropriate and unrealistic operating scheduling, and (IV) poor safety considerations. The proposed solutions included imposing stricter regulations for competing for medical records, such as reduction of payments, development of guiding brochures or protocols for patients on their arrival, assigning a certain number of experienced nurses and surgeons for schedule management, rewarding the report of medical and surgical error cases, and developing a regular monitoring program for the proper implementation of surgical safety guidelines. CONCLUSION: There are various managerial barriers that hamper QI in hospitals' surgery-related processes. Implementing simple but agreed solutions can lead to saving patients' lives, reduction of the unnecessary use of resources, and enhance of patient and staff satisfaction.

BACKGROUND: In the 21st century, with the epidemiological and demographic transition and the changing nature of diseases and the increase in the burden of chronic diseases, the need to strengthen primary health care and the development of the family medical program as a strategy is felt significantly. AIM: The purpose of this study is to compare the model of implementation of family physician program (FPP) in the United States, England, Germany, Singapore, Turkey, Egypt, and Iran. MATERIALS AND METHODS: This is a comparative study that examines the model of family physician implementation in selected countries. Data for each country were gathered from the valid databases, were compared according to the comparative table, and analyzed by a framework approach. In order to assure the validity of data, the researchers referred to the websites of the selected nations' Ministry of Health and also cross-checked the findings with reports published by the World Health Organization. RESULTS: In this study, we used the Control Knobs framework to compare countries' FPPs because the framework can demonstrate all necessary features of national health system programs. This framework includes governance and organization, regulation, financing, payment, and behavior in each country. The results of this study show that although the principles of FPP in the selected countries are almost common, they use different methods in FPP implementation. CONCLUSIONS: As the success of any policy depends on the political, economic, social, and cultural context of each country, considering these factors and reinforcing each of the control knobs are critical to the success of the family physician's policy implementation.

INTRODUCTION: Knowledge management enhances efficiency, empowers employees, and enhances organizational health. Social capital provides a good basis for more productive human resources, and training hospitals also play a key role in the health-care system. The purpose of this study was to determine the relationship between knowledge management and social capital with organizational health in selected educational hospitals of Tehran in 2018. METHODS: This analytical cross-sectional study was performed on 310 medical staff of hospitals using proportional sampling method. The data gathering tools consisted of three standard questionnaires of knowledge management, social capital, and organizational health. Data were analyzed using descriptive and inferential statistics using SPSS version 22 software. RESULTS: Most participants in this study were male (8/66%) and in the age group 31–36 years. The mean of knowledge management and organizational health were 3.43 and 3.49, respectively. There is a significant direct relationship between knowledge management components and organizational health. Moreover, there is a significant but weak direct relationship between knowledge management and social capital with organizational health dimensions (P ≤ 0.05). CONCLUSION: Considering the relationship between knowledge management and social capital with organizational health, enhancing the level of organizational health can help to improve the dimensions of knowledge management and social capital. It is suggested that hospital managers, using knowledge management and social capital components, enhance organizational health so that the hospital is more prepared to adapt to the complexities and changes in the market providing services.

INTRODUCTION: Reporting medical errors is a major challenge in patient safety and improving service quality. The purpose of the present study is to investigate the status of error reporting and the challenges of developing an error-reporting system in Iran. METHODS: This study was designed with qualitative approach and grounded theory method in teaching hospitals affiliated to Iran University of Medical Sciences. The views of safety authorities at various levels of management, including those responsible for safety at the Ministry of Health, Vice Chancellor and Hospitals affiliated to Iran University of Medical Sciences, were investigated in 2019 regarding adverse events. RESULTS: Four major themes were identified included iceberg reporting and disclosure, weak reporting, underreporting, and non-error disclosure. The most common problems in reporting medical error were non-involvement of physicians in the error-reporting process, structural (human and information) bugs in root cause analysis sessions, and defective error prevention approaches designed based on the failure mode and effects analysis. DISCUSSION: Despite a large number of medical errors occurred in health-care settings, error reporting is still very low, with only a limited number of errors being reported routinely in hospitals and the rest are minor and occasional reports. CONCLUSION: Creating a mandatory error-reporting system and requiring physicians to report and participate in error analysis sessions can create a safety culture and increase the error-reporting rate.

Introduction: Despite advances in science and technology, still some natural hazards such as earthquakes cannot be predicted accurately. However, with appropriate knowledge, accurate planning and necessary predictions, we can decrease the mortality and financial losses of such disasters. Therefore, attitude and preparedness of healthcare managers toward earthquake can have an important role in improving the preparedness. Therefore, knowledge and attitude of Rey-country health network managers and the preparedness of healthcare centers covered by these managers and the relationship between them have been investigated. Methods: This study was a cross-sectional descriptive analytical study. The sample population was consisted of healthcare administrators at Rey-country health network. Data were gathered by a questionnaire that was designed in three types (knowledge assessment, attitudes study, and preparedness of centers) and its validity and reliability have been verified. Date analysis was based on correlation and descriptive statistics, assisted by SPSS. Results: Managers’ mean score of knowledge was 14.2 (out of 33), with a standard deviation of 5.5. The maximum and minimum scores were 23 and 1, respectively. The results showed the unpreparedness of health care centers and mean score was 40.2%totally, based on responses of these centers’ managers. Most managers generally believed that earthquake is a very probable hazard in Rey-country. Conclusions: Considering that managers’ knowledge was rather low, preparedness among centers was low as well. According to low knowledge and unsuitable preparedness, more theoretical and practical trainings and maneuvers were necessary to be held for managers about earthquake preparedness.

Dear Editor-in-Chief; International Journal of Community Based Nursing and Midwifery The International Journal of Community Based Nursing and Midwifery published an article entitled: “Health related quality of life in Iranian elderly citizens: A systematic review and meta-analysis” in its volume 5, issue 2.1 Thanks to the authors of this paper, we decided to point out some of our concerns about the paper. As you know, searching and finding relevant studies and pooling their data as a meta-analysis are very technical and time-consuming tasks.2 Then for a systematic review, it is vital to include all necessary and related databases. However, the current study did not include ISI Web of Science (WoS). Our examination shows that at least three key articles which all used SF-36 questionnaire for the elderly were not retrieved through the authors’ electronic database searching, including Abbasimoghadam,3 Farhadi4 and Rakhshani.5 This can be due to either exclusion of WoS or rather insensitive search strategy. Altogether, due to the lack of a comprehensive data searching and missing certain key papers in the systematic review, the result of the meta-analysis could be questionable. From our perspective, another shortcoming in the review is the way the result of meta-analysis is reported. The analysis reports just a pooled mean for SF-36 score, neglecting the mean score for each of the eight SF-36 domains. Sure, otherwise, the meta-analysis would be more informative and allow the authorities to make better policies and decisions based on the results. Therefore, with respect to the authors for their notice to the issue of the elderly people in Iran, we think that based on the above-mentioned concerns, possibly, the results are not a precise estimation of Iranian elderly’s health related quality of life.