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Abstract Background Smuggling health goods given the importance and critical nature of health services should be undeniably addressed and controlled by all countries. This issue is especially more widespread in developing countries with more damaging consequences. This paper therefore aims to identify and analyze the challenges of preventing smuggling of health goods in Iran. Method Within this qualitative study, we conducted face-to-face, semi-structured interviews with 30 purposefully recruited key informants and stakeholders in the detection, prevention, and combating of health goods smuggling. Each interview was analyzed thematically, using an inductive approach to generate codes, then categorized and presented in the form of main themes and sub-themes. Maxqda 11 assisted in coding, analysis, and data management. Results Three main themes emerged representing the challenges of prevention of smuggling in Iran in the areas of anti-smuggling policy development, including categories of inefficient policy and plan, and failure to reach agenda; policy implementation; categorized into actors, resources and instruments, and implementation guarantee; and finally monitoring and evaluation; including, procedures and practices, and the role of surveyors. Conclusion Prevention of smuggling health goods proves to be a highly complex, challenging, and multi-faceted practice. Therefore, strengthening policy-making, regulatory frameworks, and facilitation functions about smuggling, counterfeiting, and corruption should be promoted in parallel.

Background and purpose: An organization's safety culture is the product of its values, attitudes, beliefs, and behavioral patterns that define the organization's commitment and framework for managing safety and health. The purpose of evaluating the safety culture is to identify the current state of the safety culture raise the awareness of the employees in this field evaluate the interventions related to safety and track the changes that have been made. The present study was conducted to analyze the status of patient safety culture among the employees of hospitals covered by Mazandaran University of Medical Sciences in 2022. Materials and methods: The current descriptive, analytical, and cross-sectional study was conducted in 1401 on 440 employees of medical and educational hospitals covered by Mazandaran University of Medical Sciences. The sample size was calculated using Cochran's formula and the sampling method was simply random. The tool used in the Standard Patient Safety Culture Questionnaire (HSOPSC) The questionnaire had 42 questions, and 12 dimensions of the patient safety culture including dimensions of general understanding of the patient, organizational learning and continuous improvement, discipline within hospital departments, non-punitive policy in cases of errors, issues Work related to staff, manager/supervisor expectations and actions to promote patient safety, open communication channels, feedback and exchange of information about errors, hospital management support, teamwork among hospital departments, hospital handovers and transfers, and frequency of incident reporting. Unwantedness was measured based on a five-point Likert scale. The average score of less than 2.5 indicates a low patient safety culture, between 2.5 and 3.75 an acceptable state of safety culture, and 3.75 and above indicates the patient safety culture is a strength of the hospital. The study was conducted with IR.TUMS.SPH.REC.1400.289 code of ethics. Analysis was done using Spss 24 software and independent t-tests, one-way analysis of variance, and Friedman. Results: Most of the participants (47%) were 30 to 40 years old and had work experience of 1 to 10 years (44.6%). Also, most of the studied people (59%) were on rotating shifts. The overall status of patient safety culture in hospitals covered by Mazandaran University of Medical Sciences was 64.4% with an average of 3.22±0.43, so 86.1% of the participating employees considered the patient safety status as an average. Among the dimensions of patient safety culture, the highest and lowest scores are respectively related to the dimensions of "teamwork within hospital departments" with a mean and standard deviation of 3.90±0.79 (78 percent) and "hospital delivery and transfers" with a mean, and the standard deviation was 2.75±0.92 (55%). According to the single-sample independent parametric T-test, the score obtained from the status of patient safety culture in covered hospitals was higher than the average standard score of 3 (P

Background: Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients’ condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs. Methods: The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients’ information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded. Results: During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin. Conclusion: This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden.

Background: Communication and cooperation among health care organizations have become nowadays crucial for improving the quality and equity in providing health services, and integration has been expressed as a solution by the World Health Organization. The purpose of this review was to identify the challenges and solutions of integration in health services. Methods: This research was carried out from September 2023 to April 2024. All articles on the challenges and solutions of integration in health, using scoping review, were identified and used in the PubMed, Scopus, Web of Science and Google Scholar search engines in the period from 2000 to 2024. The total number of English articles found was 4996, of which 662 were removed due to repetition. Among the remaining 4334 articles, 4249 articles whose titles and abstracts were not related to the research topic were removed, left a total of 85 articles, and after reviewing the full text of the articles, 27 articles entered the data extraction phase, which were finally analyzed using the framework analysis method. Results: Finally, 27 articles were selected from which, 46 challenges and 26 solutions were extracted as to the integration in health services and categorized based on the framework of WHO six building blocks in five areas of governance and leadership, financing, human resources, information system and service delivery. The most important challenges of integration include; weakness in planning, imbalance of power between organizations, differences in geographical and spatial boundaries of organizations, weakness in maintaining data security, workforce resistance and the lack of laws and regulations, needs assessment from patients, related knowledge, financial resources, suitable payment models, integrated communication and information systems and interoperability between technologies. Conclusion: Integration of health service endures a series of challenges such mainly as the lack of rules and regulations for collaborative processes and resistance from providers and employees requiring innovative solutions. Addressing issues such as stakeholder power-benefit analysis, interoperability and data sharing among the providers could be essential for successful integration.

Introduction In recent years, smuggling of health goods has apparently increased in the country. Despite the preventive and regulatory measures taken to combat this problem, the outcomes seem to be undesirable. This study thus aims to identify and elucidate the role of economic barriers in the prevention of smuggling health goods in Iran.Method We conducted semistructured interviews with 29 purposefully identified key informants in the detection, prevention and control of health goods smuggling in different organisations, between May 2021–January 2022. An inductive data-driven thematic analysis approach was further adopted to identify patterns of meaning, using MAXQDA 2020 software to facilitate data management.Results We identified four main themes representing the economic barriers to prevent the smuggling of health goods in Iran; Monetary and financial policy, which includes subthemes of financial rules and procedures, market regulation, economic incentives and imbalanced development; Behavioural patterns, consisting of consumer behaviour, the opportunism of smugglers, the behaviour of statesmen and politicians; Economic diplomacy, categorised into international relations and interactions, relations and interactions in the national arena, interaction with non-governmental organisations and Health economic monitoring and evaluation including transparency of statistics and economic information and supervision.Conclusion Smuggling health goods has become a concerning challenge in the health sector. It is, therefore, imperative to develop and implement appropriate policies and operations towards security and international cooperation, lobbying and coalition-building. Demonopolisation, creating competitive and dynamic markets, removal of rent-seeking layers at all levels, and the use of commercial diplomacy to reduce the burden of smuggling in the health sector of Iran, and perhaps beyond might be of sizeable use to combat such challenge.

The provision of virtual health care has currently received ample attention from health systems worldwide, due to the recent conditions and events. Many countries are trying to provide their preliminary visits and a relatively wide range of other care virtually, paving the way towards the introduction of virtual clinics. However, in many countries, this concept has not been clearly defined, and the characteristics that are necessary to use the virtual clinics are still unknown. This perspective has sought to explain the concept of virtual clinics and their characteristics with a brief review of related literature.

Background: Nowadays, beauty practices have attracted the attention of people following the change in lifestyle and social values. Therefore, the present study was conducted with the aim of examining the opinion of experts regarding the challenges and management solutions of the aforementioned practices in Iran. Methods: This qualitative study was conducted through interviews with 26 policymakers and cosmetic surgery service providers in Tehran from April to September 2022. Sampling was purposeful and snowball. The interviews were semi-structured and thematic analysis was used to analyze the data obtained from the interviews. The inclusion criteria for the interviewees' entry were knowledge and experience in the subject and willingness to participate. Results: Challenges under the four categories of service providers (improper education, non-specialist providers, moral hazards, deficiencies in the way laws are written, and the ineffectiveness of the complaint handling process), service receivers (being influenced by deceptive advertisements, low level of public health literacy and lack of mental health), the place of providing services (performing surgeries in non-standard places and non-integrated information system) and medicines, products and medical equipment (insufficient control over supply, distribution and use and price fluctuations) were categorized. Experts considered the major part of the challenges to be related to the service providers. In the category of service recipients, "being influenced by deceptive advertisements" was the main problem mentioned by the experts. Performing surgeries in non-standard places, including limited surgery centers, non-sterile places, and unauthorized places, is among the unsolved problems regarding the place of providing services. In relation to medicines, products, and medical equipment, the main problem was insufficient supply, distribution, and use supervision. Conclusion: The main effective measure to solve the challenges is to strengthen the supervision of the health system administrator with internal and external coordination and cooperation. In this regard, it is recommended to develop educational, ethical, and legal frameworks, regulate regulatory laws, public awareness, clinical interviews and psychological counseling, especially before cosmetic surgery, and the establishment of an integrated electronic health record system.

Abstract Background Health care facilities are responsible for preventing and controlling diseases and must be resilient enough to deal with crises. The Iranian health care facilities have faced challenges in managing COVID-19 pandemic. The purpose of this study was to identify the challenges faced by the Iranian health care facilities during the Covid-19 epidemic and to provide solutions. Methods This qualitative study was conducted with a phenomenological approach and using semi-structured interviews with 59 healthcare policy makers, managers, and employees, and medical university faculty members. The participants were selected through purposive and snowball sampling. Thematic analysis was used to analyze the data. Results Overall, 43 challenges to the resilience of health care facilities during the Covid-19 pandemic were identified and grouped into 8 themes (i.e., leadership and management, planning, organizational culture, organizational learning, employee management, customer management, resource management, and process management. The most important resilience challenges were: fragmented management system; poor leadership; incompatible health network structure; lack of a national holistic plan; poor case detection; insufficient resources; inefficient information system; negative attitude of managers and employee; organizational inertia; failure to build on lessons learned from crises; low workforce preparedness; lack of community-based management; and improper monitoring and evaluation. Managers should use community-based, evidence-based, and integrated management to build health system resilience against COVID-19, have sufficient knowledge and experience to organize operations, use appropriate and effective coordination models, develop a creative and participatory culture, reengineer processes, and provide necessary resources. Conclusion The Iranian health care facilities face challenges that prevent them from becoming resilient, responsive, and efficient in managing COVID-19. Policy makers and managers should increase the resilience of health care facilities to shocks and crises by using the suggested measures.

Background: Access to healthcare is a fundamental right of every individual, regardless of their geographic location or socioeconomic status. In many countries, deprived areas often face a shortage of physicians and other healthcare professionals. This study aimed to investigate the approaches essential to attract and retain physicians in the deprived and rural areas. Methods: The present study is a systematic review using appropriate keywords in Persian and English language. The main databases including Google Scholar, Scopus, Web of Science, PubMed, SID, and IranMedex were searched from May 2005 to September 2022 in both languages. Different approaches implemented by countries to attract and retain doctors were classified using thematic analysis. Results: A total of 18 articles were selected for inclusion in the study. Educational, regulatory, motivational, and personal and professional support drivers have been used to attract and retain physicians. The successful interventions implemented were mainly educational and supportive; such as admitting native medical students, providing relevant curricula on working in the deprived and rural areas, and conducting training courses in these regions. Those studying the topics and courses related to serving in the rural areas during their academic education or internship and residency programs had served more time in these areas. Assimilating the topics related to providing services in rural areas into the curriculum, holding fellowship courses and related graduate studies, awarding scholarships to the physicians working in deprived areas, providing free amenities, reducing working hours, and considering special holidays are considered among the recommended solutions. Conclusion: Various drivers were used for attracting and retaining physicians in the deprived and rural areas. Besides, the challenge to retain doctors in such areas was fairly common. Most countries have put more priority on the use of financial incentives, nevertheless, a combination of interventions was preferred. It is worth mentioning that a range of economic, political, and social factors could play a key role in the success of recommended interventions.

One of the serious challenges regarding interactions between Iran’s social security system and health system is basic health insurance stewardship. It has existed for a long time and has been given a special place concerning the related laws and policies in recent years. In this regard, it seems that approving of rules conflicting with upstream laws and policies has increased existing conflicts. This is done by creating ambiguity in the position of basic health insurance. But, it should not be forgotten that the main goal is universal health coverage and effective insurance protection against financial risks caused by illness. Therefore, any decision in these areas should be made with respect to the social, cultural, economic and political conditions of the country and according to the historical experiences and structural characteristics.

Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19. Methods: The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals’ directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census. Results: On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals’ readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion: The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.

Background: Human resources determine the quality of performance of health care organizations and are one of their most important competitive advantages. Also, committing is very important to perform their duties. Therefore, it is necessary to recognize the factors that affect organizational commitment. This study aimed to investigate how organizational transparency could affect organizational trust and commitment from the perspective of hospital staff. Materials & Methods: The present study is an applied descriptive-analytical study conducted on 640 staff members in teaching hospitals affiliated to Tehran University of Medical Sciences. The instruments used were: Organizational Transparency and Trust developed by Rawlins (2008) and Organizational Commitment developed by Meyer and Allen (1997). Data were analyzed using SPSS software version 26 and AMOS. Results: Organizational transparency dimensions (overall transparency, participation, substantial information, and accountability) had a positive indirect effect on organizational commitment dimensions (affective, continuance, and normative commitment). Additionally, secrecy has a negative indirect effect on organizational commitment dimensions. The relationship between organizational transparency and commitment was also statistically significant, which indicates that organizational trust mediated the relationship between organizational transparency and commitment. Conclusion: Managers might be able to improve transparency and staff participation in decision-making by taking cognizance of the priorities and information that can be disseminated by hospitals. In fact, increasing organizational transparency expands cooperation and leads to enhancing staff’s organizational trust, and ultimately increases their organizational commitment.

Objective (s): Critical success factors (CSF) are a set of limited factors that, when applied and reinforced in an organization, give competitive advantage. The purpose of this study was to identify the critical success factors of hospitals in Tehran province. Methods: This qualitative research was conducted by phenomenological method. Semi-structured and in-depth interviews were used to collect data. The interviewees included 93 senior, middle and front-line managers working in 30 hospitals in Tehran province. Data analysis was performed by thematic analysis method using MAXQDA software. Results: A total of 51 critical success factors were identified for hospitals, which were classified into 8 main themes and 22 sub-themes. Key themes include management and leadership, planning, organizational learning, organizational culture, employee management, patient management, resource management, and process management. Transformational leadership, plan-oriented, organizational trust, the presence of renowned physicians, patient satisfaction, and the availability of resources and facilities were key factors in the success of hospitals. Conclusion: Hospital managers should strengthen these critical success factors. Their application increases the possibility of achieving organizational goals and achieving competitive advantage.

Objective (s): An accreditation program aims to evaluate the quality and safety of services provided in health care organizations. Governance, standards, surveying methods and surveyors are the four main pillars of an accreditation program. Validity of an accreditation program depends largely on the performance and behavior of the surveyors. Therefore, this study seeks to identify the typology of styles and methods used by the hospitals accreditation surveyors. Methods: This qualitative research was conducted using 35 purposeful semi-structured interviews with surveyors of the accreditation program and hospital managers. We employed thematic analysis method for data analysis. The insights from a panel of experts were then sought to verify the accuracy and precision of the styles. Results: Overall six styles including mainly Disciplined, Personalized, Participatory, Interrogative, Systematic and Explorative were emerged to be practiced by the accreditation surveyors while evaluating the hospitals. Conclusion: Cognizance of surveyors’ style might play a role in organizing effective assessment teams and their optimal distribution in a way to enhance the learning and improve surveyors' capabilities and skills. Moreover, it is possible to arrange the evaluation teams in a way to suit the surveyors’ encounter with various organizational environments. It is expected that paying attention to the results of this study by managers and policy makers in the field of accreditation help to create positive results in the accreditation process of hospitals.

Objective(s): Hospital accreditation is “an external evaluation of a hospital by an independent professional accreditation body using pre-established optimal structural, process and outcome standards”. The Iranian hospital accreditation program faces some challenges. This study aimed to identify the Methods challenges of Iran hospital accreditation program and its solutions. Methods: This qualitative study of interpretive phenomenology was performed using semi-structured interviews in 2019. Using a pluralistic evaluation approach, 151 policy makers, hospital managers and staffs, accreditation surveyors, academics, from ministry of health, medical universities, hospitals and health insurance companies were purposively and snowballing recruited and interviewed. Thematic analysis was used for data analysis. Results: Overall, 27 challenges and 17 solutions were identified in the form of five sections including accreditation time, accreditation method, duration of accreditation, feedback and accreditation certificate. Inadequate time to start accreditation, not having the same approach to evaluation, Inefficiency of self-assessment and periodic evaluation, Failure to provide detailed feedback to hospitals, Lack of support for hospitals, Irrational validation of an accreditation certificate and the lack of public announcement of results were the main challenges. Some of solutions for overcoming these barriers are as set a specific time frame for accreditation, using a scientific and patient-centered approach, development of assessors' knowledge and skills, Independence of the evaluation organization, provide detailed feedback, Determining the biennial validity for the accreditation certificate and public announcement of hospitals’ accreditation results. Conclusion: Iran Hospital Accreditation Program lacks a scientific, coherent and integrated method for hospital accreditation. Improving the Methods of Iran's hospital accreditation program can increase the validity and reliability of Iranian hospital accreditation results.

Abstract Background Over the past three decades, allocation of foreign currency subsidies has been the primary strategy of various administrations in Iran to improve access to medicines. This strategy has resulted in several challenges, including stakeholder conflicts of interest. Objective To identify the power, interest, and role of the stakeholders in allocating foreign currency subsidies to medicines in the Iranian health system. Methods In this qualitative study, 39 semi-structured interviews were conducted. Key informants were recruited using a purposive sampling technique. The theoretical framework adopted by Varvasovszky and Brugha was employed. The data were analysed using directed content analysis. Results The foreign currency subsidy for medicines included 21 stakeholders in five main categories: governmental organizations, Iranian Parliament, general population, nongovernmental organizations (NGOs), and the pharmaceutical industry. Stakeholders varied in their level of participation and support in the policy-making process. Among them, the Iranian Government, Planning and Budget Organization, the Ministry of Health and Medical Education (MoHME), and Iran Food and Drug Administration (IFDA) were the most important stakeholders, with highly supportive positions, while domestic drug manufacturers were the strongest opponents of this policy. The Government of Iran is the most powerful institution with regard to the ability to allocate foreign currency subsidies to medicines, followed by the MoHME and the IFDA. Conclusion This study demonstrated that identifying and analysing the stakeholders involved in allocating foreign currency subsidies to medicines can provide valuable information for policy-makers to enable a more comprehensive understanding and better capacity to determine whether or not to eliminate these subsidies. Moreover, decision-making in this process is a long-term issue that requires consensus among all stakeholders. Because of the political and social consequences of eliminating foreign currency subsidies, the necessary political will is not institutionalized. We recommend a step-by-step approach in eliminating foreign currency subsidies if the requirements are met (i.e., those related to the consequences of such interventions). Therefore, revision of the current policy along with these requirements, in addition to financial transparency and enhanced efficiency, will facilitate progress towards achieving the Sustainable Development Goals by improving access to medicines.

Background and Aim: Expenditure in the health sector requires appropriate resources management. This study was conducted to determine the amount of moral hazards associated with the service providers in the medication prescriptions paid by an insurance organization. Methods: Study population included paid pharmaceutical documents in Tehran province in 2019. 2000 prescriptions for 500 insured people were randomly selected from the database of the organization. Two indicators (the number of suspicious prescriptions based on the incompatibility of a drug with the history of the disease or the drug spectrum of an insured and the number of prescriptions with a financial burden higher than the average usual burden of a normal patient) were matched with transcript data and analyzed with SPSS version 24. An experienced pharmacist was consulted to examine the drug spectrum of all prescriptions. Results: 5.4% of total prescriptions were incompatible drugs and 6.4% had created extra financial burden. The highest incidence of risks by speciality was related to general practitioners (16 % with a surplus financial burden of 87/500/000 Rials). The highest number and amount of risks in Rials per insured group was related to supervisors (63 % with a surplus financial burden of 26/000/000 Rials). The risk in the military centres’ prescriptions were more than private and governmental centres and it was relatively equal in contracted (48%) and non-contracted (52%) centres. Conclusion: The abuse in the health service provision is a high risk for health care managers in countries that have health insurance programs which their intelligent tracking reduces many of the insurers’ costs and prevent the shortage of vital medicines.

Background: Economic evaluation is used for the optimal allocation of resources in the health sector. While a large number of economic evaluation studies have been conducted, there is less critical review of these studies. We critically examined the economic evaluation studies of preventive health interventions. Methods: The study was carried out using critical review method. Seven databases (i.e., PubMed, Cochrane Database of Systematic Reviews, Web of Science, Science Direct, Scopus, Springer Link, and Elsevier) were searched to find articles on economic evaluation of health interventions published from 1985 to 2018. In addition, the references of retrieved studies were hand screened for articles that were not indexed in these databases. Finally, 206 articles, including 33 cost- benefit analysis, 146 cost- effectiveness analysis, and 27 cost- utility analysis were included in this study. These studies were critically evaluated using a checklist of 11 criteria. Results: Only 20% of the studies met all the methodological criteria of health economic evaluation. The cost perspective, costs type, cost data source, and cost measurement were not explained and discussed in 17%, 20%, 5%, and 33% of studies respectively. Outcome data sources and outcome valuation method were only mentioned in 53% and 69% of studies. The sensitivity analysis and results’ generalizability were not reported in 16% and 46% of studies. Conclusion: The quality of economic evaluation studies is low, and it can be misleading if resource allocation decisions are made using this evidence. Authors should use valid protocols to conduct and report economic evaluation studies, and journals’ editors should use valid checklists to evaluate these articles.

Objective (s): Access to relevant information is the basis for making the right decision and choice. However, people have very little information about the structures, processes and outcome of hospitals and the quality, price and efficiency of services provided. The experiences of other countries have shown that the first step to move towards transparency is the tendency and determination of the authorities. This research then aimed to measure the tendency of hospital managers to be transparent in disclosing information to public. Methods: The present study was an applied descriptive study using survey method. A questionnaire was developed by research team and used after confirming the face and content validity as well as its reliability. This questionnaire was completed by 310 senior, middle and operational managers of genral public hosptials affilated to Tehran University of Medical Sciences (TUMS). Data analysis was performed using SPSS software. Results: The highest tendency of participants was towards information transparency related to the structural indicators and the lowest was in outcome indicators of hospitals. Management level, organizational position and level of education showed significant relationship with the tendency to transparency in its various dimensions. Conclusion: Hospital managers have a relatively strong tendency for transparency of information in the general public hospitals. Taking knowledge of the priorities and desires of managers, policymakers might be able to identify the disclosable performance indicators. Public disclosure of less sensitive indicators (i.e. structural indicators) might pave the way for the transparency practices.

Objective(s): Hospital accreditation is “an external evaluation of a hospital’s structures, processes, outputs and outcomes by an independent professional accreditation body using pre-established optimum standards”. Accreditation is a strategy for ensuring the quality, safety, effectiveness and efficiency of hospital services. The efficacy of an accreditation program depends on the validity of the accreditation governance, methods, standards, and the surveyors. Iranchr('39')s hospital accreditation system faces some challenges. Benchmarking leading international accreditation bodies’ methods benefit the Iranian hospital accreditation system. Hence, this study aimed to compare the Iranian hospital accreditation methods with the world leading international hospital accreditation bodies’ methods. Methods: A comparative research was used in this study in 2019. The Iranian hospital accreditation methods was compared with those of the Joint commission international, the Accreditation Canada international and the Australian Council on Healthcare Standards International. Framework analysis was used for the qualitative data analysis in this study. Results: While the Iranian hospital accreditation program is governmental and compulsory, the three leading international accreditation programs are private, not for profit, and voluntary. While Iran’s hospital accreditation method includes the self-assessment and the on-site survey, the other countries use self-assessment, on-site survey, un-noticed survey, periodic review, examining key performance indicators and measuring patient satisfaction. The international accreditation award levels include “Fully accredited”, Provisionally accredited” and “Not accredited” and the accreditation certification is valid for 3-4 years. The Iran’s accreditation certificate is valid for 2 years and consisted of 7 levels from “Excellent” to “Not accredited”. Conclusion: Complementary evaluation methods should be used to strengthen the validity and reliability of Iran’s hospital accreditation program. Furthermore, the time period of the accreditation certificate validity should be increased and the awards levels should be decreased.

Abstract Background Antimicrobial resistance (AMR) is currently causing various challenges for all countries around the world. Accordingly, the WHO is placing a great emphasis on the global partnership and allinaces to drive countries towards developing policy guidances and a strategic framework for AMR contatiment. This study thus seeks to elaborate on the international factors underlying AMR management in Iran. Methods Semi-structured interviews were conducted with managers from the Ministry of health (n = 14), Iran veterinary organization (n = 4), the national professional associations (n = 3) and researchers (n = 3), between November 2018 and July 2019. Participants were selected using purposeful and snowball sampling. Interviews were recorded and transcribed verbatim and were subsequently coded and analyzed thematically using MAXQDA software (V.18) and reported. Results International enabling and predisposing factors were identified in relation to the AMR control in the country. Enabling factors included knowledge transfer, facilitation in policy agenda setting, formulation and implementaion process, and AMR monitoring. Predisposing factors, alternatively, encompassed the migration of infectious patients, trafficking of medicine and livestock from neighboring countries, and the imposed sanctions. Conclusion Nowadays, AMR is taken cognizance of as a global challenge, thus to be addressed effectively, needs an international consensus more than ever. This harmony would not certainly underrate national efforts, but instead, is needed to reinforce such efforts through e.g. technical and financial assistance. It is suggested for policymakers to use all available political and legal means such as health diplomacy to establish humanitarian channels in order to enhance global convention and remove possible barriers as the sanctions and reduce their adverse consequences for AMR control.

Accessing to health goods is one of the essential parts of human rights. Iran has experienced several rounds of economic sanctions in recent decades. As can be seen from past experience, it is obvious that these sanctions affected Iran's financial relations with other countries and banking services and as a result, it had adverse effects on the country's production. Although these sanctions have not directly targeted pharmaceutical products, but due to disruption of financial relations, they have affected widespread issues such as the possibility of importing raw materials, exporting pharmaceutical products, trade cooperation and partnership with foreign partners in the Iranian drug and health technologies market

Protection of patients' rights is critical in improving healthcare quality, and hence this study aimed at reviewing patient rights’ practices in healthcare organizations of Iran. Using systematic search, this review was conducted based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Several keywords, including "patient rights", "patient bills of rights" and "patients rights’ charter" were searched bilingually in the databases of SID, Magiran, PubMed, Scopus, and Web of Science from 2010 to 2021, and then, following a three-tier screening using the Critical Appraisal Skills Program (CASP) checklists, 76 articles were extracted. The degree of compliance with the Patients' Rights Charter (PRC) in healthcare organizations was 60.88% on average. As to the observance of the PRC dimensions, respectively, the highest and lowest scores were related to the "right to privacy and confidentiality" (70.16%) and "right to access an efficient complaining system" (53.01 %). Respect for patients' rights in organizations was assessed at a moderate level, and some aspects of patients' rights should be attended to immediately. Therefore, discrepancies in the dimensions of patients' rights and their implementation by organizations should be on the agenda of healthcare managers and policymakers.

Introduction: Performance appraisal is a formal process to review and improve the organizational performance of employees regularly. Despite the appropriate organizational frameworks for performance appraisal, they are not apparently addressing the operational realities of health care organizations. This study thus aimed to examine the effectiveness of the current performance appraisal system of employees at Tehran University of Medical Sciences (TUMS) from the perspective of employees. Methods: The data were collected from 504 TUMS employees using researcher-developed questionnaire following the validation. It consisted of 46 questions covering such various dimensions as performance expectations, communication of performance objectives to employees, self-assessment, performance metrics, surveyors, and performance appraisal results. ANOVA, t-test, Post hoc and Tukey statistical tests were used during analysis process by SPSS 22. Results: The performance appraisal system was not found as effective as expected from the employees’ perspective and the scores for all its dimensions dropped below the average. The overall performance appraisal score was 2.71 (out of 5). There was also a significant correlation between the employees’ education and organizational job group and the score of performance appraisal (p

Background and Aim: Hospital accreditation is an external evaluation strategy used to improve the quality and effectiveness of services. Accreditation surveyors are among the important factors affecting the validity of accreditation results. Since the effectiveness of an accreditation system depends on its surveyors, the aim of this study is to identify the evaluation criteria of hospital accreditation surveyors in Iran. Materials and Methods: This qualitative study was conducted in 2017 based on stakeholders’ views about the hospital accreditation program. Data were collected through semi-structured interviews and analyzed by thematic analysis method. Then the framework was designed and finalized with expert opinion. Results: Forty-four criteria identified for the evaluation of hospital accreditation surveyors in Iran were classified into six domains: personality, experience, knowledge, attitude, skills, and organizational citizenship behavior. Accreditation surveyors should have an acceptable combination of such criteria. Conclusion: Evaluation of accreditation surveyors with these criteria will lead to their better performance and ultimately promote the validity of the accreditation results. These criteria also result in a native definition for “accreditation surveyor” that can be used by the directors of accreditation system of hospitals for the management of accreditation surveyors.

A Conceptual Framework for Evaluation of Accreditation Surveyors of Iran Hospitals Salarvand Abbas1, Jaafaripooyan Ebrahim2* 1. MSc in Healthcare Management, Apapdana Hospital, Tehran, Iran 2. Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran *Correspondence: School of Public Health, Tehran University of Medical Sciences, Enqelab Square, Tehran, Iran Tel: 00982142933058 Email: jaafaripooyan@tums.ac.ir Abstract: Background & Objectives: Accreditation, as a known method for evaluation of health care centers, is used with the aim of enhancing healthcare quality in the health systems of different countries and its success has a direct relation to the effective performance of its surveyors. So, the purpose of this study was to provide a conceptual framework for evaluating the accreditation surveyors of Iran hospitals. Methods: This qualitative study with a phenomenological approach was conducted in 2018 through eliciting the views of 30 expert and experienced interviewees in the field of hospital accreditation at the Ministry of Health, medical universities, hospitals, as well as accreditation surveyors selected purposefully with maximum diversity. Data were collected through semi-structured interviews and analyzed using content analysis. Results: A total of 4 main codes and 28 sub-codes were identified. Main codes included necessity and importance, principles and requirements, structure and methods of surveyors’ evaluation. Conclusion: The results of this study can provide an effective framework for health system administrators in evaluation of accreditation surveyors of Iranian hospitals. In other words, continuous evaluation of accreditation surveyors’ performance using different methods based on the principles and requirements found in this study can lead to the performance improvement of accreditation surveyors and finally the achievement of the accreditation goals. Key­words: Hospital accreditation, Accreditation surveyors’ management, Accreditation surveyors’ evaluation Citation: Salarvand A, Jaafaripooyan E. A Conceptual Framework for Evaluation of Accreditation Surveyors of Iran Hospitals. Journal of Health Based Research 2019; 4(4): 421-36. [In Persian]

Abstract Background: Advanced medical imaging technologies (AMIT) are greatly associated with the pace, accuracy and ability of physicians to better diagnose and treat various diseases, and boost the possible potential of non-invasive operational procedures. Accordingly, this study aims to investigate inpatient use of MRI and CT and the effect of their use on inpatient mortality and length of stay (LOS) in Tehran general university hospitals. Methods: The study gathered its data from all general university hospitals in Tehran in 2017. Analysis unit was hospital. Multiple linear Regression model was constructed for each combination of technology and outcomes (mortality and LOS), and all models were Controlled for patients’ demographic and clinical characteristics and structural characteristics of hospital. In calculating Hospital standardized mortality ratio (HSMR) for each of seventy two diagnosis groups related to death, a Binary logistic regression model was fitted with predictors including LOS, admission type, comorbidity level, sex, and age. Results: The use of CT varied from 0.39 to 149.35, and MRI from 0.24 to 80.23 exams per 100 discharges. The HSMR ranged from 76.8 percent to 146 percent and, the average length of stay (ALOS) from 3 to 8.46 days. The use of MRI and CT had no significant effect on the HSMR and ALOS in the studied hospitals. Conclusions: Further use of AMIT has not improved efficiency and quality in health care. This research indirectly assessed the appropriateness of MRI and CT services in the studied hospitals, and it is possible that inappropriate and unnecessary use of these services affected the results. Better management of the use of AMIT requires clear rules and regulations with assertive commitment, in addition to establishing clinical guidelines with the support of insurance companies.

Undoubtedly, the COVID-19 pandemic is not the first and most frightening global pandemic, and it may not be the last. At the very least, this phenomenon has though seriously challenged the health systems of the world; it has created a new perspective on the value of national, regional, and international cooperation during crises. The post-coronavirus world could be a world of intensified nationalist rivalries on the economic revival and political influence. However, strengthening cooperation among nations at different levels will lead to the growth of health, economy, and security. The current situation is a touchstone for international actors in coordinating the efforts in similar future crises. At present, this pandemic crisis cannot be resolved except through joint international cooperation, global cohesion, and multilateralism. This perspective concludes that the pandemic could be an excellent opportunity for the scope of global health diplomacy (GHD) and how it can be applied and practiced for strengthening five global arenas, namely (1) International Cooperation and Global Solidarity, (2) Global Economy, Trade and Development, (3) Global Health Security, (4) Strengthening health systems, and (5) Addressing inequities to achieve the global health targets. GHD proves to be very useful for negotiating better policies, stronger partnerships, and achieving international cooperation in this phase with many geopolitical shifts and nationalist mindset among many nations at this stage of COVID-19 vaccine roll-out.

Letters to the Editor: no abstract

Abstract Background Dual practice (DP) by medical specialists is a widespread issue across health systems. This study aims to determine the level of DP engagement among Iran’s specialists. Methods A pre-structured form was developed to collect the data about medical specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes, and eventually a combination of the first name, surname, and father’s name. Results A total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals. Sixteen thousand eight hundred forty-nine (69% of) specialists were non-faculty members and 6317 (26% of) specialists were employed on a contract basis. Eleven thousand six hundred and thirty-eight (47.7% of) specialists were engaged in DP on total. Female specialists had 0.78 times less DP chance; faculties compared to non-faculties had 0.65 times more DP chance and full-time geographic specialists compared to non-full-time specialists had 0.15 times more DP chance. DP was more frequent in specialists with higher age and more job experience and in provinces with more population, deprivation, and higher number of specialists per facility (P

Background: Hospital accreditation is assumed as an effective control mechanism for health systems to improve quality and efficiency. Current study thus, seeks to look into the relationship between hospitals’ accreditation and efficiency Materials and Methods: In order to measure efficiency, hospital inputs and outputs included the ratio of physician and nurse to bed, mortality and nosocomial infection rate and quality of inpatientservices were used. A sample of 554 hospitalized patients selected using stratified random sampling method. Data gathering instruments were researcher-developed questionnaire and checklists. DEAP and SPSS software deployed to assess correlation between accreditation rank and technical efficiency Results: Average hospitals’ technical efficiency score was 0.94 indicating an improvement capacityof %5.1 for hospitals efficiency. The mean quality score was 4.13 out of 5( in the range of 3.9-4.3)There was no correlation between hospitals accreditation rank and their technical efficiency Conclusion: According to the results, it seems efficiency should be also considered in accreditationmetrics. In addition, for measuring efficiency, performance based inputs and specifically outputs tohave reliable results should be chosen

Introduction: Since incorrect selection of a manager might lead to incorrect choices of other members, organizations need to consider this important issue and use well-sought mechanisms for managers’ selection process. Accordingly, this study aims to rank the key factors associated with the selection of operational managers in Tehran University of Medical Sciences. Materials and Methods: This research employed a logical and systematic trend to develop and rank the indicators using fuzzy TOPSIS method. In order for prioritization of key indicators of qualification of operational-level; after reviewing the literature and using experts’ viewpoints , the dimensions of performance have been selected and using, the SMART technique the key criteria were weighted. A validated and reliable questionnaire was used for data collection. Results: Fifty individuals participated in this study. 37 (74%) and 13 (26%) were male and female respectively. The mean and standard deviation of age of participants were 41.68 and 7.06 years. Literature reviews and related studies indicated 48 indices for choosing qualified managers. Among these, according to the expert’s opinion in management science and managers, 36 indices were selected as key indicators. Based on the FTOPSIS analysis, indicators of higher education in the field of management, compliance time, power of expression, adornment and belief in law and order achieved coefficients as 0.205, 0.204, 0.203, 0.202 and 0.197, rank first to fifth. Conclusion: According to the results management related education and expertise in technical aspects of organizational management control were at the top of ranking . Results of this study can help medical universities and health service organizations to develop guidelines for selecting their managers.

Background: The success of organizations depnds on their managers’ performance. This study aimed to measure hospital managers’ performance in the city of sari in 2017, Iran. Materials and Methods: About 294 top, middle and first-line managers working in the hospitals in Sari (including four public, two private and one social security hospital) particaipated in this descriptive and cross-sectional study. A valid and reliable questionnaire was used to assess managers’ performance in eight functions including decision making, planning, organizing, coordinating, leadership, communication, budgeting and control. SPSS software, the 21st version, was used for data analysis. Results: The mean score of hospital managers’ performance was 3.87 out of 5. Managers scored high in organizing (4.12), leadership (4.06), and decision making (3.97) and low in budgeting (3.27), planning (3.83), and coordinating (3.84). Managers’ performance was linked to their age, marital status, education level, and educational background. Those managers who worked in a position related to their educational background had better performance. Conclusion: Hospital managers rated their performance as good. Measuring managers’ performance, determining their strengths and weaknesses and applying corrective actions are beneficial to the improvement of hospitals’ performance.

Background: Hospital managerschr('39') success depends not only on internal of the hospital environment, but also on the external. Considering the importance of the social responsibility of hospitals as an external organizational issue, this study aimed to assess the importance of social responsibility and the implementation status of hospitals. Materials and Methods: This analytical descriptive study was conducted in Kermanshah educational hospitals in 2016. The study population consisted of management team of each hospital in middle and first-line level, of which 150 were selected using census sampling method. The data gathering tool was a researcher-made questionnaire. Validity and reliability of the instrument was confirmed. Data analysis was performed using SPSS20 software, descriptive and inferential statistics. Results: The mean score of importance and status of social responsibility implementation were high (86.20 ± 9.98) and moderate (60.62 ± 12.41), respectively. Among the domains, the highest and the least attention were paid to environment (11.65 ± 88.30) and suppliers (13.47 ± 81.48) domains, respectively. The highest level of accountability in patients was (68.87 ± 26/14) and the least was found in organizational processes (14.47 ± 42.02). There was a significant statistically difference in social status according to organizational status and employment type (p

Background & Objectives: Charity hospitals with increasing public participation in the provision of health services could play an important role in assisting government for providing health care and promoting society health. Since most deprived people use the services of these hospitals, paying attention to these organizations and their management can help improve the quality and equality of health services distribution. Thus, this study aimed to explore the challenges of management of charity hospitals in Tehran province and provide solutions for these challenges in 2017. Methods: This qualitative phenomenological study was conducted in 2017. Data were collected through semi-structure interviews with 26 participants from various organizations including top and middle hospital managers, experts from Vice-chancellor in treatment affairs of Universities of Medical Sciences in Tehran, and the Endowments and Charity Affairs Organizations. Snowball sampling method was used to select the respondents. Data were analyzed using a thematic analysis method. Results: The challenges of charity hospitals could be categorized into 5 main codes including financial resources, human resources, physical and structural resources, management, and cultural challenges, and 13 sub codes. Conclusion: Endowment selling and creating endowment funds in charity hospitals to develop sustainable financial resources, supervision of Ministry of Health (MOH) and Universities of Medical Sciences (UMS) for teaching, quality improvement, development of human resources, reconciliation with the goals of the health system, participation in macro policy making and planning, development of structural standards for the management of these hospitals and their announcement by the MOH, are the main solutions for these challenges. Keywords: Charity hospitals, Qualitative study, Challenges, Tehran Citation: Jaafaripooyan E, Javadi Ghale E, Arab M, Sharifi T. Challenges of Charity Hospitals in Tehran: Evidence of Private Sector Participation in the Provision of Health Care. Journal of Health Based Research 2018; 3(4): 323-37.

Background: Global payment system is a first example of per-case payment system that contains 60 commonly used surgical operations for which payment is based on the average cost per case in Iran. Objective: The aim of the study was to determine the amount of reduction, increase or no change in the trend of global operations. Methods: In this retrospective longitudinal study, data on the 60 primary global surgery codes was gathered from Tehran Health Insurance Organization within the ten-year period of 2005-2015 separately, for each month. Out of 60 surgery codes, only acceptable data for 46 codes were available based on the insurance documents sent by medical centers. A quantitative analysis of time series through Regression Analysis Model using STATA software v.11 was performed. Results: Some global surgery codes had an upward trend and some were downwards. Of N Codes, N83, N20, N28, N63, and N93 had an upward trend (p

Background: Necessity of development, quantity and quality improvement needs of medical tourists had been unavoidable based on medical tourism growth with its competitive function. This study aimed to determine satisfaction rate of medical tourists referee to Tabriz hospitals to get treatment services. Materials and Methods: This descriptive and analytical study was conducted on 82 medical tourists referee to all wards of selected hospitals using convenient sampling method in Tabriz city. Data was collected using a-28 items valid and reliable researcher made questionnaire. Cronbach’s Alpha was calculated 0.708. In order to data analysis, SPSS Software version 23 was utilized. Also, Spearman’s correlation coefficient was used to assess the association between different aspects of patients’ satisfaction. Results: Satisfaction rate was obtained in five main aspects including cultural problems (51.88%), structural issue (57.50%), insurance payment system (16.04%), information system and communication channels (41.34%) the economic challenges (50.35%). The information system and communication channels had high effect on economic aspects (p

The operational management of healthcare services is expected to directly touch patient experiences. Iranian Ministry of Health and Medical Education (MoHME) for the first time, as such, has sought to improve the operational management of healthcare delivery within a reform agenda by setting benchmarks for ‘number of visit per hour’ and waiting time in outpatient clinics of about 700 affiliated hospitals. As a new initiative, it has faced with mixed reactions and various doubts have been cast on its successful implementation. This manuscript aims to shed some light on the operational challenges of the initiative and the requirements of its successful implementation.

Background: Hospitals directly affected by disasters and crises which will be provided services facing with crises by well-informed and high performing personnel. This study aimed to determine self-efficacy level in disasters among senior managers of hospitals. Materials and Methods: This study was a descriptive-analytical and applied one which was conducted in all public and private hospitals affiliated to Tehran University of Medical Sciences in 2015. Study population was all senior managers of hospitals and data was collected by a researcher-developed, valid and reliable questionnaire. Data analyzed using descriptive and Inferential statistics. Results: Self-efficacy facing with crisis was assessed on average level (101 out of 130) and high among married men with previous experience in disasters. Also, self-efficacy level reported high among aged and position of ED managers. Nevertheless, there was no significant relationship between self-efficacy and participation in educational course and hospital ICS membership. Conclusion: Given the relationship of self-efficacy with the aged and prior experience in disasters, these variables should be considered in selecting proper people for these positions. Moreover, having successful experiences dealing with challenges enhances the level of Self-efficacy among managers. Hence, using some techniques such as simulation or providing maneuvers can acquaint managers with the possible conditions facing with disasters.

Introduction: Over the last few decades, total fertility rate (TFR) has followed a downward trend in Iran. The consequences of this trend from the perspectives of some are negative. Considering the macro-population policies in recent years, this study aimed to examine the effect of some macro socio-economic variables, including divorce, marriage, urbanization, and unemployment rate on TFR in Iran from 2002 to 2012. Methods: This time series research was conducted in 2015 using the databases of the National Organization for Civil Registration (NOCR) and the Statistical Center of Iran. The study population was the related data of provinces in the selected variables. The main methods used in the research were the common unit root test, Pedroni Cointegration test, redundant fixed effects tests, correlated random effects-Hausman test, and panel least squares of fixed effects. In order to determine the suitable model for estimating panel data, likelihood ratio and Huasman tests were done using Eviews software, and the fixed effects regression model was chosen as the dominant model. Results: The results indicated that the divorce rate had a negative and significant effect on TFR (p < 0.05). A positive and significant relationship between marriage rate and TFR variables also was observed (p < 0.05). Urbanization rate (p = 0.24) and unemployment rate (p = 0.36) had no significant relationship with TFR. According to F statistic, significance of the overall model also was confirmed (p < 0.001). Conclusion: Due to the lower effect of the studied factors on the reduction of TFR, it seems that variables other than the ones studied, as well as cultural factors and values, might be fundamental factors for this change in the country

Introduction: In recent years, platelet rich plasma (PRP) has been receiving increasing attention for the treatment of soft tissue injuries. These numerous applications have raised a great deal of questions and debate about the effectiveness of this method. This study aimed to determine the efficacy of PRP in improving sports injuries and subsequently throw some light on these controversies. Methods: A systematic review of the literature and meta-analysis of results were undertaken. All related databases, such as PubMed, Cochrane Database of Systematic Reviews, DARE, and EMBASE, were searched on the use of PRP on athletes and in sports medicine. The search was conducted from June 2013 to February 2014. Results: Our search retrieved 905 studies, of which 13 randomized control trials (RCT) met our inclusion criteria for systematic review and meta-analysis. All articles were appraised by Critical Appraisal Skills Program (CASP) checklist for RCT studies. The analysis of the results of pain scores and physical activity/functions did not show any superiority for PRP as opposed to the other options. Conclusions: The meta-analysis showed no more effectiveness for PRP application in sports-related injuries in terms of physical function improvement and pain relief. Therefore, the extensive use of PRP for such injuries should be limited. Well-designed RCTs are needed to support the findings.

Introduction: The health sector evolution (HSE) plan has been implemented since 2014 and includes seven programs. Since one of the goals of this plan was to improve the condition of emergency departments, in this study we evaluated the effect of HSE plan on performance indices of emergency department in hospitals affiliated with Tehran and Iran Universities of Medical Sciences, Tehran, Iran. Methods: The present cross-sectional study was conducted in all Hospitals affiliated with Tehran and Iran Universities of Medical Sciences. Six performance indices of emergency department were collected monthly in two 12-month periods before and after implementation of the HSE plan by referring to the hospitals’ statistics unit. Data were analyzed via SPSS 22 using paired T-test and Interrupted Time Series (ITS) model. Results: The results of ITS showed that implementation of HSE plan had no significant effect on the rate and trend of indices such as percentage of patients who left the emergency department within 12 hours and percentage of patients discharged against medical advice (p > 0.05). On the other hand, HSE plan implementation affected the rate and trend of indices such as percentage of patients who were decided upon within 6 hours and the average turnaround time for emergency tests significantly (p < 0.05). The rate of both indices has increased but their trend has decreased. Conclusion: Implementation of HSE plan has resulted in improved percentage of patients who were decided upon within 6 hours and increased average turnaround time for emergency tests. In addition, although it has significantly increased the trend of successful CPR percentage, it has decreased the rate of successful CPR.

Background: Patient safety is one of the key principals to the trust in any health care system nowadays. Medication errors, as a key safety threatening factors, could increase patients’ length of stay and healthcare costs in hospitals and might lead into injury and finally death. Therefore, this study seeks to compare the incidence and proposed solutions of Iran and selected countries in order for preventing medication errors. Materials and Methods: This applicable study is a review article searching in such databases as SID, IranMedex, Pubmed, and Scopus to identify and select its related papers. At last, 25 studies were considered for this study. Results: According to the results of studies, shortage of nurses, nurses’ inexperience, job stress, physicians’ handwriting and lack of information on medications were the highly frequent incidence causes. Training courses on medicine dispensing and hands-on training were the most important solution. Conclusion: Given the existing gap between the medication errors incidence rate of Iran and selected countries, the latter’s experiences such as transparency and responsibility and active role of hospital pharmacies could be utilized by the former.

مقدمه: طرح تحول نظام سلامت از سال 1393، مشتمل بر 7 برنامه در کشور ما آغاز شده است. از آنجايي كه بهبود وضعيت بخش های اورژانس نيز جزو اهداف اين طرح بوده است در اين مطالعه به بررسي تاثير طرح تحول نظام سلامت بر شاخص هاي عملكردي بخش اورژانس در بيمارستانهاي دانشگاههاي علوم پزشكي تهران و ايران پرداختیم. روش کار: پژوهش مقطعی حاضر در كليه بيمارستان هاي دانشگاههای علوم پزشكي تهران و ایران انجام شد. 6 شاخص عملكردي اورژانس به صورت ماهانه و در دو بازه زماني 12 ماهه قبل و بعد از اجراي طرح از طریق مراجعه به واحد آمار بیمارستان ها جمع آوري گرديد. داده ها با نرم افزار SPSS نسخه 22 و با استفاده از آزمون تي زوجي و نيز مدل سری زمانی منقطع (ITS) آنالیز شدند. يافته ها: نتايج تحليل سري زماني منقطع نشان مي دهد اجراي طرح تحول نظام سلامت بر سطح و روند شاخص هاي درصد بیماران خارج شده از اورژانس ظرف مدت 12 ساعت و درصد ترک از اورژانس با مسئولیت شخصی تأثیر معناداري نداشته است (05/0p>). اجراي طرح تحول نظام سلامت بر سطح و روند شاخص هاي درصد بیماران تعیین تکلیف شده ظرف مدت 6 ساعت و متوسط زمان دریافت پاسخ آزمایشات اورژانس تأثیر معناداري داشته است (05/0>p). به طوري كه سطح دو شاخص مذكور بعد از اجراي طرح تحول نظام سلامت افزايش ولی روند اين دو شاخص كاهش داشته اند. نتيجه گيری: اجراي طرح تحول باعث بهبود وضعیت درصد بیماران تعیین تکلیف شده ظرف شش ساعت و افزایش متوسط زمان دریافت پاسخ آزمایشات اورژانس شده است. همچنین اگر چه موجب افزايش معني دار روند CPR موفق بوده اما سطح CPR موفق را کاهش داده است.

Background Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. Methods A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. Results Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs’ over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. Conclusion Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs.

Background: European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM.Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-2010) was used to gather appropriate data. The results were compared with those of INPHE. MS Excel was used to classify and display the findings.Results: The average assessment score of the EDs based on the INPHE and EFQM model were largely different (i.e. 86.4% and 31%, respectively). In addition, the variation range among five EDs’ scores according to each model was also considerable (22% for EFQM against 7% of INPHE), especially in the EDs with and without prior record of applying QMSs.Conclusion: The INPHE’s assessment results were not confirmed by EFQM model. Moreover, the higher variation range among EDs’ scores using EFQM model could allude to its more differentiation power in assessing the performance comparing with INPHE. Therefore, a need for improvement in the latter drawing on other QMSs’ (such as EFQM) strengths, given the results emanated from its comparison with EFQM seems indispensable.

Background: This study aimed to calculate the child labor rate and establish the factors affecting this phenomenon in the less developed provinces of Iran. Methods: This study has used the secondary data of population and housing census gathered by Iranian Statistical Center in 2011. The data belonged to 14859 children between 10 and 14 of 9 less developed provinces of Iran. A multiple regression model was hypothesized drawing on related literature and accordingly using data; the logistic regression was estimated. Data cleaning process was also conducted prior to the analysis. Results: The child labor force participation rate for all children between 10 and 14 years old was 1.7%, of which boys’ child labor rate was higher than girls’ (2.4% over 1%). As such, the mothers’ fertility rate and education were of the strongest, yet converse, effect on child labor supply in the country. Conclusion: A little proportion of children in less developed regions of Iran was suffering from child labor. However, given the diminishing and rising effects of, respectively, variables such as mothers’ literacy and working on the child labor; the authorities could restrict child labor attending more to such a group. The factors identified could also be of a high value for the policy-makers at both national and international level such as the Health and Welfare ministries, EMRO, ILO and UNICEF.