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Background: To assess prevalence and predictive factors for Nosocomial Infection (NI) in the military hospitals. Methods: PubMed, Scopus, Cochrane and PreQuest databases were systematically searched for studies published between Jan 1991 and Oct 2017 that reported the prevalence of NI and predictive factors among military hospitals. We performed the meta-analysis using a random effects model. Subgroup analysis was done for heterogeneity and the Egger test to funnel plots was used to assess publication bias. Results: Twenty-eight studies with 250,374 patients were evaluated in meta-analysis. The overall pooled estimate of the prevalence of NI was 8% (95% 6.0–9.0). The pooled prevalence was 2% (95% CI: 2.0–3.0) when we did sensitivity analysis and excluding a study. The prevalence was highest in burn unit (32%) and ICU (15%). Reported risk factors for NI included gender (male vs female, OR: 1.45), age (Age≥65, OR: 2.4), diabetes mellitus (OR: 2.32), inappropriate use of antibiotics (OR: 2.35), received mechanical support (OR: 2.81), co-morbidities (OR: 2.97), admitted into the ICU (OR: 2.26), smoking (OR: 1.36) and BMI (OR: 1.09). Conclusion: The review revealed a difference of prevalence in military hospitals with other hospitals and shows a high prevalence of NI in burn units. Therefore careful disinfection and strict procedures of infection control are necessary in places that serve immunosuppressed individuals such as burn patient. Moreover, a vision for the improvement of reports and studies in military hospitals to report the rate of these infections are necessary.

Objective This study examined the effects of two evidence-based practice (EBP) educational programs for postgraduate medical residents on their attitude, behavior, knowledge, outcome, and competencies in EBP. Results Forty-five and thirty-five medical residents were recruited in the active and passive educational intervention groups, respectively. Among those, 39 and 30 participants were included in the final analysis. The participants of the active group received 12 h of EBP-structured presentation. The passive educational group received EBP education through their daily rounds, evidence-based journal clubs, and morning reports. Participants were evaluated with EBP-KABQ and ACE tools questionnaires. The active and passive intervention groups were not significantly different from each other at the baseline in the EBP-KABQ questionnaire and ACE tools score (p > 0.05). However, most questions in the EBP-KABQ questionnaire were significantly different from the pre-intervention measurement and the passive intervention group after the educational intervention. Educational intervention in both groups led to a significant difference in ACE tools score between groups (8.86 ± 2.62 vs. 7.31 ± 2.92, p = 0.029, in the active and passive groups, respectively). Paired t-test analysis revealed that our intervention led to a significant increase in ACE tool scores in both groups (p

Background: Hospitals, the main providers of healthcare services, are costly centers which account for about 80% of the health sector budget and have a huge share of resources. Objective: This study aimed to analyze the economic performance of selected military hospitals in Tehran using hospital indicators and inpatient bed-day costs. Methods: This descriptive, cross-sectional, retrospective study conducted in hospitals affiliated with a military medical university. Data was collected with forms completed by referring to the hospitals’ finance and accounting, medical records, staffing, and logistics departments. The extracted data converted to hospital indicators using the appropriate formulas and analyzed using Excel and SPSS software with the T-test. Results: The average bed occupancy rate (BOR) was 71%, the average length of stay (ALOS) was 2.5 days, the average bed turnover (BT) was 31 times, and the average bed turnover interval (BTI) was one day. The comparison of means of all the above-mentioned indicators other than BOR with the national standards was statistically significant (P < 0.05). Inpatient bed-day costs with and without capital costs were calculated to be 3 312 353 IRR and 12 253 775 IRR, respectively. Conclusion: Higher BOR and BT and lower ALOS and BTI indicators were appropriate compared with the national standards, but the cost performance was not appropriate. An unreasonable increase in inpatient bed-day cost revealed that there were unused beds and that hospitals had no monitoring systems for revenues and expenditures. Therefore, serious attention must be given to the scientific criteria and principles of health economics to improve resource productivity.

Aims: The aim of the study was to investigated competencies and the role of nursing team members in managing the nosocomial infections (NIs) in a large military teaching hospital in Iran. Settings and Design: The study data were collected using standard 3-part questionnaire including demographic characteristics, self-rated competency ability rating and role in competency activities. Subjects and Methods: Nurses were selected by stratified random sampling and proportional to size between wards. Statistical Analysis Used: The answers were analysed by Chi-square test and one-way analysis of variance in Stata 14. Results: The results showed that only 12% of nurses were expert and the majority (48.8%) were proficient for each of the 8 core competency activities. Preventing/controlling the transmission of infectious agents had the highest proportion of nurses who self-rated competency level as novice (53%), followed by surveillance and epidemiologic investigations and environment of care (52% and 45%, respectively). Competency differences by sex, age, experience, occupation unit, job category and working hours a week were obtained (P < 0.05). Only, 26% of nurses reported that they did not have role in each competency activity. Conclusions: The results showed that the majority of nurses were involved in different tasks, while their competencies were at the novice level. Considering the vital role of nurses in providing the services and preventing the infection, low levels of competency will be an alert for hospitals about the prevalence of NIs and its consequences, which should be taken into consideration in the future programs seriously.

Due to the sanctions imposed by the USA government upon the Iranian health system, achieving the UHC might face some financial problems. This study aimed to make the best solution for the Iran health care system to overcome not only the temporary sanctions but also a program to reach the UHC goals through the strategic purchasing approach. This was a qualitative study carried out from 2015 to 2017 containing two phases: a comparative analysis and a three-step Delphi technique. In the first phase, the Garden model was applied to select the countries. In the second phase, 20 experts who specialised in health management, health economics, and health insurance science were asked. Data were analyzed with SPSS (version 20.0) and STATA (version 15.0) In the threat of trade and economic sanctions imposed on the Iranian health care system, the experts identified and emphasized that the vulnerable groups to receive financial assistance can be the retired, fecund women, teenagers and people with lower wages. The experts thought that, in the context of resource constraints, different payment systems are proposed for cities and villages based on the different needs of local population. Considering the difficult situation, this study focused on how Iran can cope well in a dangerous situation and economies the health expenditure applying strategic purchasing as one of the key tools in controlling costs to achieve universal health coverage. Economic evaluation, payment system, and priority population are the linchpins of the UHC. Universal health coverage, if it is to be considered, not only is applicable, but it could also be a solution for future generations. Therefore, the proposed policy proposals can provide both a short-term and long-term basis for the health care system of countries that are facing budget constraints or are basically low-income.

ObjectiveTo explore the causes and consequences of non-urgent visits to emergency departments in Iran and then suggest solutions from the healthcare providers’ viewpoint.DesignQualitative descriptive study with in-depth, open-ended, and semistructured interviews, which were inductively analysed using qualitative content analysis.SettingA territorial, educational and military hospital in Iran.ParticipantsEleven healthcare providers including eight nurses, two emergency medicine specialists and one emergency medicine resident.ResultsThree overarching themes of causes and consequences of non-urgent visits to the emergency department in addition to four suggested solutions were identified. The causes have encompassed the specialised services in emergency department, demand-side factors, and supply-side factors. The consequences have been categorised into three overarching themes including the negative consequences on patients, healthcare providers and emergency departments as well as the health system in general. The possible solutions for limiting and controlling non-urgent visits also involved regulatory plans, awareness-raising plans, reforms in payment mechanisms, and organisational arrangements.ConclusionWe highlighted the need for special attention to the appropriate use of emergency departments in Iran as a middle-income country. According to the complex nature of emergency departments and in order to control and prevent non-urgent visits, it can be suggested that policy-makers should design and implement a combination of the possible solutions.

Purpose Accreditation helps to ensure safe and high-quality services in hospitals. Different occupational groups have various hospital accreditation experiences. The purpose of this paper is to investigate nurses’ accreditation experience and its effects on Iranian teaching hospital service quality. Design/methodology/approach This was a qualitative study involving a phenomenological approach to studying nurses’ hospital accreditation experience and understanding the effects on Iranian teaching hospital service quality. Data were collected using two focus groups in which nurses were selected using purposive sampling. Transcripts were analyzed using content analysis. Findings Nurses’ experiences showed that hospital administrators and nurses had greater role in implementing accreditation than other occupational groups. Accreditation improved patient-centeredness, patient safety, logistics and managerial processes and decision making. However, a weak incentive system, extra documentation and work stress were negative experiences. Practical implications Nurse experience, as the most important care team member, reveals accreditation’s strengths and weaknesses and its effects on service quality. Originality/value The author used a phenomenology approach to measure accreditation effects on service quality – a valuable tool for understanding a phenomenon among those that experience hospital accreditation processes.

Purpose The purpose of this paper is to determine accreditation effects on Iranian military hospital health service quality through nurses’ viewpoints. Design/methodology/approach The paper is a cross-sectional questionnaire-based study. Sampling drew from a hospital nurse census (n=160). Descriptive statistics were used to analyze participant demographics and nurses’ views. Linear regression analysis determined the independent variables’ overall effect on the accreditation quality results dimension (dependent variable). Findings From the nurses’ viewpoints, accreditation effects on services quality mean score was 3.60±0.61. Linear regression analysis showed that leadership and quality management were identified as the most important accreditation quality predictors. The R2 value (0.698) showed that nearly 70 percent of the dependent variable changes were affected by the independent variables. Practical implications This study gives hospital managers a deeper insight into accreditation and its effects on military hospital service quality. Military hospitals benefit from military organization such as hierarchy and command chain, so managers should employ these characteristics to adopt appropriate policies to promote human resource management as a competitive advantage. Furthermore, results will guide public and private hospital managers on how to manage organizational variables that benefit from accreditation. Originality/value Accreditation was introduced as a hospital quality improvement program. However, implementing accreditation programs should be cost-effective. Hospital managers and employees should feel that accreditation can improve service quality. Nurses had positive viewpoints about accreditation and its effects on military hospital service quality.

The supply chain management of medical equipment and consumer goods is full of uncertainties and unexpected issues and one of the major challenges of hospitals is the suppliers’ evaluation and sele...

Background: In order to achieve success in future goals and activities, health research centers are required to identify their key success factors. Objective: This study aimed to extract and rank the factors affecting the success of research centers at one of the medical universities in Iran. Methods: This study is a mixed method (qualitative-quantitative) study, which was conducted between May to October in 2016. The study setting was 22 health research centers. In qualitative phase, we extracted the factors affecting the success in research centers through purposeful interviews with 10 experts of centers, and classified them into themes and sub-themes. In the quantitative phase, we prepared a questionnaire and scored and ranked the factors recognized by 54 of the study samples by Friedman test. Results: Nine themes and 42 sub-themes were identified. Themes included: strategic orientation, management, human capital, support, projects, infrastructure, communications and collaboration, paradigm and innovation and they were rated respectively as components of success in research centers. Among the 42 identified factors, 10 factors were ranked respectively as the key factors of success, and included: science and technology road map, strategic plan, evaluation indexes, committed human resources, scientific evaluation of members and centers, innovation in research and implementation, financial support, capable researchers, equipment infrastructure and teamwork. Conclusion: According to the results, the strategic orientation was the most important component in the success of research centers. Therefore, managers and authorities of research centers should pay more attention to strategic areas in future planning, including the science and technology road map and strategic plan

Academic entrepreneurship is a dynamic field which is growing after the second academic revolution that added entrepreneurial mission as the Third Mission of universities. In this sense, dynamics of this phenomenon is a suitable field of study and provides fruitful insights for both theory and practice. Thus, in this research, system dynamics approach is used to scrutinize academic entrepreneurship. The main question of this research is 'how academic entrepreneurship might evolve in a medical university of a developing country?' Therefore, Cross Impact Analysis method is used to examine the system behavior. In this study, the main attributes are adapted from a recent study by Salamzadeh et al. (2013a). Then, some policy variables are proposed and their effects on the model were shown. Findings show that although entrepreneurial ecosystem is growing in the country, still there are problems to be taken into account in order to improve the entrepreneurship in university.

Introduction Quality is a key factor for the success of any organization. Moreover, accessing quality in the emergency department is highly significant due to the sensitive and complex role of this department in hospitals as well as the healthcare and medical treatment system. This study aimed to identify, from the perspective of medical experts and nurses serving in the military health and medical treatment system, the factors that affect the quality of emergency service provided in selected military hospitals in Iran. Methods This qualitative research was performed in Valiaser Hospital of Tehran (Iran) in 2015, using the framework analysis method. The purposive sampling technique was used for data collection. A total of 14 participants included two emergency medicine specialists, four general physicians, two senior nurses (holding M.Sc. degrees), and six nurses (holding B.Sc. degree). Data were collected through semistructured interviews. Sampling continued until data saturation occurred. The Atlas/Ti software was employed for data analysis. Results Four basic themes emerged as the effective factors on the quality of emergency services, namely, structural themes, process/performance themes, outcome themes, and environmental/contextual themes. Moreover, through a framework analysis, 47 subthemes were specified and summarized as indicators of the different aspects of the main themes. Conclusion The factors affecting the quality of emergency services in Iran's selected military hospitals are especially complicated due to the diversity of the missions involved; thus, different factors can influence this quality. Therefore, an effort should be made to tackle the existing obstacles, facilitate the identification of these effective factors, and promotion of the quality of healthcare services.

CONTEXT: Iranian National Health Scientific Map is a national plan the implementation of which remarkably influences the progress of the country, though it is facing challenges in its implementation phase. AIMS: The present study has been conducted with the main aim of identifying the challenges facing the comprehensive scientific health map of Iran. SETTING AND DESIGN: This is an applied and qualitative study. SUBJECTS AND METHODS: The study was done in 2017 with the content analysis approach among experts of research and technology management. Some 18 people were selected and were deeply interviewed, meanwhile observing the credibility of research. STATISTICAL ANALYSIS USED: Data analysis was performed based on content analysis and using ATLAS.ti software. RESULTS: Data analysis resulted in the identification of 427 codes, 84 subthemes, and 12 themes. Twelve themes were specified including policy-making, management, university autonomy, quantitative development, consideration of science production chain, designing and monitoring of science map, finance, qualitative assessment, human resources, research ethics, as well as allocating attention to the infrastructure and communication. CONCLUSION: The scientific map of health challenges are indicative of the need for modification of the scientific map and adhering to solutions in line with the removal of the identified challenges. Today, paying attention to the solutions capable of meeting such challenges is a must.

Background: One of the techniques used to achieve productivity, employees’ job satisfaction and higher quality goods and services, as well as to solve the problems by using a team, is the formation of quality control circles. Quality control circles enable managers to meet the organization’s and employees’ needs through making effective use of resources and facilities. On the other hand, the quality of services is always affected by uncertainty and ambiguous and implicit judgments, which make its measurement uncertain. Aim: The present study aimed to identify important factors affecting the effectiveness of quality control circles in a hospital, as well as rank them using a combination of fuzzy VIKOR and Grey Relational Analysis (GRA). Methodology: This was an applied, cross-sectional and descriptive–analytical study conducted in 2016. The study population consisted of five academic members and five experts in the field of nursing working in a hospital, who were selected using a purposive sampling method. Also, a sample of 107 nurses was selected through a simple random sampling method using their employee codes and the random-number table. The required data were collected using a researcher-made questionnaire which consisted of 12 factors. The validity of this questionnaire was confirmed through giving the opinions of experts and academic members who participated in the present study, as well as performing confirmatory factor analysis. Its reliability also was verified (α=0.796). The collected data were analyzed using SPSS 22.0 and LISREL 8.8, as well as VIKOR–GRA and IPA methods. Results: The results of ranking the factors affecting the effectiveness of quality control circles showed that the highest and lowest ranks were related to ‘Managers’ and supervisors’ support’ (Š = 6.80, [Formula: see text] = 0.36) and ‘Group leadership’ (Š = 2.63, [Formula: see text] = 0.98). Also, the highest hospital performance was for factors such as ‘Clear goals and objectives’ and ‘Group cohesiveness and homogeneity’, and the lowest for ‘Reward system’ and ‘Feedback system’, respectively. Conclusion: The results showed that although ‘Training the members’, ‘Using the right tools’ and ‘Reward system’ were factors that were of great importance, the organization’s performance for these factors was poor. Therefore, these factors should be paid more attention by the studied hospital managers and should be improved as soon as possible. Applying quality control circles in any organization is very helpful and provides opportunities for maximum use of employees’ creativity, initiative and skills in reaching their and their organization’s goals and objectives, and prepares favorable working conditions for the employees’ optimal performance through increasing the managers’ sense of responsibility and commitment.

PurposeStrategic planning is the best tool for managers seeking an informed presence and participation in the market without surrendering to changes. Strategic planning enables managers to achieve their organizational goals and objectives. Hospital goals, such as improving service quality and increasing patient satisfaction cannot be achieved if agreed strategies are not implemented. The purpose of this paper is to investigate the factors affecting strategic plan implementation in one teaching hospital using interpretive structural modeling (ISM).Design/methodology/approachThe authors used a descriptive study involving experts and senior managers; 16 were selected as the study sample using a purposive sampling method. Data were collected using a questionnaire designed and prepared based on previous studies. Data were analyzed using ISM.FindingsFive main factors affected strategic plan implementation. Although all five variables and factors are top level, “senior manager awareness and participation in the strategic planning process” and “creating and maintaining team participation in the strategic planning process” had maximum drive power. “Organizational structure effects on the strategic planning process” and “Organizational culture effects on the strategic planning process” had maximum dependence power.Practical implicationsIdentifying factors affecting strategic plan implementation is a basis for healthcare quality improvement by analyzing the relationship among factors and overcoming the barriers.Originality/valueThe authors used ISM to analyze the relationship between factors affecting strategic plan implementation.

Background: The diagnostic services such as Magnetic Resonance Imaging (MRI) require advanced and costly technologies; and making the right managerial decisions to reduce patients’ waiting time and increase employees’ productivity in providing such services is essential. Objectives: The current study aims at optimizing the performance of the mentioned MRI department using queuing theory and simulation to increase its productivity and patients’ satisfaction. Methods: It was an applied and cross-sectional study conducted in 2015 in the MRI department of a military hospital affiliated to Baqiyatallah University of Medical Sciences, Iran, in day and night shifts in which the referral rate and the time spent in different workstations were recorded for a sample of 264 patients by Quota Sampling. After the initial evaluation of data using Excel 2013, arrival time of patients and the average time of service delivery, associated with the queuing network, in both shifts were calculated. Then, to provide practical solutions, various scenarios were modeled using Arena14.5 and the results were compared. Results: The current study results showed that the highest average of patients’ waiting time was related to turn-taking until admission (56 days) while the average time spent from admission to leaving the studied MRI department was 124 minutes. The department productivity on average was 52.5% indicating the high system capacity, which had not been used. There was dramatically reduced waiting time and increased required services in the 4th scenario indicating that the waiting time could be significantly reduced by making small changes in the human resources (changes in the working hours and the number of personnel) and the number of machines (adding an MRI machine). Conclusions: In the 4th scenario, the department and its personnel’s productivity improved and the patients’ waiting time for turn-taking until admission was eliminated by adding an MRI machine and an MRI technologist. Therefore, the implementation of this scenario is proposed, after performing cost-benefit analyses.

ObjectivesTo determine the percentage of non-urgent (NU) visits in an Iranian emergency department (ED), to explore why patients with NU conditions refer to EDs and also to assess the association between patients’ characteristics and their visits.DesignA cross sectional study based on face to face survey.SettingA territorial, teaching and military hospital in Tehran province, Iran.Participants and data collectionAll patients who visited the ED during the 2-week period were recruited. Data were collected using a validated questionnaire.ResultsOf 1884 patients who visited the ED, 1217 (64.6%) patients were triaged as NU while 667 (35.4%) were urgent and semiurgent visits cases. The most important reasons for NU visits were seeking prompt (36.6%) and less costly care (35.9%). We found that NU visits have increased with younger patients, during weekends and night shifts, and with patients suffering from recurrent symptoms lasting in 1 week or less.ConclusionsEDs are a common source of care for NU problems in Iran. The most invaluable solution is building up special clinics for providing healthcare services to NU patients during the weekends and, in the busy and night shifts. Receiving higher fees from NU patients could also be adopted with caution. Promoting awareness and knowledge of both healthcare providers and patients about the main role of EDs will contribute in improving their performance. As a long-term solution, adopting the family physician programme and ameliorating the referral system are recommended.

Introduction:Informal payments are a serious obstacle to equitable access and universal health coverage in developing countries. This study aimed to identify the most important factors affecting he...

Background: The surveyors in hospital accreditation program are considered as the core of accreditation programs. So, the reliability and validity of the accreditation program heavily depend on their performance. Objectives: This study aimed to identify the dimensions and factors affecting surveyor management of hospital accreditation programs in Iran. Materials and Methods: This qualitative study used a thematic analysis method, and was performed in Iran in 2014. The study participants included experts in the field of hospital accreditation, and were derived from three groups: 1. Policy-makers, administrators, and surveyors of the accreditation bureau, the ministry of health and medical education, Iranian universities of medical science; 2. Healthcare service providers, and 3. University professors and faculty members. The data were collected using semi-structured in-depth interviews. Following text transcription and control of compliance with the original text, MAXQDA10 software was used to code, classify, and organize the interviews in six stages. Results: The findings from the analysis of 21 interviews were first classified in the form of 1347 semantic units, 11 themes, 17 sub-themes, and 248 codes. These were further discussed by an expert panel, which then resulted in the emergence of seven main themes - selection and recruitment of the surveyor team, organization of the surveyor team, planning to perform surveys, surveyor motivation and retention, surveyor training, surveyor assessment, and recommendations - as well as 27 sub-themes, and 112 codes. Conclusions: The dimensions and variables affecting the surveyors’ management were identified and classified on the basis of existing scientific methods in the form of a conceptual framework. Using the results of this study, it would certainly be possible to take a great step toward enhancing the reliability of surveys and the quality and safety of services, while effectively managing accreditation program surveyors.

Introduction: Given the competitive nature of the health market and the multiplicity of factors that may contribute towards patient’s choices of a hospital, patients' needs and preferences for a hospital must be considered in the planning and decision making of hospitals and health care organizations. This study aimed to identify the factors that contribute to patient’s choices of a clinic and the importance of each factor. Methods: A mixed-method approach was used to collect quantitative and qualitative data in two phases. The study was conducted in a hospital clinic in 2014. Qualitative data were collected by face-to-face semi-structured interviews of a sample of 22 managers and heads of outpatient wards. The self-administered questionnaire designed for this study collected quantitative data from a stratified random sample of 381 patients referred to this clinic. The qualitative data were analyzed by a system of coding, while parametrical statistical analyses were conducted to analyze the quantitative data using the independent-samples t-test and ANOVA in SPSS software, version 21.0. Results: The qualitative data indicated that there were 21 factors that may contribute to patient’s choices of a clinic, and these factors were classified into six categories, i.e., facilities and physical assets, physicians and employees, location and place, services, price, and promotion. Among the 16 questions studied in the quantitative questionnaire, the highest and lowest means were related to "appropriate clinic environment" (2.47 ± 0.58) and "advertising through TV and radio, the Internet, newspapers, etc." (1.77 ± 0.75), respectively. There were significant associations between "having experienced and responsive personnel, including physicians and employees" and the patient’s gender and frequency of referrals, between "belonging to the Armed Forces" and the patient’s age and frequency of referrals, between "advertising through TV and radio, the Internet, newspapers, etc." and shifts and frequency of referrals, between "inadequate facilities and poor quality of services provided in other health care organizations of the Armed Forces" and "adornment and good behavior of staff" and shifts (p < 0.05). Conclusion: The most significant contributing factors to attract patients were the "physicians and employees," and “the clinic’s environment.” Therefore, it is essential for clinic managers and heads of outpatient wards to focus on and strengthen these two factors. Also, since the means of the factors were better in the morning shift, the employees should perform their duties properly and consistently in all shifts.

Background and Aim: Medical research institute is the main basis for knowledge production through conducting research, and paying attention to the research is one of the most important things in the scientific communities. At present, there is a large gap between knowledge production in Iran compared to that in other countries. This study aimed to identify the challenge of research system in a research institute of medical sciences in Iran. Matherials and Methods: This was a descriptive and qualitative study conducted in the first 6 months of 2013. A qualitative content analysis was conducted on 16 heads of research centers in a research institute of medical sciences. The required data were gathered using semi-structured interviews. The collected data were analyzed using MAXQDA 10.0 software. Results: Six themes identified as challenges of research system. The themes included barriers related to the design and development, and approval of research projects, the implementation of research projects, the administrative and managerial issues in the field of research, the personal problems, publishing articles, and guidelines and recommendations. Conclusion: Based on the results of the present study, the following suggestions can be offered: pushing the research towards solving the problems of society, employing the strong executive and scientific reseach directors in the field of research, providing training courses for researchers on how to write proposals, implementing administrative reforms in the Deputy of Research and Technology, accelerating the approval of the projects through automating the administrative and peer-reviewing processes.

Lack of attention to real costs has made implementing a costing system which targets the listed purposes in the appropriate format pilot units seem essential. The purpose of this study is to calculate the unit cost of services provided in a health care center in Iran. This study has a cross sectional description and is based on the 2010 financial data. The department studied is a health center affiliated to Tehran University of Medical Sciences. A scientific committee which is composed of the health and budget and financing experts was set up. Then the required form was designed to collect data on the costs and services provided. Data entry was done through Excel software and analyzed based on activity based costing system following eight steps. The results of this study are presented as a “unit cost” of more than 80 types of services offered in the final activity units of the health center studied. Polio vaccine by the unit of vaccination with the unit cost of $0.84 and TB treatment by disease unit with the unit cost of $64.79 are respectively the lowest and highest unit costs of services rendered by the health center studied. Due to the high share of personnel costs of total expenditures (73%), increased labor productivity plays an important role in reducing costs. Moreover, integrated units with similar services, according to their capacity to accept and organize similar activities in the implementation process of various services to prevent their repetition, are also effective in reducing costs. Key words: Activity based costing, health care center, Iran.

Background: This study aimed to identify and prioritize factors affecting the development of military hospital beds and provide a model using fuzzy analytical hierarchy process (Fuzzy AHP). Methods: This applied study was conducted in 2016 in Iran using a mixed method. The sample included experts in the field of military health care system. The MAXQDA 10.0 and Expert Choice 10.0 software were used for analyzing the collected data. Results: Geographic situation, demographic status, economic status, health status, health care centers and organizations, financial and human resources, laws and regulations and by-laws, and the military nature of service recipients had effects on the development of military hospital beds. The military nature of service recipients (S=0.249) and economic status (S=0.040) received the highest and lowest priorities, respectively. Conclusion: Providing direct health care services to the military forces in order to maintain their dignity, and according to its effects in the crisis, as well as the necessity for maintaining the security of the armed forces, and the hospital beds per capita based on the existing laws, regulations and bylaws are of utmost importance.