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Background: Each country’s health system is tasked with providing services to ensure the health of its population. Dental services are among these essential services. However, dental service utilization is unevenly distributed worldwide. This study’s findings will give health sector officials and policymakers valuable insights to enhance system performance.Methods: This descriptive-analytical study, conducted in 2021, aimed to determine the distribution of dentists worldwide. The analysis utilized the Pareto curve, the dentist-to-population ratio (DPR), the Gini Coefficient (GC), and the Lorenz curve. The goal was to identify the countries with the highest number of dentists.Results: There are over 2,500,000 dentists globally, averaging 3.6 dentists per 10,000 people. However, the ratios vary significantly, with about 6.8 per 10,000 in countries with very high Human Development Index (HDI) groups and 0.19 per 10,000 in low HDI groups. The data indicates that more than 80% of dentists work in countries with very high and high HDI.Conclusion: This study suggests that job concentration is higher in areas with superior welfare and facilities, and dentistry is no exception. Therefore, creating better welfare in more disadvantaged areas, implementing mandatory government plans, and strategic government planning can help mitigate distribution inequality.

Background: Equity in health refers to ensuring that individuals have timely and sufficient access to healthcare services when needed. Human resources are a vital component of healthcare organizations, and they play a crucial role in improving people's access to services. Dentists, in particular, are essential healthcare professionals as oral and dental health significantly impacts overall societal health. This study aims to investigate the key factors contributing to the inequality in the distribution of dentists. Methods: A scoping review was conducted, systematically searching three databases—Scopus, PubMed, and WOS—using relevant keywords until January, 2023. A total of 565 preliminary results were screened, and 447 titles and abstracts were reviewed. Ultimately, 23 full-text articles were included in the analysis. Qualitative content analysis and thematic network were used to synthesize the extracted data. Results: Thematic analysis of the evidence yielded four main themes that contribute to inequality in the distribution of dentists: the development of the inequality situation, methods for analyzing inequality, causes of inequality, and potential solutions to address inequality. Conclusion: Policymakers should gain an understanding of the determinants that contribute to inequality and how these factors manifest in their respective countries. Policymakers can work towards achieving a more equitable distribution of dentists by directing resources towards policies and measures that improve access to oral and dental services. This will ultimately enhance overall societal access to oral healthcare services.

Abstract Background and Aims Continuous routine care is necessary to prevent long‐term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic. Methods All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method. Results Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient‐side factors and health system‐side factors. Patient‐side factors including psychological, individual and social, disease‐related, and health system‐side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic. Conclusion Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.

Abstract Background and Aims One of the main responsibilities of health systems impacted by the global Coronavirus disease 2019 (COVID‐19) pandemic, where the first case was discovered in Wuhan, China, in December 2019, is the provision of medical services. The current study looked into the impact of vaccination on the utilization of services provided to COVID‐19 patients. Methods This study was conducted in Iran between 2021 and 2022, utilizing a cross‐sectional research design. The research team collected data on the utilization of provided services and the number of COVID‐19 vaccines administered to 1000 patients in Iran through a random sampling approach. The data were analyzed with statistical methods, including the mean difference test, and multiple linear regression. Results Regression estimates show that after controlling for confounding variables like age, type of admission, and comorbidities, vaccination reduces the utilization of healthcare services in the general majority of services. The study's results reveal a fall in COVID‐19 patients' utilization of services, specifically in patients administered two or three doses of the vaccine. However, the reduction is not statistically significant. Regression models are in contrast to univariate analysis findings that vaccination increases the mean utilization of healthcare services for COVID‐19 patients in general. Comorbidities are a crucial factor in determining the utilization of diagnostic and treatment services for COVID‐19 patients. Conclusion Full COVID‐19 vaccination and other implementations, including investing in public health, cooperating globally, and vaccinating high‐risk groups for future pandemics, are essential as a critical response to this pandemic as they reduce healthcare service utilization to alleviate the burden on healthcare systems and allocate resources more efficiently.

Abstract Introduction Unequal Access to human resources for health, reduces access to healthcare services, worsens the quality of services and reduces health outcomes. This study aims to investigate the distribution of the nursing workforce around the world. Methods This is a descriptive-analytical study, which was conducted in 2021. The number of nurses and world populations was gathered from World Health Organization (WHO) and The United Nations (UN) databases. The UN has divided world countries based on the Human Development Index (HDI) into four categories of very high, high, medium and low HDI. To investigate the distribution of the nurses around the world, we used the nurse population ratio (per 10,000 population), Gini coefficient, Lorenz curve and Pareto curve. Findings On average, there were 38.6 nurses for every 10,000 people in the world. Nations with the very high HDI, had the highest nurse/population ratio (95/10,000), while the low HDI nations had the lowest nurse/population ratio (7/10,000). Most nurses around the world were females (76.91%) who were in the age group of 35–44 (29.1%). The Gini coefficient of nations in the each four HDI categories varied from 0.217 to 0.283. The Gini coefficient of the nations between the four HDI categories was 0.467, and the Gini coefficient of the whole world was 0.667. Conclusion There were inequalities between countries all over the world. Policymakers should focus on the equitable distribution of the nursing workforce across all local, national and regional levels.

Background: In recent decades, especially after the publication of the World Health Report in 2000, many efforts have been made to develop assessment tools and improve the performance of health systems at the global and national levels. The purpose of this study was to design a method and assess the performance of health systems in various countries in its use.Methods: In this retrospective study, health systems were evaluated using the opinions of experts as well as international data. Health system experts expressed their views on appropriate indicators for evaluation. The performance of the studied health systems was ranked using multi-criteria decision-making techniques (SAW & TOPSIS). Collected data were analyzed using multiple regression analysis.Results: Data related to 38 indexes in eight general areas of macroeconomics, affordability for health costs, disease control, health care financing, health and nutrition, life expectancy, health resources, and mortality rates were collected in 105 countries from 2018 to 2020. According to the findings of country ranking, the health systems of Sweden, Norway, and Japan have the best performance and Afghanistan, Nigeria and Guinea have the weakest performance in the years examined.Conclusion: Health systems face major challenges around the world. Scientific evaluations show that spending more resources and costs does not necessarily enhance the performance of health systems, yet using and distributing these resources and costs in health systems could enhance the hope for better performance.

Abstract Background Policymakers use simulation-based models to improve system feedback and model the reality of the problems in the system. This study uses the system dynamics approach to provide a model for predicting hospital bed shortages and determine the optimal policy in Shiraz, Southern Iran. Methods This study was designed based on Sterman's system dynamic modeling (SDM) process. Firstly, we determined the main variables affecting bed distribution using a mixed qualitative and quantitative study which includes scoping review, expert panel, Delphi, and DANP. Then, dynamic hypotheses were designed. Subsequently, we held several expert panels for designing the causal and stock-flow models, formulating and testing a simulation model, as well as developing various scenarios and policies. Results Dynamic modeling process resulted in four scenarios. All of the scenarios predicted a shortage of national hospital beds over a 20-year time horizon. Then, four policies were developed based on the changes in the number of beds and capacity of home care services; finally, the optimal policy was determined. Conclusions Due to the high cost of setting up hospital beds, developing and supporting cost-effective home care services, strengthening the insurance coverage of these services, and improving the quantity and quality of community care, considering the real needs of the community could be considered as an optimal option for the future of the city.

Abstract Background and Aims A pandemic has posed a major challenge to health systems all over the world. All countries have realized that the only way to get real growth and development and solve their problems is to use what they have learned from research. Methods A descriptive and analytic type of study was conducted with the help of experts in the field of health research. The components affecting the research system were obtained via process approach and content analysis methods, and then the position of each component was identified by the Mic Mac technique. Results Seventeen influential structural components in the health research system were identified. The leadership and management components had the most direct and indirect influence among other components. The health promotion component had a greater dependency than the other components. Conclusion All health systems need to provide adequate financial resources and manpower to provide a useful research system. Human resources are the most important inputs to such a system. Components such as the research process, research sustainability, quality, or innovation in research can play a balancing role. Having the right infrastructures for creating, transferring, developing, and getting access to knowledge makes it possible to do systematic science. It is hoped that this science will be used in other results of the health research system, like improving the effectiveness or promoting health.

BackgroundApplication of a Clinical Information System (CIS) like Electronic Patient Record (EPR), PACS system and CPOE has turned into one of the most important criteria of priorities of health care systems. The aims of the clinical information system include improving the physicians' efficiency level, integrating the caring process, and expanding the fuzzy quality of the services offered to patients. Achievement of these benefits in reality is not an easy task, and there are lots of plans in this field which are doomed to failure. About 50% of the implementation plans of clinical information systems in health care organizations have failed, and this trend is significantly affecting industrial countries. Proper implementation of hospital information systems lies in identifying and assessing the relationships among the most important risk factors of fuzzy. The present study aimed to provide an applicable model for identifying, ranking and evaluating the risk factors associated with projects of clinical information technology in hospitals of Shiraz University of Medical Sciences.MethodThis is an applied study which evaluates the risk factors associated with implementation of clinical information technology projects in hospitals of Shiraz Medical Sciences University. The participants consisted of professionals and senior experts of clinical information technology. Fuzzy logic was used in this study. We also applied ANP-DEMATEL combined model with fuzzy procedure to provide the analytic model of the study.ResultsAccording to the study findings, lack of top-executive supports, and unstable organizational environment were the two most important risk factors, while the main organizational factors and technology were also highly important. In addition, the factors associated with technology had the highest influence on the other studied risk factors.ConclusionHospital authorities can benefit from this proposed model to reduce the risk of implementing the projects of clinical information technology and improve the success coefficient of the risk of such projects.

Background: The present study aimed to evaluate the surge capability of Shahid Rajaee Trauma Hospital in Shiraz City, Iran, in response to a mass causality incident. Materials and Methods: This descriptive study was conducted in Shahid Rajaee Hospital in Shiraz in 2017. The Delphi technique was used in this study. Three checklists were used for the Emergency Department, Operating Room, and Intensive Care Unit. The surge capacity was calculated for each unit based on the formulas derived from different studies. Results: The surge capacities of the Emergency Department, Intensive Care Unit, and Operating Room were obtained 36%, 20%, and 17.5%, respectively. Shahid Rajaee Hospital of Shiraz can quickly increase its capacity by 27% based on the scenario defined in this study. However, if an accident leads to more causalities, it will likely face several limiting factors for increasing the surge capacity. Conclusion: Due to the critical role of hospitals in the crisis, it seems that the studied hospital should look for ways to increase its surge capacity to cope with unexpected accidents as soon as possible.

Abstract Objective Health insurance is based on people’s significant risks in receiving health services that they cannot afford alone. Since the outbreak of the corona epidemic, the health insurance system has suffered many economic problems. Designing a model of a health insurance system based on the requirements of a resilient economy can improve the functions of this system in the corona crisis. Results In this research 12, structural components were obtained in the form of 4 conceptual components. The 4 main conceptual components are Knowledge-based economy, Economic stability, Economic resilience, and justice. The knowledge-based economy is the basis for the formation of economic resilience in the health insurance systems. Health insurance systems will achieve two crucial intermediate results, namely economic resilience, and economic stability, by building the basic infrastructure of a knowledge-based economy. In the long run, maintaining such intermediate results is the foundation of justice in the health insurance system.

Background: Estimation of cost functions is an appropriate tool for optimal resource allocation in hospitals. The present study aimed at estimating cost function for hospitals affiliated to Shiraz University of Medical Sciences. Materials & Methods: In the current cross-sectional study, inputs, costs and resources data for 28 hospitals were gathered from hospital statistics and information system. Required data were collected monthly for two years (2015-2016). Then, The Cobb-Douglas cost function was estimated using panel data analysis. STATA 14 was used for data analysis. Results: Estimates showed that hospitalschr('39') cost elasticity concerning the inpatient and outpatient admission were 0.555 and 0.058 for large hospitals, and 0.769 and 0.099 for small hospitals (P

Background: Shift work as a social phenomenon is one of the effective factors on operation of health workers which can have significant impacts on their health. Hence, the current study was conducted to determine the effect of shift working on health problems and the risk factors causing these disorders among nurses. Methods: This cross-sectional study was carried out on 189 nurses selected randomly from Shahid Namazi and Shahid Faghihi hospitals. The data collection tool was the "Survey of Shift Worker" standard questionnaire. Data were then analyzed by SPSS 16 software using Pearson coefficient of correlation test. Results: The results showed that the highest prevalence of problems caused by shift work was related to individual, family, and social life disorders. Moreover, the compulsory selection of shift work system has reduced job satisfaction (p = 0.001). Conclusion: Based on the findings, shift working could be associated with physical complications such as cardiovascular diseases and disturbances in circadian rhythm, as well as mental disorders in nurses. Therefore, it is necessary for nursing authorities to plan shifts more precisely regarding factors such as employees' age and job experience.

Introduction: Performance measurement is receiving increasing verification all over the world. Nowadays in a lot of organizations, irrespective of their type or size, performance evaluation is the main concern and a key issue for top administrators. The purpose of this study is to organize suitable key performance indicators (KPIs) for hospitals’ performance evaluation based on the balanced scorecard (BSC). Method: This is a mixed method study. In order to identify the hospital’s performance indicators (HPI), first related literature was reviewed and then the experts’ panel and Delphi method were used. In this study, two rounds were needed for the desired level of consensus. The experts rated the importance of the indicators, on a five-point Likert scale. In the consensus calculation, the consensus percentage was calculated by classifying the values 1-3 as not important (0) and 4-5 to (1) as important. Simple additive weighting technique was used to rank the indicators and select hospital’s KPIs. The data were analyzed by Excel 2010 software. Results: About 218 indicators were obtained from a review of selected literature. Through internal expert panel, 77 indicators were selected. Finally, 22 were selected for KPIs of hospitals. Ten indicators were selected in internal process perspective and 5, 4, and 3 indicators in finance, learning and growth, and customer, respectively. Conclusion: This model can be a useful tool for evaluating and comparing the performance of hospitals. However, this model is flexible and can be adjusted according to differences in the target hospitals. This study can be beneficial for hospital administrators and it can help them to change their perspective about performance evaluation.

Background: High turnover intention rate is one of the most common problems in healthcare organizations throughout the world. There are several factors that can potentially affect the individuals’ turnover intention; they include factors such as work-family conflict, family-work conflict, and organizational commitment. The aim of this research was to determine the relationship between family-work and work-family conflicts and organizational commitment and turnover intention among nurses and paramedical staff at hospitals affiliated to Shiraz University of Medical Sciences (SUMS) and present a model using SEM. Methods: This is a questionnaire based cross-sectional study among 400 nurses and paramedical staff of hospitals affiliated to SUMS using a random-proportional (quota) sampling method. Data collection was performed using four standard questionnaires. SPSS software was used for data analysis and SmartPLS software for modeling variables. Results: Mean scores of work-family conflict and desertion intention were 2.6 and 2.77, respectively. There was a significant relationship between gender and family-work conflict (P=0.02). Family-work conflict was significantly higher in married participants (P=0.001). Based on the findings of this study, there was a significant positive relationship between work-family and family-work conflict (P=0.001). Also, work-family conflict had a significant inverse relationship with organizational commitment (P=0.001). An inverse relationship was seen between organizational commitment and turnover intentions (P=0.001). Conclusion: Thus, regarding the prominent and preventative role of organizational commitment in employees’ desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase people’s organizational commitment must be considered by health system managers more than ever.

Introduction: The Family Physician Program is one of the most important plans for increasing the equitable access and affordable health services. This study aimed to examine the performance of Urban Family Physicians and associated factors in the third year of its implementation. Method: A cross-sectional study was conducted on all Family Physicians (31 persons) working in the private and public polyclinics and clinics in the Firoozabad, from October to December 2014. The population of the study consisted of all the physicians (31 persons) who were involved in the Family Medicine Program. The main instrument for data gathering was a standard questionnaire developed by Ministry of Health and Medical Education (MOHME). Validity and reliability of the questionnaire have been confirmed by MOHME. The questionnaire had four parts including medical equipment, informing the patients, referral system rules, and protocols. The data were analyzed using SPSS statistical software, version 16, through appropriate statistical tests including Independent T-test, Pearson Correlation, One sample T-test, in a significance level of

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. Methods: This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the “bed area” server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the numberwaiting to 586 patients. Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

Introduction: medication errors, patient safety risk factors that attempt to identify and track which has been discussed in recent years. This study aims to identify, assess, prioritize and process analysis to medication administration errors in hospitals Peymanieh using Failure Mode and Effect Analysis error as risk management techniques and was designed to enhance patient safety. Methods: This study is a descriptive study which combines quantitative - qualitative methodology Modes and Effects error with FMEA (Failure Mode and Effect Analysis) Peymanieh at the hospital in 2012, has analyzed. To collect data from a worksheet and standard error modes analysis technique and its effects and sampling was purposeful. In this method, each of errors based on the severity of the error occurrence rate of error and the probability of error detection was given a score between 1 and 10, which is obtained by multiplying the score RPN. Results: method FMEA, 81 cases of potential error in 11 selected areas of medication administration process to identify and evaluate and score each of RPN was calculated. The overall mean score eleven RPN scope of the drug was found to give the lowest score of nearly 190 references related to service personnel receive the highest score in drug-drug card for drugs belonged to the sphere of writing. For analysis data use of Excell 2010 software and data calculating and rating based on RPN= S.O.D formula. Conclusion: Considering the high rate of medical error, it seems that the field of study and understanding of working conditions and adjusted to reduce errors and provide. In general, techniques such as FMEA and a proactive approach must be based on teamwork, increase accuracy and attention to their employees' career potential weaknesses and trying to eliminate them.

Objective: A large proportion of hospitals’ private income is provided by insurance organisations. Hospitals in Iran face various problems in terms of insurance deductions from insurance organisations resulting from inefficient performance by both the hospitals and the insurers. These problems necessitate more specific cost control in this area. This research assesses the causes of insurance deductions by using the Failure Mode Effects Analysis (FMEA) technique, and addresses the issues resulting in deductions by providing some interventions through the Pareto technique. Design: The 10-step pattern of FMEA was implemented for assessing the main causes of insurance deduction in this study. Setting: Data was collected from deduced amounts by three main/largest contracting party insurance organisations (e.g. the Social Security Insurance Organisation, Medical Services Insurance Organisation and Armed Forces Medical Services Insurance Organisation of Namazi Hospital, a large healthcare provider in the South of Iran, in 2014. Findings: Sixty-five potential failure causes were identified, of which 26 were related to the anaesthesia unit, 23 were related to the surgery room unit and 16 were related to the hospitalisation unit. Deductions in the anaesthesia and hospitalisation units and the surgery room were reduced after intervention programs by 14.42%, 57.76%, and 51.52%, respectively. Conclusions: Using the FMEA technique in a large healthcare provider in Iran resulted in identifying the main causes of insurance deductions and provided intervention programs in order to increase the efficiency and productivity of healthcare services. Abbreviations: FMEA – Failure Mode Effects Analysis; RPN – Risk Priority Number.

Objective (s): To determine economics cost of diabetes in type II diabetic patients under the cover of Naderkazemi clinic in Shiraz in the first half of 2008.Methods: this study is an applicable one and the way of study is descriptive-analytic.the study society includes type II diabetic patients that referred to Naderkazemi clinic and made file. in this study among the 4900 files related to type II diabetic patient, at first, in the pilot study,30 files chosen by the way of systematic sampling and examined. standard deviation these files was ±/38.that in respect to received standard deviation,220 files were chosen as samples that eventually with the help of statistics advisor,288 file were chosen as samples and were studied in a systematic way. the needed information in this study were gathered from observing the existing information in patient´s files, interviewing with personnel and manager and also from existing information and ducuments in provision, accounting and personnel departments. results were classified as charts and graphs and were expressed descriptively.Results: in this study, total economic costs of type II diabetes calculated 37942315040 Rials (4079818.8 $), that medical direct costs and indirect costs share was 3994348680(429499.9 $) and 33947966360(3650319 $) Rials, respectively. Medical direct and indirect costs of diabetes in a type II diabetic patient in first half of 1387 was 815173/2(87.65 $) and 6928156/4(744.96 $) Rials respectively, and altogether was 7743329/6 Rials (832.61 $).Conclusion: Economic cost of type II diabetes is very high and complications of this disease can important influence on patient and their family. Be cause of restricting resources of medical-health in society, diabetes is one of medical-health priority in our country and should have large actions to reducing costs and complications of this disease.||

IntroductionDiabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year.MethodsThis is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups.ResultsThe total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million).ConclusionsT2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority.

Background: Most medical errors are preventable. The aim of this study was to compare the current execution of the 3 patient safety solutions with WHO suggested actions and standards. Methods: Data collection forms and direct observation were used to determine the status of implementation of existing protocols, resources, and tools. Results: In the field of patient hand-over, there was no standardized approach. In the field of the performance of correct procedure at the correct body site, there were no safety checklists, guideline, and educational content for informing the patients and their families about the procedure. In the field of hand hygiene (HH), although availability of necessary resources was acceptable, availability of promotional HH posters and reminders was substandard. Conclusions: There are some limitations of resources, protocols, and standard checklists in all three areas. We designed some tools that will help both wards to improve patient safety by the implementation of adapted WHO suggested actions.