مجله بیمارستان
سال یازدهم شماره 1 (بهار 1391)

The inefficiency of financing health care in developing countries made led in many health policy-makers to consider alternate means of service provisions. Outsourcing public financed health services in private sector organization is one of the interventions. Advocates claim that the contracting out of health care services will improve the service delivery performances through stimulating competition among providers and also by creating economic incentives to improve performance through linking payment to provider performance.

The purpose of this cross sectional study was to provide decision matrix to guide decision-makers whether outsource hospital services or not. Tow kind of questionnaire were developed and used.

Findings showed that the most propensities of outsource is in nutrition services (87%), and the least is in nursing services (43.4%) based on administrators’ attitude. Shaping of decision matrix showed propensity to outsourcing of nursing, radiology, laboratory services are high while nutrition services is been low.

Finding showed some differences between results of decision matrix and administrators’ propensity to outsourcing in radiology and laboratory services. Lack of attention in characteristics of the hospital services might be one of the reasons. Cost saving is the main reason for outsourcing the services while administrators should consider as an effect and side effect of outsourcings.

The organizational Citizenship behaviors in an appropriate and desirable in performing the duties among nurses is a valuable point. Most of nurses usually meet organizational citizenship behaviors which are enable them to attract other staffs and patients. It might be continues in job all togethersto treatment process with more productivity. A descriptive study approach consisted of 130 female nurses who worked in the emergency, surgery, women, children and the heart wards in the Rasht public hospital were asked by standard questionaire throughtout the moral atmosphere of that hospital with institutional support, and behaviors in a civic organization to complete a demographic questionnaire. Data obtained with the correlation test, Regression analysis and ONE-way analysis of Variance were analyzed. There are significant relationships between moral climate, organizational supports and organizational civil behavior among nurses in the Rasht hohospital (p<0/01). Regression analysis showed that the correlation between hospital ethics climates and organizational supports. Changing the moral climates of the hospital has been able to predicted variance related to the organization of civil behavior among nurses (p<0/01). Organizational supports failed to predict of civil behavior among nurses. Results showed that the moral climate affected in the organization citizenship behavior of nurses. It means that organizational citizenship behavior plays an important role to efficient conducting of the professional activities among nurses. Health care organizations could provide an appropriate training to enhance the ethical climate in their organizations to help ultimate nursing services in achieving to appropriate culture.

Focusing on making opportunities to participate of patients in all levels of health care system is important in order to develop of system capability that could make improving of patients’ safety and quality of care services. The aim of this study was to determine inpatient perceptions in general hospitals of Tehran medical university regarding patient participate in treatment decisions and safety. This was a cross-sectional study in 1390. First, the list of eight general hospitals affiliated to Tehran University of medical sciences and all clinical wards were obtained through the university website. Then, stratified random sampling method applied to collect 300 patients as a sample size. Data were collected by using a structured questionnaire that validity and reliability were accepted. Descriptive statistical methods, linear regression and multivariate logistic regression were applied to analyze. From total of 300 patients, 60% of them were female. The level of participating by patients in cure decision making were at high level (59.7%) and 27% in low level. The range of patients’ safety was at high (60%) and low (26%). The level of participate in decision making of cure process had high rate among young people and employed participants. The patients who were unmarried, educated, and employed had lower score in patients’ safety. The participants’ perception had no effect on thepatients’ safety perceptions. The symptoms that might be interpreted as an abnormal could be interpreted in different ways by the others. These unusual results could come from dissimilarities in demographic features.

With more than 12 million new cases of cancers and nearly 7.6 million deaths all around the world in 2007, cancer currently is the third leading cause of death in the world. This study was conducted to determine medical and non-medical direct costs of cancer patients’ hospitalized in the cancer institute affiliated with Imam Khomeini hospital. This was a cross-sectional study. All patients over 18 years old with kind of head, neck, and stomach cancers that undertaken of oncology treatments in the cancer institute which affiliated” Imam Khomeini Hospital”. Initially eligible patients invited to participate in this study. The data was collected through structured interviews with patients and or their carers. The data,then, was analyzed by SPSS software. The average medical and non-medical direct out-of-pocket costs during primary treatment were 2,609,000 and 245,000 Tomans per patient, respectively. Furthermore, the direct average of medical costs for patients who lived in Tehran and other cities were 3,313,000 and 1,870,000 Tomans;while the direct average of non-medical costs for patients who lived in Tehran and other cities were 136,000 and 360,000 Tomans, respectively. The new policies for costs coverage related to cancer patients’, particularly the medical insurance organizations, financial supports from finance intuits like as banks or charity organizations,appropriate distribution of cancer’s centers or providing accommodation to cancer patients who are referred from the remote sites in other cities, and also achieving the equities in health sectors could be reduced the financial costs of cancer patients and might be helped them to manage of cancersefficiently and effectively.

The existed difference statistical indicators is necessary to measure the efficiency of the health organization and as an exact strategy, could be removed the developed problems in heath services sectors. This is a descriptive research as a cross sectional study throughout obstetric and gynecology wards in the general hospital of RASOOL. The questionnaires and statistical Forms applied for data gathering. The methods were completed questionnaires, statistical Forms, face to face interviews and observation. The Delphi technique, standardized questionnaires and references’ textbooks used to determining the reliability and validity. Data analysis was done by using likret ranking. The results showed that some indicators, such as inpatient bed occupied rate (63%), bed turnover interval(5) & mean length of stay(4), patient per nurse(19), meanwhile service education(10),staff per active bed(1for 12), midwife per delivery bed(0), staff(50.9%) and patient satisfaction(89%)were lower than expected. Some indicators such as rooming in technique(100%), breast feeding(100%), patient information access from HIS system(100%), emergency and hostelling medicine access(100%), round and morning reports(100%), the mean admitted time in the ward(30 minutes), Infant and maternal mortality rate per total deliveries(0), and the percentage of trained patient(100%) were as expected. Some indicators such as expert physician per active bed (1 for 7) and C/S per total delivery ratio (69%) which was higher than expected, and the necessary data for calculating book & papers per assistant professor & non colonial infection rate were not found. Hospital indicators showed the performance of hospitals in the various bases. Therefore,the broad attentions to these indicators are necessary. Meanwhile, it should be compared them and to distinct time periods.

Developing countries request to alternative revenue resources. Iran as one of the developing countries with high potentiality for attracting medical tourist is seeking to enter medical tourism marketing. This study aimed to analyze the importance- performance of the Tehran as a capital city to medical tourism viewed by medical tourists and medical service providers. This descriptive, cross-sectional study was carried out in Tehran selected hospitals in the 3th first months of 2011. The data were gathered by using a validated self-constructed questionnaire. The data were analyzed by descriptive statistical techniques. The results indicate that the majority of the medical tourists are attracted from the United Arab Emirates (22.3%). The respondents considered medical tourism factors as an importance (M=4/40±0/61).The Tehran selected hospitals` performance is average as related to medical tourism factors (M=2/75±0/66). Despite the importance given to medical tourism factors by medical tourists and medical services providers, Tehran selected hospitals` performance is an average and there is no serious attempts are being made to attract medical tourists at macro levels. In spite the quality, variety and costs of the medical services and equipments in the selected hospitals are satisfactory, international accreditation of the hospitals are still in a major problems.

One of the main goals in each organization is to achieve success. The only way to achieve this goal is resort a kind of systematic, native and functional views. Remarkable successes in the recent decades by organizations with the minimum facilities and failure of the organizations by the best material capabilities is on the other hand, demonstrates the significant role in non-material and spiritual factors in reach to success. The organizational culture is considered as an effective factor in organizational performance. The present study has been done to find relationships between these two categories; organizational culture and organizational success in the public hospitals of the Kerman cities (Kerman, Sirjan, Rafsanjan). This was a descriptive analytical cross-sectional study during the last six months in 2009.The sample size composed the public hospitals in three selected cities of the Kerman province. To define organizational culture, Richard Deft Model was used, and also to identify the organizational success orator elements were used. Simple random sampling used to choose samples and the Cochrane Formula used to define sample size. The gathered data were analyzed by descriptive (frequencies tables and diagrams) and analytical (correlation tests: Pearson, Spearman, XSquare,t-tests, NOVA test) statistics methods through SPSS software. The results showed that among all kinds of existed organizational culture, bureaucratic culture was the dominant culture with average score 3/162 and the others were: participatory:2/722,flexibility:2/525 and missionary:2/405 respectively. Comparing average score of organizational success elements showed that flexibility element with average score 2/96 was the most important element and the others were: cohesiveness: 2/885, speed:2/88 and innovation:2/725 respectively. The dominant organizational culture of subordinate hospitals in the Ministry of Health and Medical Education are bureaucratic culture. The dominant culture in subordinate hospitals of the Social Security Organization is a participatory culture. Also the average number of organization success in subordinate hospitals of the Social Security Organization is significantly greater than the average number of organization success in subordinate hospitals of the Ministry of Health and Medical Education. In relationship between the organizational culture and organization success, the participatory culture only had a positive correlation with organization success and in the other cultures, either an assumption of lack of relationship confirmed or a negative correlation was concluded. Hospitals are the main organizations in providing services in the health care system in each country. Implementing participatory culture, increasing hospital flexibility in an accountability to customers and patients needs play basic roles in patient’s satisfaction to achieve the main mission of the hospital organization that is providing services.

Medical diagnostic laboratories play an important role in diagnosis, treatment and prevention of the diseases. Today’s without assisting of the laboratories, conserving of public health and outbreaks prevention of infectious and genetic diseases is impossible. In this research the cases determined by the department of health and medical education questionnaire in quality control of public and private laboratories. This study is a cross sectional (descriptive and analytic) in which 20 private medical diagnostic laboratories and 16 training centers were selected. The quality control standards were reviewed and compared. From 12 items of the questionnaire the two following items, rules and regulations in both private and public laboratories gained the highest priorities with 100% private and 93% governmental laboratories respectively. The lowest score was related to testing quality control of the laboratories with that of public and private ones, 82% and 75.7 percent respectively. In all that cases, governmental laboratories and training centers were rated lower than private labs. This study showed that both private and public laboratories’ score were under below of standards. Governmental laboratories were rated lower than private labs. In private laboratories, identifying errors and in the governmental laboratories, testing quality control should be considered.