فهرست مطالب احسان زارعی

Objective (s):

 Health system responsiveness and meeting patients' expectations are important in creating public trust in the health system. This study was conducted to determine the relationship between health system responsiveness and public trust in the health system in Gorgan, Iran.

This cross-sectional study was conducted in 2020. The sample size in this study was 450 households. To collect data, a health system responsiveness questionnaire including 32 questions in 8 dimensions, and a public trust questionnaire including 25 questions in 6 dimensions were used. The validity and reliability of the instruments were confirmed. The path analysis was used in AMOS software to determine the relationship between responsiveness and public trust in the health system.

The mean score of responsiveness was 3.4 (±0.53) out of 5, the highest score was related to social support and the lowest was related to the right to choose a doctor. The mean score of public trust was 3.3 (± 0.52) out of 5, the highest score was related to the quality of care, and the lowest was related to macro health policies. The hypothesis test findings showed a positive and significant relationship between all dimensions of responsiveness and public trust in the health system. In general, 64% of the variance in public trust is explained by the health system responsiveness.

The health system responsiveness and public trust in the health system were evaluated at an average level, and responsiveness plays an important role in influencing public trust in the health system. Therefore, the government should play its role in properly managing citizens' needs in order to regulate its credibility and most importantly to maintain public trust.

Compliance with the principles of environmental health is of particular importance in any gathering ceremony. This issue needs more attention in the Muharram and Safar mourning ceremonies due to the position of health in Islam and the presence of different populations in this ceremony. Based on this, the present study was conducted with the aim of environmental health management during Muharram and Safar days using the Analytic Hierarchy Process.

According to the main purpose of the study, a literature review was done. Then, a team of experts was formed and criteria, sub-criteria and programs related to the purpose of the study were determined by brainstorming, and the relevant questionnaire was prepared and after completion by 25 experts, the relevant criteria were prioritized using the Analytic Hierarchy Process.

Based on the weighting with the Analytic Hierarchy Process method, the highest score (0.441) was awarded to the health inspection criteria, and then the administrative coordination criteria(0.186), education (0.182), reporting (0.169) and finally the support and services criterion (0.022) were prioritized.

The results of the study indicate the emphasis on environmental health management during the Muharram and Safar mourning ceremonies from the point of view of experts, that compliance with the three principles of health inspection, administrative coordination and continuous training has the particular importance.

Despite the availability of vaccines, the use of face masks remains a recognized and effective measure in preventing the spread of COVID-19. However, it is crucial to comprehend the underlying factors influencing people's adherence to preventive behaviors, particularly mask usage within communities, as negligence and disregard for this matter persist. Therefore, the present study aimed to identify the reasons for not using masks by people during the COVID-19 pandemic from the point of view of health experts.

This research employed a qualitative approach and content analysis in 2019. A targeted sampling method was employed, and 15 healthcare experts from Kashan and Aran and Bidgol, Iran, participated in this study. Participants were selected to represent maximum diversity in terms of age, gender, and education level. Semi-structured interviews were conducted as the primary method of data collection. The duration of the interviews varied between 20-30 min. The interview transcripts were carefully documented, extracted, and segmented into meaningful units. To enhance the research's reliability and confirm the accuracy of the findings, credibility criteria were employed to validate the collected data.

Out of the interview participants, 66.6% held a bachelor's degree, 13.4% possessed a master's degree, and 20% had a doctorate degree. Around 80% of the participants were male, with 53.5% falling within the 40-50 age range, and all were married. During the data analysis process, 40 core concepts sharing common characteristics were categorized into six subclasses, which were further condensed into three main classes based on abstract commonalities. The research findings were classified into three main categories: individual factors, interpersonal factors, and environmental factors. The subcategories included lack of awareness, behavioral and belief patterns, physical barriers, subjective norms, economic barriers, environmental barriers, inappropriate mask structure, and health policies and guidelines.

Based on the findings of this research, in addition to individual factors (e.g., awareness and beliefs regarding preventive behaviors), interpersonal factors, abstract norms, and economic and environmental factors can significantly influence mask usage within a society. This finding highlights the necessity of government organizations' support to address these challenges effectively.

The main purpose of this paper is to identify the methods of informal induction for new teachers worldwide. In this qualitative research with the emergence design, the technique of thematic analysis (Attride-Stirling) was used to analyze the themes of English papers on the Induction published from 2010 to 2020,and selected from three data-bases by using a systematic text review model.  After using the MAXQDA software, the data were analyzed in the form of two comprehensive, six organizing, and twenty-nine basic themes. The results show that the informal Induction for new teachers includes two components of "out-school support" and "in-school support" that complement each other. The informal Induction have made teachers more resilient and efficient. Accordingly, it is suggested that our new teachers and educational system use this global experience And to increase the efficiency and sustainability of new teachers, to use the capacities that exist in the communication networks of their living and working environment.

Medical tourism refers to travel for receiving health services abroad. The COVID-19 crisis affected a wide range of tourism-related businesses, including medical tourism, and caused a decrease in the supply and demand of health services in this market. This study aimed to investigate the impact of the COVID-19 pandemic on Medical Tourism in Iran.  

This cross-sectional study was conducted in Iran in 2021. The data used in this study were extracted from the information system of the Ministry of Health from 2018 to 2021, which includes the number, origin, and destination of medical tourists, per capita revenue, and monthly revenue two years before and one and a half years after the COVID-19 pandemic. For data analysis, t-tests of independent groups and interrupted time series regression were used in SPSS and EViews 10 software.

The COVID-19 pandemic has caused a 42% decrease in the average monthly number of medical tourists, a 45% decrease in the monthly revenue, and a 10% decrease in the per capita income per tourist (P<0.05).  The arrival of medical tourists from the Republic of Azerbaijan, Bahrain, Iraq, and Oman has decreased by more than 80%, and the largest decrease in the number of tourists has been related to Ahvaz, Urmia, Tabriz, and Shiraz. In all diagnostic groups except obstetrics and gynecology, there has been a decrease between 50 to 70% The declining trend of medical tourism indicators was stopped in the second year of the COVID-19 pandemic and has continued as a constant trend.

The COVID-19 crisis has hurt the number of international patients and their revenue in Iran. Relative success in controlling COVID-19 can return to a pre-pandemic situation that requires appropriate policies and administrative measures by government and industry players, such as policies to facilitate patient entry, marketing measures, branding and creating a positive image of the country to potential clients, use of telemedicine facilities for consultations and follow-up, etc.

One of the dangers that environmental health experts face at work is violence, the incidents of which are observed every year. The type and extent of this violence depend on the ethics of the operator. This s tudy aimed to determine the s tate of violence among environmental health experts in Kashan and Aran va Bidgol, Isfahan, Iran.

In this descriptive s tudy, 53 environmental health inspectors working in the centers affiliated with Kashan University of Medical Sciences, Kashan, Iran, were selected. The data collection tool was a 58-item reliability-validated ques tionnaire consis ting of four parts, including physical violence (18 items), psychological violence (12 items), sexual violence (12 items), and racial violence (12 items), and there were three open ques tions at the end of the ques tionnaire. After the ques tionnaire was completed, information was recorded in SPSS software, and analysis was performed using independent t, Chi-square, and Fisher s tatis tical tes ts.

According to the results, 30% of the subjects experienced a physical attack, 90% verbal violence, and 7% racial violence in the pas t three years. No cases of sexual violence were reported. Moreover, the curator's insult to the inspectors had no relationship with the inspectors' behavior and was influenced by factors related to the curator himself and cultural and social factors.

Based on the results, a combination of personnel training and improving their communication skills, as well as behavioral training for attendants, would be effective in reducing cases of violence.

  With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran.

 This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method.

 The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05).

 Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.

In recent years, public trust in health system has been considered one of the performance evaluation indicators of health systems. However, most of the research on public trust in health system is related to developed countries, and research in this regard is limited in Iran. A better understanding of trust in health system and some influential factors helps to develop targeted interventions to increase trust. The present study was conducted to investigate the level of public trust in health system in Rasht County.

In this cross-sectional study, 680 households (510 urban and 170 rural) were included. The data collection tool was a questionnaire to measure public trust in health system with 30 items and six dimensions, whose validity and reliability were confirmed. Mann-Whitney and Kruskal-Wallis tests were used to compare and analyze the difference in public trust in health system between groups.

The overall score of trust in health system was 66.7 out of 112. The highest score for the quality-of-care dimension was 16.38 out of 28, and the lowest for the cooperation quality of providers dimension was 7.47 out of 12. Among service providers, the highest trust was in nurses and specialist doctors, and the least was in traditional medicine service providers. Women, government employees, people without health insurance, people with excellent and good health status, those who had used hospital services, and those who were satisfied with the last service received had a high level of trust in the health system (P<0.05).

The results showed that despite people’s trust in the expertise and knowledge of physicians and other providers, public trust in health system was relatively moderate, indicating deficiencies in the health system’s performance. Focusing on physician-patient communication and improving communication skills, establishing electronic records and sharing patient information between health service providers, and respecting patient rights can build greater trust in the health system.

The teachers’ qualification has become more important today compared to the past; however, there are still doubts to be considered whether new teachers graduating from teacher training universities are well-prepared to face the challenges in their initial years of teaching. The main purpose of this paper is to identify the methods of formal induction for new teachers worldwide. In this study, the technique of thematic analysis (Attride-Stirling) was used to analyze the themes of English papers on the Induction (initial period of service) published from 2010 to 2020, and selected from three data-bases by using a systematic text review model. After using the MAXQDA software, the data were analyzed into three themes including in the form of three comprehensive themes, fourteen organizing themes, and fifty-eight basic themes. The results showed that the formal induction for new teachers includes three components of "organizational (administrative) support", "mentoring," and "school-based support" during the initial period of service that complement each other. The formal induction have made teachers more resilient and efficient. Accordingly, it is suggested that Iranian Education Ministry takes actions and apply this global experiences to developing and implementing a local curriculum of Induction for the initial period of teacher service.

The aim of the current research is to identify the methods of induction for new teachers at the global level. In this research, the theme analysis method, Atride-Sterling style, has been used to analyze the themes emerging from English articles related to induction of the "initial service period" of new teachers. First, using the systematic text review model, researches in the period of 2010-2020 from three databases Springer, Taylor&Francis Group and sciencedirect were selected, refined and then using MAXQDA software in the form of 3 overarching themes, 14 organizing themes and 58 The basic theme was analyzed. The results show that induction for new teachers during the "initial period of service" includes three components: "organizational (administrative) support", "mentoring" and "school support" which complement each other. induction programs for the initial period of service have made new teachers more durable and efficient. Based on this, it is suggested that the education of Iran use this global experience to develop and implement a "native curriculum of induction for the initial period of teaching service".

Psoriasis is a systemic and non-transmissible chronic inflammatory autoimmune skin disease that about 2-3% of Iranians suffer from it. Cost of management and budgeting and planning for the treatment of patients with psoriasis requires accurate information. The present study estimates the direct and indirect costs for one-year treatment of patients admitted in Razi Dermatology Hospital.

In this descriptive-analytical study, treatment costs of 170 patients with psoriasis, including direct (medical and non-medical) and indirect costs were evaluated by census method and using a researcher-made checklist, from October 2017 to October 2018. The fee was collected through reviewing patients' bills in the hospital information system and through telephone interviews with patients.

The average cost of one year was 9037480 Tomans ($ 758), of which direct cost of treatment was 90.22% (8178681 Tomans) and indirect cost of treatment was 9.78% (858799 Tomans). The highest cost of treatment was related to pharmaceutical services with 5825233 Tomans. Also, the total direct medical cost was equal to 7069890 Tomans, of which 62% was the insurance share and 38% was the patient share. The findings showed that injecting biological drugs and accommodation had a significant effect on the direct cost of treatment. Supplementary insurance and accommodation variables also affect out-of-pocket costs.

Drugs made up most of the costs. The high price of biologics and the low coverage of these drugs by insurance companies have caused many economic problems for these patients. According to the findings of this study, it seems necessary to review the more complete insurance coverage of these drugs as well as the use of charitable assistance to cover part of the cost for treatment.

This paper aims to identify, describe and analyze the effective factors in creating visual order in Jiroft soapstone works based on documentary studies and with the aim of identifying different types of painted works. Accordingly, the authors try to answer the question with documentary studies and descriptive-analytical method in order to answer the question: Artist or craftsman of Halilrood archaeological site, heir or founder of which artistic experience? Since the designs performed on these works are ultimately designed and executed in beauty, balance, fit and balance, it can be assumed that their creators, in addition to being aware of the artistic application of lines and designs, also have little knowledge of visual knowledge and basics in the field. Findings show that engineering and visual understanding of elements at the level of objects, in the direction of structural interaction of their line and role, and achieving unity in works of art has been one of the most important goals of their construction. The artist / craftsman of Halilrood has a relatively clear knowledge of his work as a work of art and has tried to create a relationship between design and background, perspective, diversity and statism by repeating figures and elements.

Competency-based education seeks to bridge the gap between the labor market and the academic education system. Due to the problems of graduates of this field in the professional contexts, this study endeavored to up to date the curriculum of the field based on the expected job qualifications of the health system.

This qualitative and applied study with the focus-group discussion method was conducted in the Faculty of Management and Medical Education of Shahid Beheshti University of Medical Sciences in the academic year 2019. To discuss the group, 13 faculty members and experts, graduates as well as two hospital managers were selected to identify the differences between academic learning and the professional requirements, and then to evaluate the content and topics of the Master of Health Services Management course. At the end of the groupchr('39')s consensus, notes were taken on the agreed results.

 The data analysis revealed that the essential competencies are like this: leadership, effective teamwork, problem-solving, system thinking, and quality improvement. Changes were suggested in the content of existing courses, like working abilities with STATA software, expertise to design solutions by systems thinking methodologies, awareness of the ultimate challenges of the decisions without supporting evidence, and capacity to compare and criticize strategic planning process and outcomes.

Findings revealed that modifications to current courseschr('39') content were suggested by adding new curriculum approaches to cover the required skill set. Given changes in the formal curriculum is a time-consuming process, transforming the content of existing courses is recommended.

Awareness about prescribing pattern and comparing that with standards of the World Health Organization (WHO) can affect health policy-makers in adopting policies and implementing necessary interventions for rational use of drugs. The aim of this study was to determine the pattern of drug prescribing in outpatients covered by Social Security Organization in Semnan province.

In this study, 952,712 prescriptions in Semnan province in 1396 were investigated and indicators of use of drugs include average price of each prescription, average number of drugs in each prescription, percentage of prescriptions containing 4 drugs or more, percentage of prescriptions containing antibiotics, injections and corticosteroids, physicians by specialty and by the length of activity were extracted and compared with those provided by the WHO standards.

The average price of prescriptions was 254,377 IRR and average number of drugs per prescription was 2.65. Generally, 26.9 percent of the prescriptions included 4 or more drugs. Percentage of the prescriptions containing antibiotics, injections and corticosteroids was 55 percent, 29 percent and 11.1 percent, respectively. All of the examined indicators were higher than the recommended level by the WHO.

This study showed some evidence of irrational drug prescription especially in the polypharmacy, antibiotics and injectable drugs. Therefore, it is suggested that adequate supervision of the prescribing and training of prescribing principles for physicians should be considered in continuing education programs.

Ensuring high quality care for diabetic patients is a challenge for healthcare systems throughout the world. The aim of this study was to evaluate the relationship of quality of services provided to type 2 diabetic patients with self- assessment in comprehensive health service centers.

This descriptive-analytic cross-sectional study was conducted on 203 patients with type 2 diabetes referred to ten comprehensive health service centers of south Tehran/ Iran in 2018 selected through convenience sampling method. Data collection tool was a questionnaire for comprehensive assessment of quality of health services. Data were analyzed through SPSS22 and using t-test, ANOVA and logistic regression statistical tests.

From the perspective of patients, mean score of quality of services was 7.47. Among different health services, the highest mean score of quality was related to trust and continuity of service while, support and prevention gained the lowest mean score of quality. There was a significant statistical relationship between the quality of service and self-assessment of diabetes control in the past 12 months (P= 0.007). Also, a significant relationship was found between the quality of service and diabetes complication (P = 0.04). With each unit increase of the quality of service, the odds of a standard visit increased by 27% (P = 0.013). 

Design and implementation of interventions in order to increase the social support of patients and sharing their experiences with each other as well as improving the dimensions of prevention and safety in care are essential.

Ethical values act as the most powerful factors influencing citizenship behaviors. This research was conducted to investigate the relationship between ethical climate and organizational citizenship behavior in nurses of hospitals affiliated to Shahid Beheshti University of Medical Sciences.

This descriptive-analytical study was performed on 307 nurses selected through random sampling in 2016. Data gathering tools were two questionnaires of ethical climate and organizational citizenship behavior. Data analysis was done through SPSS20 and using descriptive statistics, t-test, One- Way ANOVA, correlation and multiple regression tests.

Mean scores of ethical climate and citizenship behavior were respectively 3.51 ±0.55 and 3.49 ± 0.45 that reflects the favorable view of nurses towards ethical climate and citizenship behavior. Head nurses had the highest mean scores in the dimensions of ethical climate. Among the dimensions of citizenship behavior, the dimension of conscience gained the highest mean score among nurses. There was a significant relationship between employment status and ethical climate (P<0.001) and also a positive and significant correlation between ethical climate and citizenship behavior (P<.0.001).

Promotion of ethical climate enables nurses to respond better to ethical stress, to adapt to other causes of workplace dissatisfaction and consequently showing citizenship behaviors. Some meetings are required to be held in order to improve the relationship between physicians and nurses, to create alignment and understanding among staff and consequently to improve citizen behaviors.

Public private partnership (PPP) model has been recently introduced as an approach to improve functional efficiency and solving governments’ health care shortages in various aspects. The number of studies focused critically and explanatory on this model are scarce. Furthermore, lack of study organization and structural coherence for deducing practical consequences are still bold in this field. This review summarizes and categorizes these shortcommings. This study is designed in review manner: search was conducted in Pubmed, Google scholar, SID.ir and Scopus with all of the combinations of the two keyword groups with the time period search restriction of 2010 to 2017 published studies: group one included ―Public private partnership‖, ―Public private cooperation‖, ―Privatization‖, ―Public private initiatives‖ and their abbreviations; and group two included ―Health‖, and ―Hospital‖. After stepwise evaluations and appropriate screening, of 145 assessed papers in the first place, 23 papers were finally selected for data extraction. After reading the full-text of included articles, all of the mentioned information about the problems and challenges of PPPs were extracted. Then, the drafted results for each study were evaluated and compared with each other and organized as main subgroups. Afterwards, the frequency of repeats and emphasis of each subgroup was calculated for all of the 23 studies. Finally, a description review was adapted and registered for each subgroup using related articles. Analysis and assessment of the papers included in this study pointed to several discrete issues which were categorized and discussed in 12 main subgroups based on their conceptual coherence: complexity, low-quality evaluation and supervision, lack of transparency, inadequate coordination, neglecting justice and public interest, lack of flexibility, lack of experience and practical knowledge, insufficeient financial resources, lack of appropriate risk assessment, inadequate cooperation of stakeholders, partner choice restrictions, and paying insufficient attention to the staff. The most important problems and challenges currently confronting health care PPPs were assessed to be complexity, low-quality evaluation and supervision, lack of transparency, and inadequate coordination. All of the items highlight the need to enhance the comprehension of both agreement sides regarding the nature, structure, and complexity of these types of cooperation; as well as complete and precise clarifications for sides, community, and other stakeholders.

Nowadays, burnout as a psychological syndrome is a major problem, especially in health services, that has been identified in a large number of health care providers. The aim of this study was to determine the extent of burnout and the relationship between demographic characteristics and burnout dimensions among primary health care providers. This cross-sectional descriptive-analytic study was conducted in 2019. The statistical sample included all primary health care providers (n=335) working in one of the medical colleges in Markazi province. Data were collected using Maslach Burnout Inventory (MBI). Simple and multiple regression tests were used. Data were entered into SPSS version 23 software. The mean score of emotional exhaustion, depersonalization, and personal accomplishments was 15.5, 4.9, and 33.8, respectively. Among health care providers, 21.8% had high emotional exhaustion, 23%, high depersonalization, and 47.5% had low personal accomplishments. The results of multiple regression tests indicated a significant relationship between gender, work experience, and place of service with burnout. Some strategies such as conducting training courses, providing advisory services, and optimizing human resources management, especially for women, urban employees, and those with high work experience, are suggested to reduce burnout.

The aim of this study was to assess the knowledge, attitude and practice of health science students of Shahid Beheshti University of Medical Sciences about the outbreak of water and foodborne diseases in 2017.
In this descriptive and analytic study, 335 students from school of Health and school of Health, Safety and Environment (HSE) were randomly assigned to the study. Data collecting tool was a researcher-made questionnaire containing 61 questions. The data were analyzed using SPSS 18 software.
The mean and standard deviation of knowledge, attitude and practice of students were (66.15 ± 61.15), (66.63 ± 14.68) ± 66.33 and (±21.55) ±65.96, respectively. Only 13.7, 6.6 and 24.5% of students had a good knowledge, attitude and good performance regarding the subject. Mean score of knowledge, attitude and practice among students of the School of Health was more than the students of HSE. The results showed a significant relationship between knowledge and attitude (p According to the average level of knowledge, attitude and practice of students, it seems necessary to plan for an effective intervention in order to improve the level of education of students who are studying in the field of health and will be the trustee of public health as people who guide other sectors of society.

Treatment cost and lack of insurance are the principal reasons for patients absconding or leaving without permission from a hospital. Here we aimed to investigate the effect of the Health Transformation Plan (HTP) on patients absconding from a large general hospital in Tehran, Iran.
In this descriptive study, we considered March 2011 to April 2014 as the period before and June 2014 to March 2017 as the period after the introduction of the HTP. The data of 701 absconded patients were collected. For data analysis, the Mann-Whitney test and Interrupted Time Series model were used in STATA.12 software.
The proportion of absconding patients immediately has decreased significantly since the implementation of the HTP (P = 0.002, β = 0.342). However, during the 3-year period after the implementation of the HTP, the patient absconding rate has increased monthly by 0.12% (p = 0.019). Investigating the difference in the patient absconding rate before and after the HTP, we found that the proportion of patients absconding has significantly increased since the HTP implementation (0.011 slope; p = 0.019).
Immediately after the implementation of the HTP, the proportion of patients absconding from hospital dropped significantly. This suggests that the HTP has been effective at reducing the patient absconding rate by creating insurance coverage and reducing costs. However, the reasons for a reversal of this trend during the third year of the HTP should be further investigated.

One of the most important characteristic of a successful performance appraisal system is its acceptability to employees. Therefore, it is necessary to use a reliable and valid tool that can specifically measure employee's attitudes towards performance appraisal.The current study aimed at developing and psychometrically evaluating an instrument to assess health workers attitudes towards annual performance appraisal.
In the current methodological study, after reviewing the existing literature on employees performance appraisal, an initial instrument containing 43 items was developed. The content validity index and content validity ratio were measured using the opinions of 10 faculty members, in the department of health service management at medical sciences universities, as well as health workers. Construct validity was measured by the exploratory factor analysis on a sample of 185 health workers of Hamedan District Health Center. Reliability of the instrument was measured by Cronbach's alpha and test-retest methods in 2-week intervals by 15 employees. The data was analyzed using SPSS version 16.
After assessing the content validity, the initial 43 items were reduced to 33 items. Exploratory factor analysis identified 6 factors: performance feedback, performance measurement, organizational contexts, training and employees’ development, performance criteria, and using the results of the appraisal. The first 2 factors were the most important dimensions of annual performance appraisal in the view of employees, explaining 25.5% of total variance. Cronbach's alpha coefficients and test-retest correlation coefficient were 0.95 and 0.93, respectively.
The resulting 33-item instrument showed acceptable psychometric properties to assess the attitude of health workers towards annual performance appraisal process; it can be used to assess and improve the various dimensions of employee performance appraisal.

One of the most valuable assets of any organization is its brand because it causes more profit margins, better cooperation channels and other benefits for the organization. The aim of this study was to investigate the factors affecting brand identity of hospitals in a semi- governmental hospital in Tehran/ Iran. In this descriptive-analytic study, 403 hospitalized patients in a semi-governmental hospital were selected by available sampling method in 2016. The data gathering tool was a researcher-made questionnaire based on the Kapferer model (including 30 questions in 6 domains of brand personality, brand physique, brand culture, relationship, self-image and reflection). Data were analyzed using one-sample t-test in SPSS 16 software. The highest mean scores were attributed to the importance of service quality (4.21), known cases (4.15) and easy access (4.02). The least mean scores belonged to patients' mental and psychological needs (2.31), the distinctive character (2.45) and happy and motivated staff (2.63). There was a significant relationship between total mean score (3.51) and brand personality, brand physique and brand culture (P<0.05). Hospitals cannot survive without attention to the patients' demands. Therefore, by implementing any of the factors affecting the hospital brand identity, it is possible to improve the hospital brand status in the minds of the patients as a superior and valuable brand.

Defensive Medicine (DM) is defined as the deviation of a doctor from his or her usual behavior, and its aim to reduce or prevent complaints from patients or their families. This study aimed to investigate DM behaviors of the surgeons participating in the 41st Congress of Iranian Association of Surgeons (IAS) in 2017. In this cross-sectional study, 160 surgeons were selected using convenience sampling. The data gathering tool was a researcher-made questionnaire consisting of 60 items including 4 parts (demographic characteristics, the prevalence of DM behaviors, its causes and potential reduction solutions) that its validity and reliability were confirmed. For data analysis descriptive statistics including frequency, percentage, mean and standard deviation in SPSS 21 software were used. The prevalence of positive and negative DM behaviors was 100 and 80%, respectively. The most common positive DM behaviors included ordering unnecessary biopsy, imaging, and laboratory tests, and avoiding caring for high-risk patients and refusal to admit patients with a specific social status were the most common negative DM behaviors among surgeons. Lack of support of physicians by health system rules and regulations in adverse situations and fear of patient’s claim were the most important reason for DM behaviors. The most effective potential solutions to the DM reduction were team decision-making in case of complex patients, modification of the law’s view on medical malpractice as a crime, and more support of the legislature. All surveyed surgeons showed at least one of the varieties of DM behaviors, ultimately leading to increased health care costs and resources wasting as well as having negative impact on patient safety. Applying strategies such as modification of the medical malpractice rules and regulations, increasing supervision and monitoring of service provision, establishing appropriate adverse events reporting systems and blame-free culture, developing and implementing evidence-based medicine in practice and reforming of medical liability insurance can be effective steps in reducing DM

The ability to attract tourists in international health markets depends on the quality standards. The aim of this study was to determine the state of educational hospitals of Shahid Beheshti University of Medical Sciences based on organization-oriented standards of joint commission international.
This Descriptive study was performed in four selected teaching hospitals of Shahid Beheshti University of Medical Sciences in Tehran. Data collection was carried out using the questionnaires of the organization-oriented standards of joint commission international including 76 questions in 6 areas of improving quality and patient safety, infection prevention and control, leadership and guidance, safety and facility management, training and staff competence and information and communication management. Descriptive statistics were used as mean and percentage. Data were entered into SPSS20 software.
The compliance rate of organization-oriented standards in the hospitals was 81.2% that indicated the relative readiness with regard to the standards of joint commission international in attracting medical tourists. The highest compliance rate of standards was related to safety and facility management (84.4%) and the lowest compliance rate was related to quality improvement and patient safety (75.2 %).
Hospitals should pay more attention to the quality improvement and patient safety in order to meet international standards and obtain an international accreditation certificate, and they are supposed to improve standards in this area through corrective actions.