فهرست مطالب شقایق وحدت

The purpose of this research was to investigate the factors influencing the attraction of medical tourism in selected educational and therapeutic hospitals of Shahid Beheshti University in 1401.

This research was an applied research. 200 managers and employees of these hospitals were included in the study, and 127 of them were selected as samples based on Morgan's table. In this research, the researcher made a questionnaire with 24 questions taken from the background of the research and by confirming the validity and reliability to the amount of 0/711 and 0/802 Used. Exploratory factor analysis test, sample t-test and confirmatory factor analysis with SPSS and PLS software were used.

In total, all factors with eigenvalues higher than one were able to explain 91.371 of the variance of 24 items related to the questionnaire. Considering that all values are higher than 0.7, therefore Cornbrash’s alpha of the research variables is confirmed. According to the AVE table, all structures are greater than 5. And as a result, the convergent validity of the model and the appropriateness of the fit of the measurement models are confirmed.

The investigations showed that the physical space of the hospital, the supporting infrastructure for foreign patients, the strengthening of the transportation system, the strengthening of marketing, the role of experienced medical staff, the quality of providing medical services, and the respect for the opinions of tourists are important in attracting tourists. Medical tourism has an impact.

Hospitals use natural resources; All of which have a negative impact on the environment. But they spread the concept of green hospital in the world by intelligent and sustainable use of natural resources. The purpose of this research is to investigate the factors affecting the implementation of the green hospital standards in the hospitals of the Social Security Organization in 1401 in GGHH model.

research was applied, quantitative and descriptive with targeted sampling (manager, quality improvement, environmental/professional health) in social security hospitals (sample: 210). The questionnaire was researcher made and the statistical method is Shapiro-Wilks, Wilcoxon and Friedman test in SPSS (0.001: p-values).

Components with more than average (CI: 95%) are of sufficient importance. The effectiveness of components in the energy sector has the highest rating (20.27) related to the use of energy efficient devices and the lowest rating (7.09) related to the minimum use of artificial heating. The effectiveness of the components in the food sector is the highest rating (10.83) related to the use of reusable food containers and the lowest rating (4.79) related to the supply of food inside the hospital. The effectiveness of the components in the water sector has the highest rank (8.35) related to the use of wastewater recycling and the lowest rank (3.42) related to the use of "water curtain".

According to the findings of the current research, with optimal planning and provision of resources to the standards of the Green Hospital, the GGHH model was implemented in hospitals.

Nowadays, at the international level, it is necessary to use evidence in decision-making in the field of policy and planning of the health and medicine sector, the present study was conducted with the aim of investigating the status of management based on economic evaluation evidence in the field of medicine in the health system of Iran and selected countries.

This research is a comparative study that was conducted in 1401. The sampling was purposeful and the countries of Australia, England, Germany and Canada were compared in terms of the components of using evidence in the economic evaluation of the drug field. To collect data, reliable databases and other related sources were used in the field of the research topic. The findings were compared in the form of a comparative table.

The findings showed that producing and extracting evidence is mandatory in Canada, England and Australia and optional in Iran and Germany. Also, except for Australia and Canada, in other countries, evidence is not used to add drugs to the drug list. Also, there are standards and frameworks for producing evidence in all countries except Iran.

The results showed, designing an integrated model to reduce work parallelism, developing communication with research centers, determining principles and regulations for the production and application of evidence, strengthening the leadership, management and supervision of the health system in accordance with the state of the country and other countries with similar conditions are proposed.

Lack of financial protection in health is known as a disease of health systems. Households suffer not only from the burden of disease but also from the burden caused by the destruction and economic poverty, in other words, facing back-breaking costs and poverty caused by financing their health. The aim of the current research is to investigate the impact of different dimensions of inequality on the financial financing of household health.

This is a descriptive, cross-sectional, and applied study, which examines the impact of inequality on the financing of household health expenses. The research tool is the financing inequality questionnaire (2008) by Saito. All out-of-pocket costs related to inpatient care, outpatient care, diagnostic tests, and medical expenses due to illness have been estimated for one year. Experts have confirmed validity and reliability.

The dimensions of inequality among households in Tehran are higher than the average (1.329), which has a significant impact on the financing of household health expenses. The direct effect of justice on the financing of household health expenses is rejected. With the increase in the back-breaking cost, equal opportunity, economic status, insurance coverage, and financing of household health expenses increases. According to P<0.001 and P=0.005, the age of the head of the household is not related to justice and gender in the financing of household health expenses.

There is a direct relationship between back-breaking expenses, equal opportunity, economic status, insurance coverage, and financing of household health expenses.

Smartening hospitals can be effective in improving the quality and providing faster and better services and increasing the possibility of tracking and security of the equipment in the hospital. The current research aims to identifying effective factors in making hospitals smarter.

The present research is a qualitative method of content analysis. The statistical population includes managers, doctors, experts in the field of hospital intelligence, hospital information and communication technology experts, and hospital medical equipment experts in 2019-2019. Sampling method was done in a purposeful way and by snowball method. Data collection was done through semi-structured interviews with 12 experts who are familiar with hospital smart issues. The data was analyzed by content analysis and using coding method.

The number of 135 primary codes, 22 sub-categories, and after combining the codes, 4 categories including information and communication platforms, advanced medical equipment and facilities, trained human resources and management in hospitals were identified as effective factors for making the hospital smarter.

In the present study, 4 categories including information and communication platforms, advanced medical equipment and facilities, trained human resources and management in hospitals were identified as effective factors for making the hospital smarter. It is suggested to use the findings of the present study for better performance in hospitals.

Diagnostic and curative services are a major source of healthcare expenditures, indicating their potential to control such expenditures. This study aimed to evaluate appropriateness of medical imaging services and to provide policy options to address this challenge.

Following a systematic review design, international (Elsevier, PubMed, Web of Science, and Scopus) and national (IranMedex, MagIran and SID) databases were searched from 1990 to November, 2021 using various combinations of the following keywords: Diagnostic imaging/Radiology, Medical Imaging, CT-Scan, Rational consumption, appropriateness, Health service misuse/Medical overuse, and services utilization. Google Scholar was also mined. STROBE checklist was used to evaluate the quality of articles.

Initially 605 articles were found, of which 22 were found as eligible. All studies mention various levels of inappropriateness of services (i.e., 21 to 76%), and mentioned different causes, including benefiting from complementary health insurance coverage, insufficient knowledge of providers, and various referrals of patients. The most widely mentioned solutions include training providers and establishment of a strong monitoring systems.

Inappropriateness of prescribed results in increased burden for health systems, health insurance funds, and providers. Also, this problem is not restricted to Iran and several high income countries with well-established health systems are also faced with this problem.

Patient participation in treatment decisions has been associated with improved treatment results. By checking the level of knowledge of patients and informing patients about the risks and benefits of treatment methods, the level of participation of patients in treatment can be checked. This study was conducted with the aim of determining the participation rate in the treatment of breast cancer patients. The current cross-sectional study was conducted in descriptive and analytical form in 2019. The statistical population includes 15 doctors who worked in the field of breast diseases and 300 patients with breast cancer who visited clinics and doctor's offices in the cities of Shiraz, Kerman, Rasht and Tabriz, who were selected by cluster random sampling. In order to measure the level of participation, a researcher-made questionnaire was used after validity and reliability. The data were analyzed using SPSS 20 software with the help of descriptive statistics and chi-square inferential tests. The findings of the research showed that patients' participation in treatment has a significant and direct relationship with age, education, duration of illness and income of patients (P value < 0.05). Based on the findings of this study, patient participation was reported in three areas (decision-making process (53%), doctor's practical behavior (67.6) and patient preferences (66.2)) and in general, the level of participation in the treatment of patients with Breast cancer was estimated at 52%. Empowering patients by increasing awareness about diagnosis and treatment, as well as covering breast cancer as a special disease and receiving treatment allowances, can help increase patient participation.

The ageing of the population lead to various problems in terms of health care. An important issue related to the promotion of elderly health is preventive care. The health care systems make appropriate changes in the structure and process of providing these services to the patients. This study aims to identify the most important factors of providing primary preventive care services to the elderly in Iran.

 In this descriptive-survey study, the variables were measured using a questionnaire and the causal relationships between them were identified. First, the factors affecting the provision of primary preventive care services to the elderly in selected countries including Iran were compared. Then, using the experiences of a panel of experts (n=12), an initial questionnaire was designed. To obtain consensus from the panel of experts, a Delphi process was carried out in three rounds. After determining the face and content validity of the questionnaire and assessing its reliability using Cronbach’s alpha coefficient, the questionnaire were completed by 176 experts. To measure the effect of the components on the main variable, the structural equation modeling (SEM) was used.

The model had 6 dimensions (planning, organizing, resource supply, monitoring, leadership, and preventive care). The factor load for the variable of planning was 0.68 (t=5.22); for organization, 0.56 (t=4.54); for resource supply, 0.47 (t=3.65); for monitoring, 0.59 (t=2.67); for leadership, 044 (t=3.05); and for preventive care, 0.650 (t= 3.85). Eight indicators were identified for the planning dimension, six indicators for the organization dimension, seven indicators for the resource supply dimension, seven indicators for the monitoring dimension, three indicators for the leadership dimension, and six indicators for the preventive care dimension.

Planning, preventive care, monitoring, organizing, resource supply, and leadership are the most important factors of the provision of primary preventive care services to the elderly in Iran. Development of infrastructure, scientific and practical measures, promoting the health culture, and the seriousness of the health system in using the existing capacities and facilities, can help increase the quality of life and reduce health costs and disease burden in the elderly.

Patient participation in treatment decision-making has become a political necessity in many countries and health systems around the world. At the global level, how to deal with cancer patients has found a different approach. Considering that cancer affects a person's physical, mental and social health, patient-centered care can be one of the proper approaches for cancer patients. The purpose of the present study was to determine and investigate the barriers to participation in the treatment of breast cancer patients in Iran.

The present qualitative study was conducted in 2021.The data were collected using semi-structured interviews with the cooperation of 15 breast surgeons and 300 breast cancer patients who visited doctors' offices and clinics at Shiraz University of Medical Sciences, Tabriz, Gilan, and Kerman. Sampling of patients was done by cluster random method, 20 patients for each doctor. The validity and reliability of the questions were verified using the opinions of 15 experts. To end with, coding and classification of data was done using the paradigm model in the grand theory way. The data were analyzed using SPSS24 software and qualitative methods in Grand Theory.

The result of the present research indicated that the fear and anxiety of patients is the most important factor in non-cooperation and weak participation of patients during treatment. Patients’ lack of awareness and insufficient information was the second obstacle in poor participation in treatment decision making. Moreover, the findings indicated that the treatment costs had no effect on the continuation of the treatment process and the type of treatment chosen despite the occurrence of many problems for the patients.

The results of the present study indicated that fear and anxiety, not having enough information about the disease and financial problems are among the most important factors affecting patients' participation in treatment.

In today’s societies, “health” is the inalienable right of all members of society and indicators showing health in society are important factors in showing the level of development of the country. The purpose of this study is to determine and prioritize the factors affecting financing in Iran.

This descriptive research is a survey method and in terms of implementation process, it has been done qualitatively and quantitatively. In this research, first with a qualitative approach and by theoretical and library studies, the financing model in the world health system was examined and then by comparative comparison and determining the points of difference and commonality, the main factors were identified. Then, using the opinion of experts, the researcher proceeded to prioritize the factors.

To investigate the research hypotheses, because the dimensions and components affecting health financing did not have the same rankings, as a result, prioritization was done in the field of contextual factors, instrumental factors, content factors and structural factors. The results showed that the central tax system with 4.451 points, the budgeting system with 4.420 points and the formulation of the financing plan with 4.368 points are the most influential components, respectively.

In the study of the studied countries and financing models and frameworks, the variables that had the highest frequency in the financing system included the variables of tax axis, integrated financial fund, subsidies, financial participation and protection of investment risks. It shows the emphasis of the mentioned models on the tax view along with investment. The results of this study show that in Iran, despite the existing insurance system, creating a mechanism in the tax system, budgeting system and formulating a financing plan with respect to sanctions and creating restrictions in the investment system in the health sector has the most importance and rank.

 The global shift from infectious diseases to chronic diseases is a global problem that will reduce the quality of life and increase the need for services such as rehabilitation services and services related to disability. An important issue in relation to aging is preventive care and how it is managed in the world. This systematic review has conducted a comparative study on the management of preventive healthcare for the elderly in the world.

 This is a review study that was done comparatively in 2020. This study was conducted to model the existing policies and programs for the care of the elderly in the countries. To collect data, Persian and international databases as well as Google Scholar scientific search engine were used using appropriate keywords, and finally 200 suitable articles were identified. The studies were categorized and their management system was evaluated and differences and similarities were determined while comparing.

In the present study, it was found that 50% of the surveyed countries had insurance coverage for the elderly. 64% of the countries, management and organization of health prevention services at the national level, 7.5% local, 21.4% state-federal and 7.1% national. It was local. How to finance the provision of services for the elderly in 50% of the countries surveyed through taxes, 14.2% premiums, 7.1% national health system, 7.1 individual reserve funds and the rest of the countries through the payment of the federal government, health insurance and etc. In 50% of the surveyed countries, the providers of first level services were the public sector, 28.5% of the private sector and the rest of the countries were municipalities, government, etc.

The systems of elderly support and primary healthcare are intertwined in the main health system and function similar to the primary healthcare system of the country.

The present study aimed to determine the causes of patients' readmission in hospitals affiliated to Bam University of Medical Sciences in 2019.

The current study was a descriptive-analytic study and the study population included patients readmitted in Pasteur Hospital in Bam, Javad Al-Aimeh Hospital in Narmashir, and Ayatollah Hashemi Rafsanjani Hospital in Regan in 2019. The samples consisted of 312 patient records which were chosen randomly. Data were collected by a checklist and were analyzed using SPSS software version 23 and descriptive and analytical tests (Chi-square and one-way analysis of variance).

The results showed that the internal medicine department received 34% of readmissions. The average readmission cost was 17,265,353 Rials. The most common reasons for readmissions were having a new disease (46.2 percent) and recurrence of the former disease (39.8 percent). Findings of inferential statistics revealed no significant relationship between the causes of readmissions and gender (P = 0.566), age (P = 0.065), or costs (P = 0.625), but there was a significant relationship between the causes of readmissions and marital status (P = 0.049) and married people had more readmissions than single people.

It is necessary to pay more attention to readmissions caused by disease recurrence. It is also possible to prevent such readmissions and improve the quality of medical services by standardizing hospital processes and tools, standardizing staff training, and employing new diagnostic and treatment methods.

Background and Objectives :

Public-private partnerships can lead to increased efficiency, equity, accountability, quality and access to services in the health system. The aim of this study was to explore the opinion of health system managers about the advantages, disadvantages and barriers of public-private partnership in the provision of primary health care services.

Material and Methods: 

We used both quantitative and qualitative methods to explore the opinion of experts about the objectives of the study. First of all a literature reviewe was done to identify the problems and challenges of public-private partnership in the health sector in the year 2020. Based on the literature review and interviews conducted with experts, a two-part questionnaire was developed to collect data. The sample for the interviews was selected by snowball method until saturation was reached. After the validity and reliability of the questionnaire were established, the questionnaire was completed by 100 health managers. The collected data were analyzed using Stata software version 14.

Results:

The most important benefits of public-private partnership in providing primary health care services from the point of view of health managers include providing financial resources for health services plans with an average of 4.02 (SD 1.00) , as well as the high technical and managerial efficiency in the private sector with an average of 3.90 (SD 0.60). Lack of full coverage of primary health care services and incomitment to social justice with an average score of 3.99 (SD 0.92) as well as the inadequate job security of human resources in the private sector with an average score of 3.97 (SD 0.9) were found as the most important disadvantages of partnership of public-private. It was revealed that the major barriers hindering public-private partnership in service delivery include "legal, and monitoring shortcomings alongside hampering rules and regulations in partnership with the private sector" with a mean score of 4.06(SD 0.60), "reluctance of health managers for risk-taking when in partnership with the pivate sector "with a mean score of 4.05 (SD 0.61) and" Insufficient expertise of government managers regarding knowledge of partnership with the private sector "with a mean score of 4.04 a(SDf 0.53).

Conclusion: 

It seems that managers' attention to the disadvantages of partnership, such as lack of full coverage of services and withdrawal from social justice, etc., can pave the way for developing much clearer and smoother public-private sectors’ partnerships.

Municipality is one of the most important urban institutions with which citizens necessarily communicate. Municipality, with it is long-term management and planning, can identify the primary and secondary needs of citizen whereby the security of urban life can be guaranteed. In the realm of health and its enhancement, municipalities can potentially play an important role. The main goal of this study is to propose a model for municipalities’ participation in health promotion projects in urban settings in Iran. In this study both qualitative and quantitative approaches are utilized. In the first step, dimensions, components, and indices of a questionnaire are identified by interviewing members of the expert group and implementing Delphi technique in three stages. Subsequently, using the survey method, research toolkits were distributed among the members of the sample group. Finally, a model for municipalities’ participation in health promotion projects in urban settings was proposed and was compared to other models exercised in other countries.The results of structural equations indicated that the municipal participation model in health promotion projects in Iran has six main dimensions: urban planning improvement, living conditions improvement, democratic and collaborative governance, safety in face of disastrous and emergency events, creating age-friendly cities, and public health improvement. The improvement of living conditions with a coefficient of 0.96 is the most significant dimension. According to the findings of this study, the role of municipalities in public health promotion in Iran is quite negligible. Overall, this study suggests that municipalities should enhance their involvement in public health promotion particularly in terms of improving living conditions.

Health promotion services has a significant impact on health system, and hospitals are the best places for health promotion and preventive services. Therefore, this study aimed to determine the level of implementation of standards and activities of health promotion in hospitals (HPH) in four areas of health promotion.

This was a descriptive-survey study, and the research environment of hospitals in Golestan Province, Iran. The managers, authorities, and experts being in contact with the process of HPH standards and activities (n = 80) were our sample population. A researcher-made questionnaire was employed to gather data, and analysis was performed using one-sample t-test.

Standards and activities were implemented in hospitals with good and desirable level in the dimensions of staff (6.01) and patients (5.60), and moderate level in the dimensions of environment (4.22) and society (4.03); the efficacy was in a significant level (P < 0.01). Moreover, the comparison of dimensions with Friedman test showed that the dimension of the staff and society had the highest and lowest level of implementation.

Some of the standards and activities of the health promotion hospital are being carried out in hospitals. Therefore, achieving and fully implementing of these standards and activities for improving the quality of health services and improving the situation of hospitals require to encourage policymakers and healthcare managers, create consistent policies for the knowledge promotion and train of health promotion skills (patients, staff, and community), and promote health centers and turn it into a healthy work environment, cooperation, coordination, and interaction with all stakeholders (internal and external).

Evaluation in hospitals is a necessity in the way of promoting the health of the community and requires valid and reliability instruments. Therefore, the present study was conducted with the aim of developing and psychometrics "Evaluation Criteria for Health Promoting Hospitals Scale".

The present research is methodological. Initially, a comprehensive review of the research topics included documents, service providers at hospital management levels, all published library documents, and national strategic documents in the field of hospital health promotion and Social Security documents. The " Evaluation Criteria for Health Promoting Hospitals Scale" was then developed with 72 items. Face validity, content validity ratio, and content validity index were measured by a survey of 10 experts. Construct validity (factor analysis) was determined by distributing the scale between 272 samples. Reliability was measured by internal consistency method by calculating Cronbachchr('39')s alpha coefficient with 15 participants and composite reliability. Data were analyzed in SPSS. 21 and LISREL.

The " Evaluation Criteria for Health Promoting Hospitals Scale" was developed with 68 items, 11 components (in 3 structural, process and consequential dimensions). The ratio of content validity, content validity index and construct validity was confirmed. Reliability was performed by internal consistency method by calculating Cronbachchr('39')s alpha coefficient and its value was 0.758 for structural dimension, 0.895 for process dimension and 0.924 for consequential dimension. 

The "Evaluation Criteria for Health Promoting Hospitals Scale” with 68 items, 11 components (in 3 structural, process and consequential dimensions), has a high validity and reliability. It is recommended to use the above scale to evaluate health promotion hospitals.

Designing and constructing hospitals using green approach, renewable resources reduce energy consumption and carbon emissions, and improve environmental air quality. The purpose of the present study was to determine Green hospitalchr('39')s criteria in Fars province, Southwest of Iran, 2019.

In the Qualitative study, first, the criteria were identified systematically. Then, the criteria for establishing a green hospital were determined by content analysis and software methods. Then, for localization, using the Delphi method, the effective criteria for establishing a green hospital in Fars province were selected. Thirty experts in the field were selected using purposive sampling. Excel 2016 software was used for analysis.  This study was a  mixed-method study that was conducted from 2018 to the first half of the year 2019. At first, the criteria were identified by the systematic review method, and then the data extraction was analyzed using the content method. Finally, the criteria identified by the questionnaire were provided to 30 health experts. Experts were selected by purposeful sampling. In the present study, Excel 2016 software was used for analysis.

Green Hospitalchr('39')s criteria were 72 criteria out of 21 common angles in the systematic review stage. In Fars province, 34 criteria in 13 dimensions of site stability, construction stage (architecture), environmental quality, management, resources, bio purchase, Experts selected energy efficiency, water, wastewater, waste and waste recycling, transportation, healthcare, and innovation. The most important aspects for Fars province are the management costs.

The approved criteria for Fars province, as well as other valid models in the field of the green hospital, management, water efficiency, and energy, were approved. In general, the reasons for choosing approved dimensions can be due to the various models emphasizing these dimensions and the relevance of dimensions to hospitalschr('39') challenges.

The importance of evidence-based strategic decision making in hospitals has led to the aim of this study to develop and implement evidence-based strategic decision-making in hospitals in Tehran.

The present study was a mixed exploratory research conducted in the field. The qualitative community included academic experts. Also, the quantitative community includes the managers of selected hospitals of Tehran University of Medical Sciences. The research tools included interviews and questionnaires. The statistical method used in this study was structural equations with partial least squares method.

The results showed that eight factors (knowledge, judgment, experience, context, managerial preferences and values, stakeholder preferences and values, ethical considerations, and organization plans) were used as proponents of strategic decision-making development. The evidence was identified in Tehran hospitals. The results of the present model showed that all factors influence the development of evidence-based strategic decision making in hospitals in Tehran, with the most influential context being 0.224. Also the results of model fit indices showed that the model presented in the present study has a good fit.

According to the results of the present study, the causative agent was identified as the most important factor in the development of evidence-based strategic decision making in hospitals in Tehran, which indicates the importance of paying attention to these factors in hospitals.

Designing and constructing hospitals using green approach leads to the reduction of energy consumption and carbon emissions, and improvement of indoor air quality and the environment. The purpose of the present study is to prioritize the criteria for green hospital deployment model in Fars province.

This studywhich included identifying criteria systematically, categorizing criteria for green hospital deployment, and agreeing on the most important criteria affecting green hospital deployment using Delphi method was conducted with 30 hospital experts in the field under study in two stages of Delphi and sampling using snowball method. Priority and relevance of variables have been discussed using dimethyl.

In the systematic review phase, the criteria for green hospital were 72 criteria out of 21 common patterns/models in the world. In Fars province, experts selected 34 criteria from 13 dimensions. Based on experts’ view, the most important dimensions in Fars province are management, water consumption, health care and treatment. Management dimension having the highest weight and being the most influential among the 13 dimensions of green hospital indicates the significance of managers' role in executing green hospitals.

Green hospitals have an impact on healthcare industry and people. In this regard, the strategic role of managers in today's hospitals affects the environment while increasing costs in increasing the disease burden. It is also important to use modern methods and creativity in establishing green hospital standards.

Today, due to the increasing demand for health services and the increase in health care costs, it is necessary to pay attention to cost management in hospitals. The present study was conducted with the aim of developing and psychometric "Hospital Cost Management Scale".

The present research method is a combined (qualitative-quantitative) method. In the qualitative section, literature review and semi-structured interviews were conducted with 20 health economics experts and hospital managers using content analysis and Atlasti software. In the quantitative part, the content validity ratio of the scale by Lawshe table and the content validity index was based on Waltz & Basel method were measured by opinion of 20 experts. Construct validity was measured factor analysis method. Reliability was calculated by internal consistency and stability by retesting among 20 experts in the qualitative phase with a 2-week interval. Cronbachchr('39')s alpha coefficient was measured a second time for the whole scale in sample 207. The data were calculated by SPSS. 22.

From the qualitative section, the "Hospital Cost Management Scale" were obtained. The content validity ratio was 0.42 and the content validity index was 0.79.  The results of factor analysis showed 35 items in 5 dimensions of hospital management and structure, control and supervision, consumption resource management, financing, and human resource management. The Cronbachchr('39')s alpha coefficient ranged from 0.75 to 0.86 and the reliability by the retest method was again between 0.76 and 0.88 two weeks’ interval. Cronbachchr('39')s alpha coefficient with 207 samples was 0.87.

The "Hospital Cost Management Scale" was developed with 5 dimensions with high validity and reliability. Therefore, its use is recommended in planning and controlling hospital costs and directing further research.

Strategic purchasing of health care services is one of the major issues contributing to the enhancement of the performance and reform of healthcare systems across the globe. Traditional (passive) purchasing suffers from serious weaknesses, such as low efficiency in the health care system, lack of targeted resources, Resource inefficiency, and unfair access to services. To solve these problems, the World Health Organization has introduced strategic purchasing as the main activity to improve the performance of healthcare systems. In light of the aforementioned issues, the present study aimed to investigate the challenges and problems of strategic purchasing in the health sector.

For the purpose of the current qualitative study, the upstream laws and policies in the field of strategic shopping in Iran were initially investigated to gather the needed information. In the next step, 25 health policymakers were interviewed about the challenges of strategic purchasing and the implemented measures. The data were analyzed in MAXQDA software (version10) using content analysis 

Assessing the current situation, strategic purchasing was classified into 5 dimensions, 21 them, and 57 sub-thems. The most important issues among the findings included governance with the highest frequency of 62% and the health information system with a frequency of 47%. Analyzing the research findings, 52 challenges were identified and examined.

Despite all the benefits of strategic purchasing, its effectiveness depends on the successful implementation and effective cooperation of all stakeholders. In addition, strategic purchasing might need to be tailored to the circumstances of each country and the needs of that community. Therefore, the establishment of the needed infrastructure and tackling the presented challenges are indispensable for the optimal implementation of strategic purchasing in our country.

Health promotion is a new mission of hospitals, and the mission of health promotion hospitals is to change the treatment-oriented approach to the health-oriented approach. Therefore, this study aims to evaluate the components of health promotion hospitals.

The present study is an integrated review that searches using the keywords Health Promotion, Evaluation model, Hospitals (HPHs) and review in IranMedex Iran Medical Sciences Article Information; (SID) Published by Jihad Daneshgahi Scientific Database PubMed, Ovid, Science Direct, (Magiran) Iran Publications Database, (IranDoc) Iranian Scientific Documents CINAHL, and Google Scholar was obtained. The time of the documents used for the year 2004 to the end of 2018 was determined with the priority of the newer documents. Finally, 76 articles were reviewed. Among the 76 Persian and English articles reviewed, 15 articles were selected that were more closely related to the subject.

Among the 76 Persian and English articles reviewed, 15 articles were selected that were more closely related to the subject. The purpose of establishing health-promoting hospitals was to improve the quality of health care, increase patient satisfaction and their companions, improve the work environment of medical centers, and increase hospital employee satisfaction. The criteria for evaluating a health promotion hospital in the structural dimension consisted of three components (communication and cooperation, organizational development and hospital infrastructure development); all components were of great importance. In the process, which had the highest evaluation criteria (31), four components (management policy; resource planning; patient evaluation and interventions and healthy human capital) were extracted and proposed. In the validation stage, 30 criteria were approved. In the consequential dimension, 27 criteria were obtained in the form of four components (organization leadership, patient health promotion, staff health promotion and community health promotion).

The results of this study can help establish a health promotion hospital with appropriate indicators and standards of hospital centers and can be effective as a valid tool in monitoring, policy, service quality assessment, health promotion, hospital staff and community promotion interventions.

Inadequate attention to health care as a necessary commodity can be detrimental to the health of the community and the huge resources spent in this area can be wasted. Limited financial resources, sanctions on the country, reduction of budget revenues, low share of funds allocated from the general government budget and low share of health care costs are among the total gross national expenditures that limit the financing of health care costs. It is necessary to provide a model that fits the requirements, requirements, laws and culture of the country. For this reason, in this article, we tried to identify the effective and functional factors on the realization of the health financing system in the country and present them in the form of a model.

This descriptive research is based on survey research and is qualitative and quantitative in terms of the implementation process. In this research, first with a qualitative approach and by theoretical and library studies, the financing model in the health system in the world is examined. The design of the initial model was done by comparing and describing the differences and commonalities. Then, with the help of experts, the researcher designed the initial model, and in the next step, the model analysis algorithm was used in the Smart-PLS-SEM method to validate the presented model of the health system.

In order to study the research hypotheses and the conceptual research model in general, because the dimensions and components affecting health financing did not have the same ranks, as a result, prioritization was done and in the field of field factors, the dimensions of the budgeting system, respectively. Health-oriented services, tax-oriented system, in the instrumental factors section of the disease fund, financial participation and social hospital, in the content factors section, financing and legislation plans were developed and in the structural factors dimensions, service quality structure, risk structure and financial structure were measured. Then, the necessary analyzes were performed in three sections: fit of measurement models, structural model fit and general fit of the model, and then the existing relationships in the structural section were examined and interpreted, and in the reliability stage, the overall fit of the research model was examined.

The research results show that creating a mechanism in the tax system, budgeting system according to the sanctions and creating restrictions in the investment system in the health sector and the spread of chronic and sudden diseases of the greatest importance and ranking in creating the model. The country has a health financing system.

A green hospital is established to increase competitiveness, productivity, and cost savings to save resources and energy. This study is performed to identify and classify factors determining a green hospital.

The five-step guideline of the University of York, York, England, for conducting systematic scoping reviews of the field of study was employed in this study. Searching for foreign and domestic scientific databases in both English and Persian, with a time limit from 2015 to 2019 was performed using keywords including criteria, dimensions, components, and approaches to green or eco-friendly hospitals. Finally, this study was carried out by reviewing 25 articles published in Iran and abroad in the field of green hospital which were selected out of 10493 articles.

Green criteria were identified in 15 dimensions and five environmental, economic, social, health, and novelty categories. The data collection indicated the method for collecting data and the data interpretation addressed analyzing and processing the data collected.

In this study, different criteria for a green hospital deployment pattern in five environmental, economic, social, health, and innovation categories were obtained. Green hospital standards are a good model for establishing an environmentally sound health care

Considering the importance of the effect of chronic renal failure on various aspects of patients' life, the purpose of the study was to determine the factors affecting the quality of services provided to hemodialysis patients.

The research was carried out using a mixed method. Samples were targeted at the qualitative stage and included 24 experts from hemodialysis section from 6 provinces of the country. In the quantitative phase, 150 employees in the hemodialysis department were examined. The information gathering tool in the first step was a library and in the second step was a questionnaire. The researcher-made questionnaire was designed with 6 elements; validity and reliability of the questionnaire were also evaluated using goodness of fit. The analysis in the descriptive statistics section included frequency, percentage, mean and standard deviation, and was used in the inferential statistics of exploratory and confirmatory factor analysis. Exploratory factor analysis was performed using SPSS 21 software and confirmatory factor analysis through Laser Level software.

Six factors influencing the quality of hemodialysis services were identified, and based on the importance were: human resources (0.866), management (0.874), information technology (0.749), equipment (0.731), facilities (0.683) and physical space (0.628). The fittest indices also showed that effective factors have suitable fit and can be mentioned as factors affecting the quality of hemodialysis services in Iran.

Due to the low quality of life in hemodialysis patients, appropriate strategies should be taken to prevent the loss of resources and improve the patients' life quality by using the result.