soudabeh vatankhah

The present study investigated how a general hospital is restructured in Iran when transforming from a non-teaching into a teaching hospital.

This applied study was conducted based on a mixed-method design from 2020 to 2021 using a systematic search and review, document analysis, comparative and cross-sectional design, multiple voting technique, and qualitative phenomenological method.

The conceptual framework of the components of a hospital as a system includes inputs (governance and policy-making, goals and mission, clinical and support departments, physical space, clients, and human resources), processes (internal and external relations, key processes, type and level of services, and teaching mission systematization), and outputs (performance evaluation, internal and external customer satisfaction, human capital empowerment, organizational behavior, income-cost management, cost-effectiveness and efficiency, service quality, and legal and social responsibility).

The findings from the present study depicted how the components of teaching and non-teaching hospitals are restructured when changing their functions. Restructuring an established organization, such as a hospital, is very challenging and requires multiple changes. This study had some implications including highlighting the need to formulate protocols for restructuring non-teaching hospitals into teaching hospitals or constructing new teaching hospitals, classifying teaching hospitals and clarifying their differences, focusing on the teaching mission in hospitals, and reviewing and updating the integration of medical education in providing health services.

Many hospitals globally have valuable experiences in preparing for man-agement and responding to infectious epidemics. Identifying and analyzing these expe-riences can provide comprehensive and practical data for decision-making and effec-tive performance. This study aimed to conduct a scoping review and content analysis of the best practices of hospital (private or public) management in epidemic conditions.

This research is a scoping review and content analy-sis, conducted in 2021. Data was collected by searching different databases, includ-ing Pubmed, Scopus, Web of Sciences, ProQuest, websites, search engines, and pub-lic reports without time limits. Content analysis was performed for data analysis.

We retrieved 8842 records from databases and other sources. Finally, 24 studies from 12 countries were selected for analysis. Most studies belonged to the United States (9 cas-es), and most subjects were on Coronavirus disease 2019 (Covid-19) (19 studies). We clas-sified the results into two major categories of in-hospital executive readiness and logistic readiness. Executive readiness included 11 main categories (physical structure, resource man-agement, exposure reduction, patients and caregivers’ management, corpse management, dis-infection, staff support, patient admission, instructions and guidelines, tele- communication, and education) and 26 sub-categories. Logistic readiness consisted of three major categories (leadership/team making, communication, and using capabilities) and five sub-categories.

Healthcare managers can use the identified categories and dimen-sions of managerial readiness and responsiveness as an action plan during an in-fectious disease epidemic.

Context:

 Growing needs mandates economic growth. Entrepreneurship policies play a significant role in achieving productive employment and sustainable development for the health and wealth of society. Aims: This study is conducted to find the accordance of this document with the basic theory of the global alphabet model of entrepreneurship on the one hand and a comparison to the real entrepreneurial and economic achievements as social determinants of health (SDOH) on the other hand.

Methods and Material: 

This research is a quantitative and qualitative content analysis of entrepreneurship documents in the health sector of Iran, using the basic theory of the global alphabet model as our target. We reviewed the Work Bank and Global Entrepreneurship Monitor (GEM) reports as world indicators to compare whether our entrepreneurship policies have been successful.

Statistical Analysis: 

MAXQDA is a software program designed for computer-assisted qualitative and mixed methods data, text and multimedia analysis in academic, scientific, and business institutions.

Results:

 The findings showed that the retelling of the word employment is more dominant than entrepreneurship. Imbalanced attention is paid to the components of the standard global alphabet model, and a downhill regression is seen in almost all aspects of entrepreneurial results.

Conclusions: 

The written health policies have not been effective in promoting the development of health by wealth.

 In-service training is one of the requirements for developing health workforce skills and providing quality services to patients.

 This study aimed to determine the policy formulation of in-service training for the health workforce in Iran.

 In this qualitative policy analysis study, semi-structured interviews with key informant persons and document analysis were used to gather data. Interviews were conducted with 12 informed people about health system policies, experts, and managers of in-service training centers of medical universities and the Ministry of Health and Medical Education (MOHME) selected purposively. Targeted and snowball sampling was used to identify the participants. Data analysis was performed using the MAXQDA10 software, and framework analysis was run using the Kingdon model.

 Centralized planning, lack of access in rural and remote areas, and the inability to use the potential of universities in staff training were the most frequent problems in in-service training of the health workforce. Establishing the Board of Trustees for universities affected the opening of the opportunity window to policy-making, and political entrepreneurs in MOHME took advantage of it and developed policies for in-service training.

 The development of policies has created a suitable platform for medical universities to increase the number of training hours and develop the skills of the health workforce. It also seems that policymakers' attention can lead to improving processes and using new approaches in the continuous development of health professions.

 Hospitals play a crucial role in providing medical services to medical tourists and their satisfaction; however, they face many problems in this field.

 This study aimed to explain hospitals’ challenges in providing healthcare services to medical tourists.

 In this qualitative-phenomenological study conducted in 2021, data were collected through semi-structured interviews, purposive sampling, and the participation of 21 key informants involved in hospitals and medical tourism industries in six large cities in Iran. They were then analyzed using the thematic analysis method with the MAXQDA-10 software.

 Hospital challenges were included in 165 final codes. The six main ones were governance and leadership, financing, human resources, technology-equipment-medicine, information systems, and service delivery. Three categories of structure, process, and outcomes related to medical tourism were also identified.

 Improving the information and communication infrastructure, developing the activities of facilitator companies, updating the standards of the International Patient Department (IPD), compiling guidelines related to insurance, and setting tariffs are suggestions that can help reduce the existing challenges.

In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran.

A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.

According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client’s costs, considering increase management team’ legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital.

Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

Hospitals, similar to other organizations, are complex social systems influenced by elements, such as staff, resources, and structures, that work to achieve specific goals. In terms of goals and missions, hospitals are divided into teaching and non-teaching categories. There are many differences in the nature and needs of these two types of hospitals that must be considered for proper operation by policymakers and managers.

The present study compared issues between non-teaching and teaching hospitalsin Iran.

A qualitative study was conducted using semi-structured interviews according to an interview guide with 40 Iranian hospital managers and policymakersselected through purposivesampling in 2021. Data were analyzed through thematic analysis with an inductive approach using the MAXQDA software (version 10).

According to the results, the main categoriesof differences between non-teaching and teaching hospitals in Iran were as follows: legal and social responsibility, cost-effectiveness and efficiency, supply of resources, empowerment of human capital, goals and missions, external and internal communications, revenue-cost management, organizational structure, customer satisfaction, organizational behavior, clinical and support departments, hospital processes, type and level of services, manpower, performance evaluation, and the organization of the teaching mission.

Practical findings of this study include understanding the complexity and instability of command unity in teaching hospitals, understanding the differences in organizational hierarchy, developing a mechanism to cover costs for clients, increasing the legal and social responsibility of the management team, prioritizing organizational goals, coordinating policy demands with providing resources, funding the teaching mission, organizing multiple supervisory organizations, establishing transparent communication between hospitals and colleges, understanding the complexity of processes, considering the change of individual and group communication, changing the performance appraisal system, and paying for performance. It is suggested that policymakers consider these issues in providing the resources and facilities needed for hospitals based on their function.

Rare diseases-related services, care, and drugs (Orphan Drugs) in a lower-middle-income country such as Iran with international limitations due to the sanctions is a challenging issue in terms of their financing and providing. This study aims to address financing issues related to rare diseases in a lower-middle-income country that is under international sanctions.  

This is a qualitative study that has been conducted through 14 interviews with experts from different stakeholders in the country to find the challenges of financing rare diseases and orphan drugs in Iran through a content analysis according to Mayring’s approach. We accomplished this study based on the World Health Organization’s universal health coverage model.  

We achieved four themes and 12 sub-themes. The themes are the unstable and sanctioned economy including 4 sub-themes; extending the covered population by the social security net in the country including 2 sub-themes; reducing the cost-sharing for the covered population including 4 sub-themes; including more orphan drugs and services including 2 sub-themes.  

The financing of rare diseases and orphan drugs in Iran is challenged by several contextual and internal factors. The political issues seem to have the main contribution of the challenge to develop an efficient and effective financing mechanism for rare diseases and orphan drugs. This is especially can be related to the politicians’ commitments and pursuing an effective plan to allocate the financial resources to rare diseases. However, the country’s economic situation, especially at the macro level because of international limitations, has intensified the problem.

Community engagement, as a key factor in changing the behavior can affect the prevention and management of communicable diseases in rural areas. This study aimed to determine the role of community engagement innovations in controlling Coronavirus pandemic in rural areas.

this qualitative study was carried out using observation, reviewing documents and semi structured interviews, for data gathering. Interviews were done by Key informant persons that selected purposefully. All interviews recorded ,transcribed verbatim and analyzed manually by using thematic analysis method.

45 codes and three themes  were obtained by open, axial, and selective coding method. Main themes were Management and leadership, public confidence and trust, and accountability and transparency that could have many important role in engaging people in controlling COVID.

 the findings show that using the community engagement in rural areas can be play a critical role in controlling the spread of COVID-19, but it depends on the cultural, social, and economic status of the community. In addition, promoting the health literacy and a sense of responsibility individuals for their health and the health of others can increase the success of these innovations

In terms of missions, hospitals are divided into teaching and nonteaching. In addition, differences in health‑care systems in countries will lead to differences in hospitals’ operation. Iran, as a specific health‑care system, is different from other countries. Hence, the present study investigated differences between teaching and nonteaching hospitals and their differences in Iran and the world.

A concurrent mixed‑methods study was conducted in two stages. The first stage was a narrative review of studies (2000–2020). Using narrative inquiry and reflective analysis, the content was analyzed and the categories were extracted. The second stage was a qualitative study conducted using semi‑structured interviews with forty Iranian hospital managers and policymakers through a purposive sampling in 2020. Content analysis was made using deductive approach, and MAXQDA 12 was used for data analysis.

According to the first stage, categories were extracted as follows: service quality, type of cases, patient satisfaction, efficiency, performance indicators, patient safety, personnel, use of drugs, access to services, technologies, justice in the type of services received, using guidelines, processes, and number of services. In the second stage, 8 main categories, 17 categories, and 45 subcategories were extracted. The extracted main categories were as follows: mission and target, management and behavioral organizations, supply chain and chain of results, human resources, costs and budget, policy demands, clients’ satisfaction and patients’ right, and integration of medical education.

Unlike other countries, in Iran, the combination of missions and the complete dependence of teaching hospitals on the government has caused differences. Reducing the treatment mission of teaching hospitals; differences in the budget and development of its indicators; lower tariffs for teaching hospitals; developing a cost–income management model and supply chain; preventing uncertainty other than medical students except medicine; considering the clients’ right to choose hospital; and organizing research missions in hospitals were the solutions for decrease differences.

The performance appraisal system is known as one of the factors affecting employeeschr('39') performance, and organizations are required to consider the components of organizational entrepreneurial orientation toward achieving effective goals and performance. This study aimed to investigate the relationship between performance appraisal and organizational entrepreneurial orientation in selected employees of Health Deputy at Iran University of Medical Sciences.

This descriptive-analytical and sectional study was conducted in 2020. The sample consisted of 102 employees with a score of last yearchr('39')s performance evaluation. The annual performance evaluation score and a standard questionnaire were used to assess the performance of employees and their organizational entrepreneurial orientation, respectively. Data analysis was performed using SPSS statistical software version 25.

The organizational entrepreneurial orientation was reported as moderate. The highest and lowest mean scores were related to the autonomy and competitive aggressiveness dimensions, respectively. Although there was a significant and negative relationship between performance and risk-taking, competitive aggressiveness and innovativeness variables, no significant relationship was found between proactive ness and autonomy variables.

The results showed that there was a significant negative relationship between performance appraisal and the organizational entrepreneurial orientation. It seems that this inverse relationship is due to the lack of necessary conditions for the tendency toward organizational entrepreneurship and also ignoring entrepreneurship in the axes and indicators of employee performance evaluation.

Payment mechanisms are one of the effective tools for achieving optimal results in health system. Pay for performance (P4P) is one of the best programs to enhance the quality of health services through financial incentives. Considering of implementing family physician program in Iran and the P4P system, it is essential to address the challenges of implementing P4P system in the family physician program.

This study aimed to investigate the challenges of implementation of P4P system in family physician program. SETTINGS AND DESIGN: The qualitative study was carried out at areas covered by Iran University of Medical Sciences in Tehran, Iran.

The semi‑structured interview was conducted on 32 key informants in 2019. The sampling method was determined based on purposeful sampling. The topic guide of interviews was experiences in implementing of family physician program and challenges of implementing P4P system. Participants had least 5‑year experience in the family physician program. STATISTICAL ANALYSIS USED: A framework analysis was used to analyze the data using the software MAXQDA 10.

The current study identified 7 themes, 14 subthemes, and 46 items related to the challenges to successful implementation of P4P systems in the family physician program including family physicians’ workload, family physician training, promoting family physician program, paying to the family physician team, assessment and monitoring systems, information management, and the level of authority of family physicians.

The study results demonstrated notable challenges for successful implementation of P4P system which can helpful to managers and policymakers.

Cancer is one of the leading causes of death globally. It changes the patient’s life, and not only causes many physical and emotional symptoms but also reduces the quality of life (QOL) in patients during the advanced stages of cancer. Today, the main approach in taking care of these patients is to provide supportive and palliative care with the aim of enhancing the QOL in patients and their families and to reduce the cost of treatment and health care. This study was conducted with the aim of comparing the policies and the strategies related to cancer supportive and palliative care in the selected countries, using the World Health Organization (WHO) guideline in the United Kingdom (UK), Malaysia, and South Africa.

This study is a comparative study. The data were collected through reviewing scientific and administrative documents, WHO website and reports, the Ministry of health websites, and other authoritative websites. The search was done through texts in English and the databases, including Science Direct, Scopus, and PubMed between 2000 and December 2018. We used a strategy search according to Medical Subject Headings, using the keywords (cancer, palliative care, supportive care, patients, policies, programs, strategies, UK, Malaysia, and South Africa). The data were analyzed by content analysis approach, using MAXQDA software version 11.

The rates of cancer and mortality differed according to the health differences in the selected countries. With regard to palliative care, various policies and programs were implemented. The implementation of more policies was carried out by the Ministry of Health. In some countries, adequate funding was available to support programs. Countries have been trying to provide decent manpower to provide services. Despite the successes achieved in implementing palliative care programs, some factors, such as inadequate healthcare structures and insufficient financial resources have caused problems in implementing programs.

Countries should consider palliative care as one of the important priorities of the health system and a way of enhancing QOL in patients with cancer and their families, and with regard to the context of each country, focusing on each area of practical guide, reviewing the status and available facilities, and learning from the experiences of other countries should be considered to achieve this goal.

Open heart surgery is a prevalent therapeutic intervention for cardiovascular diseases. Significant adverse effects occur after heart surgery, one of which is patient readmission to the hospital. The present study aimed to determine the relationship between performance indicators and the readmission of patients with open heart surgery in a teaching hospital in Iran. This study was performed using a cross-sectional and descriptive method with a retrospective approach. Data was collected on a data collection form. The statistical population of this study comprised all patients who underwent open heart surgery from mid-September 2015 to mid-September 2016 in a teaching hospital in the north of Iran (n=849). Those patients readmitted to the hospital within 90 days after discharge, based on a review of patient records, were included in the study. Descriptive statistics and Spearman correlation coefficient were used for data analysis by SPSS 20. Among the patients who had open heart surgery in the selected hospital, 12.5% were readmitted within 90 days after discharge. The most important reasons for readmission in this study were infection in surgery place (25.8%), pleural effusion (18.7%), warfarin toxicity (9.8%), and tamponade (8.9%). There were inverse relationships between patient readmission and the two performance indicators of bed occupancy percentage (r = -0.594, P = 0.042) and bed turnover rate (r = -0.664, P = 0.018). There were no statistically significant relationships between any of the other indicators (length of stay, mortality, and bed turnover interval) and readmission rate (P > 0.1). Hospital authorities can use these results for bed management and targeting interventions to reduce costs and readmissions as a measure of hospital quality. However, further research into readmission factors in other hospitals is recommended.

Since there is no agreement on the best approach of teachers’ evaluation, this study was conducted to determine medical teachers’ evaluation methods and clarify the viewpoints of Iranian faculty members toward them.
A mix method study was conducted in two phases, systematic review and survey, in Tehran University of Medical Sciences on 400 faculty members. In phase one, 24 studies were analyzed among 1520 and based on that, the viewpoints of faculty members about 14 methods were assessed through a validated questionnaire. Independent t-test and one-way ANOVA were used for data analysis.
The participants’ age mean was 48.62.23 and most of them were assistant professors (121/36.01%). About 280 participants (83.3%) chose “mixed method rating” as the best way of evaluation; 68.7% of the participants though “student rating” cannot be an appropriate indicative for evaluating teachers’ performance. The findings indicated statistical relationships between the average of some evaluation methods (student rating, peer evaluation, self-ratings, teaching scholarship, teaching awards) and the faculty members’ gender (P None of the evaluation methods can be sufficient to show a correct status of teachers’ performance. It is obvious that mix method evaluation as a combination of different measures and methods can be considered as a comprehensive approach; it is recommended to be applied in this university, and then compare teachers’ satisfaction and performance before and after this transition.

Congenital anomalies are considered as main causes of disability and mortality among children in developing and developed countries. Expenditures of hospitalization and treatment procedures for these children impose a large burden on health system and their families. This study aimed to review the prevalence of congenital anomalies among infants in Iran.
The review of studies was conducted through searching databases including IranMedex, SID, Magiran, Scopus, and PubMed. Descriptive and cross-sectional studies investigating on the prevalence of congenital anomalies among infants were included into the study. Hand search for some related journals and websites was done. The list of studie's references was reviewed. The data were analyzed using the CMA 2 software.
Of 455 studies, 27 studies were included into the meta-analysis study. The studies were conducted between 1992 and 2014.The overall prevalence of congenital anomalies among infants was estimated to be 2.3%. The overall prevalence rates, in terms of gender, were estimated to be 3% in boys and 2% in girls. While the highest prevalence rates were related to musculoskeletal anomalies (27.5%), skin anomalies (19.7%) and genitourinary system anomalies (15.8%), the lowest prevalence rate was related to respiratory system (1.82%)
The prevalence of congenital anomalies among infants in Iran is high. In order to reduce the rates of these anomalies and complications resulted from them, coping and preventive strategies such as the necessity of genetic counseling particularly in consanguineous marriages seem to be appropriate solutions.

Economic, physical, and human resources capitals played the most important role in the traditional views of management. However, for development in the current era, social capital is required more than economic, physical, and human capitals. Attitudes and performance of social capital in any organization is one of the important prerequisites for the success in that organization. The aim of this study was to investigate the relationship between psychological capital and organizational citizenship behavior among employees of selected hospitals in Tehran.
This research was an analytical and applied study that was conducted in 2015. Simple stratified random sampling was conducted based on organizational positions (administrative, financial, and para-clinic) among each class to a certain proportion and based on Cochran formula. Data collection tools included two questionnaires of Luthans psychological capital and organizational citizenship behavior of Netmir. Pearson correlation and hierarchical regression tests were used in order to analyze data in the form of Spss18 software at the significant level of 0.05.
Psychological capital and organizational citizenship behavior were desirable among studied hospital staffs. On the other hand, altruism and self-efficacy had the highest mean scores, while chivalry and optimism had the lowest ratings. Hierarchical regression analysis showed that organizational citizenship behavior is able to predict the overall psychological capital (β = 0.285).
Given that citizenship behavior can clearly predict psychological capital in staff, hospital administrators should try to promote organizational citizenship behavior and consequently psychological capital by involving employees in decisions, consult with them, and hold training courses to motivate them.

Prehospital emergency is an important part of the health care system. The prerequisite for providing appropriate services in this sector is existence of the necessary equipment, particularly equipped ambulances that plays an important role in saving the patients’ life who need emergency measures. Given the high incidence of traffic accidents and other emergencies, this study was concluded to investigate current status of medical equipment of prehospital EMS ambulances in Rasht and compare with Iranian standards. In this descriptive-analytical and functional study, 13 active ambulances of emergency medical services were studied in Rasht in 2013. Data were collected and studied due to the checklist of standard medical examination card of ambulances type B MOH (Ministry of Health) and the checklist of 4374 of relief vehicles and equipment of Iranian National Standards Organization. Researchers completed the checklists with reference to emergency medical centers in Rasht and observation of medical equipment and ambulances. Data were analyzed by using descriptive and inferential statistics appropriate. Overall, average medical equipment of EMS ambulances in Rasht was 66.5% and 64.8% respectively that had a significant difference with standards (p<0.05) according to standards of MOH & Iran Standard National organization. In addition, the average equipment regarding both standards was as follows: In the medical and diagnosis groups:80% and 82.4%; equipment of respiration/ventilation: 97%; injection/drugs: 73% and 58.4%; equipment of treatment-critical management: 65.3% and 55.7%; nursing care/ bandage 58.3% and 53.8% that have significant differences with Iran defined standards in all cases (p<0.05). According to the results and both standards, about 84% of ambulances had all equipment related to the airway/ventilation management. According to the results, the best condition of medical equipment of EMS ambulances was related to equipment of airway/ventilation management. There was a significant deficiency in other equipment groups. The deficiencies of medical equipment of ambulances will reduce the efficiency of all the pre-hospital emergency medical services; therefore, it seems essential to reduce deficiencies and to achieve the national standards.

Stewardship and delivery of health services are considered as the most important areas in the healthcare system of the Islamic Republic of Iran in 1404. This study was conducted to investigate the main challenges in medical education stewardship because of its importance in the management and leadership of education from the viewpoint of education process providers. This qualitative research was conducted using thematic and framework analyses to obtain the collective view of faculty members of Medical Sciences Universities in Iran. The data were collected applying deep semi-structured interviews. To increase the acceptability of the study، four criteria of Lincoln and Gupta were used. Codes، categories and themes were extracted by expert researchers of qualitative studies who had no conflict of interests with the topic. Of the 24 faculty members interviewed، 7 were females and 17 were males. They comprised 5 full professors، 8 associate professors، 9 assistant professors and 2 lecturers. The findings of the interviews were categorized in three main lines of stewardship in health system in the form of main and sub themes so that there were 2، 2 and 5 main themes in each line، respectively. Since many of the challenges extracted from the present interviews are considered as essential interventions for achieving the stewardship functions of health system – and، as a result، medical education –، it is important to pay more attention to these challenges and at the same time conduct more complete studies to get more practicable solutions to these problems.

This study was designed to present and compare Iranian hospitals` performance applying ratio analysis technique. This cross-sectional survey was conducted to present an instant image of 139 Iranian hospitals` performance status applying ratio analysis as one of the non parametric technical efficiency assessment methods in 2008. Data was collected using nine dimensional questionnaires supported by world wide web to achieve main hospital ratios. Final analysis was performed applying classic statistics and relevant statistical tests on significant level of 0.05. Four hospital performance indicators were estimated in the studied hospitals as follows: Bed turnover rate (BTR) was fluctuated from 64.5 to 114.8 times for hospitals located in rich and poor areas respectively. Moreover Bed Interval Rate (BIT) was calculated 1.36 versus 2.4 in the poor and rich areas. Average length of stay (ALS) was computed 1.82 for the poor regions but 3.27 for the rich ones furthermore, a positive statistical significant correlation was seen between ALS and the hospital size (P=0.001,r=0.28). Average bed occupancy rate (BOR) was 57.8% and its variation was from 31.4% to 64.5% depending on the hospital size so that there was a positive statistical significant relationship between the hospital size and BOR (P=0.006, r=0.32). Regarding that BOR, ALS, BTR and BIT along with mortality rates are mentioned as the most considerable performance indicators, applying analytic frameworks more than considering single and raw indicators are severely recommended.

According to the importance of manpower in all of the organizations and specially hospitals as the most significant center for healthcare provision and considering those evidences assume higher level of creativity in the organizations can lead to higher stage of effectiveness, productivity and satisfaction. This study is conducted to investigate the effect of multi internal organizational factors on creativity and productivity. This was a cross-sectional descriptive analytic study that was conducted on 123 of Shohadaye Tajrish Hospital`s staffs in 1390 that was selected with systematic accidental sampling. The research instrument was a 76-item questionnaire that its face and content validity were determined by expert view. For determination of construct validity in each aspect of the questionnaire, Spearman co-relation was applied. Furthermore, reliability was confirmed using α Chronbach. Data was analyzed by relevant statistical tests on the significant level of 0.05. Results showed that there was a significant statistical relationship among all the aspects of inter- organizational factors and creativity except challenging work. On the other hand, only three dimensions of superior reward, organization reward and adequate resources had a statistical relationship with productivity. As organizational culture and creativity are presented as two predictor factors for effectiveness and production, it is essential to be institutionalized in the organizations. It is also important for managers to develop a creative culture inside their organizations that can be interacted positively with productivity.

Quality measurement and management has changed to be one of the most important topics in health care today. This study aims to analyze service quality through Importance-performance Analysis tool in selected hospitals. This is an Analytical-descriptive study. Research community was all admitted patients to four hospitals during a specific period، the sample of the study consists of 284 inpatient person selected by stratified random sampling method. The main instrument was a questionnaire consists of two parts «importance» and «performance» with the same items in 8 dimensions. Assigning the scores for each of those service items in a two-dimensional diagram with four cell، each gives special guideline for hospitals. SPSS 17. 0 for windows was employed for the scale measurement. The results of the study indicate that the most important dimensions in patients attribute with 3. 55 mean were for «accountability» and the best performance in patients point of view was for «responsiveness» and «reliability». The key dissatisfier with least importance and performance score was for «service organization» with the mean of 3. 11. In analyzing service quality، reliability، empathy، assurance and accountability dimensions were located in Cell I، service process was located in Cell II، service organization was located in Cell III and finally tangibles and responsiveness dimensions were located in Cell IV. Application of IPA to these data showed that developing service process management system in order to improve process of service delivering is important directions for hospitals to work on.

The main purpose of this project was exactly identification of the applied researches done by different offices of the Iranian Ministry of Health, Remedies and Medical Education in the deputy between September of 1998 to September of 2003, considering their results and the degree of utilization by the users. This project had 4 steps. The 1st step was a questionnaire for identifying some demographic data. Study of research final reports was the 2nd step, gathering special goals and tangible products. In the 3rd one, an interview was made with the researches main users. The last step was to analyze the findings and to emphasize on systematic obstacles with relevant suggestions. For total of 23 researches, about 4’620’350’000 Rials paid. For 16 researches a public announcement have done, the reminders had restrict announces. Among the researchers, 17 were selected by their proposals, but 6 ones just by their Cerculem Vitaes. Only the degrees of 17 researchers were relevant to the research subjects. The sum of all researches done in this period, the utilization capability was “High”, but the utilization indeed was “Low”. About 38% of them were faced with some managerial obstacles and 62% had some kinds of operational ones. According to the results, choosing better subjects, documenting the main goals of the research, selecting the researchers based on their experiences and their proposals, attention to operational agenda, stability of policies, and higher administration commitment are useful suggestions for removing the obstacles.