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BACKGROUND: Nurses, as the largest working group in the hospital, experience many problems, conflicts, and stressors in the workplace and family especially after the widespread distribution of coronavirus 2019 (COVID-19). OBJECTIVE: The perceived conflict and burnout among nurses, as well as the correlation between these two variables and the associated factors, were the main subjects of this study. METHODS: This cross-sectional study involved 256 nurses from three COVID-19 referral hospitals in northwest Iran. Participants completed demographic, work-family conflict (WFC), and burnout questionnaires. The nonparametric tests including Mann-Whitney U, Kruskal-Wallis, and Spearman correlation coefficient were applied to statistical analysis. RESULTS: The overall score of conflict was 55.3 (12.7). The time dimension received the highest score 11.4 (2.9). In terms of intensity 27.6 (8.7) and frequency 27.6(8.8), nurses had the most burnout in the lack of personal accomplishment dimension. All aspects of WFC, emotional exhaustion, and depersonalization characteristics of burnout had statistically significant positive correlations (p < 0.01). The ward, hospital and employment status variables were associated with WFC (p < 0.05). The association between taking the crisis management course and the severity of depersonalization, and the frequency of lack of personal accomplishment was confirmed (p < 0.01). Additionally, the frequency and severity of emotional exhaustion were associated with employment status and work experiences (p < 0.05). CONCLUSION: The findings showed that nurses had WFC and burnout rates that were above average. Regarding the negative effects of these two phenomena on health, and also nurse's clinical practices, rearranging work conditions and providing better organizational support seem necessary.

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BACKGROUND: Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures. METHODS: This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts' perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center. RESULTS: A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts' views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction. CONCLUSION: Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.

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This article describes the characteristics of the health system and reviews the history of health technology assessment (HTA) in Iran, including its inception, processes, challenges, and lessons learned. This study was conducted by analyzing existing documents, reports, and guidelines related to HTA and published articles in the field. HTA in Iran has been established since the late 2000s and was first introduced as a secretariat by the Deputy of Health at the Ministry of Health and Medical Education. The mission of the HTA office is to systematically assess technologies to improve evidence-informed decision making. Despite its 10 years of existence, HTA in Iran still faces some challenges. The most pressing problems currently facing HTA in Iran include conflicts of interest among researchers performing the HTAs, the absence of a systematic structure for identifying and introducing new technologies, the lack of interest in HTA results among high-level policy makers, and the lack of external oversight for HTA projects.

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Background: Nursing can be demanding and stressful with occupational stress posing a serious threat to nurses and patient outcomes. Aims/Objectives: To determine the prevalence of nurses' occupational stress and its associated risk factors. Design: Cross-sectional survey design. Methods: Nurses in 115 tertiary-level hospitals in 13 provinces in Iran were surveyed from August 2016-December 2017. Demographic information and occupational stress were assessed. 5422 distributed questionnaires were distributed with 2895 of returned surveys analyzed. One-way ANOVA and multiple linear regression analyses identified risk factors for occupational stress. Results: Mean score for overall occupational stress was 3.48 indicating a stress level between moderate and high, with 78.4% of respondents reporting that their job was stressful. Nurses reported issues with shiftwork, staffing, pay, workplace discrimination, management, policy and excessive workloads as sources of occupational stress. Risk factors in the multivariate analysis for higher occupational stress were female gender (p = .002), being married (p = .008), having lower educational levels (p < .001), increased work hours (p <.001), and working in emergency (p = .025), general wards (p = .012) and teaching hospitals (p < .001). Conclusions: The high prevalence of occupational stress amongst nurses in Iran demonstrates the extent of the issue, with recent reforms not effectively addressing occupational stress. The risk factors identified allow for more targeted interventions.

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BACKGROUND: Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. METHODS: A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76%, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 "strongly disagree" to 5 "strongly agree". In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. RESULTS: The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. CONCLUSIONS: The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits.

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Outsourcing is used as a strategy to improve efficiency, quality, and satisfaction of beneficiaries in hospitals. This study aimed to determine the reasons for outsourcing, outsourced services, achieved objectives, and outsourcing challenges. This qualitative study was conducted through 58 face-to-face semi-structured interviews with chief executive officers (CEOs), chief financial officers (CFOs), and contracting experts (CEs) in 42 public hospitals in Tehran, Iran. Purposive and snowball sampling techniques were used. Interviews were recorded digitally and transcribed verbatim. Data analysis was performed based on an inductive-deductive approach via MAXQDA-10. The Participants included 26 CEOs, 15 CFOs, and 17 CEs. The most important reasons for outsourcing were divided into four main categories including financial resources and funding, customers, management, and factors related to the hospitals. Accessing to up-to-date knowledge and technology, improving service quality and accountability, focusing on strategic points, reducing workload, and increasing patient satisfaction turned out to be the positive outcomes of outsourcing. Weakness in laws and regulations, monitoring and assessment of an outsourced unit, creating dependency and changing organizational culture, as well as human resource issues were introduced as the main pitfalls and challenges of outsourcing. Based on the results, it was suggested that the hospital managers must attempt to outsource services by realistic analysis of the organization's current status. They should specify the reasons and objectives of outsourcing and make decisions based on outsourcing potentials. By taking the current challenges of outsourcing in Iranian hospitals into account, the authorities can make the most efficient decisions with regard to outsourcing.

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Purpose The WHO Surgical Safety Checklist (SSC) has improved patient safety effectively. Despite the known benefits of applying the checklist before surgery, its implementation is less than universal in practice. The purpose of this paper is to determine the operating room personnel's attitude, their awareness and knowledge of the SSC, and to evaluate staff acceptance of the SSC (including personal beliefs). Design/methodology/approach This cross-sectional study was conducted in eight tertiary general hospitals in Tehran, Iran. Some 145 operating room personnel (surgeons, anaesthetists and nurses) were selected for the study. Data collection was carried out via a validated questionnaire in three parts which included socio-demographic, attitude, awareness and acceptance. Data were then analysed using the Kruskal-Wallis and χ2 statistical test. Findings Out of the 145 participants in the study, 92 per cent were aware of the existence of the SSC and 73.9 per cent of them were aware of the objectives of SSC. Overall, the attitude to SSC was positive. The attitude of surgeons was positive towards the impact of the SSC on safety and teamwork. Surgeons were significantly more sensitive to the barriers of SSC application compared to nurses and anaesthetists ( p=0.046). Among the three groups, nurses had the highest level of support for SSC ( p=0.001). Practical implications Despite high acceptance of the checklist among staff, there is still a gap in knowledge about when exactly the checklist should be used. Therefore, involvement of all surgical team members to complete the checklist process, support of senior managers, on-going education and training and consideration of the barriers to its implementation are all key areas that need to be taken into account. Originality/value This is the first research to examine the operating room personnel's attitude, awareness and acceptance about SSC in Iranian hospitals. The outcomes of this study provide documentation and possible justification for effective establishment of SSC in Iran and other countries.

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BACKGROUND: Health science and technology today is a rapidly growing field. Health is a multifaceted concept influenced by several factors, and health literacy is essential to deal properly with the current situation. In this study, the association between health literacy and sexual function and sexual satisfaction were investigated in 2016. MATERIALS AND METHODS: This descriptive and correlational study was conducted on 193 couples in the Royan Institute, Tehran. Data collection instruments were three standard questionnaires which included the Test of Functional Health Literacy, the Female Sexual Function Index (FSFI) and the International Index of Erectile Function, and the Iranian version of the Sexual Satisfaction Scale. The data were analyzed using SPSS-v23 software at a significance level of 0.05. RESULTS: Marginal health literacy, 49.7% among men and 44.1% among women, was more common than adequate or inadequate health literacy. Erectile function for the majority of men was appropriate (53.3%), compared to 16.6% who had perfect function and 30.1% for whom function was less than appropriate. The majority of women (57.0%) had sexual dysfunction. One hundred and three (53.3%) men had appropriate sexual function and 57% of women had normal sexual function. The greater proportion of men (50.8%) and women (46.1%) had good, rather than very good or less than good, sexual satisfaction. The results of chi-square tests indicated that greater health literacy was associated with higher levels of sexual function and sexual satisfaction among men and women. However, application of the Cramer's V test indicates that the strength of these associations is moderate to weak. CONCLUSION: Health literacy was marginal among most couples and its adverse impacts on sexual function and sexual satisfaction were confirmed. Accordingly, it is recommended that plans be developed to promote health literacy among infertile couples.

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OBJECTIVE: Hospital emergency management is a continuous process that requires monolithic integration of planning and response attempts with local and national schemes. The aim of the current study is to evaluate emergency response by hospitals against potential disasters in Tabriz, north-west Iran. METHODS: A cross-sectional study was conducted in the city of Tabriz, in Iran, in 2016. The study population included all hospitals in Tabriz. A total of 18 hospitals were assessed. The hospital emergency response checklist was used to collect data. Tool components included command and control, communication, safety and security, triage, surge capacity, continuity of essential services, human resources, logistics and supply management, and post-disaster recovery. Data entry and analysis were carried out using SPSS software (version 20). RESULTS: The results showed that the emergency response rate of hospitals was 54.26% in Tabriz. The lowest response rates were for Shafaa hospital (18.89%) and the highest response rates were for Razi Hospital (91.67%). The components of hospital emergency response were assessed to be between 48.07% (surge capacity) and 58.95% (communication). CONCLUSION: On the basis of the World Health Organization checklist, the emergency response rate for hospitals in Tabriz was only 54.26%. Therefore, hospital emergency responses against disasters have to be improved and must be made to reach 100%. It is essential to design a comprehensive framework for hospital emergency response. (Disaster Med Public Health Preparedness. 2018;12:166-171).

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BACKGROUND AND AIM: DAMA is a result of patient dissatisfaction, which increases the rate of readmission, mortality, and complications. In this study, the causes and predictors of DAMA in Shahid Labbafinejad Hospital of Tehran were determined. METHODS: The descriptive and analytical study was conducted in 2016 from the information of 1,168 hospitalized patients in the period of 2015 and the first half of 2016. Patients' information was collected using checklists and through clinical records, nursing unit reports, and telephone calls. The collected data were analyzed using SPSS-v18 software and by employing chi-square test and logistic regression modeling. RESULTS: The DAMA rate was estimated at 3.27%. Among the causes of DAMA, the high rates were related to personal problems (39.04%) and going to other centers (34.93%), and the lowest level was related to dissatisfaction with the physician (3.08%). Age groups (19-37, OR=2.17), (38-56 years, OR=1.70), and (57-75, OR=1.62), gender (male, OR=1.47), locations (Tehran city, OR=0.61) and (Tehran Province, OR=0.63) were predictors of DAMA (p<0.05). CONCLUSIONS: The importance of DAMA requires practical measures such as creating a suitable environment for patients, providing consulting services for youth, improving staff relations, providing assistance for patients in need, and removing accommodation problems of patients and their companions to reduce the DAMA.

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BACKGROUND: Despite advances in science and technology, human resources are of the major capital for organizations. Workforce retention is required to improve organizational efficiencies. OBJECTIVE: Therefore, in this study, the relationship between organizational justice (as one of the most influential factors) and turnover intention was investigated. METHODS: This descriptive-analytic study was done in the Comprehensive Jame Women's Hospital of Tehran in 2015. The statistical sample consisted of 135 nursing staff members. The data were collected using a questionnaire of Beugre's organizational justice and analyzed by the use of Spearman's and Anova statistical tests. RESULTS: Averages of organizational justice was obtained to be 68.85 ± 7.67 . Among different sorts of organizational justice, the highest average score of 75.24 ± 16.68 was achieved relevant to interactional justice. A significant relationship was observed between organizational justice (r = -0.36), interactional justice (r = -0.38), and procedural justice (r = -0.36) and turnover intention, but no relation was found between turnover intention and systemic and distributive justice. Furthermore, there was no relationship between demographic variables, organizational justice, and turnover intention. CONCLUSION: Considering the prominent role of organizational justice in the personnel's intention to stay or leave and due to the high costs of recruiting and training new staff, managers should pay especial attention to justice and provide their employees' satisfaction and stability in their organizations by creating a positive mindset in them.

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BACKGROUND: Restrictions on resource accessibility and its optimal application is the main challenge in organizations nowadays. The aim of this research was to study the technical efficiency and its related factors in Tehran general hospitals. MATERIALS AND METHODS: This descriptive analytical study was conducted retrospectively in 2014. Fifty-four hospitals with private, university, and social security ownerships from the total 110 general hospitals were randomly selected for inclusion into this study on the basis of the share of ownership. Data were collected using a checklist with three sections, including background variables, inputs, and outputs. RESULTS: Seventeen (31.48%) hospitals had an efficiency score of 1 (highest efficiency score). The highest average efficiency score was in social security hospitals (84.32). Private and university hospitals ranked next with an average of 84.29 and 79.64, respectively. Analytical results showed that there was a significant relationship between hospital ownership, hospital type in terms of duty and specialization, educational field of the chief executive officer, and technical efficiency. There was no significant relationship between education level of hospital manager and technical efficiency. CONCLUSION AND RECOMMENDATIONS: Most of the studied hospitals were operating at low efficiency. Therefore, policymakers should plan to improve the hospital operations and promote hospitals to an optimal level of efficiency.

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INTRODUCTION: The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients. MATERIALS AND METHODS: The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures. RESULTS: A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P < .001). The overall risk of graft loss was lower with 1.5 mg/d of everolimus (RR, 0.76; 0.95% CI, 0.59 to 0.99; P = .04, I2 = 25.0%). There was no relationship between the rates of efficacy failure, biopsy-proven acute rejection, death, or loss to follow up outcomes in all the three time follow-up times between the two doses of everolimus. CONCLUSIONS: The result of this systematic review and meta-analysis showed that the overall outcomes of adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications.

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BACKGROUND: Today, the concept of organizational learning has attracted the attention of many managers and researchers in scientific and research circles as well as those in the organization-related studies. Taking the organizational learning into account might offer a means of organizational effectiveness that has gone unnoticed. Thus the present study aimed at investigating the relationship between the organizational learning in each of its four aspects as independent variables and organizational citizen behavior of the staff as constituting the dependent variable of the study. METHODS: This was a descriptive-analytical study with a practical approach conducted in 2010. The sample included 167 staff members working in educational health centers affiliated with Qazvin University of Medical Sciences. The data were collected via both the organizational learning questionnaire and organizational citizen behavior questionnaire and analyzed by using SPSS software and Spearman test. RESULTS: The results indicated that the mean of organizational learning indicator was 2.9±0.648 and that of organizational citizen behavior 3.78±0.413. In addition, the spearman correlation coefficient ranging from 0.058 to 0.129 between the elements of the organizational learning and the organizational citizen behavior was not statistically significant (p>0.05). The findings also indicated that the correlation between them was average among the staff of Shahid Raja'ee Educational health center (0.319), thus the relationship between the two sets of variables proved significant (p=0.031). However, the same was not true in other centers. CONCLUSION: It was concluded that management commitment, open space, transfer of knowledge, and systemic vision could all enhance the level of organizational learning in hospitals which calls for focus on the elements of organizational citizen behavior.

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BACKGROUND: One of the most important indexes of the health care quality is patient's satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. METHODS: This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. RESULTS: Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. CONCLUSION: by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time.

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