Examining the Problems and Solutions to Facilitate the Payment and Receipt of Health Taxes.

Background: In addition to creating significant health gains, taxation can be used to increase public health funding. However, achieving the goals of health-related taxes faces many barriers and problems. We aimed to examine the barriers and solutions to facilitate the payment and receipt of health taxes. Methods: The present descriptive and analytical study was conducted in 2021-2022. The first part of the research was the questionnaire's design and validation, and the second part was using the designed questionnaire to collect and analyze data. The validity of the questionnaire was measured using the content validity, and the reliability of the questionnaire was measured using Cronbach's alpha. Then, the questionnaires were distributed in person at the workplace of 430 professors, managers, and experts in economics and health, and the collected data were reviewed and analyzed. Results: Barriers and problems related to structure and infrastructure, evasion, avoidance, and tax exemption, and coordination and cooperation are the most important problems related to health taxes. Moreover, evasion, avoidance and tax exemption, cultural and social issues, and coordination and cooperation are the most important solutions to overcome the problems of health taxes. Conclusion: To dispel the barriers and facilitate the payment and receipt of health-related taxes and achieve the goals of the health sectors, it is very important to deal with tax evasion, build a culture, and close cooperation with related organizations.

Learner satisfaction with synchronous and asynchronous virtual learning systems during the COVID-19 pandemic in Tehran university of medical sciences: a comparative analysis.

BACKGROUND: The need for electronic learning and its systems, especially during specific circumstances and crises, is crucial and fundamental for users in universities. However, what is even more important is the awareness and familiarity of learners with different systems and their appropriate use in e-learning. Therefore, the present study was conducted to determine the satisfaction of learners with synchronous and asynchronous electronic learning systems during the COVID-19 period at Tehran University of Medical Sciences. METHODS: The present study was a descriptive-analytical study conducted cross-sectionally from the first semester of 2019-2020 academic year until the end of the second semester of 2021-2022 academic year, coinciding with the COVID-19 pandemic. The sample size was determined to be 370 students and 650 staff members using the Krejcie and Morgan table. The face validity and reliability of the research tool, which was a researcher-made questionnaire, was confirmed. Considering a response rate of 75%, 280 completed questionnaires were received from students, and 500 completed questionnaires were collected from employees. For data analysis, absolute and relative frequencies, as well as independent t-test, analysis of variance (ANOVA), and Post Hoc tests in the SPSS software were utilized. RESULTS: During the COVID-19 pandemic, both students and staff members at Tehran University of Medical Sciences showed a relatively decreasing level of satisfaction with electronic learning. There was a significant difference in satisfaction between these two groups of learners regarding electronic learning (P = 0/031). Learners were relatively more satisfied with the offline system called "Navid" compared to online learning systems. Among the online systems, the highest level of satisfaction was observed with the Skype platform. CONCLUSION: Although learners expressed relative satisfaction with electronic learning during the COVID-19 period, it is necessary to strengthen infrastructure and provide support services, technical assistance, and continuous updates for electronic learning platforms. This can contribute to more effective and efficient utilization of electronic learning, especially during particular circumstances and crises, or in hybrid models combining online and face to face education and training.

The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study.

BACKGROUND AND AIM: Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system. MATERIALS AND METHODS: This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted. FINDINGS: In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health. CONCLUSION: Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.

Explaining specific taxes management and use in the health sector: a qualitative study.

BACKGROUND AND AIM: Being the major source of revenue and essential economic tool for policymakers to improve public health, taxes contribute to government spending on the development of health care facilities and services. Given the financial challenges facing the health sector together with the public health issues that affect each society, placing specific taxes on some goods, services, and activities can be effective in this regard. The study aims to explain the various dimensions of specific taxes in the health sector and management of these resources in order to achieve the health system goals. MATERIALS AND METHODS: This study with a qualitative research design was conducted using semi-structured interviews with open-ended questions in 2020-2021. In total, 38 managers, policymakers, economists, key experts, and other individuals, as informants, were interviewed. Purposive and snowball with maximum variation was also employed. As well, content analysis was utilized to shed light on the data. The transcribed interviews were further imported into MAXQDA for extracting and classifying the relevant codes. FINDINGS: In this study, 5 main themes and 23 subthemes were labeled. The main themes accordingly included "Objectives and Conditions of Specific Health Taxes", "Earmarked Taxes", "Taxes on Goods and Measures of Harmful to Health", "Value-Added Taxes", and "Green Taxes". DISCUSSION AND CONCLUSION: Considering the specific taxes in the health sector, i.e., taxes on goods and measures of harmful to health, value-added taxes, and green taxes, all taxation and pricing policies need to take account of the effects as well as the advantages and disadvantages of types of taxes, a country's economic structure, the conditions of industries and manufacturing enterprises, cultural aspects in society, and peoples' socioeconomic status.

Expression of miRNA1, miRNA133, miRNA191, and miRNA24, as Good Biomarkers, in Non-Small Cell Lung Cancer Using Real-Time PCR Method.

BACKGROUND: Lung cancer has recently shown the highest incidence among all cancers. microRNAs (miRNAs) are the molecules playing a role in regulating gene expression and contributing to many pathogenic mechanisms. Therefore, these molecules could be used as biomarkers for the detection, anticipation, and treatment of cancer. With this in mind, we decided to investigate and compare the expression of miR-1, miR-133, miR-191, and miR-24 and also the expression differences in these four RNA molecules between lung cancer patients and the controls. METHODS: A total of 50 patients with lung cancer participated in this study. In addition, 50 healthy blood samples were selected as the control group. Real-time PCR determined the expression levels of miRNA. The RNAs extracted from the patients' white blood cells were initially synthesized, and then cDNA was extracted. Finally, the synthesized cDNA was amplified using real-time PCR, and its expression was compared with the control group. RESULTS: The result indicated a low expression level of miR-1 and miR-133, and a high expression level of miR-191 and miR-24 in the blood of patients with lung cancer compared to the healthy subjects. CONCLUSION: Our findings revealed that miR-1, miR-133, miR-191, and miR-24 are oncogenes, and their expression could result in cancer. It appears that a therapy to overexpress miR-1 and miR-133 and downexpress miR-191 and miR-24 could contribute to the treatment of lung cancer.

Developing an Evaluation Model for Maternity Care: A Mixed-Method Study from Iran.

BACKGROUND: Maternity care is an integral part of primary health care (PHC) systems worldwide. This study aimed to develop a new model for evaluating the maternity health program (MHP) in Iran. METHODS: In this mixed-methods study, first, the challenges of MHP were surveyed through systematic review and expert interviews. Next, to identify the existing shortcomings in MHP evaluation system, the SWOT technique, cross-sectional study and comparative analyses were used. Finally, the Delphi technique was used to reach consensus on developed evaluation standards. RESULTS: The final developed evaluation model contains five dimensions including reproductive health/family planning, maternity health, health records, evaluation, and resources management. Overall, this model has 32 standards and 289 measures. The scores obtained for the sum of the measures in two importance and applicability criteria were 8.24 and 7.85, which these scores are estimated to be equal to 91.55 and 87.22 percent of the highest possible scores, respectively. CONCLUSION: Considering the comprehensiveness of the obtained model, it is hoped that it could lead to performance improvement of the PHC centers in the area of maternity health.

A phenomenological study on barriers of adherence to medical advice among type 2 diabetic patients.

BACKGROUND: More than three decades of research and study for overcoming the problem of "non-acceptance/non-compliance" of patients has neither resolved nor reduced the severity of this problem. This phenomenological study aimed to identify barriers of adherence to medical advice among type 2 diabetic patients. METHODS: This study was a qualitative research using phenomenology approach, and the data were analyzed using content analysis approach. Participants were 69 type 2 diabetic patients covered by the diabetes unit of West and East Community Health Centers of Ahvaz, Iran. The views and attitudes of patients about the barriers of adherence to medical advice were elicited by conducting 20-45 min sessions of semi-structured interviews. Data analysis was performed following Colaizzi's seven-step method. RESULTS: Barriers of adherence to medical advice were classified into systemic and individual barriers. Individual barriers included 11 codes and 5 categories, and systemic barriers contained within 5 codes and 3 categories. Physiologic and physical factors, financial problems, occupational factors, attitudinal problems and lack of knowledge, and social and family problems were identified as individual barriers. Systemic barriers included inadequate publicizing and limited notification, inadequate equipment and facilities, and poor inter-sectional coordination. CONCLUSIONS: Generally, problems stated by diabetic patients at the individual level can partly be solved by training patients and the people around them. However, as for the systemic problems, it seems that solving the barriers of adherence to medical advice requires coordination with other organizations as well as intersection coordination. Overall, these problems require not only comprehensive health service efforts, but also the support of policymakers to resolve barriers at infrastructure level.

Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project.

BACKGROUND: SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran. METHODS: This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method. RESULTS: We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context. CONCLUSION: To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

Barriers to reporting clinical errors in operating theatres and intensive care units of a university hospital: a qualitative study.

BACKGROUND: Clinical errors are one of the challenges of health care in different countries, and obtaining accurate statistics regarding clinical errors in most countries is a difficult process which varies from one study to another. The current study was conducted to identify barriers to reporting clinical errors in the operating theatre and the intensive care unit of a university hospital. METHODS: This qualitative study was conducted in the operating theatre and intensive care unit of a university hospital. Data collection was conducted through semi-structured interviews with health care staff, senior doctors, and surgical assistants. Data analysis was carried out through listening to the recorded interviews and developing transcripts of the interviews. Meaning units were identified and codified based on the type of discussion. Then, codes which had a common concept were grouped under one category. Finally, the codes and designated categories were analysed, discussed and confirmed by a panel of four experts of qualitative content analysis, and the main existing problems were identified and derived. RESULTS: Barriers to reporting clinical errors were extracted in two themes: individual problems and organizational problems. Individual problems included 4 categories and 12 codes and organizational problems included 6 categories and 17 codes. The results showed that in the majority of cases, nurses expressed their desire to change the current prevailing attitudes in the workplace while doctors expected the officials to implement reform policies regarding clinical errors in university hospitals. CONCLUSION: In order to alleviate the barriers to reporting clinical errors, both individual and organizational problems should be addressed and resolved. At an individual level, training nursing and medical teams on error recognition is recommended. In order to solve organizational problems, on the other hand, the process of reporting clinical errors should be improved as far as the nursing team is concerned, but when it comes to the medical team, addressing legal loopholes should be given full consideration.

Organizational behaviour management in clinical laboratory: A literature review.

BACKGROUND: The clinical laboratories require organizational behavior management approach that creates a balance between directors' expectations and staffs' needs in this field. This study was aimed to explain the role of organizational behavior management in clinical laboratories and suggest mechanisms for its implementation in these organizations. MATERIALS AND METHODS: In this research, using several Persian and English databases by keywords consist of the clinical laboratory, organizational behavior management, and staff diversity. Three hundred and fifty four references from 1990 to 2020 were studied, and 72 references, including abstracts and full papers utilized for this research, and excluded papers presented at conferences, seminars, and dissertations. Using MESH strategy and Pico's instruction. RESULTS: The results of studies revealed staffs' individual differences in all aspects, including early and secondary dimensions may influenced the style of leadership implemented in clinical laboratories, "job-personality compatibility theory," job satisfaction and job commitment of staffs work in clinical laboratories and the way the directors and managers can develop the job loyalty and improve the organizational productivity in these organizations. CONCLUSION: It is suggested a conceptual model for understanding and assessing the different organizational behaviors of clinical laboratories staffs based on communication skills, staffs' interaction, and socio-political, economic, and cultural elements, which should be more developed in future using the other similar studies.

The relationship between managers' ideal intelligence as a hybrid model and employees' organizational commitment: a case study in Tehran University of Medical Sciences.

High ideal hybrid intelligence of managers is among the factors that can improve employees' organizational commitment. Therefore, this study aimed to determine the relationship between managers' ideal hybrid intelligence and employees' organizational commitment in the Vice Chancellors' Headquarters of Tehran University of Medical Sciences. This was a descriptive-analytical and cross-sectional study conducted in 2017 - 2018. The research sample size consisted of 86 senior and middle-level managers selected through census method, as well as 181 employees, selected using the Kerjecie and Morgan table. The research tool was an ideal hybrid intelligence questionnaire consisting of 102 questions on cultural, moral and spiritual intelligence, and also Meyer and Allens' organizational commitment questionnaire including 24 questions. Face validity and reliability of each questionnaire were confirmed by an expert panel and Chronbach's alpha method. The data were analyzed by SPSS software, and descriptive results were shown through mean and standard deviation, and analytical results by inferential tests. The results showed that the ideal hybrid intelligence of the Vice Chancellors' Headquarters managers and employees' organizational commitment were at a desirable level. Also, there was a significant correlation between cultural, moral and spiritual intelligence as constituents of the ideal hybrid intelligence of managers and employees' organizational commitment. We found that ideal hybrid intelligence may affect employees' organizational commitment, but it should be mentioned that other forms of intelligence may also affect organizational commitment.

Design and Psychometrics of the Assessment Instrument for Innovation Capabilities of Medical Sciences Universities Using the Cube Model Approach.

BACKGROUND: To investigate any subject, a scholar needs a suitable instrument to collect the required information with the utmost accuracy and the least amount of error. Therefore, this study aimed at designing and conducting a psychometric analysis of an assessment instrument for innovation capabilities of Medical Sciences Universities using the Cube Model Approach. METHODS: This study began by searching in questionnaires in the fields of input and process, considering innovation outcomes. Accordingly, a preliminary questionnaire was developed, and in the second stage, to determine the validity of the designed instrument, the face validity, content validity, and construct validity of the instrument were approved, and in the third stage, using Cronbach's alpha, its reliability was assessed. At first 200 phrases were obtained, finally, 25 questions were initially approved in three areas of structure (input), innovation processes, and output. All the phrases were retained in the face validity and content validity carried out quantitatively and qualitatively. RESULTS: Exploratory Factor Analysis was performed on 25 items, and finally the terms were set in six factors. These factors explained 53.19% of the total variance. The rotated factor loading for all questions was obtained more than 0.3, and therefore, no questions were eliminated. Calculation of the Cronbach's alpha coefficient confirmed the high internal consistency of the questionnaire (0.762). CONCLUSION: This instrument was designed for the first time in the context of Iranian academic culture and seems to be a suitable instrument for the assessment of innovation capabilities, considering its adequate validity and reliability, simplicity, and practicality.

The Health Sector Evolution Plan and the Technical Efficiency of Public Hospitals in Iran.

BACKGROUND: Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of public hospitals during before and after the implementation of Health Sector Evolution Plan (HSEP) and to determine whether, and how, efficiency is affected by various factors. METHODS: Forty-two public hospitals were selected in Tehran, Iran, from 2012 to 2016. Data envelopment analysis was employed to estimate the technical and scale efficiency sample hospitals. Tobit regression was used to relate the technical efficiency scores to seven explanatory variables in 2016, the last year. RESULTS: Overall, 24 (57.1%), 26 (61.9%), 26 (61.9%), 24 (57.1%) and 21 (50%) of the 42 sample hospitals ran inefficiently in 2012 to 2016, with average technical efficiency of 0.859, 0.836, 0.845, 0.905 and 0.934, respectively. The average pure technical efficiency in sample hospitals increased from 0.860 in 2010 (before the HSEP) to 0.944 in 2012 (after the HSEP). Tobit regression showed that average length of stay had a negative impact on technical efficiency of hospitals. In addition, bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency. CONCLUSION: Despite government support, public hospitals operated relatively inefficien. Managers can enhance technical efficiency by increasing bed occupancy rate through shortening the average length of stay, proportioning the number of doctors, nurses, and beds along with service quality assurance.

Three Markers in Cancerous and Healthy Cells of Patients with Non-Small-Cell Lung Carcinoma (NSCLC).

Introduction: Lung cancer is the most common cause of cancer-related death among males and females. The diagnosis of lung cancer is of great importance for clinical considerations and follow-up treatment. This study aimed to examine the expression of CEA, LUNX, and CK19 biomarkers in the cancerous and healthy tissues of patients suffering from NSCLC. Methods: In this study, 30 patients with NSCLCs referring to Masih Daneshvari Hospital in Tehran were voluntarily selected prior to taking any treatment. A tissue sample from the center and a sample of healthy tissues close to the cancerous masses were prepared by a specialist in the bronchoscopy sector and tested using real-time RT-PCR. Results: Positive CEA mRNA was observed in cancerous tissues in the center of tumors of 25 out of 30 cases. In the healthy tissue group, the same was found in 10 out of 30 cases (P<0.001). The markers CK19 and LUNX mRNAs showed to be positive in cancerous samples in the center of tumors of 15 and 22 out of 30 cases, and in the healthy tissue group, the expression was observed in 5 and 4 out of 30 cases, respectively(P<0.001). Conclusion: This study confirms that the aformentioed markers are the ones with a relatively appropriate sensitivity and specificity for the diagnosis of lung cancer.

Family Medicine Program in Iran: SWOT Analysis and TOWS Matrix Model.

BACKGROUND: We aimed to determine strength, weakness, opportunities and threats analysis and intended to present strengths, weaknesses, opportunities and threats matrix model for appropriate implementation of Family medicine program in Iran. METHODS: This was a descriptive-analytical and cross-sectional study. All attending physicians in 30 health care centers of Tehran University of Medical Sciences, Tehran, Iran were asked to present and prioritized their views about strengths, weaknesses, opportunities, and threats factors of family medicine program in Iran in 2015. Then, the prioritization of these factors was showed by weighted score of each factor. Finally, the respondents determined four groups of TOWS model including SO, ST, WO, and WT strategy for development of family medicine in Iran. RESULTS: Totally, the respondents expressed 44 factors as strengths, weaknesses, opportunities, and threats of family medicine program and prioritized these factors and suggested 30 TOWS matrix strategy for efficient implementation of this program. CONCLUSION: There were many internal and external factors that impress the implementation of family medicine program. There is a gap between the ideal and the current situation of this program. We suggest the health care system policy makers notice the TOWS matrix strategies determined for improvement of family medicine program in Iran.

Evaluation of service quality from patients' viewpoint.

BACKGROUND: Measuring patients' perception from health service quality as an important element in the assessment of service quality has attracted much attention in recent years. Therefore, this study was conducted to find out how the patients evaluated service quality of clinics at teaching hospitals affiliated with Tehran University of Medical Sciences in Iran. METHODS: This cross-sectional study was conducted in Tehran in 2017 and 400 patients were randomly selected from four hospitals. Data were collected using a questionnaire, the validity and reliability of which were confirmed in previous study. In order to analyze the data, T-test, ANOVA, and Pearson correlation coefficient were calculated using SPSS 23. RESULTS: The results indicated that among eight dimensions of health service quality, the patients were more satisfied with physician consultation, services costs and admission process. The highest and lowest mean scores were related to physician consultation (Mean = 4.17), and waiting time (Mean = 2.64), in that order. The total mean score of service quality was 3.73 (± 0.51) out of 5. Outpatient services were assessed as good, moderate and weak by 57.5, 40 and 2.5% of the patients, respectively. There was a significant relationship between the positive perception of service quality and reason for admission, source of recommendation, gender, education level, health status, and waiting time in the clinics (p <  0.05). CONCLUSION: The majority of the patients had a positive experience with visiting clinics and perceived service provision as good. In fact, patients' perceptions of physician consultation, provision of information to patients and the environment of delivering services, are the most important determinants of service quality in clinics.

Design a Fuzzy Rule-based Expert System to Aid Earlier Diagnosis of Gastric Cancer.

INTRODUCTION: Screening and health check-up programs are most important sanitary priorities, that should be undertaken to control dangerous diseases such as gastric cancer that affected by different factors. More than 50% of gastric cancer diagnoses are made during the advanced stage. Currently, there is no systematic approach for early diagnosis of gastric cancer. OBJECTIVE: to develop a fuzzy expert system that can identify gastric cancer risk levels in individuals. METHODS: This system was implemented in MATLAB software, Mamdani inference technique applied to simulate reasoning of experts in the field, a total of 67 fuzzy rules extracted as a rule-base based on medical expert's opinion. RESULTS: 50 case scenarios were used to evaluate the system, the information of case reports is given to the system to find risk level of each case report then obtained results were compared with expert's diagnosis. Results revealed that sensitivity was 92.1% and the specificity was 83.1%. CONCLUSIONS: The results show that is possible to develop a system that can identify High risk individuals for gastric cancer. The system can lead to earlier diagnosis, this may facilitate early treatment and reduce gastric cancer mortality rate.

Assessment of High Reliability Organizations Model in Farabi Eye Hospital, Tehran, Iran.

BACKGROUND: A high-reliability organization (HRO) is a separate paradigm can indicate medical error reduction and patient safety improvement. Hospitals, as vital organizations in the health care system, can transform to HROs to achieve optimal performance and maximum safety in order to manage unpredicted events efficiently. Therefore, the aim of this research was to determine the knowledge of managers and staffs of Farabi Eye Hospital, Tehran, Iran about HROs model, and the extent of HROs establishment in this hospital in 2015-2016. METHODS: In this descriptive-analytical and cross-sectional study, data were collected through HROs questionnaire and checklist. Validity of questionnaire and checklist was confirmed by expert panel, and the questionnaire reliability by Alpha-Cronbach method with 0.85. The collected data were analyzed with Spearman's correlation coefficient and Mann-Whitney test using the SPSS software version 19. RESULTS: Most of the respondents were familiar with HROs model to some extent and only 18.8% had a high level of knowledge in this regard. In addition, there was no significant correlation between the knowledge of staffs and managers with establishment of HROs model in Farabi eye hospital. CONCLUSION: Managers and staffs of Farabi Eye Hospital did not have a high knowledge level of the model of HROs and had little information about the functions and characteristics of these organizations. Therefore, we suggest HROs training courses and workshops should be established in this hospital to increase the knowledge of the managers and staffs for better establishment of HROs model.

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.

Technical Efficiency of Hospitals in Tehran, Iran.

BACKGROUND: Nowadays, restriction on access and optimum use of resources is the main challenge of development in all organizations. Therefore, the aim of this study was to determine the technical efficiency and its factors, influencing hospitals of Tehran. METHODS: This research was a descriptive-analytical and retrospective study conducted in 2014-2015. Fifty two hospitals with public, private, and social security ownership type were selected for this study. The required data was collected by a researcher-made check list in 3 sections of background data, inputs and outputs. The data was analyzed by DEAP 1.0.2, and STATA-13 technique. RESULTS: Seventeen (31/48) of hospitals had the efficiency score of 1 as the highest technical efficiency. The highest average score of efficiency was related to social security hospitals as 84.32, and then the public and private hospitals with the average of 84.29 and 79.64 respectively. Tobit regression results showed that the size, type of practice, and ownership of hospitals were effective on the degree of their technical efficiency. However, there was no significant correlation between teaching / non-teaching hospitals with technical efficiency. CONCLUSION: Establishment of competition system among hospitals, constitution of medium size hospitals and allocation of budget to hospitals based on national accreditation system are recommended.