Identifying factors affecting the selection of heads of city health centers in Iran: A phenomenological study.

INTRODUCTION: Managers in the health care sector have the responsibility of accomplishing objectives and guaranteeing the excellence of services. To be chosen as a manager in a health organization, individuals must possess specific qualities and skills. Examining the process of selecting and appointing managers at the highest level of service provision might offer policymakers valuable insights into the importance of considering competences when choosing and appointing leaders of health centers. Hence, this study was conducted to identify the characteristics that influence the selection process of heads of city health centers in Iran. METHODS: The present study employed a qualitative and phenomenological approach, utilizing interviews performed in the year 2023. The study sample consisted of health deputy from medical sciences universities, local health network managers, and heads of city health center. The participants were selected using a purposive selection method. A total of 16 male participants were interviewed, and the interviews were then analyzed using MAXQDA-10 software using the usual content analysis method. RESULTS: In this study, the factors affecting the selection of the heads of health care centers were classified into two general topics: individual factors and environmental factors, and eight sub-topics, including health literacy, experience, individual characteristics, communication skills, mental characteristics, legal issues, political factors, and cultural factors. CONCLUSION: The development of health literacy, specialized knowledge, and communication skills to coordinate and resolve organizational problems helps train competent managers. Top health system managers, who select health center managers, must understand political and cultural variables and regulate and steer their influence to select effective managers.

What may encourage or deter health services utilization by people living with or at the risk of HIV/AIDS in special health centers? Qualitative evidence from a stigmatized community.

BACKGROUND: Behavioral Diseases Counseling Centers (BDCCs) and Vulnerable Women's Counseling Centers (VWCCs) in Iran are the main peripheral centers that offer educational, counseling, diagnostic, preventive, curative and protective services to individuals living with or at high risk of contracting HIV/AIDS and female sex workers respectively. Due to the social stigma surrounding HIV in Iran, this study aims to identify the factors that may hinder or encourage HIV/AIDS patients and women with risky sexual behaviors from visiting these centers. METHODS: Conducted in 2023, this qualitative study involved individuals visiting BDCCs and VWCCs in two western provinces of Iran, Ilam and Kermanshah. The study participants included 21 health staff members working in BDCCs and VWCCs and 20 HIV/AIDS patients and vulnerable women with unsafe sexual behaviors referring to these centers. Purposive, snowball and maximum variation sampling techniques were applied to interview the participants. Interviews were conducted between January 5th and May 21st, 2023, using a semi-structure guideline. Interviews were transcribed and content analysis approach was applied to analyze data using MAXQDA20 software. RESULTS: According to the findings, the barriers and facilitators of visiting specialized centers for HIV/AIDS patients and vulnerable women were categorized into three main categories, 10 subcategories and 35 sub-subcategories including: Medical and operational processes (4 subcategories and 12 sub-subcategories), mutual interactions between the personnel and visitors (people living with and at the risk of getting HIV/AIDS) (3 subcategory and 13 sub-subcategories), and physical characteristics of the centers (3 subcategories and 10 sub-subcategories). CONCLUSIONS: To improve the performance of BDCCs and VWCCs and encourage people living with and at the risk of contracting HIV/AIDS to visit these centers regularly, health policy makers should consider modifying clinical processes, physical features, personnel behaviors and visitors' concerns raised by the interviewees and the issues identified in this study.

Survival Analysis of Hospital Length of Stay of COVID-19 Patients in Ilam Province, Iran: A Retrospective Cross-Sectional Study.

Knowledge of the length of hospitalization of patients infected with coronavirus disease 2019 (COVID-19), its characteristics, and its related factors creates a better understanding of the impact of medical interventions and hospital capacities. Iran is one of the countries with the most deaths in the world (146,321 total deaths; 5 September 2023) and ranks first among the countries of the Middle East and the EMRO. Analysis of confirmed COVID-19 patients' hospital length of stay in Ilam Province can be informative for decision making in other provinces of Iran. This study was conducted to analyze the survival of COVID-19 patients and the factors associated with COVID-19 deaths in the hospitals of Ilam Province. This is a retrospective cross-sectional study. Data from confirmed COVID-19 cases in Ilam Province were obtained from the SIB system in 2019. The sample size was 774 COVID-19-positive patients from Ilam Province. Measuring survival and risk probabilities in one-week intervals was performed using Cox regression. Most patients were male (55.4%) and 55.3% were over 45 years old. Of the 774 patients, 87 (11.2%) died during the study period. The mean hospital length of stay was 5.14 days. The median survival time with a 95% confidence interval was four days. The probability of survival of patients was 80%, 70%, and 38% for 10, 20, and 30 days of hospital stay, respectively. There was a significant relationship between the survival time of patients with age, history of chronic lung diseases, history of diabetes, history of heart diseases, and hospitalization in ICU (p < 0.05). The risk of dying due to COVID-19 disease was higher among men, older age groups, and patients with a history of chronic lung diseases, diabetes, and heart disease. According to the results, taking preventive measures for elderly patients and those with underlying conditions to prevent the infection of COVID-19 patients is of potential interest. Efficiency in the management of hospital beds should also be considered.

Preferences of people in choosing a family physician in rural areas: a qualitative inquiry from Iran.

BACKGROUND: Creating a stable and long-term relationship called 'longitudinality' between the population and general practitioners is crucial for the family physician program. The constant change of family physicians (FPs) can deteriorate longitudinality. This study aims to reveal what factors people usually consider when choosing a new FP or changing their current FP. METHOD: A qualitative study with a thematic analysis approach was carried out in Ilam province, Iran, in 2019. Purposeful sampling with a maximum variation strategy was followed to select the key informants. We did 34 interviews with following groups: patients (rural residents); FPs; and experts from Iran Health Insurance Organization, Ilam University of Medical Sciences, and Health Network Development Center. Data were analyzed using a thematic analysis to identify and contextualize the preferences of people in choosing a FP in rural areas. All the processes related to data coding and emerging themes were carried out using MAXQDA 2012 software. RESULTS: The content of the interviews was categorized into 2 main themes, 6 sub-themes, and 39 codes. The first theme was 'family physician characteristics' including four sub-themes: general behaviors, social and physical characteristics, professional expertise, and pharmaceutical prescriptions. The second theme was 'health center' consisting of two sub-themes including location and physical features and properties of the health center. CONCLUSION: Some of the factors extracted from the interviews may have a different effect on the choice of people with different demographics. For instance, patients may have different ideas about the age, gender, years of medical practice, and finally, language and origin of the birthplace of FPs. Quantitative studies are needed to rank the factors identified in this study according to their significance for choosing FP and reveal patients' preferences for each factor.

Economic evaluation of laboratory diagnostic test types in Covid-19 epidemic: A systematic review.

BACKGROUND: Corona 2 virus (SARS-CoV-2) is known as the causative agent of COVID-19 disease; the World Health Organization (WHO) declared it an epidemic on March 11, 2020. The Joint Guidelines of the Centers for Disease Control and Prevention (CDC) and the WHO including social distancing, the use of face masks, emphasis on hand washing, quarantine, and using diagnosis tests have been used widely, but the value of diagnostic interventions to prevent the transmission of SARS-CoV-2 is unclear. We compared the economic evaluation of different laboratory diagnostic interventions with each other and also with implementing the conservative CDC & WHO guidelines. MATERIAL AND METHODS: Electronic searches were conducted on PubMed, Embase, Science Direct, Scopus, Cochrane Library, Web of Knowledge, NHSEED, NHS Health Technology assessment (CRD), and Cost-Effectiveness Analysis Registry databases. Related articles were reviewed from January 2020 to the end of November 2021. RESULTS: Out of 1791 initial studies, 13 articles had the inclusion criteria. According to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, ten studies were of excellent quality, and the remaining two studies were of very good quality. Most studies were cost-effectiveness analysis studies. The entered studies had different time horizons. Diagnostic tests reviewed in the studies included real-time polymerase chain reaction (RT-PCR) test, immunoglobulin G (IgG) & Antigen, point of care tests. Although polymerase chain reaction (PCR) testing improves the quality of life and survival for patients with infected Covid-19 based on its greater effectiveness compared to standard protection protocols, due to the high cost of this intervention, it has been considered a cost-effective method in some countries. CONCLUSION: Since most studies have been conducted in developed countries, it unquestionably does not make sense to extend these results to low-income and developing countries. Therefore further studies are required in low-income and developing countries to evaluate the cost-effectiveness of laboratory-based diagnostic methods (RT-PCR) of covid-19 in variable prevalence of infectious cases.

Outcome evaluation of COVID-19 infected patients by disease symptoms: a cross-sectional study in Ilam Province, Iran.

BACKGROUND: Novel coronavirus disease-19 (COVID-19) was declared as a global pandemic in 2020. With the spread of the disease, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. This study aimed to evaluate clinical outcomes of COVID-19 patients by disease symptoms in Ilam province, Iran. METHODS: This was a cross-sectional study. Data were collected from integrated health system records for all hospitals affiliated with the Ilam University of Medical Sciences between 26-Jan-2020 and 02-May-2020. All patients with a confirmed positive test were included in this study. Descriptive analyses, chi-square test, and binary logistic regression model were performed by using SPSS version 22. RESULTS: The mean age of participants was 46.47 ± 18.24 years. Of the 3608 patients, 3477 (96.1%) were discharged, and 129 (3.9%) died. 54.2% of the patients were male and were in the age group of 30-40 years. Cough, sore throat, shortness of breath or difficulty breathing, and fever or chills were the most common symptoms. Patients with symptoms of shortness of breath, abnormal radiographic findings of the chest, and chest pain and pressure were relatively more likely to die. According to binary logistic regression results, the probability of death in patients with shortness of breath, abnormal chest radiographic findings, and chest pain was 1.34, 1.24, and 1.32 times higher, respectively, than for those without. CONCLUSION: Our study provides evidence that the presentation of some symptoms significantly impacts outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19.

Investigation of health-promoting behaviors of employees of medical university: A perspective from West of Iran.

BACKGROUND: Employees spend most of their time at work, and hence, it is important to pay attention to health-promoting behaviors. The purpose of the present study was to investigate the status of health-promoting behaviors of employees in the Medical University of Ilam-Iran. MATERIALS AND METHODS: This cross-sectional, descriptive study has been conducted by the participation of 208 employees, whom selected through the simple random sampling method. In the present study, participants completed Walker's Health Promoting Life Style Profile II in the self-report form. The gathered data were analyzed using software at the significant level of 0.05. Data were analyzed by the independent samples t-test, one-way analysis of variance, and Pearson correlation coefficients. RESULTS: The highest correlation of health-promoting behaviors was related to spiritual growth (r = 0.785), stress management (r = 0.777), interpersonal relationships (r = 0.767), health responsibility (r = 0.730), nutrition behaviors (r = 0.641), and physical activity (r = 0.611) were in the next places (P < 0.001), respectively. Among sub-scales, the highest correlation was observed between spiritual growth and stress management (r = 0.676, P < 0.001) and the lowest correlation between physical activity and interpersonal relationships (r = 0.253, P < 0.001). CONCLUSIONS: The score of physical activity was lower compared to other dimensions of health promoting behaviors. Therefore, it is necessary to make more effective interventional measures for improving physical activity status.

Effects of the COVID-19 Pandemic on the Intimate Partner Violence and Sexual Function: A Systematic Review.

INTRODUCTION: The pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), or coronavirus disease 2019 (COVID-19), has affected many people in the world and has impacted the physical, social, and mental health of the world population. One of these psychological consequences is intimate partner violence affecting sexual health. METHODS: This study was performed as a systematic review on the effect of the SARS-CoV-2 pandemic on sexual function and domestic violence in the world. Accordingly, all English-language studies conducted from the beginning of the SARS-CoV-2 pandemic to the end of 2020 were extracted by searching in the Scopus, Web of Science, PubMed (including Medline), Cochrane Library, and Science Direct databases and then reviewed. The quality of the articles was assessed using the STROBE checklist. RESULTS: A total of 11 studies were included in the systematic review. Accordingly, domestic violence during the exposure to COVID-19 had increased. Moreover, the mean scores of sexual function and its components had reduced at the time of exposure to the pandemic compared to before. CONCLUSION: Given the potential long-term effects of the coronavirus crisis and the large population being affected by this disease, strategies to promote sexual health and fertility of families to prevent or further reduce violence and sexual functions should be chosen.

Coronavirus disease-2019 risk management using strengths, weaknesses, opportunities, threats analysis approach in the health system: A qualitative multimethod study.

BACKGROUND: Utilizing the successful experiences of countries and local regions can be useful in the management and control of coronavirus disease-2019 (COVID-19), so the research team aims to determine and extract the strengths, weaknesses, opportunities, and threats of the health system in the risk management of COVID-19 using strengths, weaknesses, opportunities, threats (SWOT) analytical approach. MATERIALS AND METHODS: This study was performed by a qualitative multimethod approach. In addition to reviewing the minutes of meetings and approvals of the Provincial Anti-Corona Headquarters, focused group meetings and in-depth semi-structured individual interviews were conducted. The results were extracted based on the SWOT analytical approach in the form of strengths, weaknesses, opportunities, and threats of the health system and then based on the SWOT matrix, the necessary strategies were identified. RESULTS: In the necessary strategies, based on SWOT matrix in SO strategies: SO1, formation of regional health assessment teams; SO2, promotion of preparedness, resilience, and effective response; SO3, activation of research and training centers; SO4, integrated management, supervision, and coordination; in WO strategies: WO1, analysis and COVID-19 risk monitoring; WO2, communication and risk information management; WO3, people-based management; and WO4, activation of local economic institutions and manufacturing centers; in ST: ST1, comprehensive care system strategies; and ST2, enhancing social trust with a transparency approach; and finally in WT strategies; WT1, stress management; and WT2, specific financial system design for disaster management were identified. CONCLUSION: Now, for the prevention and control of this disease, the need of empathy and participation of all human societies is felt more than anything else. These experience and analysis are based on the SWOT approach for the health system to be able to provide solutions and practical points that can be used by stakeholders.

Relationship between Organizational Citizenship Behavior and Social Capital: Survey from Hospital Setting.

Background: The importance of organizational citizenship behavior in the hospital is increasing positive relationships between employees and engages them in organizational activities.Methods: This study is a descriptive-correlation survey, the research population consisted of all the staff of selected hospital of IUMS, and 312 of them were chosen based on the formulas and were selected by two-stage sampling. The tools used in the study were two questionnaires.Results: The mean and standard deviation of the two components of social capital and citizenship behavior were moderate.Conclusion: Strengthening the components of employee's citizenship behavior can increase the staff's satisfaction and productivity while increasing social capital in hospitals.

An assessment of implementation and evaluation phases of strategic plans in Iranian hospitals.

OBJECTIVES: To assess the implementation and evaluation phases of strategic plans in selected hospitals. METHODS: We conducted a cross-sectional study of implementation and evaluation of strategic plan in 24 hospitals in 2015, using a questionnaire which consisted of two separate sections for strategic implementation and strategic evaluation. Data were analyzed with SPSS version 18. RESULTS: Nearly one-third of hospitals claimed that they allocate their budget based on priorities and strategic goals. However, it turned out that although goals had been set, no formal announcements had been made. Most of the hospitals stated that they used measures when evaluating the plan. For hospital staff, clarifying the hospital's priorities was the most important advantage of a strategic plan. CONCLUSION: There is no clear definition for strategic management in Iranian hospitals, which results in chaotic implementation and control of strategic planning.

Measuring and Analyzing Waiting Time Indicators of Patients' Admitted in Emergency Department: A Case Study.

BACKGROUND & AIMS: Measuring and analyzing of provided services times in Emergency Department is the way to improves quality of hospital services. The present study was conducted with aim measuring and analyzing patients waiting time indicators in Emergency Department in a general hospital in Iran. MATERIAL & METHODS: This cross-sectional, observational study was conducted during April to September 2012. The study population consisted of 72 patients admitted to the Emergency Department at Baharlo hospital. Data collection was carried out by workflow forms. Data were analyzed by t. test and ANOVA. RESULTS: The average waiting time for patients from admission to enter the triage 5 minutes, the average time from triage to physician visit 6 minute and the average time between examinations to leave ED was estimated 180 minutes. The total waiting time in the emergency department was estimated at about 210 minutes. The significant correlation between marital status of patients (P=0.03), way of arrive to ED (P=0.02) and type of shift work (P=0.01) with studied time indicators were observed. CONCLUSION: According to results and comparing with similar studies, the average waiting time of patients admitted to the studied hospital is appropriate. Factors such as: Utilizing clinical governance system and attendance of resident Emergency Medicine Specialist have performed an important role in reducing of waiting times in ED.

The relationship between learning style preferences and gender, educational major and status in first year medical students: a survey study from iran.

BACKGROUND: Identifying and employing appropriate learning styles could play an important role in selecting teaching styles in order to improve education. OBJECTIVES: This study aimed to determine the relationship between learning styles preferences and gender, educational major and status in first year students at Isfahan University of Medical Sciences. PATIENTS AND METHODS: A cross-sectional study employing the visual-aural-read/write-kinesthetic (VARK) learning style's questionnaire was done on 184 first year students of medicine, pharmacy, dentistry, nursing and health services management at Isfahan University of Medical Sciences in 2012. The validity of the questionnaire was assessed through experts' views and reliability was calculated using Cronbach's alpha coefficients (α = 0.86). Data were analyzed using the SPSS ver.18 software and x(2) test. RESULTS: Out of 184 participants who responded to and returned the questionnaire, 122 (66.3%) were female; more than two-thirds (68.5%) of the enrolled students were at the professional doctorate level (medicine, pharmacy, dentistry) and 31.5% at the undergraduate level (nursing and health services management). Eighty-nine (48.4%) students preferred a single-modal learning style. In contrast, the remaining 95 students (51.6%) preferred multi-modal learning styles. A significant relationship between gender and single modal learning styles (P = 0.009) and between status and learning styles (P = 0.04) was observed. CONCLUSIONS: According to the results, male students preferred to use the kinesthetic learning style more than females, while, female students preferred the aural learning style. Knowledge about the learning styles of students at educational institutes is valuable and helps solve learning problems among students, and allows students to become better learners.

Using VARK Approach for Assessing Preferred Learning Styles of First Year Medical Sciences Students: A Survey from Iran.

BACKGROUND: Preferred learning styles of learners are different, which depend on tastes, mentality preparedness, as well as physical condition, in terms of sensory modalities. Identifying and employing appropriate learning styles could play an important role in selecting teaching styles, which can improve education ultimately. AIM: The present study aimed to assess the diversity of learning styles amongst medical students of a medical sciences university which was located west of Iran, in 2010. METHODS: A cross-sectional study which employed VARK learning style's questionnaire was done on 141 first year medical sciences students at Ilam University of Medical Sciences in 2010. Data was collected with use of VARK questionnaire. The validity of the questionnaire was assessed on basis of experts' views and its reliability was calculated by using Cronbach's alpha coefficients (α=0.86). Data were analysed by using SPSS software and Chi-square test. RESULTS: Overall, 41.6% of the samples preferred to use a single learning style (Uni-modal). Of these, 17.7% preferred the Aural style, 17% preferred Reading and Writing, 6.4% preferred Kinesthetic style and 0.7% preferred Visual styles. Among the rest of the 82 students who preferred more than one style (multimodal), 17% chose two modes (bimodal), 13.5% chose three modes (tri-modal), and 27.6% chose four modes (quad-modal). There was a significant difference between educational levels and majors on one hand and choice of quad modal of VARK styles on the other hand (p=0.008). A significant association was also found between participants' genders and selection of visual and reading/writing styles (p=0.03). CONCLUSION: The preferred learning styles of medical students in the present study were aural and reading/writing. It is suggested that all medical students must be tested to determine their desired learning styles by using VARK questionnaire, also to choose appropriate teaching methods and to improve educational goals.

An analysis of disparities in access to health care in Iran: evidence from Lorestan province.

Equal distribution of healthcare facilities in order to increase the accessibility of the individuals to services is one of the main pillars in improvement of health. This study was aimed to examine the disparities in access to health care services across the cities of Lorestan province located in west of Iran. This study is a descriptive study. Data related to indicators of institutional and manpower was collected using statistical yearbook of Statistical Centre of Iran (SCI) and analyzed by Scaogram Analysis Model. The results revealed distinct regional disparities in health care services across Lorestan province. According to Scalogram analysis model, Khorramabad and Delfan towns were ranked as the first and the last according to access to health care services. Overally, 44% of the cities are undeveloped and only 22% are credited as developed. Taking the advantage of development-oriented programs, reduction of the gap in health care services in the must be considered in the health policy. Therefore, Delfan, Dorood, Koohdasht and Selseleh are characterized as the underdeveloped and consequently urgently should be considered in planning and deprivation programs.

Assessing health inequalities in Iran: a focus on the distribution of health care facilities.

BACKGROUND AND OBJECTIVE: Equality in distribution of health care facilities is the main cause for access and enjoyment to the health. The aim of this study was to examine the regional disparities in health care facilities across the Markazi province. METHODS: This was a cross-sectional study. Study sample included the cities of Markazi province, ranked based on 15 health indices. Data was collected by a data collection form made by the researcher using statistical yearbook. The indices were weighted using Shannon entropy. Finally, technique for order preference by similarity to ideal solution (TOPSIS) was used to rank the towns of the province in terms of access to health care facilities. RESULTS: There is a large gap between cities of Markazi province in terms of access to health care facilities. Shannon entropy introduced the number of urban health centers per 1000 people as the most important indicator and the number of rural active health house per 1000 people as the less important indicator. According to TOPSIS, the towns of Ashtian and Shazand ranked the first and last (10th) respectively in access to health services. CONCLUSION: There are significant inequalities in distribution of health care facilities in Markazi province. We propose that policy makers determine resource allocation priorities according to the degree of development for a balanced and equal distribution of health care facilities.

Prerequisites of preparedness against earthquake in hospital system: a survey from Iran.

BACKGROUND AND OBJECTIVE: Considering the history of frequent, and severe, earthquakes in Iran and the importance of health care service delivery by hospitals in these cases, having a plan to deal with disasters should be considered a priority. The aim of this study was the observance of preparedness prerequisites against earthquake in hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBUMS) and its relationship with demographic and organizational characteristics. METHODS: This was a cross- sectional study that was conducted in 15 hospitals affiliated with SBUMS, Iran in 2012. Data were collected using observation of documents and questionnaire consists of 138 questions in 8 dimensions. The content validity and reliability were confirmed. Data analysis was performed with descriptive statistic, t-test and ANOVA. RESULTS: Results showed that 86.7% of hospitals were in good preparedness level, with the average 85.9 ± 15.5. The maximum and minimum level of preparedness was related to mitigation of construction hazards (56.6 ± 35.6) and support of vital services (97.2 ± 6.0) dimensions, respectively. According to the results, there was a significant statistical difference between mean preparedness and safety of equipment and hazardous materials, hospital evacuation and field treatment, hospital environmental health proceedings, hospital curriculum programs and support of services dimensions with management experience (P<0.05). CONCLUSION: Although results corroborate that preparedness prerequisites against earthquake are in good level but attention to the weaknesses mitigation of construction hazards dimension and strengthening these prerequisites, which have obvious impacts on the structural vulnerability of hospitals and adjacent buildings in earthquakes, have been proposed.

Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran.

BACKGROUND & AIM: Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. METHODS: The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. RESULTS: All the investigated hospitals had a strategic plan. The obtained percentages for the items "the rate of the compliance to requirements" and "the quantity of planning facilitators" (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). CONCLUSION: According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.

The factors affecting the refusal of reporting on medication errors from the nurses' viewpoints: a case study in a hospital in iran.

Objective. Medication errors are the most common types of medical errors which considerably endanger the patient safety. This survey aimed to study the factors influencing not reporting on medication errors from the nurses' viewpoints in Abbasi Hospital of Miandoab, Iran. Methods. This was a cross-sectional, descriptive and analytical study conducted in 2012 in which all nurses (n = 100) working in different inpatient units were studied using a consensus method. Required data were collected using a questionnaire. Collected data were analyzed through some statistical tests including Independent t-test, ANOVA, and chi-square. Results. According to the results, the most important reasons for not reporting on medication errors were related to the managerial factors (3.56 ± 0.996), factors related to the process of reporting (3.32 ± 0.797), and fear of the consequences of reporting (3.01 ± 1.039), respectively. Also, there was a significant relationship between employment status and fear of the Consequences of reporting on medication errors (P < 0.008). Conclusion. This study results showed that managerial factors had the greatest role in the refusal of reporting on medication errors. Therefore, for example, establishing a mechanism to improve quality rather than focus only on finding the culprits and blaming them can result in improving the patient safety.