Evidence Based Health Policy,

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Background: Health and nutrition are important aspects in the analysis of households’ multidimensional poverty. The present research investigated poverty in Tehran’s households through a cohort approach. In this regard, households’ financial participation about health costs and food intake calories were analyzed.
Methods: Households’ data of costs – income survey were then collected. Health and nutrition poverty trend was investigated through generational approach, index of poverty "Foster, Greer, Turbak", and in the period of 1984-2014 by dividing Tehrany families into eight various age groups. Excell and Stata₁₁ were applied to process and calculate the indices.
Results: During the study years, the highest level of health poverty (29%) in 1999 was in age range of 21-26 and the highest level of nutrition poverty in 1984 (65%) was in age range of 42-46. There has been an ascending trend of health and nutrition poverty at the end of the Fourth Development Plan (2009) up to 2013 for all age groups.
Conclusion: Generally, rate and severity of health and nutrition poverty had many fluctuations among different age groups of Tehrani households’ heads. This rate has raised during recent years which indicates lack of stable and coherent social policies to reduce households’ exposures with catastrophic health care costs and funding of the food aid needs.
 

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Background: Paving the way for having equitable access to medical intervention programs is the most important action that a health system can take in realizing social justice. This study aims at examining proper distribution of specialist physicians as an strategy towards realizing justice and equity in access to and use of health services as well as providing recommendations for policy-makers. 
Methods: This is a review-narrative and bibliographic research that used databases consisting of Magiran, Irandoc, Iranmedex, SID, PubMed, Scopus, EMBASE, Direct Science with the key words including Specialists, Health, Equity,  Accessibility, Health system and Human resources. The data were collected from 1990 to 2015.
Results: There are evidences of regions in the world that still are lacking sufficient number of physician workforce and are not only faced with challenges of recruiting, but also with retention of specialist physicians. In fact, migration of human workforce from deprived regions to more organized and prosperous parts has been a factor influencing workforce shortage in these regions; thereby it adds further problem of recruitment and retention of specialist workforce.
Conclusions: Human workforce distribution (Specialist or non-specialists) has direct effects on realizing equity and justice in health system; it also influences economy of a given country indirectly. On the other hand, compensation is one of the important incentives that drives workforce behavior and makes them more inclined towards working in deprived regions. Taking the above mentioned ideas, it is recommended for the health system to use more economic incentives and insure proper distribution that fits individuals' needs. Using various tax policies in deprived, wealthy, and generally different geographical regions is one of the most important incentives available to leverage this purpose.

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Background: The need for training throughout the whole occupational life time of a personnel is crucial. As educational needs of all personnel in hospitals are not the same, planning for holding in-service training courses is complex and sensitive, which in some cases causes incidence of challenges and different taste in training. Understanding these challenges and offering solutions to them are really important.
Methods: This research was a qualitative study, conducted through a phenomenological approach, for which structured interviews were used to collect data. A total of 10 training supervisors, training volunteers, and administrators of clinical sections, who had been chosen through a targeted method were interviewed. The average duration of interviews was 35 minutes, and their analysis was done through content analysis method.
Results: In this research, five primary codes and fifteen secondary codes were obtained. The primary codes comprised support by managers, financial supply, need assessment, time period, and program content.
Conclusion: Based on this research, holding in-service training is faced with serious challenges due to different training needs of the hospital personnel and medical team, which are categorized into five groups of support by managers, program need assessment, program time period, program financial support, and educational content. It appears that solving such challenges requires collaboration between the three major decision-maker pillars, i.e. vice-chancellor for treatment, hospital, and universities of medical sciences.
 

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Background: Hospitals are the largest and most costly operating units of health systems, and their share of current government expenditures in the healthcare sector is between 50 and 80 percent. The hospital efficiency is more indicative of the proper function of the resources devoted to it. The aim of this study was to evaluate the efficiency of hospitals in Tabriz by using the Pabon Lasso model.
Methods: This is a descriptive study that investigated the efficiency of Tabriz hospitals during 2009-2013. All hospitals of Tabriz were entered by census. Data (bed occupancy rate, bed turnover and patient length of stay) were collected in summer 2014 and charts were plotted using SPSS₁₉ software.
Results: The mean of Pabon Lasso's three indices of efficiency in 5 years (excluding psychiatric beds) was 67.6% for bed occupancy rate, 104.3 times bed turnover, and 2.48 days average patient length of stay. The coefficient of bed occupancy increased by 3% over 5 years, the bed turnover index increased by 8 times and the average length of stay decreased by 0.17 day. On average, 25.2% of hospitals were in Region 1, 23.5% in Region 2, 26.1% in Region 3 and 25.2% in Region 4 of Pabon Lasso Diagram.
Conclusion: The presence of 26% of hospitals in the region of Pabon Lasso Diagram shows the effective efficiency of hospitals which is not an acceptable statistics for hospitals and requires the intervention of health practitioners and policymakers.

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Background: The identification of strengths and weaknesses of services provided is the first step for the improvement of the quality of services. In hospitals, patients are the most important groups for the evaluation of the quality of healthcare services. Thus, this systematic review and meta-analysis aims to evaluate hospital service quality from patients’ perspective in Iran using Servqual model.
Methods: A systematic review and meta-analysis of studies evaluating patients’ perspective about hospital services quality was conducted. Required data were collected through searching following key words: Servqual, services quality, gap, hospital, patients, Iran, using the database sources including PubMed, Scopus, Google Scholar, MagIran, SID and IranMedex. Comprehensive meta-analysis (CMA) software, Version 2 was used to estimate the total mean score of patients’ perception and expectation of services quality and the gap between them.
Results: Totally, 11 eligible studies were entered into the systematic review. Based on the random effect model, the total mean score of patients’ perception, patients’ expectation and the gap between them were estimated 3.66 (95% CI, lowest = 3.40, highest = 3.92), 4.62 (95% CI, lowest = 4.42, highest = 4.82) and 0.94 (95% CI, lowest = 0.78, highest = 1.10), respectively. The mean score of the gap between perception and expectation was 0.95 and the biggest gap was related to the responsiveness dimension.
Conclusion: Responsiveness is related to the areas, such as providing appropriate and timely services, the reliability of providers, good communication between staff or physicians and patients. The importance of these areas signifies the necessity of taking actions in order to provide more appropriate and higher quality services.

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Background: High hospital costs on one hand, and limited resources and facilities on the other hand, have led hospital managers to reduce costs and increase efficiency. Performance measurement is one of methods for assessing efficiency of hospital .in terms of resource utilization. Therefore, the present study was conducted with the aim of evaluating the efficiency of hospitals affiliated with Bushehr University of Medical Sciences before and after the implementation of the Health development Plan.
Methods: This study is descriptive-analytic. The research population of this study was all hospitals affiliated with Bushehr University of Medical Sciences whose performance was evaluated in two years of 2013 and 2014. To measure the efficiency of these hospitals, data frontier analysis was used. The criteria of the total number of employees, the total number of physicians, the number of nurses and active beds were studied as input variables, and the percentages of cesarean section in total deliveries, number of surgeries, average residence. The data were collected in collaboration with the University's Center of Statistics as well as referring to the hospitals and analyzed using DEA software.
Results: The mean technical efficiency, managerial and scale of performance before the implementation of health system development plan were reported 0.934 ± 0.116, 1.00 ± 0.0 and 0.934 ± 0.116, respectively. Furthermore, six out of the eight hospitals studied were technically and scale-oriented efficient, and all eight hospitals were efficient regarding management. Only two hospitals had a surplus and two hospitals were inadequate. The mean efficiency after the implementation of the development plan was 0.9504 ± 0.131, 0.977 ± 0.059 and 0.966 ± 0.088, respectively. Conclusion: According to the findings of this study, the health system development plan has had a positive effect on the efficiency of hospitals, Although the efficiency of hospitals is desirable, it is essential that managers and policymakers of the health sector take measures to improve the efficacy and increase the use of resources.

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Background: Job burnout is one of the factors affecting the quality of staff performance which can lead to undesirable effects. One of the factors affecting the job burnout of employees is the organizational culture that requires managers and decision makers of the human resources pay special attention to it. In this research, the relationship between job burnout with organizational culture and the source of individual motivation has been investigated.
Methods: This is a descriptive-analytic study, with the practice aim in a cross-sectional fashion. The statistical population included all personnel of Isfahan University of Medical Sciences, among whom 211 were selected as research sample. The data collection tool was Maslach's Professional Burnout Questionnaire (MBI), Denison's Standard Organizational Culture Questionnaire, and Motivational Source of Individual Questionnaire (MSI). Data were analyzed by SPSS₂₁ software and also by structural equation modeling (SEM) software Lisrel 8.5.
Results: The relationship between all dimensions used in the model to explain the latent variables was significant except for the emotional exhaustion level of burnout (P-value < 0.05). The relationship between organizational culture and job burnout and the relationship between the sources of individual motivation and burnout were confirmed. In total, based on the structural equation model, two variables of organizational culture and individual motivation sources have been able to explain 32 % of the changes in occupational burnout.
Conclusion: Regarding the effect of organizational culture and the sources of individual motivation on employees' job burnout, it is recommended to strengthen the organizational culture in four dimensions of engagement in work, adaptability, conformity and mission, which is effective in reducing job burnout of employees.

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Background: Measurement of the organizational performance would be effective and helpful for improvement, in the case that it is based on an appropriate and principled system. Such a system uses specific indicators to measure the productivity and performance of the organizations. In fact, these indicators act as useful tools for strategic planning in managerial levels. Given the importance of the issue, this study aimed to develop the key productivity indicators for hospitals affiliated to Isfahan University of Medical Sciences. These indicators are designed to be applied in evaluation, implementation, and improvement processes of the organizations under study.
Methods: This was a qualitative study conducted among the hospitals affiliated to Isfahan University of Medical Sciences in 2015. Purposive sampling method was applied and the study participants were selected through snowballing. Then, the participants were organized in a focus group consisting of 16 experts in the field of hospital performance and efficiency indicators to achieve the research objectives by using indexing matrix method. Finally, validity of the developed indices was confirmed using Delphi method.
Results: A total of 42 productivity indicators were formulated. Of these, nine indices were input (structural), which included financial, human resources, and energy consumption indicators. The next 29 indices were output and mainly belonged to the financial, efficiency, and quality area. The final four indices included process indicators and consisted of length of stay in emergency department, waiting time for out of hospital counseling, and waiting time for the presence of resuscitation team at the patient bedside during the cardiopulmonary resuscitation.
Conclusion: Development of the indicators in three areas of input, process, and output helped managers and policy makers to access reliable and valid instrument for measuring organizational productivity.

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Background: Internal marketing is defined as "the process of attracting, developing, motivating, and retaining the qualified employees through
job-products that satisfy their needs". Internal marketing practices in hospital make a positive work environment, which in turn, leads to the provision of higher care quality. This study was aimed to investigate the internal marketing practices in two educational hospitals of Yazd City, Iran
Methods: In this quantitative cross-sectional study, we used a valid questionnaire of internal marketing (Sarah May Lubbe, 2013) in two educational hospitals of Yazd, Iran. A total of 156 clinical and non-clinical employees selected from the studied hospitals participated in the study. Stratified random sampling method was applied and data analysis was done using SPSS₁₉. We used descriptive statistics in data analyses.
Results: The mean score of internal marketing was 2.78 ± 0.60. Furthermore, employee satisfaction and benchmarking obtained the
highest and lowest scores among the internal marketing dimensions with
3.22 ± 0.64 and 2.27 ± 0.86 scores, respectively.
Conclusion: Our results showed the weakness of internal marketing practices in educational hospitals, which should be improved. For this, the results of our study should be prioritized to improve the activities.
 

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Resource generation in health system provides mechanisms for training efficient and effective workforce and supplies facilities and equipment for delivering health services. Iran’s Health Transformation Plan is one of the major reforms implemented in 2014 designed to realize the scientific authority of the country among the countries in the region in horizon 2025 (Solar Year 1404). Therefore, the state of function of resource generation in the areas of education, research, and infrastructure suitable for provision of health services may provide valuable policy implications for informed decision-making. Therefore, the status of resource generation in the areas of education, research and infrastructure (focusing on human resources and medicine as two expensive and effective drivers) from the lens of productivity and equity can provide invaluable policy implications for informed decision-making. The function of resource generation in the three areas of education, research, and infrastructures of human resources and medicine in health system encounters many challenges in terms of productivity and equity. In this perspective paper, besides assessing these challenges in the light of available research evidence, it has been tried to identify these and aimed to suggest several policy recommendations in these areas for improving evidence-based policymaking.

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Background: The operating room staff is exposed to stress due to the frequent contacts with patients, which may ultimately leads to burnout. The aim of this study was to determine burnout and its related factors among the operating room staff in teaching hospitals affiliated with the Isfahan University of Medical Sciencesin 2018.
Methods: The present quantitative and qualitative study was conducted in Isfahan. In the quantitative phase, 206 employees were selected by simple random sampling method and data were analyzed by SPSS₂₃ using descriptive statistics, one-way ANOVA, t-test, and other related tests.  Data were collected by “Demographic form” and “Maslach Burnout Inventory” (MBI) questionnaires.  In the qualitative phase, data were collected by conducting interviews with 20 participants including managers, supervisors, and matrons of the operating roomby using MAXQDA12. Software.
Results: Results showed that the demographic variables had a significant relationship with burnout variable and its dimensions. Work experience and academic degree had a significant relationship with depersonalization (P-value < 0.05). According to the multiple linear regression, academic degree had the highest predictive power for depersonalization. In the qualitative phase, three factors associated with burnout included: internal factors of organization, external factors of organization and individual and personal factors of organization.
Conclusion: Burnout affects the staff's efficiency and performance in the operating room. Therefore, managers must provide programs to reduce burnout among the staff, so that they can provide high-quality services and reduce costs.
 

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 COVID-19 is considered to be one of the crises that occurred at the end of 2019. It seems that the chain of crises never ends, and the occurrence of events is unavoidable. Normally, declaring an emergency for the hospital’s medical staff is the first reaction from the health authorities in each country concerning all crises. Thus, the medical staff will start their activities to rescue, transfer, hospitalize and release of the injured people. According to health regulations, the surveillance system must promptly expand its activity based on crisis recognition, including the continuous and regular collection of data related to public health, aggregation, analysis, and assessment of the health status (1). A common element of crises is the lack of time to make accurate and timely decisions (2). Although some commentators believe that the social nature of COVID-19 is different from other crises (3), the experience gained from other crises can be useful. World Health Organization (WHO) has currently faced a major challenge in confronting COVID-19. So, their only reference to deal with this crisis is using previously recorded experiences about other similar coronaviruses, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome(MERS) and some of the published information from other countries involved in the crisis. There is some documentation available in databases,but the vast experience of medical staff has been neglected. There is a chance that each medical staff had valuable experiences that would be forgotten over time. Indeed, medical staff is one of the main groups involved in dealing with the crisis and certainly gain much experience in
this area. Therefore, health practitioners can
use the experience of medical staff as tacit knowledgerepositories to manage crises during them or in case of facing future ones because their experiences are considered as primary information sources.
In this regard, in order to reduce the extent of damages, costs, and human casualties, the approach of recording and sharing their experiences should be taken into consideration at the national and even global levels. Authors have tried to address this important topic as well as the features of this database to encourage health managers to design it and to encourage medical staff to record and share their experiences.

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Background: Since lifestyle is a multi-dimensional concept and various dimensions of health or disease are affected by each other, the measures taken to promote health should pay attention to all aspects of individual physical, mental, spiritual health, as well as the general health of society. The present study aimed to investigate the relationship between psychological components including personality factors, social support, and regulation with lifestyle among obese individuals.
Methods: This study was analytical in terms of purpose and cross-sectional in terms of time and was conducted in 2018. In this study, the individuals referring to the health centers of Isfahan were considered as the research population. A number of 357 individuals randomly entered the study. Data collection was based on the perceived social support questionnaire of Zimet et al., health promoting lifestyle questionnaire of Walker, the CERQ emotion cognitive regulation questionnaire, and Neo five-factor inventory. Data were analyzed by SPSS₁₈ using independent T-test, Pearson correlation, and ANOVA.
Results: In the final model, a significant relationship was found between gender, nervousness, extroversion, openness, conscientiousness, social support, and health promoting lifestyle (P-value < 0.05). In addition, a significant relationship was observed between marital status, nervousness, extroversion, openness, agreement, and social support (P-value < 0.05). A significant relationship was observed between personality factors and health promoting lifestyle. Such a relationship in nervousness was inverse and significant while it was positive and significant in extraversion, openness, and conscientiousness (P-value < 0.05). Based on the results, there was an inverse relationship between social support and lifestyle and also between regulation and lifestyle (P-value < 0.05).
Conclusion: In order to take motivational measures for changing the lifestyle of obese individuals, it is recommended to regard the psychological factors and their relationship to increase the effectiveness of interventions.

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Chronic diseases have become an acute challenge in health. Providing a framework for the transformation of services could be very helpful. In this study, the teamwork services based on lifestyle modification used in a series of Health Clinics in Isfahan (Iran); have been reported as a desirable method in the treatment of metabolic Syndromes. "Iranian Health Clinics" have been providing services in the fields of lifestyle modification, promoting healthy lifestyles, diagnosing and treating metabolic syndromes such as diabetes, hypertension, hyperlipidemia, as well as weight regulation and stabilization. This clinic series offers its services as a team of psychologists, nutritionists, physical trainers, and physicians. Treatment of metabolic syndromes by the team-based method as well as continuing contact with patients in the courses of treatment, stabilization, and training of health ambassadors can be instrumental in consolidating the results using this framework in the control of metabolic syndromes.

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Background: The medical tourism industry is a rapidly growing global market that has capabilities such as earning income and improving the quality of services. The purpose of this study was to utilize the capabilities of Shiraz city by developing a strategic plan.
Methods: This mixed-methods (qualitative and quantitative) research was conducted in 2019. The study population included all entities and key stakeholders involved in the medical tourism industry in Shiraz. A strategic plan was developed through focus groups and conventional content analysis and then the Decision Making Trial and Evaluation Laboratory (DEMATEL) technique was utilized to map it.
Results: The strategic plan of the medical tourism industry of Shiraz city was explained in the form of 63 strategies, 5 goals, and 18 objectives. Also, the medical tourism industry strategic map was illustrated.
Conclusion: Achieving common agreement of all policy-making and implementing institutions, empowering managers on various medical tourism industry dimensions, and developing operational plans required by each organization in charge of the medical tourism industry can be effective in better use of the capabilities of Shiraz in attracting medical tourists.

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Background: Dialysis, a critical treatment for kidney failure, faces challenges related to patient safety, treatment efficiency, and overall care quality. Despite advancements in technology, improved information exchange is essential to overcome limitations of traditional sharing methods, which often lack accessibility and security. Cloud computing offers a promising solution with its scalability and efficiency, potentially revolutionizing dialysis information exchange and leading to improved patient outcomes and enhanced healthcare delivery.
Methods: This scoping review aimed to synthesize research on cloud computing solutions for improving dialysis information exchange by conducting a systematic search across five databases (PubMed, Web of Science, Scopus, Embase, and ProQuest) using relevant keywords. The review included observational studies published from 2010 to the present, and employed a rigorous selection process to ensure the studies were pertinent to dialysis care while excluding irrelevant articles.
Results: Six key areas where cloud computing can enhance dialysis information exchange were identified: telemedicine, cloud computing infrastructure, clinical information systems, information management, standards and models, and associated challenges. It emphasizes the potential of cloud-based solutions to improve patient care through remote monitoring, data analytics, and improved communication among healthcare providers.
Conclusions: Cloud computing solutions present a promising opportunity to enhance dialysis information exchange by improving security, transparency, cost-effectiveness, and efficiency. This review highlights the potential of cloud-based platforms to streamline data management, facilitate communication, and enhance patient care. However, realizing these benefits requires addressing challenges such as data security, establishing unified standards, and ensuring interoperability. By integrating advanced technologies like blockchain, attribute-based encryption, and federated learning, and prioritizing research on data privacy concerns, the advantages of cloud computing in dialysis care and improve patient outcomes. Can be further unlocked.