Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 Efficiency Evaluation of University Hospitals In Bushehr Province before and after the Implementation of the Health System Development Plan 1 11 EN Mohammad Mehdi Kiani Department of Management and Health Economic, School of Public Health, Tehran University of Medical sciences, Tehran, Iran Y Khatere khanjankhani Department of Management and Health Economic, School of Public Health, Tehran University of Medical sciences, Tehran, Iran N Seyyed Abdolhossein Mosavi Rigi Department of Health in Disaster and Emergency, School of health management and information sciences, Isfahan University of Medical Sciences, Isfahan, Iran N Hassan Karami 3 Department of Health Economic, School of Health Management and Information Sciences, Iran University of medical sciences, Tehran, Iran Health and Care Office, Farashband town, Fars province, Iran N Fatemeh Sepaseh Department of Management, School of Public Health, Shahid Sadoughi University of Medical Science, Yazd, Iran N Beheshteh Naghdi Expert Education Department, Isfahan University of Medical Sciences, Isfahan, Iran N Maryam Shiravani Department of Management and Health Economic, School of Public Health, Tehran University of Medical sciences, Tehran, Iran N 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. Data Envelopment Analysis, Health System Development Plan, Management Efficiency , Scale Efficiency , Technical Efficiency http://jebhpme.ssu.ac.ir/article-1-124-en.html http://jebhpme.ssu.ac.ir/article-1-124-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 The Impact of the Health Care Reform Plan on the Rate of Caesarean Section in the Educational Hospital: A Case Study 12 19 EN Mahnaz Afshari Maragheh University of Medical Sciences, Maragheh, Iran School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Y Mehrak Pourmotahar Tehran University of Medical Sciences, Tehran, Iran N Zohreh Qavami Azad Tehran University of Medical Sciences, Tehran, Iran N Rasoul Corani Bahador School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran N Maryam Radin Manesh School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran N Background: In recent years, the tendency of women to have C-section has increased, without enough knowledge about it and its side-effects. Vaginal birth promotion program is one of programs included in the health care reform plan which is an important step in promoting the awareness of vaginal birth. The aim of this study is to investigate the impact of the health care reform plan on C-section rates in one of educational hospitals in Tehran University of Medical Science. Methods: The present study was descriptive-analytic which was conducted in longitudinal and retrospective manner. Data were collected from 8510 deliveries through the patients' medical records in the span of three consecutive years, one year before implementing the health care reform plan and two years after its implementation. Calculations were done via Excel and SPSS 20 soft wares. Results: From the total of 2309 deliveries in 2013, (before implementing the plan), 69 percent of them had C-section and 31 percent had vaginal delivery. In the first year of the plan, from a total of 2989 deliveries, 70.8 percent had C-section and 29.2 percent had vaginal delivery and in the second year, from a total of 3212 deliveries, 71.3 percent had C-section and 28.6percent had vaginal delivery. The rate of avoidable C-sections in 2013, was 21.6 %, in 2014, 14.8 % and in 2014, 15 % .The execution of health care reform plan led to a 6.7 % decline rate in avoidable C-sections such as elective caesarians.(p = 0.001). Among the reasons for non-avoidable caesarians are, repeated caesarian, failure in delivery, and preeclampsia, respectively. Conclusion: Although this hospital did not succeed in reducing the rate of C-section, considering the causes for C-section, it could reduce avoidable caesarians like elective deliveries. Given that this hospital has a large number of critically ill patients referred from other centers for C-section, it has a high rate of C-section. Two important factors contributing to the execution of this program are, making the delivery room's space pleasant according to the birth center standards, and increasing human resources and professional and friendly obstetricians. Therefore, in order to promote vaginal birth a comprehensive planning is needed. Vaginal Birth Promotion Program, Health Care Reform Plan, Investigation http://jebhpme.ssu.ac.ir/article-1-125-en.html http://jebhpme.ssu.ac.ir/article-1-125-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 Personnel Attitude toward Power Distance in Hospitals Affiliated by Qazvin University of Medical Sciences 20 25 EN Sima Rafiei 1 Department of Healthcare Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran Y Pejman Sadeghi 1 Department of Healthcare Management, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran N Background: Human resources have a significant role in improving organizational performance specifically in healthcare institutions. This study aimed to study the hospital staff perception toward power distance in 2016. Methods: A cross sectional, descriptive study was conducted among 668 hospital staff affiliated by Qazvin University of Medical Sciences. A standard questionnaire developed by Hofstede consisted of 31 questions in seven domains including hierarchy, reward, climate, communication, decision making, learning and management was applied to gather data. SPSS Software package version 20 was used to analyze data using descriptive statistics (mean, standard deviation), t-test and ANOVA analysis. Results: Study findings showed a low level of power distance perceived by employees (mean score = 67.6 ± 2.3). The most inequality perceived by study staff belonged to decision making aspect and the method of applying managerial authority in the organization.  Conclusion: Applying strategies to improve staff participation in work decisions and job responsibilities would help organizations maintain and develop employees with positive perception toward justice. Power Distance, Hospital Employee, Perception http://jebhpme.ssu.ac.ir/article-1-126-en.html http://jebhpme.ssu.ac.ir/article-1-126-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 Evaluating the Performance of Isa Ibn Maryam Hospital, in Isfahan University of Medical Sciences based on quality management indicators with a 360 Degree feedback approach 26 33 EN Saeed Mohammadpour Management Sciences and Health Economics Research Center, School of Management and Information Technology, Iran University of Medical Sciences, Tehran, Iran Y Rouholla Sheykhabumasudi Management Sciences and Health Economics Research Center, School of Management and Information Technology, Iran University of Medical Sciences, Tehran, Iran N Morteza Bakhshi Mohammadi Management Sciences and Health Economics Research Center, School of Management and Information Technology, Iran University of Medical Sciences, Tehran, Iran N Shaghayegh Yusefi Management Sciences and Health Economics Research Center, School of Management and Information Technology, Iran University of Medical Sciences, Tehran, Iran N Alireza Rezazadeh Management Sciences and Health Economics Research Center, School of Management and Information Technology, Iran University of Medical Sciences, Tehran, Iran N Yusef Shaabani Department of Management, Health Policy and Health Economics, Faculty of Management and Medical Information, Kerman University of Medical Sciences, Kerman, Iran N Background: Medical diagnostic laboratories and accuracy and precision of laboratory test results play a decisive role in improving services delivery to patients. Therefore, special attention to the quality of medical health services activities appears to be essential. This study aimed to evaluate the performance of laboratory of Isa ibn Maryam hospital of Esfahan due to the concept of quality management and carried out by using a 360 degree feedback approach. Methods: The current paper is a cross-sectional study which was conducted in Isa ibn Maryam hospital in Isfahan University of Medical Sciences. Simple random sampling is used and totally 42 patients and hospital staff (laboratory customers) were selected. The data collection tool was a self-made questionnaire and data were analyzed using Microsoft Excell 2010. Results: Based on the findings, the highest mean score of evaluating performance was related to pediatric department with a score of 5/50 and the lowest mean was related to hygiene and the infection control unit was with a score of 5/42. Conclusion: The most important flaws in each performance evaluation system are personal taste orientation and applying personal views. Thus, it may be possible to minimize the deployment of personal opinion in evaluations by using a 360 degree feedback approach. Laboratory, Performance Evaluation, 360 Degree Feedback http://jebhpme.ssu.ac.ir/article-1-127-en.html http://jebhpme.ssu.ac.ir/article-1-127-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 Smoking Prevention Programs Based on Schools Health Profile in the Viewpoint of School Administrators and Health Educators of Tabriz 34 41 EN Rahim Khodayari-Zarnaq Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Y Hasan Jafari Department of Health Care Management, School of Public Health ,Shahid Sadoughi University of Medical Sciences, Yazd, Iran N Keyhan Sajadi School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran N Habibeh Mir Student research committee, Tabriz University of Medical Sciences, Tabriz, Iran N Habib Jalilian Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran N Background: Smoking is a global issue, Iran as one of the youngest contemporary societies, is involved in this dilemma. Therefore, this study was conducted with the aim of studying the implementation of programs and policies on preventing and controlling smoking in schools in Tabriz in 2017 using school health profiles from the viewpoint of school administrators and health educators. Methods: This is a cross-sectional study. The statistical population included all school administrators and health educators in Tabriz in 2017. In the first stage, stratified proportional sampling and in the second stage systematic randomized sampling was applied. The data collection tool was schools health profiles. Relevant questionnaires were filled out by school administrators and health instructors. The data were analyzed by SPSS version 22 using descriptive statistics (frequency and percentage). Results: 34.4% of schools had an approved policy on tobacco prohibition and 65.6% had no approved or coherent policies or programs on prohibition of smoking. The average and standard deviation of schools based on the use of teaching materials related to smoking prevention and control was 36.14 ± 40.57 out of 100. Most activities were related to the training of short-term and long-term health effects of smoking (50%) and the least activities were related to the provision of health services for preventing and quitting smoking (23.3%). Conclusion: Most schools in Tabriz do not apply any smoking policy. Most schools also do nothing about preventing and controlling smoking outside the schools. Educational materials do not have necessary information in this regard to be taught by teachers. As a result, health managers and policy makers, in collaboration with school administrators and health educators, need to plan and take steps to develop appropriate programs, policies and materials for preventing and controlling smoking. Tobacco, Schools, School Health, Smoking http://jebhpme.ssu.ac.ir/article-1-128-en.html http://jebhpme.ssu.ac.ir/article-1-128-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 Exploring the Concept of Quality in Hospital Services from the Viewpoint of Patients and Companions: A Qualitative Study 42 50 EN Rohollah Kalhor Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Y Samaneh Zolghadr Health Department, Qazvin University of Medical Sciences, Qazvin, Iran N Marjan Darba Health Department, Qazvin University of Medical Sciences, Qazvin, Iran N Atefeh Aghababaei Health Department, Qazvin University of Medical Sciences, Qazvin, Iran N Background: Quality is one of the factors affecting the success of service organizations. The quality of health services is from the patients' perspectives to the best service available in a timely, safe and economical manner. The aim of this article is to explain the concept of hospital services quality from patients and companions perspectives. Methods: The study was conducted using qualitative approach. The data were collected through semi-structured interviews Sampling was done purposefully and research interviews were ended once data saturation was achieved. Fifteen patients and thirteen companions were recruited. Findings were analyzed using Framework Analysis method. Results: The analysis of question about the concept of subjective quality of existence and the ideal quality led to emergence of themes including "emotional and psychological relations" and "customer-oriented" and "environmental and tangible factors”. Also, the themes for suggestion of quality improvement included "holding training classes", "improving facilities and amenities of health" and "improving human resource management." Conclusion: The findings showed that patients in addition to the physical problems of treatment location are concerned to human relations and even clinical treatment issues. In their opinion the relationships between patients and the medical staff, support and respect for the dignity, attention and importance of the personnel to patients and their personnel and environmental factors have a significant impact on the treatment process and the quality is satisfactory.   Companions' Perspective, Patient's Perspective, Quality of Hospital Services, Qualitative Study http://jebhpme.ssu.ac.ir/article-1-129-en.html http://jebhpme.ssu.ac.ir/article-1-129-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 The Relationship between Nurses\' Five Personality Traits and Organizational knowledge with their Job Performance in 2016 Case Study: A Trauma Hospital 51 60 EN Milad Shafii Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Y Roohollah Askari 2 Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences , Yazd , Iran N Mohsen Askarishahi Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Science, Yazd, Iran N Khatere Khanjankhani School of Public Health, Tehran University of Medical Sciences, Tehran, Iran N Background: In today competitive world, human work force has always been a concern for organizations, especially healthcare providers, and organizations are always looking for improving their employees' job performance. Among various factors affecting job performance are two factors of organization and personality traits of the workforce. Therefore, the aim of this study was to investigate the relationship between five personality traits of nurses and the organization knowledge of their job performance.  Methods: This is an analytical study conducted in a cross sectional way in 2016. Sixty one nurses working in a traumatic hospital proportional to different wards were selected and entered the research. The instruments for collecting data were three organizational knowledge questionnaires (35 items), five personality traits (60 items), and job performance (15 items). Data were analyzed using SPSS20 and descriptive statistics and artificial neural networks.  Results: Among demographic characteristics, variables of marital status (% 16.7) and gender (% 1.5), among aspects of organizational knowledge, two dimensions of rewards (% 64.6) and leadership (% 4.3) and among aspects of Five-personality traits, accountability (% 100) and flexibility (% 11.3) had the highest and lowest importance coefficient respectively. Conclusion: rewarding and accountability can improve nurses' job performance. Therefore, hospital managers can help to improve their nursing performance by using appropriate rewarding mechanisms, reinforcing staff accountability and employing responsible personnel. Job Performance, Organizational knowledge, Personality Traits, Trauma Hospital http://jebhpme.ssu.ac.ir/article-1-130-en.html http://jebhpme.ssu.ac.ir/article-1-130-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 1 2018 3 1 Moral Hazards in Providing Health Services: A Review of Studies 61 69 EN Maryam Barati Faculty of Management and information Science of Isfahan, Isfahan University of Medical Science, Isfahan, Iran Y Fereshte Azami Faculty of Management and information Science of Isfahan, Isfahan University of Medical Science, Isfahan, Iran N Beheshte Nagdi Faculty of Management and information Science of Isfahan, Isfahan University of Medical Science, Isfahan, Iran N Masoumeh Foladi Imam Ali Educational- Therapy Center, Islamic Azad University, South of Tehran, Karaj, Iran N Majid Hajimaghsoudi Trauma Research Center, Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N Salah Addin Asadi Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran N Background: Moral hazard is the increased likelihood of loss driven by insured behavior, which is a major the challenges faced by the insurance system. Therefore, the purpose of this study is to review the concept of moral hazard and its types, causes, consequences and control measures. Methods: This study was conducted through review, utilizing articles related to the subject in Springer's published texts, valid sites and databases such as: Google Scholar, Magiran, Medline, Springer, SID, Scopus and PubMed. The information utilized was collected from 1960-2016. Databases were searched using keywords of moral hazard in health services, causes of hazards, types of hazards in health systems, the consequences of hazards, the ways of controlling hazards, health insurance, moral hazards and health insurance. Results: The results showed that the third party (insurer) in health insurance contracts, paying a high share of treatment costs, mitigates the motivation for the behaviors of disease prevention, and prevents harm or disease, i.e.  Because the patient pays only a fraction of the cost, it has devastating consequences such as increasing insurer costs and the health system, reducing welfare, wasting resources, reducing insurance coverage, and so forth. Conclusions: Identifying various types of moral hazards, their causes and consequences in determining control strategies and reducing moral hazard and preventing undesirable outcomes are effective. Health Services, Moral Hazard, Health Services http://jebhpme.ssu.ac.ir/article-1-131-en.html http://jebhpme.ssu.ac.ir/article-1-131-en.pdf