Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 The Genomic Revolution Has Been Started: What does it Mean for Policymakers? 141 143 FA Leila Doshmangir Health Services Management Research Center, Department of Health Services Management, School of Management and Medical Informatics, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran & Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran N 0000-0001-5197-8437 Neda Kabiri Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Y htt0000-0001-7224-9583 Minoo Alipoursakha School of Public Health, Tehran University of Medical Sciences, Tehran, Iran N 0000-0002-9318-7075 http://jebhpme.ssu.ac.ir/article-1-164-en.html http://jebhpme.ssu.ac.ir/article-1-164-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 Inflation and Financing of Commercial Insurance in the Field of Treatment 144 155 EN Moslem Sharif Social Determinants of health Research center, Yasuj University of medical sciences, Yasuj, Iran Y https0000-0002-1680-181X Rouzbeh Hojabri Department of Planning, Petroleum Industry Health Organization, Tehran, Iran N 0000-0003-2030-1719 Jalal Saidpour Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran N http0000-0002-4550-2181 Hamed Rahimpour Langroudi Department of Planning, Petroleum Industry Health Organization, Tehran, Iran N 0000-0002-6933-6456   Background: In inflationary conditions, financing is one of the most important and challenging issues in different sectors of economy, including health. Health financing means the way money is collected, accumulated and spent for health care services. The process undergoes a change in inflationary conditions. Methods: This is a qualitative research. The data were collected through a survey of documentation related to health system expenditures in Iran.. The search strategy in this study was based on the PRISMA protocol. In the preliminary search, 147 official documents and reports were obtained. After removing inconsistent and repetitive cases, 47 documents were examined. These documents were classified into 11 categories and the position analysis was based on this. Results: Findings show that inflation has had a very negative impact on Iran's financing system; specifically inflation has seriously threatened country's health insurance industry. The study of trend of return loss index in Commercial Insurance in The field of treatment revealed its unfavorable status in the study years. However, the demand for these insurance packages has also been increasing. Conclusion: The rising trend of inflation in the field of treatment in the study duration, along with increased focus of quality services in private sector, in contrast to the public sector, have led to the transfer of treatment costs from public to private sector. This has increased the share of payment from the pocket of patients. This process has increased the influence of this sector in determining tariffs. The lack of authority of insurance companies to monitor and evaluate the performance of these centers is considered as an important factor in transfer of health finances from state and social insurance to private sector and commercial insurance. It should be noted that during the period under study in health market of Iran, the inflation rate and the amount of direct payments have been interacting, and each has intensified another. Inflation, Commercial Insurance, Treatment, PRISMA http://jebhpme.ssu.ac.ir/article-1-165-en.html http://jebhpme.ssu.ac.ir/article-1-165-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 Providing Components of Personal Mastery for Learner Health Organizations 156 165 EN Razieh Montazeralfaraj Department of Health Care Management, Shahid Sadoughi University of Medical Sciences,Yazd, Iran Y 0000-0001-9450-1399 Mohammad Javad Akbarian Bafghi Department of Health Care Management, Bam University of medical sciences, Bam, Iran N 0000-0003-4824-0671 Mohammad Amin Bahrami Department of Health Care Management, Shahid Sadoughi University of Medical Sciences,Yazd, Iran N 0000-0003-2276-7440 Mohammad Ranjbar Health Policy Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N 0000-0001-5660-8048 Mohammad Mehdi Kiani Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran N 0000-0001-5280-9969 Khatere Khanjankhani Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran N 0000-0002-3467-4455 Background: Severe and complex environmental changes that have occurred from technology, makes need for change of knowledge, attitude and behavior, and as a whole empowering and Personal Mastery. The aim of this study is to present components of personal mastery model for Learning Healthcare Organizations. Methods: this is a comparative and cross-sectional study. After theoretical and organizational studies about personal mastery, comparative tables are drawn and designed Model. Delphi technique is used. Members of the Delphi technique gained consensus after two stages. Results: Personal Mastery titled as “Individual Excellence” in this study and certified with 3 components, including “Personal Excellence” with 5 variables, “Mental Excellence” with 4 variables, and “Professional Excellence” with 4 variables. Variables of general knowledge and moral growth (mean = 4.61) in personal excellence, moral growth (mean = 4.75) in mental excellence and expert skill (mean = 4.65) in professional excellence gained the highest grade from other variables. Conclusion: If managers provoke employees to gain personal excellence, mental excellence, and professional excellence, individuals and organizations would function more efficiently. Persons should change themselves through increase their knowledge, skill and moral growth and upgrade their view points, vision and system approach, as well as organizations should support employees and provide necessary resources. Personal Mastery, Individual Excellence, Learning Organization, Health Care http://jebhpme.ssu.ac.ir/article-1-166-en.html http://jebhpme.ssu.ac.ir/article-1-166-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 Estimating the Cost of Prevention and Control of Rabies: A Case Study in the Northwest of Iran 166 173 EN Madineh Abbasi Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Y 0000-0002-2025-7837 Eshagh Barfar Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran N 0000-0002-1781-7485 Teymour Hazratian Departments of Parasitology and Mycology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran N 0000-0002-2520-3811 Roghayeh Abbasi Tabriz Central Library, Tabriz, Iran N 0000-0003-1812-5920   Background: The significance of rabies is due to high mortality rate, economic damage caused by livestock loss, and high costs of treatment. Considering the economic problems in developing countries as well as the lack of resources and facilities, economic assessments will be very useful in obtaining the necessary financial information. Therefore, the present study aims to estimate the cost of prevention and control of rabies in Ahar, East Azarbaijan, during 2010-2011 and 2011-2012. Methods: This is a descriptive, cross-sectional study conducted in Ahar, East Azarbaijan. This study was carried out using available documents (Vaccine registries, Human Resources Department records, Staff daily wages) and data collection (Ministry of Health and Medical Education, Taxi Administration, Municipality Office and the Veterinary Network) to estimate the cost of prevention and control of rabies during 2010-2011 and 2011-2012. The societal perspective was taken into account to estimate costs. Data was entered into SPSS version 20 and the total cost was calculated. Also, the Mann-Whitney U test was used for data analysis. Results: The total financial burden of preventing and controlling rabies in Ahar during 2010-2011 and 2011-2012 was about 803 and 850 million rials respectively. The loss of the patient's income (240 and 260 million rials during 2010-2011 and 2011-2012), cost of rabies vaccine (approximately 231 and 237 million rials during 2010-2011 and 2011-2012), and staff costs (approximately 118 and 247 million rials during 2010-2011 and 2011-2012) had the largest share of the cost, while cost of tetanus vaccine (1.3 and 1.2 million rials during 2010-2011 and 2011-2012) had the smallest share. Conclusion: The present study showed that the prevention and control of rabies put a significant financial burden on the government through direct medical expenses, rabies control program for dogs, and care of the disease. It put a burden on the people, as well, through the loss of productivity and income, and transportation costs. Financial Burden, Rabies, Cost, Prevention, Control http://jebhpme.ssu.ac.ir/article-1-168-en.html http://jebhpme.ssu.ac.ir/article-1-168-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 Applying the EFQM Model for Evaluating the Performance: A Case Study in a Public Hospital 174 180 EN Salah Addin Asadi Iranian Center of Excellence in Health Management (IceHM), Tabriz University of Medical Sciences, Tabriz, Iran Y 0000-0001-6458-3805 Saeed Hosseini Bargzan Student Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran N 0000-0002-5322-2438 Mobin Sokhanvar Iranian Center of Excellence in Health Management (IceHM), Tabriz University of Medical Sciences, Tabriz, Iran N 0000-0003-0923-1385 Background: Evaluation is a key process to improve the organization. The maintenance and improvement of the health is the priority of the people of each country these days. Ensuring the provision of appropriate services requires the evaluation of the health system performance. European Foundation for Quality Management (EFQM) model is a self-assessment model and allocates more for health and care organizations and almost evaluates an organization in all structural and functional aspects. This study was conducted with to the aim of evaluating the performance of a public hospital in Tabriz according to the model of Europe Foundation for Quality Management. Methods: This study was a cross - sectional study in 2015 in a public hospital in Tabriz. Data collection tools had been standard questionnaire of Europe Foundation Model for Quality Management. Data was gathered through standard and prestigious questionnaire of Europe Foundation Model for Quality Management which consisted of 90 questions, same in the field of nine criteria. After visiting the hospital by experts, meeting was hold among them and proceeded to consult and complete the questionnaire. The data was reported by descriptive tests and software of EXCELL was used for data analysis. Results: The mean score of performance evaluation in terms of leadership was 73.6 points out of 100 points, in terms of policy and strategy, 46.8 points out of 80, in terms of human resources 54.1 out of 90 points, in terms of strategies and policy 41.9 points out of total 90 points, in terms of processes 59.8 points out of 140 points, 66 points out of 200 in terms of customer results, in terms of human resources results 23.76 points out of a total of 90 points, 40.2 points out of a total of 60 points, in terms of society results and in terms of key performance the result was 71.35 points out of 150 points . The average total score of 477 points out of 1000 points was performance evaluation. The results of the report are 47.75%. Finally, the results showed that the hospital had relatively appropriate status. Conclusion: The findings showed the need for more attention to human resources and customer results. Enhancing employee's satisfaction factors to increase their satisfaction and efficiency, identifying foreign customers, categorizing and measuring different needs of patients in order to response and upgrade the system of addressing the complaints through the reform the processes are those cases that are proposed to improve the organization and increase compliance with organizational excellence model . Performance Evaluation, Foundation for Quality Management, EFQM, Public Hospital http://jebhpme.ssu.ac.ir/article-1-167-en.html http://jebhpme.ssu.ac.ir/article-1-167-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 The Effect of Organizational Culture and Individual Motivation Resources on Staff Burnout: Structural Equation Modeling Approach 181 191 EN Azimeh Ghorbanian Health policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran N 0000-0001-7545-5489 Beheshteh Naghdi Isfahan University of Medical Sciences Isfahan, Isfahan, Iran N 0000-0002-8850-8057 Hasan Jafari Health Policy and Management Research Center, Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran N 0000-0002-6569-4942 Ahmad Sadeghi Department of Public Health, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran Y 0000-0003-3713-9519 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. Organizational Culture, Individual Motivational Resources, Burnout, Structural Equation Modeling http://jebhpme.ssu.ac.ir/article-1-169-en.html http://jebhpme.ssu.ac.ir/article-1-169-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 The Effect of Work-Family Conflict Mediation on the General Quality of Life and the Quality of Working Life in Employed Women 192 201 EN Mohtaram Zabihi Department of Health Services Management, Sari Branch, Islamic Azad University, Sari, Iran N 0000-0002-2725-3070 Ghahraman Mahmoudi Hospital Administration Research Center,Sari Branch, Islamic Azad University ,Sari ,Iran Y 0000-0003-3769-4379 Ghassem Abedi Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran N 0000-0002-7321-0266 Background: General life quality and its impact on the quality of working life are among the most important and critical issues in today's organizations. Work-family conflict is an important phenomenon that affects both employees and employers. This study aims to determine the relationship between general life quality and the quality of working life in working women with the role of work-family conflict mediation. Methods: This descriptive-analytical study was conducted in 2017. The study population was 4266 women working in the health department of Mazandaran University of Medical Sciences. In this study, 351 samples were selected by stratified sampling method in 11 cities of 19 provinces of Mazandaran province. Data were collected using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) with 26 questions, Casio quality of work life questionnaire with 29 questions, and Carlson work-family conflict with18 questions. The results were analyzed using SPSS 24 and AMOS 22 softwares. Furthermore, Kolmogorov-Smirnov tests, structural equation model, path analysis and standard coefficients, Chi-square, fit index, Bootstrap, and Sobel tests were utilized. Results: Demographic data included age, education, marital status, professional background, employment status, household size, job title, and income. The relationship between general quality of life and quality of working life in employed women was significant (P-value = 0.009). There was a significant and negative relationship between life quality and work-family conflict (P-value = 0.009). The effect of mediating variable of work conflict, between general quality of life and specific quality of working life was not statistically significant (P-value = 0.009). Conclusion: Since general quality of life has a direct effect on the quality of working life in employed women, proper planning and training courses on time management, life and problem solving skills for employees, especially women working in the health sector can improve general  life quality as well as  quality of working life and reduce their work conflicts. Quality of Working Life, Work-family Conflict, Employed Women http://jebhpme.ssu.ac.ir/article-1-170-en.html http://jebhpme.ssu.ac.ir/article-1-170-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 Evaluation of Discharge Against Medical Advice in Victims of Traffic Accidents at the Emergency Department: A Case study 202 207 EN Behrooz Pouragha School of Health, Alborz university of medical sciences, Karaj, Iran N 0000-0002-0290-1238 Roya Rajaee School of Health, Shahid Beheshti university of medical sciences, Tehran, Iran Y 0000-0002-1449-5775 Marziye Najafi School of Health, Tehran university of medical sciences, Tehran, Iran 4; Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran N 0000-0002-5445-2235 Background: Annually in the world 2.1 million people are killed and more than 50 million people are either injured or disabled in road accidents. Discharge against medical advice (DAMA) has increased risk of morbidity and mortality. This study aimed to evaluate the rate and reasons for DAMA in the traffic accident victims at the emergency department (ED) to provide solutions in reducing its complications. Methods: This is a descriptive and cross-sectional study. The population in this study consisted of the victims of traffic accidents referred to the ED of Imam Khomeini Hospital affiliated by Tehran University of Medical Sciences. The  random sampling method was usedand by Cochran formula 147 people were selected and examined for two months. In order to evaluate the validity of checklists, 10 patients were randomly assigned to call and the cause of discharge was requested. Data collection was done through DAMA checklist in the patients’ documents. The finding were entered into spss16 for descriptive statistics and analysis. Results: Most of traffic accident victims (79.6%) discharged with physicians’ recommendations. The DAMA was 17.7% and 2.7% escaped from hospital. In all of patients’ DAMA (26), 46.15 percentage was about all four reasons, 23.08 percentage was treatment reason, and the last reason was due to hospitalized issues (3.85%). Conclusion: Among the four causes of DAMA, treatment problems was higher than others. Patients’ participation in the selection of treatment and focusing on medical equipment are recommended. It is a challenge to the quality of health care services when patients do not adhere to their physicians’ recommendations for treatment.   Discharge Against Medical Advice, Emergency Department, Traffic Accident, Victim, Hospital http://jebhpme.ssu.ac.ir/article-1-171-en.html http://jebhpme.ssu.ac.ir/article-1-171-en.pdf

Shahid Sadoughi University of Medical Sciences Evidence Based Health Policy, Management and Economics 2538-5070 2538-4716 2 3 2018 9 1 Evaluation of Pre-Marriage Counseling Program in Iran: A Narrative Review of Structural, Procedural, and Outcome Dimensions 208 225 EN Mohammad Hossein Mehrolhassani Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Y 0000-0002-2412-9277 Vahid Yazdi-Feyzabadi Department of Health Management, Policy and Economics, Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran N 0000-0002-8009-470X Afsaneh Rajizadeh Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran N 0000-0002-6761-0407 Background: Pre-marriage counseling program, an educational intervention launched in 1993, makes the married couples familiar to maternal health issues. In order to improve the performance of this program, it is necessary to examine the various dimensions of this program. Therefore, the present study was designed and implemented to evaluate the pre-marriage counseling program. Methods: In this narrative review study, the use of standard key words, articles indexed in the databases of PubMed, Web of Science, Scopus, SID, BarakatKNS (IranMedex) and Magiran by the end of April 2017 were reviewed. Finally, the full text of 56 articles was examined, and the content of these articles was classified according to the quality assessment framework of Donabedian in three dimensions, including structure, process, and outcome of this program. Results:   After categorizing the results of the articles based on the Donabedian’s framework, 21, 8 and 41 articles were related and classified in structure, process and outcome, respectively. Most of the studies conducted between 2001 and 2011 were mostly cross-sectional, and the highest number of articles was in the outcome dimension. Structural dimension was subdivided into four sub-categories including educational content, human resources, facilities, and information resources. Then the process was sub-divided into training and counseling mechanism and eventually the outcome. Conclusion:   In the dimension of the structure, the assessment of the educational materials' contents was poor.  In the dimension of the process, the duration of training should be increased.  In the outcome dimension, the level of participants' knowledge and attitude about sexual health, reproductive health and sexually transmitted diseases was assessed moderate to weak. Pre-marriage Counseling, Donabedian’s Framework, Marriage, Narrative review, Iran http://jebhpme.ssu.ac.ir/article-1-172-en.html http://jebhpme.ssu.ac.ir/article-1-172-en.pdf