نشریه مدیریت سلامت
پیاپی 72 (تابستان 1397)

Studies conducted have shown that the rate of awareness and use of evidence-based medicine (EBM) is low. The current study aimed is a systematic review to identify barriers of using EBM.
All indexed article in national and international valid databases were reviewed by standard and sensible keywords. Articles were selected based on inclusion criteria and after quality assessment entered to the process of systematic review. In total, 9930 articles extracted and amongst them 97 were included.
Findings indicate that the most important barriers for physicians and residents in order of importance were: time limits, limited knowledge and skills, limitations of the evidence, lack of facilities, attitudinal barriers, educational barriers and barriers related to the patients.
According to the barriers and difficulties in the effective use of the resources there for the physicians, that first step in improving and removing barriers for its implementation seemed to be the awareness about EBM application status. On the other hand, clinical librarians play important role in practical application of EBM in practice.

Today, it is widely accepted that workerforce efficiency plays an indelible role in the economic growth of a country. This research study investigated the effect of public and private health expenses on workerforce efficiency in provinces of Iran.
This research was conducted, using data provided by Iran Statistics Center in 2004-2014. The data were selected on the basis of the panel data method. To this end, Romer’s indogenous growth model, MG econometrics technique, PMG, FED were evaluated and based on Hausman’s test, the appropriate model was chosen. The based on cointegration panel method and through FMOLS and DOLS estimates, the long-term relationships were derived taking cross-sectional correlation. Finaly, PMG causal test was performed.
Based on the findings, both private and public health expenditures had a positive and significant effect on workerforce efficiency in the provinces of Iran, and effectiveness of public health expenditures was higher than that of the private sector. Moreover, the results of the PMG causality test indicated that there was a long-term causal relationship between public and private health expenditures toward workerforce efficiency.
To increase the efficency of workerforce, the government should try harder to improve its investment on health in less developed provinces.

Tailoring the content of health information to the needs, preferences and abilities of individuals, leads to more informed and empowered health consumers. Computerized tailoring of Health Information requires patient’s characteristics. A user profile consists of personal data which are basic components in designing computer-tailoring systems. The present study aimed to identify and categorize aspects related to designing, implementing, and interpreting user profile in health computer-tailoring.
In this scoping review, leading databases such as PubMed and Scopus were reviewed using Arksey and O’Malley’s scoping review methodology as a guide. Furthermore, reference lists of relevant literature and key journals were searched. The search was limited to English language articles published from 1990 onwards. Search strings consisted of several keywords related to four main concepts: Individualization, Information, ICT platform, and Health Domain.
The analysis of data, collected from a total of 32 eligible studies, highlighted three aspects in designing a user profile. 1-Identifying common factors used in profiles and classifying them thematically, 2-Data collection tools and methods, and 3-Data interpretation.
Different aspects of designing a user profile in health information tailoring systems were investigated. The proposed model could be considered as a valuable guide for new researchers in the field.

The operating room efficiency is one of the main factors in determining hospital expenses leading to an increase in the capacity of operating rooms, along with an increase in quality and enhanced financial capacity of hospitals. The purpose of this study was to determine the efficiency of operating rooms of teaching hospitals of Shiraz University of Medical Sciences.
This descriptive – applied study, evaluates the efficiency of the operating rooms of teaching hospitals of Shiraz University of Medical Sciences using data envelopment analysis with data-driven approach, assuming variable returns to scale, during 2012-2014. Output variables were the number of surgeries, timing of surgeries, operating room turnover and the number of surgery cancellations. Input variables included the number of staff in the surgery units and the number of beds in the operating rooms. Data and relevant Statistics were collected from the informatics office of the University. Deap2.1 software was used to achieve the objectives of the research.
According to the results, the average technical, managerial and scale efficiency were 0.893, 0.912, 0.980, respectively during these years. Moreover, the results indicated most of the hospitals had constant return to scale. In addition, overcapacity of operating rooms staff was accounted (14.58 percent) at subsidiary hospitals of Shiraz university of medical sciences.
Removing the surplus human resources, in the form of a comprehensive plan based on the results of the data envelopment analysis, plays a major role in improving efficiency and reducing the cost of hospital and healthcare sector. Also, the results led to recommendations for improving hospital efficiency through potential savings of inputs.

Hospital services are considered to be the principal factors which contribute to increasing healthcare costs in many countries; therefore, considering health economic issues and identifying background factors affecting them, is one of the top priorities of health care management. This study aimed to determine factors affecting the culture of health economics from the perspectives of health services providers.
In this ethnography study, data were collected through interviews, observations and cultural artifacts in two major hospitals affiliated with Mashhad University of Medical Sciences. Semi-structured interviews were conducted with 35 key informants among clinical managers, and other health professionals. Data analysis was performed using Miles and Huberman methods. To determine the rigor of data, Guba and Lincoln’s criteria were used.
Data was conceptualized in the two major domains of resources, i.e., management and healthcare quality. Conscientiousness in the workplace, knowledge and experience, facilities and equipment, motivations and management’s supervision were the main factors affecting the areas under study. Conscientiousness in the workplace was turned out to be the most important factor affecting the culture in the study group and was influenced by knowledge and clinical experience and motivational factors in the workplace.
Excessive work pressure, lack of motivation and knowledge regarding the maintenance of equipment, resource constraints and weak supervision were the factors affecting the individual’s productivity which is mainly under the influence of conscientiousness and commitment in the workplace.
Therefore, it is proposed to take measures to foster Conscientiousness and commitment of professional staff in the workplace, pay greater attention to motivational factors, modify the system of funding hospitals and organize training courses related to health economics and inventory management.

In today's world, one of the main concerns of any organization is having desirable performance, as it is the main reason for the survival of any organizationLikewise, performance of the hospitals as one of the main institutions having an important and direct responsibility for improving the health of the community is very essential. The present study conducted in Yazd Shohadaye Kargar Hospital, studied two variables of social capital and organizational entrepreneurship as the influential variables on the performance of this organization. Organizational performance was also assessed from different points of view based on a Balanced Scorecard (BSC).
In this descriptive applied survey research, the required data were collected through distributing a questionnaire among 248 managers and staff members of Yazd Shohadaye Kargar Hospital. Data analysis was done using Structural Equation Modeling (SEM) approach by means of SPSS 22 and AMOS 23 soft wares.
The results of the research showed that social capital has a direct effect on organizational entrepreneurship and organizational entrepreneurship, in turn, has a direct effect on organizational performance. Intensity of these effects were 0.46 and 0.63, respectively. On the other hand, it was also found that social capital has a direct effect (0.18) on organizational performance, but this effect increases indirectly, reaching 0.29, as a result of organizational entrepreneurial mediator variable.
According to the findings of this research and the confirmation of the positive effect of social capital on entrepreneurship and organizational performance, it can be concluded that reinforcement of social capital in the organization, the morale of entrepreneurship can be increased and, consequently, the organizational performance can be improved. Furthermore, confirming the effect of organizational entrepreneurship on function as well as the mediating role of this variable in the relationship between social capital and performance can lead to enhancing the entrepreneurial spirit among employees.

Health is one of the natural rights and basic human needs and is recognized as one of the prerequisites for social welfare systems. However, Lack of financial health protection is recognized as one of the diseases in health systems. When the eleventh government get start, the Ministry of Health developed the health sector reform to seek financial protection from the people. The purpose of this study was to investigate the effect of Health System Reform on Patients’ Formal Payment in Heart Sector of Qazvin’s velayat Hospital.
This was a comparative study of discontinuous time series. The bills of all patients referring to the heart department during the specified period formed the statistical population of the study. By using Morgan table and stratified random sampling, 120 and 154 samples from cardiac files were selected in the years 2013 and 2014 respectively. Data were extracted from patient's financial bills. Finally, data was analyzed by t-test and SPSS software.
With the increase in health care tariffs during the plan implementation, the official payment of patients has not declined significantly, and new insurance mechanisms have prevented the development plan from reaching the goal of reducing the patient's direct payment to six percent of the bill.
Results of the study indicate the impact of various factors such as insurance mechanisms, health care tariffs and kind of patient insurance. Therefore, it is worth the government to use results of the study in planning to increase coverage and financial protection of the people.

The structure, requeirments, and background of professionalism has not yet been discussed in Iranina health sector. This study was conducted to to improve human resourcing in Iran by means of proposing a pattern for professional ethics development.
The present study was carried out in two stages in 2017. In the first stage, comparative analysis was implemented to identify the dimensions and requirements of professionalism in health sector. Five countires, including England, Malaysia, Japan, Turkey, and the USA were included in the study. To gather data from the selected countries, data extraction form was used. In the second stage, 20 experts were chosen to perform a three-round Delphi technique. Data analysis was done by means of SPSS software, 22nd version, and one-sample t-test.
In the comparative stage and according to similar dimensions in the selected countires, four dimensions of Structure, Education, Institutionalization and Evaluation were extracted. Results of Delphi technique showed that in the first step, 17 items were approved out of 20 items. In the second step, two items were omitted and the thematic pattern with 15 items were accepted [P The results indicated that applying professionalism in health necessites the provision of systematic processes and structure. On the other hand, factors such as education, organizational structures and institutionalization of the countries require more investigation and localization.