نشریه مدیریت سلامت
پیاپی 101 (پاییز 1404)

Hospital waste management poses a major challenge for health systems because of its infectious and hazardous nature. Waste disinfection has health, environmental, and financial implications. Although both outsourcing and in-house methods are used, evidence comparing their cost-effectiveness remains limited. This study aimed to conduct an economic comparison of these two methods in selected hospitals in Yazd, Iran.

This partial economic evaluation was conducted as a cost analysis in four public hospitals in Yazd. Data were collected using a researcher-made form through interviews with relevant experts and review of financial records. Costs were calculated as total annual cost, cost per kilogram of waste, and cost per active beds. Data were analyzed using Excel 2016.

Hospital “A” generated the highest amount of waste (432,000 kg/year). The highest waste generation per active beds occurred in hospital “D” (917.2 kg/year). In terms of total annual cost, hospital “A” was the highest, while hospital “D” had the highest cost per active bed (approximately 4 million Iranian Rials= IRR). The highest cost per kilogram of waste was observed in hospital “C” (51,527 IRR). The cost differences between the two methods were statistically significant (p < 0.05).

The findings suggest that outsourcing hospital waste disinfection is more cost-effective than the in-house method. However, improper outsourcing can lead to inefficiency and additional costs. Therefore, conducting preliminary assessments and following recommended management steps, such as the Gartner Institute’s ten-step framework, is recommended before implementation.

Human papillomavirus (HPV) is one of the most prevalent viruses worldwide and plays a major role in the development of cervical cancer. Recording and managing data related to this virus is of particular importance, as it can significantly contribute to infection control. This study aimed to determine the minimum data set (MDS) required for implementing a registry system for women infected with HPV in Iran.

This descriptive cross-sectional study was conducted in 2025 in three phases. First, relevant data elements were identified through a literature review and the analysis of patients’ medical records from Kosar Hospital, Iran. Next, the minimum data set (MDS) was categorized by a focus group of five experts, including two gynecologic oncologists, two reproductive health specialists, and a health information management professional. Finally, a Delphi questionnaire was developed and administered to 20 experts. Data were analyzed using descriptive statistics in Microsoft Excel.

Out of the 160 data elements included in the initial MDS, 110 elements achieved over 75% consensus in the first round of the Delphi process, and 20 elements reached the same level of agreement in the second round. Thirty data elements with less than 50% agreement were excluded. In total, 130 data elements were finalized and categorized into five main domains: demographic information, patient history, clinical information, laboratory data, and follow-up information.

Comprehensive recording of the HPV-related MDS can enable the assessment of virus transmission patterns, the identification of at-risk populations, and the monitoring of all aspects related to prevention and care. Considering the necessity of maintaining confidentiality and data security for patients with HPV, it is essential that identifiable information be converted into encrypted identifiers.

Good governance in the healthcare system plays a fundamental role in improving service quality, enhancing equity, and increasing efficiency. However, identifying the factors influencing it remains a major challenge. This study aims to identify the causal relationships between factors affecting good governance in the Iranian health system. 

This study was conducted using a mixed-methods approach. In the qualitative phase, data were collected through semi-structured interviews with 17 academic experts and healthcare managers selected via the snowball sampling method. The data were analyzed using thematic analysis. In the quantitative phase, the causal relationships among the identified components were analyzed using the DEMATEL method.

The thematic analysis revealed that good governance  is influenced by seven key dimensions: effectiveness, efficiency, equity, transparency and accountability, participation, legality, and leadership, each comprising multiple related components. The DEMATEL analysis indicated that "rapid accountability" had the highest degree of influence, while "process optimization and technology utilization" exhibited the highest degree of dependency. Additionally, some components, such as goal achievement, patient satisfaction, and productivity, were identified as causal factors, whereas others, including infrastructure development, decision-making transparency, and strategic leadership, were classified as dependent factors.

The study provides a framework for improving good governance in Iran's healthcare system. The results highlight the necessity of focusing on rapid accountability, productivity, infrastructure development, and process optimization to enhance healthcare governance. This framework can assist policymakers in formulating effective strategies for healthcare system reforms and serve as a foundation for future research in healthcare governance.

Non-communicable diseases (NCDs) are among the most important global health challenges, accounting for about 71% of all deaths worldwide. This trend is particularly concerning in low- and middle-income countries. This study aimed to estimate the economic burden of selected neurological disorders and diabetes among participants of the Sabzevar Cohort Study in northeastern Iran.

This study investigated the burden of neurological disorders and diabetes in the Sabzevar Cohort located in Khorasan Razavi Province in northeastern Iran, with a population exceeding 370,000. Data from 4,241 adults were analyzed. Disease burden was estimated using the Disability-Adjusted Life Years (DALY) index while the economic burden was calculated using the human capital approach based on Iran's GDP per capita.

The results showed that chronic headaches caused the highest disease burden, followed by epilepsy and diabetes. Women were significantly more affected by these diseases. Socio-economic factors such as high illiteracy and unemployment were suggested as potential factors affecting the health status in the study population. Chronic headaches accounted for the highest economic burden, followed by epilepsy and diabetes.

The economic burden imposed by the studied diseases is significant, emphasizing the need for effective disease prevention and management strategies. This study emphasizes the urgent need for targeted public health interventions that include demographic, socio-economic, and gender factors to mitigate the increasing impact of non-communicable diseases in vulnerable populations.

People with disabilities (PWD) face various barriers to accessing services. Identifying and addressing these obstacles is essential to ensure equitable service use and should be a priority for policymakers. This study synthesizes existing evidence on these challenges in Iran and suggests potential solutions.

The research was conducted in two consecutive phases. In the first phase, a scoping review was conducted using selected keywords to search five English and two Persian databases. One researcher conducted the search, screening, and data extraction according to the inclusion and exlusion criteria. Of 7,985 studies identified, 82 were included in the review, with data analyzed narratively. In the second phase, a stakeholder dialogue session was held with 14 purposively selected informants to complement the review findings. A neutral facilitator managed the two-hour session, during which the findings were presented and discussed. With participants' consent, the session was recorded, notes were taken, and the data were analyzed using qualitative content analysis.

Of the included studies, 71 (86%) were published in English, and 44 (53%) were conducted after 2021. The primary objective of 67 studies was to identify barriers to access and propose solutions. Based on the review findings and stakeholder dialogue, seven main categories of barriers and solutions were identified: individual, cultural, communicational, financial, physical, institutional, and legal barriers.

To improve access to services for PWD, policymakers should prioritize the development of physical and infrastructural facilities, support employment and economic improvement, empower professionals, enhance public awareness, and strengthen legal protections.

 Medical librarians must develop continuously evolving competencies and skills through up-to-date training programs to keep pace with emerging trends and technological advancements. This study aimed to identify the essential roles and skills required for Master's level graduates in Medical Library and Information Science in Iran.
 This qualitative study employed a conventional content analysis. Purposive sampling was used to recruit participants (n=35), including faculty members, administrators, policymakers, graduates, and current Master's and doctoral students in Medical Library and Information Science. Data were collected via semi-structured interviews and analyzed using MAXQDA software and conventional qualitative content analysis.
 Data analysis revealed four main roles—research, executive-managerial, educational, and health technology and information roles—comprising 36 sub-roles. Additionally, five key skill domains were identified: research, general, educational, executive-managerial, and health information technology related skills, encompassing 17 sub-skills.
 The identified skills can inform policymakers and curriculum designers in developing or revising Master's programs in Medical Library and Information Science to ensure responsive education. Furthermore, the roles outlined in this study may guide career engineering planners in defining organizational positions, job descriptions, and professional requirements for medical librarians and information specialists.

Revising the curricula of various disciplines and defining or redefining professional competencies, and skills, as well as organizational roles and positions is a common practice across disciplines. One study emphasized professional competencies, roles, and positions such as health information manager, and health information technology specialists as part of the expected competencies and job titles for graduates in medical library and information science. Health information technology, health information management, and medical informatics have been formally and specifically designed to address the administrative, technical, analytical, executive and managerial dimensions of health data and information, as well as health information systems and technologies, which must be considered by researchers, graduates, and policymakers in education and human resource planning.

Evaluating organizational performance is vital for strategic planning and decision-making. University libraries, particularly in medical sciences, play a key role in providing up-to-date knowledge and therefore must be assessed. This study applied the balanced scorecard (BSC) method to evaluate the performance of central libraries in Iranian medical universities.
This quantitative and descriptive study, conducted in 2024, surveyed 136 librarians and all managers of central libraries at Iranian medical universities. Two self-reported questionnaires, based on Kaplan and Norton’s balanced scorecard, were developed for employees and managers, respectively. Validity was confirmed by 10 experts in librarianship, and reliability was assessed using Cronbach's alpha. Questionnaires were distributed via email, with follow-up reminder emails and occasional phone calls. Data were analyzed using descriptive statistics (frequencies and means) and inferential tests (one-sample and independent t-tests).
A significant difference was observed (P = 0.001) between managers’ and employees’ views across four balanced scorecard dimensions. Managers scored higher in financial performance and customer satisfaction, while employees rated internal processes and learning and growth dimentions more positively. Performance rankings varied among universities: Hormozgan University of Medical Sciences excelled in “financial metrics”, and Fars University of Medical Sciences led in “customer satisfaction”, “internal processes” and “learning and growth” dimensions.
Both staff and managers viewed library performance as overall unsatisfactory. Applying the balanced scorecard model is essential for improving service quality, boosting user satisfaction, and fostering transparency and innovation in Iran’s medical university libraries.