نشریه مدیریت اطلاعات سلامت
سال یازدهم شماره 7 (پیاپی 40، بهمن و اسفند 1393)

increasing costs of health and treatment services has led health economics specialists and even physicians in all countries to seek new methods for controlling and reducing costs in medical and health services. The present study was aimed to estimate the costs of a Cardiac Care Unit (CCU) in a governmental hospital in Iran. In order to determine the end cost, a stepwise procedure based on actual figures (matrix technique) was used and all of the related documents of 2010 of the government hospital under study were evaluated. The results showed that the total cost of CCU services is 3.827.756.000 Rial, that 55.7% of the costs related to personnel costs and and expenses related to overhead costs is 44.3% and 2.9% of the total costs of hospital wards forms. Much of the CCU cost is personnel cost due to their official personnel, therefore the cost is almost constant in the hospital and it will not be easily removed. It seems we must optimize the use of personnel, and establish new bed in CCU.

Determining the patterns of article publication and citation behavior of the faculties of Qazvin University of Medical Sciences is aimed in this study. 179 articles which were published in the period time of July 2008 to June 2010 with cooperation of at least one of the faculties of the University are studied with Scientometrics and citation analysis methods. 66.3% of people who cooperated in compiling articles are assistant professors and 64.3% of them are men. 66.2% of them are employed in the faculty of Medicine. 15.6% of articles are indexed in ISI. 86% of them are researches and 2.8% of them are reviews. 16.9% of English articles are published in the Elsevier's journals. 86.2% of citations are related to journal's articles and 92.8% of them are in English. Half-time of citations is determined 9 years. 56.8% of faculties of the University are not cooperated in compiling any article in the study's period time, the share of cooperation of women, associate professors and instructors, and employees of faculties of Nursing & Midwifery, Health & Allied Medicine, and Dentistry is below the expected value; so these actions are necessary to consider: 1) determining the causes of low cooperation of the mentioned groups and creating and promoting necessary motivations in them; 2) training what is ISI and why the publishing of articles in it is necessary; 3) training faculties to write reviews; and 4) subscription of at least a nine years period of English journals.

One of the most important quantitative methods and research method in library and information sciences is scientometrics which has markedly developed over the last four decades. The purpose of this study was to map the structure of surgery discipline in Science Citation Index (SCI), during the period 2000 to 2010. This paper is descriptive - analytical and using scientometric techniques. The number of records is 83426. This study is based on bibliographic data retrieved from the Web of Science (gathering tools). The data contain all types of documents published in surgery between 2000 and 2010. The records are processed by HistCite, Pajek and VOSviewer in order to generate chronological and other tables as well as historiographs which highlight the most-cited works in and outside the collection. USA had the greatest publishing, i.e. 24,533 (29.41%) documents; also, The status of research in Iran has been compared with other world and Middle East countries that Iran, with 0.34% rating is the 33rd in the world and the 3rd in the Middle East. Regarding their subject area, most of the articles, i.e. 34.85% documents, dealt with “surgery”. As for their source of publication, 14.68% articles had been published in the CARDIOVASCULAR SYSTEM CARDIOLOGY. it is noteworthy that, In order to improve Surgery scientific publications of Iranian universities and research centers, appropriate policies should be developed while being continuously monitored by Iranian Ministry Science and Health and universities research policy makers. Also, surgery Scientists of our country should have paid more attention to the field of laparoscopy.

Among the quality approaches focused on enhancing the level of costumer satisfactions and along with considering the reduction of cost of quality issue, Six Sigma approach is known as one the most powerful tools to solve the quality problem of organizations. Six Sigma tool relies on data produced by the process. The approach leads one analyzes systematically a process to improve the process based on following the costumer requirements emphasizing the facts. The description defines clearly the diversity of Sig Sigma and other approaches introduced in literature. This research provides monitoring the implementation effects of Six Sigma allowed improving the quality and reducing cost factors in Taleghani hospital. This research conducted practically and cross section longitudinal. The time assigned to collect needed data is about 7 months. Minitab software is also used to analyze data. After implementing the project, data analysis addresses 2.5 for the new sigma, however before the implementation value of 1.25 has been recorded for the process. Furthermore the reduction of 60% for the specified cost addresses an effectiveness implementation project for Taleghani hospital. It is expected that the cost of quality of the hospital will be reduced about 600 million Rails per month. Training, cultural factor and unerring were focused on by the implementation team. The focusing assured the hospital producing constant results after the implementation.

In recent years spatial justice has gained special importance among planners and geographers. Since the urban public services form the structure, shape and the nature of the physical, social and urban space, Inequities in their distribution cause irreversible negative effects on the structure and the nature of city and social segregation of the people, and serious challenges in the city and urban management.

Accordingly, the purpose of this research was to evaluate the spatial distribution of Therapeutic centers and to identify the underserved areas regarding these Services in the Najaf Abad city using the localization standards and criteria of these services. To this end, we used the geographical information system (GIS), model Overlap index (IO) and the Analytical Hierarchy Process (AHP). By providing a comprehensive database of spatial distribution of medical centers’ in Najaf Abad we analyzed theses centers accessibility from all areas of the city and by taking the poor access of some areas to these services and considering other urban factors that influence localization we Provided a working model, in an attempt to look for the optimal spatial distribution pattern of Therapeutic centers in Najaf Abad using geographic information system (GIS).

This was a descriptive analytical study and the results showed that given the performance Radius of 1000, 1500 and 2000, meter for the existing hospitals, some parts of the city were not within the Standard service area of the three available ones. Therefore, given the current situation, the establishment of new hospitals in the areas mentioned above, seems to be necessary. Also, given the service radius of 500 to 1000 meters for Sanitary- Therapeutic centers, Southern areas of the city were outside the performance Radius of such centers. Therefore, given the current status, establishment of new Sanitary - Therapeutic centers seems to be necessary.

The amount and distribution utilities can play an effective role in spatial displacement of population and demographic changes. Since one of the criteria for sustainable urban development and social justice, according to a balanced distribution of urban facilities and services, The distribution of urban services, especially health services should be established in such a way that the space justice.

Given respect to the hospitals’ circumstances, decentralized and mandate, are of the delicate and Accurate manager’s duties in organization. This study is conducted for appointment of organizational centralization rate and its related causes on the basis opinion of executive manager in hospitals under support of Kerman university of medical science. This is a descriptive- analytical study that performed by census method on total 15 hospital under support of Kerman university of medical science and 60 manager as research society in 2008. It is used 2 author-base questionnaire For data collection that their’s validity confirmed by expert panel and their’s reliability confirmed by calculation of alpha cronbach 0.76 and 0.79 and also t-test, analysis of variance and Pierson correlation coefficient used for data analysis. the overall mean of organizational centralization was 67.3 and in order in hospitals’ manager was 71.20, nursing manager 66.47, educational supervisor 67.87 and in clinical supervisor was 63.47 respectively. Also, there was a significant association between organizational centralization rate and organizational post. From demographic variables, there was a significant association between gender and centralization degree of all manager. given respect to these results, it should be say that studied hospitals in this study were managed semi- centralized. Therefore, revision in rules that are obstacle for mandate or resignation in hospitals is urgent for promotion of quality of management’s services.

Oil plays an important role in the Iranian economy. Thus it is necessary to study of the effect of changes in oil revenues on other sectors of the economy. The paper investigates the dynamic effects of oil shocks on government health spending during the1979-2010periods. To study the effects of oil price shocks on the Iranian government expenditure in the health sector the vector autoregressive model (VAR) and impulse response functions are used. The selection of model variables was based on economic common theories and the Akaike criterion was used to determine the optimal number of lags in the model. The Engel-Granger test confirmed the existence of a long-term equilibrium relationship between oil revenues and health spending. Also, the impulse response functions showed that a positive shock equaling one standard deviation in Iran's oil revenue would increase the government health expenditure for 8 consecutive periods, then decreases, and finally, after16periods become negative. In Iran, health expenditures are largely influenced by the country's oil revenues, so that a rise in the country’s oil revenue leads to an increase in health expenditures for a relatively long period of time.

One of the most important criteria in appropriation of hospital resources in health care sector is analysis of hospital costs. The present research aims to calculate the final cost of the services offered in Crusher Unit of Ayatollah Kashani Hospital of Shahrekord using activity-based costing technique. The present study was of applied type and in a cross-sectional, descriptive framework, in which the data were gathered between 21 March, 2011 and 20 March, 2012 from Crusher Unit, Medical Records Unit, and Modern, Financial System Software of Accounting & Income Unit of Ayatollah Kashani Hospital of Shahrekord. The final cost was calculated through activity-based costing technique using Excel software. 95 patients on overage referred to Crusher Unit per month. The cost and total income was 5113128000 and 3200000000 Rials (62.6% of the costs), respectively, and the annual loss was 37.4%. Manpower and the consumed materials and energy were appropriated, respectively, the greatest and lowest (86.1% and 0.2% of the total) cost. The results indicated that the costs of Crusher Unit of Ayatollah Kashani Hospital exceeded its income. It seems that appropriate management of manpower and employment of more efficient personnel could decrease Crusher Unit’s costs.

Human capital and equipments are the main components of health care systems. The aim of this study was compare these components with standards of ministry of health for finding deficiencies and remove them. In this Applied - Descriptive study, statistical population consist of Urban and rural health centers and health houses of Dareshahr. The checklist was used to data collection. After completing the checklist and gathering them, results by using descriptive statistics were represented. Findings have shown %26/4 shortage of manpower with the standard of health. The worst situation was rural centers with %55 shortage and the best situation were the heath house with %7 shortages. Current state of Equipment from the Ministry of Health standards was % 31/6 distance. Share existing of facilities in urban centers, rural and the health houses were %81/2, % 62/7and %47/2. Most centers far as Ministry of Health standards. It is necessary for manager to eliminate defection and improve standards of management to ensure balanced development in health care systems.

Query formulation is an essential part of successful information retrieval. The challenges in formulating effective queries are emphasized in the web information search, because the web is used by a diverse population with diverse information needs, different goals and different levels of experience and topic familiarity. This research was conducted to investigate the queries variations based on the contextual factors by Postgraduate Students at Kerman University of Medical Sciences on the Web. This study was conducted through a mixed method. Thirty postgraduate students at Kerman University of Medical Sciences voluntarily participated the study in the first semester of the academic year 91-92. The data was gathered using two questionnaires and log file with using Camtasia Studio software. The questionnaires were calculated by Cronbach's alpha first questionnaire (0.90) and second questionnaire (0.87) and their reliability was confirmed by experts. SPSS19 was used to analyze the data. Three hundred and ninety-nine queries were searched the mean of iteration, was 13.30. The query iteration was significantly different based on search experience, ease of use, usefulness, satisfaction, relevance judgment. The mean of query length was 3.31. Users used two keywords in your search query. The findings indicated a significant relationship between query length with retrieval actions (viewing, navigating and Extracting) in search engines and websites. There was no significant different between the contextual factors (search experience and topic familiarity) with retrieval action (navigating and Extracting. In conclusion, this study showed that querying behavior in information searching processes on the Web varied across a user‘s contextual factors. Since experience in search leads in more efficient search, it is suggested to train students. According to the relationship between evaluation variables and search behavior, it's suggested to design interfaces matching the user's needs. The study includes implications for database and information retrieval systems designers.

Financing the health expenditures in societies which lack the prepaid mechanisms, and is often done through pay out of pocket, cause to take the financial burden to households and they face catastrophic health expenditures. Imposing such expenditures, especially in long run, could have the adverse effects on the level of household life and leads many households into poverty. The study identifies the factors affecting the cost of misery burden of health to be able to reduce these costs and can be effective step to identify vulnerable groups. This study uses a probit model to determine the long-term cost and the burden of poverty on the health of Hossein Abad district of Urmia in 2012, 300 families in the district investigates. rezults: the long term determinants of catastrophic health expenditures, based on the results of the case study, are: wealth index, gender of household head, household size, presence of household members less than 12 years, job status of household head, number of hospital services to be covered by compulsory insurance and supplemental insurance. Furthermore, the results indicate that presence of household members less than 12 years, kind of health insurance, number of use of hospitalized services, and household size will increase the probability that households face catastrophic expenditures while any increase in wealth index, male household head, employed household head, household covered by compulsory and supplemental insurance will decrease the probability of facing the catastrophic expenditures. The results of this study indicate the importance of expanding prepaid mechanisms and support vulnerable groups.

Progress in medical technology requires medical libraries to promote based on the references standards. The aim of this study was to evaluate the status of hospital libraries of Mazandaran and Babol University of medical sciences, on the basis of references standards. This descriptive and cross-sectional study has been done on 11 education hospital libraries of Mazandaran and Babol University on 2013. Data collection was through census and the assessment tool was the researcher questionnaire. It`s reliability and validity was confirmed approval by opinions of masters of science and the Chronbach`s alpha (r=0.74), respectively. Data analyzed by descriptive statistics (Frequency distribution) and excel software. Findings showed that 60 percent of libraries were managed by librarians with Bsc. and Msc. degree. None of the libraries were standardized in view of number of books (at least 40000 references). Among the libraries just Buali in Sari and Amircolah`s children in Babol deliver services to patients. All libraries were opened only 6 days a week. Ayatollah Rouhani Hospital in Babol with an area of ​​565 Sq had the most space between other libraries and with 91/63% had the more facilities. Inappropriate condition of the libraries can indicate a lack of obey of library standard and less attention from authorities particularly senior managers to hospital libraries.

Open access, a new model of scientific publishing is that readers or their institutions for access upload and copy and distribute articles and their findings do not pay a fee. This study aims to investigate the views of the faculty of Tehran University of Medical Sciences toward Open access to scientific article. A descriptive survey method was applied. Faculties’ members of Tehran University of Medical Science were population of this study. As sample, 163 faculties’ members were selected. Data gathering tool was questionnaires that its validity and reliability was confirmed in literature. Data was collected and analyzed by SPSS software and descriptive statistic methods. Results showed that more than 50 percent of faculty members believe that open access to scientific articles increase readership of them, increase the quantity and quality of scientific papers and increase citation to them. Other findings showed that the majority of faculty member (about 80 percent) thinks that publishing in open access journal hasn’t negative effect on scientific validity of articles and their academic rank. faculty members of Tehran University of Medical Sciences have a positive attitude toward open access to scientific production. Therefore, open access to scientific publications as one of the channels in scientific communication was enthusiasm by Tehran University of Medical Sciences faculty members.

Application of six sigma in library management provides quality services to the users by which the satisfaction of users can be achieved with the help of providing better and improved new services in the libraryThis research aimed to investigate the Observance amount components of Six Sigma in Medical Sciences Library, University of Tehran, Shiraz, Isfahan from the perspective of librarian.

This was a descriptive- analytical survey in which a questionnaire was used for data collection. The study population consisted of 210 librarians of Tehran, Shiraz and Isfahan University of Medical Sciences Bachelor's degree or higher in librarianship in 2012-2013. 147 questionnaires were returned. This research was analyzed using descriptive (number and percentage) and inferential statistics (one-sample t test for hypotheses) with soft SPSS software was used. For verifying the face validity of questionnaire, it was given to other professors of Management and Information Sciences and knowledge and their suggestions were applied and the reliability of the questionnaire was also estimated 83% using Cronbach’s Alpha.

In comparison to the average of six sigma in the library community, the average scale of one percent (p<0.01) there is a significant difference. This means that all variables of Six Sigma in Perspectives of Librarians i s significantly higher than desirable.

Confirmed all the hypotheses of the study indicate that the librarians well understood the challenges in libraries and Six sigma as a new approach to meet their goals as efficiently.

Information is one of the major strategic resources of development, but it is considered valuable only when it is efficient. The current study was conducted to determine the citation rate of scientific research conducted in Isfahan University of Medical Sciences in Scopus databases. This descriptive research was done on all scientific articles (1830 documents) indexed in SCOPUS between 2003-2010 using citation analysis. The data collection instrument was considering search results of the documents. To analyze the data, the following approaches were used: 1) result analysis through ‘analyze results’ tab at the Scopus 2) SPSS. Descriptive statistical indexes were used to present the findings. the results indicated that 1830 documents had been indexed in Scopus under the name of Isfahan University of Medical Sciences through 2003 to 2010.These had received a citation rate of 4129 with an average of 2/33 times for each documents received. Ten authors were most frequently cited, the first with an average citation rate of 47 and the tenth with 8.4.Dentistry was the least cited subject and veterinary the most(6.2 citations) and self-citation was observed only in 16.49% of the documents indexed. The result of this study indicated that the citation mean for scientific articles of Isfahan University of Medical Sciences is more than twice the total number of documents indexed in Scopus. The results also indicated that the amount of articles produced by every author did not affect the citation rate; some authors with a few articles had received a high rate of citation. A common field of study like veterinary received the highest citation rate and major fields received the lowest citation rates. It could be stated that the increase in scientific articles of Isfahan University of Medical Sciences on one hand and the increase in their citation rate on the other indicates a quantitative and qualitative progress.

With regard to the financial, physical and human resources, and limited facilities of organizations, and many recourse are non-renewable, scarce and their reformation requires many years, the productivity of these resources will be of great importance. The aim of this study is to identify and rank the factors affecting knowledge management on productivity of librarians by using FUZZY AHP technique in the public universities of Shiraz. This research is an analytical – survey and applied study. The population consists of librarians of libraries of Shiraz Public University (Shiraz University, Industrial Shiraz University, Shiraz Medical Sciences University) in 2012-2013(153 persons), due to the limited size of population, no samples were taken. The factors affecting knowledge management on productivity are extracted by questionnaire and by obtaining expert opinions. 14 factors were identified through exploratory factor analysis was reduced to 4 factors (culture, education, strategic thinking and technology). In order to check face validity was used confirmatory factor analysis and reliability was used Cronbach's alpha. The data was analyzed using descriptive (mean, variance, standard deviation) and inferential (ANOVA and scheffe) statistics by SPSS software and finally, ranking the factors done by using FUZZY AHP technique. Factors culture, education, strategic thinking and technology was affected on productivity and factor "education" the most and factor "strategic thinking" lowest impact on productivity of librarians in the public universities libraries of shiraz. Also there was not a significant difference among the average of subjects based on demographic variables i.e. gender, background of employment, type of work, and library type, but the academic degree was significant difference in four factors. Effective factors Identification of knowledge management and implementation can lead to greater efficiency of librarians and libraries, which will serve to strengthen.

Due to increase in information volume, the skills in searching information from scientific databases have become a necessity for researchers. This research aimed to assess the skills in searching information from online databases included in Iranian National Medical Digital Library among students in Babol University of Medical Sciences, Iran. This study was an applied research that conducted as a descriptive study. Study sample Included 335 students majoring in Babol University of Medical Sciences during the academic Year of 2011-2012 (N=2600). They were selected by using stratified random sampling. Study Instrument was a researcher-made questionnaire that its validity was confirmed by medical library and information science specialists and its reliability questionnaire by Cronbach alpha test was a=0/89. Data was analyzed by using descriptive statistics and inferential statistical (U Mann–Whitney and Kruskal-Wallis Tests) in SPSS 16 software. There was no significant difference between male and female students as to their searching skills. Their skills in searching online databases were significantly different based on their academic levels and majoring fields. Only 11.5 percent of students have medium and high level skills in searching online databases and the skills of 69.2 percent was low. 19.3 percent had no searching skills. Regarding the effect of academic levels and majoring fields on students ‘information searching skills, these variables are worth considering in information seeking skills training. The skills in searching online databases are not satisfying among the students of medical universities. Then, it is proposed that regular courses to be held and effective awareness to be informed.

For many of organizations, ability of having appropriate number of staffs in proper times and moments is an important factor in meeting client’s necessities. Generally hospital modeling is done in order to regulate the shifts and choose the optimum number of crew to increase the effectiveness of hospital and to minimize the costs, so in this study it is intended to reduce the unnecessary overtimes and to increase the efficiency of nurses through use of goal programing and then solving it with GAMS software to choose the optimum number of nurses in the ICU section of Shafa hospital in Babolsar, that eventually results in motivation of nurses for doing their assigned duties. In this research it is tried to prevent the consecutive shifts of each of nurses through help of 0-1 goal programing model and solving it with GAMS software and after that a proper model with the lowest error is presented for nurse scheduling which leads to enhancement in performance and efficiency of each nurse in respective shift. Shafa hospital in Babolsar was the statistical population of this case study that was done in winter of 1391 and 13 nurses of ICU section of this hospital chosen randomly. Performance assessment of hospital using modeling, simulation an precise scheduling of on and off days may be used as an appropriate tool for capacity programming and effectiveness improvement in the area of effective and quick health care servicing, Estimations show that in many of societies, one-fourth of work force are working in shifts and particularly in nursing profession more than half to two-thirds of crew work in shifts. In this article shifts of nurses are arranged and optimum number of nurses is determined with modeling in such a way that eventually all of the nurses should be at work for 8-10 days out of 14 days and no nurse should be in hospital more than 6 consecutive days. Hospitals can reduce the problems of scheduling and increase the performance with planning and programing human recourse and with optimal use of work force, time and cost. Health care systems include many complicated issues that can be solved through use of analysis and applications of research in operations. In this research a model for appropriate scheduling of nurses is presented in such a way that the personnel became satisfied and instructions and regulations of hospital is obeyed.

SOWT analysis is the strategic planning to evaluate the strengths, weaknesses (internal factors) and the opportunities and threats (external factors) of the environment. However, this technique can not determine the significance of each these factors from each other lonely, analytic hierarchy process (AHP) solves this problem. The purpose of the study is applicable and its type is Descriptive - case. The study Were carried out Based on a survey of experts from the hospital by 5 Questionnaire involving paired comparisons of the strengths, weaknesses, opportunities and threats, and then prioritize and determine the coefficients were performed using the software Expert choice 11 version. The results of study revealed the weight of each group SWOT: the Strengths: 38%, Weaknesses: 8/6 opportunities: 4/44 and threats 1/09%. And in group strengths modern medical equipment with 9/9 percent, canceled surgeries with 4/2 percent of the group weaknesses and in opportunities Center identified as a scientific center with 13% and the lack of financial independence center with 4.4% are the most important determined priorities In strengths modern diagnostic – care equipment gained higher scores than the other options. In weaknesses the Significance of canceled surgeries and patient dissatisfaction is more. Center identified as a scientific center is the most important opportunity for hospitals and major threats that an organization faces is the lack of financial independence.

implementing knowledge management. The purpose of this study was to evaluate the effective recognition capabilities for efficient implementation of knowledge management in hospital. The research method was descriptive correlational. Tuesday Milad Hospital, Tehran's Vali rest Allah much and the critical role of service providers in terms of the amount of Social Security benefits (milad) to cover insurance Armed Forces (Baghyatolla) and due to its centrality (vali Asr) were examined in this study as an example. In the present study, a questionnaire was used to open and close in two phases. ¬ illation method of descriptive statistics and Lizrel and Spss version 19 software was used.... The results showed that the implementation of more efficient knowledge management system components (IT capabilities of the organizational culture and structure, elements and element management capabilities, knowledge management process) there is a significant relationship at the 95% level. Knowledge management capabilities as well as the intensity between 874/0 relative to other factors is a priority. apply knowledge management in these hospitably with all of these elements (Culture-IT-Management Element- Element ability process)can do it and efficiency of knowledge management need to all of these and if one of them elements no in backbone or don’t support by System knowledge management apply have problem. any way for optimize management in theses hospitably need to this elements.

In the new age, human health is at risk more than any other time. Hospitals play an important role in restoring health to the people. The emergency department provides the patients who are damaged in an accident or their illness has worsened suddenly with emergency medical care and diagnostic services. In the emergency department every single second counts. The proper management of the patients waiting time requires identifying the parameters which affect increasing the waiting interval and “lean management” is one of the tools for identifying these parameters and optimizing the process of serving patients. This study aimed to investigate the parameters which affect the patients waiting time in emergency department of orthopedic services in Ayatollah Kashani hospital with the lean management approach. This study was a descriptive and mining survey. Population survey consisted of patients in the emergency department of Ayatollah Kashani hospital for orthopedic services in the summer. In order to create a simulation model, the required data have collected from 60 patients entered for orthopedic services in the last week of June and the first week of July (The sample size was determined according to a formula). The data collected by some forms and was processed using “EASY FIT” software. Data collection forms were collected by the researchers was designed and its validity was confirmed by professors and experts concerned. Containing these forms include patient arrival time, start time and the end of the orthopedic service. Then the value stream map was drawn on the basis of lean management principles. On the next step the existing waste was identified and some approaches for eliminating the waste were suggested. Finally the model simulated by “SIMUL8” software and the influence of the applied approaches on the average time of the patient presence was investigated. Regarding to different kinds of waste in orthopedic services, the total waste identified was 30 and 16 approaches were suggested to eliminate them. The output result of applying the approaches 4(Embed a closed operating rooms (stock)), 5 (implementation of (5s)) and 14 (using single minute exchange of die technique (SMED)) in order to receive services, orthopedics average patient stay of 139 minutes to 118, 121 and 131 declined. simultaneous implementation of the three strategies to implement the results showed that the average time a patient in the emergency 139 minutes to 95 minutes reduced. The results show we can eliminate a lot of waste in the process of providing orthopedic services with low costs. In order to do that, we should use scientific methods such as lean management techniques to improve the processes. To achieve the objective mentioned above the decision makers and health managers should be familiar with these techniques and provide practical methods in the field of health and medical care.

Hospital libraries have vital role in dissemination of information so that Quality Assessment of services is essential for developing health services. The purpose of the present research was to evaluate the quality of services provided by Hospital libraries of Isfahan using the LibQUAL model. In a an analytical survey research, 302 users of libraries that belong to Library service quality of Isfahan medical university and Social security organization Hospitals of Isfahan participated. Data was collected by using the LibQUAL questionnaire which validity and reliability of it credited in several researches cronbakh’s alpha was 80. Independent t-tests and paired t-test were conducted to analyze the data in SPSS and Excel. In “service effect” dimension there were significant differences in average of minor and major level of expected services with current level of services. In gharazi hospital (0.2) and alzahara hospital (0.1) results showed positive adequacy gap while in “Information control “and “library as place” dimension there weren’t significant differences in average range. in whole hospitals superiority gap was negative and shariati hospital had highest gap. The findings show all highly important aspects of the “Service affect” dimension in Hospital libraries so that all attempts to be done for enhancing availability of sources particularly electronic resources for who are working in diagnosis and treatment departments.

Costing and cost analysis in health care section is very important in health care management from microeconomic point of view. Various studies have shown that the most common cancer among children is leukemia. Likewise the most prevalent form of leukemia in children under 15 years old is acute lymphocytic leukemia (ALL). The aim of this study was to determine the direct medical costs of ALL among children between 1-15 years old in Isfahan - Iran. This study is a cross-sectional and descriptive study. The samples were all registered patients in Seyed Alshohada Hospital from 20th March 2007 to 21st march 2012 who were suffering from ALL. Their medical records were reviewed and all required data including the type and cost of services were extracted. Health care services were categorized into diagnostic, inpatient and outpatient services. The cost of each category was calculated and standardized based on inflation rate in order to avoid cost miscalculation. Version 18th of the SPSS software was used for statistical analysis. The profile of 252 subjects were reviewed; but considering the inclusion and exclusion criteria, only 106 subjects were included in our study; in which 106 patients received the main course of the treatment and 35 of them obtained the complementary course of the treatment at the hospital. 55.7 % of the patients were boys. The median of the direct medical cost per patient was 136,040,789 I R Rials for the main course treatment in the year 2012 and 78,835,624 Rials IRR for the complementary therapies based on public medical tariffs. However when considering the private medical tariffs the total direct medical cost of treatment was estimated at 610000000 IR Rials. The medication cost was the major cost component of the treatment. Total direct medical costs of ALL based on public medal tariffs was equal to 214876413 IR Rials. However, considering the hidden subsidy in public sector, it seems that the figure of 610 Million IR Rials is more realistic costs of managing ALL patients in Iran.