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Background and Purpose: Ïn hospitals or the other health service centers which deal with the life of the human resources who are the main economical resources, the main required information for planning and effective decision making are provided to managers by Medical Record Department in format and chart. This study was designed and performed in order to determine the rate of Medical record knowledge of the Managers in hospitals and the other health service centers under studying.
Materials and Methods: This study was descriptive and done on 24 and 12 managers from Mazandaran and Golestan provinces respectively. The data were collected in closed and open questionnaires filled by the managers.
Results: This study showed that 10.15 (66.6%) managers of educational- treatment centers and 12.9 (90.4%) managers of treatment centers had weak or very less knowledge of Medical record, but the rate of the knowledge of the managers in Ëducational-Treatment centers was more than in treatment centers. The data were analyzed by X2 test which showed statistically significant differences (P<0.05). 31.36 (86%) of the managers had non-management Üniversity degree. 5.36(13.8%) of managers had management Üniversity degree, but none of hospital management. The jop service of 26.36 (72.1%) and management experience of 29.39 (80.5) of the managers was one to two years. 5.36 (13.8%) of them were diploma or completed two-year university course and the rest had bachelor degree or higher. 19.34 (55.8%) of the administrators Medical record had diploma or under diploma. The main inefficiency of medical record was due to ignorance of the physicians and paramedical staff. Ând the main reson of unestablished medical record committee in these two stats was due to no request from the medical record administrators.
Çonclusion: For inhancing the optimization of hospital it is better to appoint those who are qualified in general management or hospital management and also the selected managers attend different workshop, and the present managers abserne different short courses on medical record subject. Ïn order to increase the efficiency of medical record in order to receive proper records the medical record staff preferably be selected from the bachelor degreee or the higher.

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Background and purpose: Hospitals are one of the most important solids sources in cities, in which large parts of the solids are hazardous. Ïf proper attention is not paid to the control of hospital solids, it will not only affect the patients and personal health in the hospitals but also will affect the human health and environmental pollution. Therefore collection, transfer and disposal of private and government hospital solids in Mazamdaran state was evaluated.
Materials and methods: Â descriptive study carried out in all hospitals of mazandaran province during the year 2001 the study included 20 government and 7 private hospitals. The equipments used in this research were researcher’s observation and a questioners (data Çollection forms) filled by researcher.
Results: The results obtained in this research showed that inspite of solids seperation in almost all the hospitals of the province, the complete seperation is not done in about 85% of the hospitals, and sometimes the infected solids are collected in non-infected solids buckets. X2 test was 3.84 which shows a significant relationship between the government hospitals and solids seperation. Ïn 45% of government hospitals, transfer of solids form wards to their temporary sites are done by hands and in 55% by wheel porters, butin 72% of private hospitals this procedure was 58% by hands and the rest by wheel porters. 60% of the hospitals and an incinerator. The obtained X2 test of 2.25 showed a significant relationship between an active and intact incinerator and government hospitals.
Çonclusion: Âsregard to the results obtained in this research, we conclude that a legislation and establishment of hospital solids waste law and also a development of hospital indection control committee and employment of skilled. Ënvironmental health staff and also a continous education of hospital staff could be an unavoidable measures to be taken in collection, transfer and healthy disposal of hospital solids.

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Background and purpose: Libraries have a specific place in universities and have also an important role in students' education and research. The aim of this study was to evaluate the situation of academic libraries in Mazandaran, Babol and Golestan Universities of Medical Sciences.
Materials and methods: This study is a descriptive survey in 25 academic libraries in Mazandaran, Golestan and Babol medical Universities. The tool of the survey was a standard questionnaire (ACRL), and the libraries were assessed using of checklist and interview.
Results: Thirteen librarians (53%) hold a BSc degree, one (4%) with an MSc degree and two (8%) had an AA degree. Regarding to prediction and design of the libraries structure, only 40% (10 libraries) had prior programs. Related to budget, 40% relied on resources from the deputy for research, 12% on faculty current budget and 8% on hospital current budget, (40%) of others libraries did not have a planned budget). 12 libraries (45%) were open 6 days a week, 10 libraries (40%) 5 days a week and 3 libraries (12%) provided services every day. 39665 references were held at central library of Babol Medical Sciences University and less than 1016 at 5 Azar Hospital in Golestan Medical Sciences University. Fifteen libraries (60%) had access to Medline and Elsevier databases and 10 Libraries (40%) did not have any access.
Conclusion: University libraries must be standardized to meet the need of the students and staff.

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Background and purpose: Implementing medical ethics rules and patients’ bills of right are necessary in achieving high quality health care services. The present study was performed to assess the implementation of patients’ bills of right from the physicians and nurses’ viewpoints, working in Mazandaran University of Medical Sciences Educational Hospitals. Materials and methods: This descriptive-cross sectional study was done using stratified random sampling in 487 physicians and nurses working in four educational hospitals in Sari, 2012. The data was collected using a two-section questionnaire including demographic characteristics and likert-type scale regarding implementation of patients’ bills of right. Analytical tests including Mann–Whitney U and Kruskal-Wallis were performed to analyze the data. Results: The mean score for patients’ bills of right was 2.65 ± 0.83 from their own points of view. The least score was for respecting the patients, their privacy and indiscrimination (2.09 ± 1.03) and the highest score was seen in the right to choose and making decision freely (2.82 ± 0.94).There was a significant difference between the physicians and nurses’ mean scores for implementation of patients’ bills of right in which physicians believed in poor implementation (P=0.006). The implementation of patients’ bills of right was followed the least in internal ward (2.30 ± 0.72) and the most in psychiatry ward (2.85 ± 0.99) (P=0.003). Conclusion: The patients’ bills of right is not fully implemented by physicians and nurses working in educational hospitals. Therefore, necessary actions are needed to remove barriers against patients’ bills of right and to facilitate its implementation in hospitals.

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Background and purpose: perceived value is defined as customer’s overall assessment of the utility of a product or service based on perceptions of what is received and what is given. The aim of this study was to investigate the relationship between service quality and perceived value by patients in private hospitals of Tehran. Materials and methods: This cross-sectional descriptive and analytic study was conducted in 2010. The study population included 969 patients selected from eight private general hospitals in Tehran. The data was collected through a questionnaire containing 18-items (service quality: 14 items and perceived value: 4 items), which its reliability and validity were confirmed. Data analysis was performed using descriptive statistics and multivariate regression in SPSS.17. Results: The mean score for patients' perception of service quality and perceived value were 4.01, and 3.43 out of 5. Regression analysis showed that about 27% of the variance in perceived value could be explained by the service quality. The interaction quality is the strongest factor influencing patient perceived value and its predictive power is about twice more than two other dimensions of service quality (process quality and environmental quality). Conclusion: Three dimensions of service quality were the key determinants of perceived value in private hospitals of Tehran. To promote the perceived value by patients, the quality improvement activities must focus on reduction and rationalizing monetary costs, accurate service scheduling, and strengthening the interpersonal relationships and communication skills of doctors, nurses and staff.

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Background and purpose: The chemical quality of feed water to dialysis instrument is very important, especially in terms of heavy metals which could cause serious health problems for dialysis patients. This study aimed to determine the concentration of selected heavy metals (lead, cadmium, chromium and zinc) in feed water to dialysis instrument and compared that with EPH and AAMI standards in hospitals of Kermanshah province in 2014. Materials and methods: A total of 42 samples of feed water, and 42 samples of permeate water (feed water to dialysis instrument) of reverse osmosis systems were collected from Kermanshah province hospitals. The collected samples were analyzed and the concentrations of lead, chromium, cadmium and zinc were determined using ICP (DV-Optima2100 model) according to standard methods. Then, the mean concentrations were compared with AAMI and EPH standards. Results: The mean concentration of lead, cadmium, chromium and zinc in permeate water of reverse osmosis system was 18.81± 14.32, 0.719± 0.53, 84.25 ± 2.46 and 43.39± 19.14 ppb, respectively. The efficiency of the settled reverse osmosis system before dialysis instrument was 61.5 and 2.1%, in removal of zinc and chromium, respectively. But this system was found inefficient in removal of lead and cadmium Conclusion: The mean concentrations of lead and chromium in the permeate water from the reverse osmosis system was higher than limited standards of AAMI and EPH, but the mean concentrations of chromium and zinc were lower than mentioned standards in all investigated hospitals. Therefore, the reverse osmosis system was able to decrease zinc in moderate and chromium in lower levels, but it was not effective in the removal of other heavy metals. So, periodic washing and cleaning or replacing the membrane of the reverse osmosis system is highly recommended.

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Background and purpose: Discharge against medical advice (AMA) has negative impacts on treatment outcomes and health care resources. Also, physicians and hospital administrators get involved in litigation. The aim of this study was to investigate the causes of AMA discharges in different wards and emergency departments in teaching and nonteaching hospitals affiliated with Mazandaran University of Medical Sciences.

Materials and methods: This cross-sectional study was performed investigating the AMA leaves within 6 months in 2014. Data was obtained from the Department of Medical Records and the Office of Quality Improvement. Data was recorded in a questionnaire consisting of two parts. Part I included demographic information and Part II was about the reasons of discharge against medical advice. Data was aggregated by expert staff in Office of Quality Improvement. SPSS V.18 was applied for data analysis.

Results: The prevalence of AMA leaves in emergency department and other wards in teaching hospitals affiliated with Mazandaran University of Medical Sciences was 3.81% and 4.38%, respectively. These figures in nonteaching hospitals were 8.38 % and 1.59%, respectively. The most common causes of discharge against medical advice were partial recovery, lack of trust in service quality, feeling uncomfortable, and emotional reasons.

Conclusion: To reduce the rate of AMA leaves and its consequences, health care staff should be supportive towards the patients and communicate effectively in order to build their confidence.  

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Background and purpose: Nowadays, human and financial losses caused by natural and non-natural disasters have a great impact on human health. This research was conducted to determine the ability of selected hospitals in crisis management according to the World Health Organization.

Materials and methods: A descriptive study was done in which the authorities (n=45) in three selected hospitals (Razi, ValieAsr, and Shafa) in Mazandaran province, Iran were participated in 2015. Data was collected by world Health Organization check-list and was analyzed using numerical taxonomy in Excel software.

Results: The check-list included five scales: general information, identification of the risks and the level of functional safety, structural safety, and non-structural safety. Compared with two public hospitals (Razi and ValieAsr) the overall safety level in private hospital (Shafa) was higher (57.84%). Considering the ranking and developmental status, except Vali-Asr hospital (0.5 0.75).

Conclusion: This study showed the need for a standard management system in crisis management and serious attention to general indices, risks and safety levels in hospitals.

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Background and purpose: Cyclophosphamide and ifosfamide are two most widely used and hazardous drugs in chemotherapy centers. This study aimed at determining surface contamination with cyclophosphamide and iphosphamide in chemotherapy centers.
Materials and methods: This descriptive cross-sectional study was carried out in three chemotherapy centers affiliated with Hamedan University of Medical Sciences, Iran 2016. Twenty eight samples were collected from contaminated surfaces. The samples were then prepared by solid phase extraction and analyzed by HPLC/UV apparatus.
Results: The mean values for surface contamination of cyclophosphamide and ifosfamide were 57.28 ± 63.8 and 44.15 ± 5.5 ng/cm², respectively. The highest levels of contamination with both drugs were observed at exhaust hood surfaces and the lowest level of contamination was seen in nursing station and staff resting place. The clothes and gloves of nurses were also found to be contaminated.
Conclusion: Daily number of medications, the location of drug preparation room and injection room, nursing station, staff resting place, daily cleaning programs, and repairing and maintenance of ventilation systems were amongst the major factors affecting surface contamination in chemotherapy centers.
 

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Background and purpose: Equitable access to health services and their fair distribution in the country, especially in deprived areas, are among the major goals of health systems. The aim of this study was to investigate the amount of health insurance subsidies in different socio-economic classes in public hospitals in Babol, Iran.
Materials and methods: This cross-sectional applied study was performed in hospitals affiliated with Babol University of Medical Sciences in 2018. The statistical population consisted of 700 patients selected by simple random sampling. Data were collected using a checklist based on patient statements and a researcher-made questionnaire. SPSS V22 was used to analyze the data applying Mann Whitney and Kruskal Wallis test.
Results: The amount of health insurance subsidies for patients of middle social class was higher than other two groups (good and lower social classes). The most discount on medical bills were offered to good-social class patients and then to patients of middle and lower classes (P<0.05). Also, health insurance subsidy paid to patients with good economic status (450,000 Tomans) was higher than patients with poor economic status (430,000 Tomans) (P<0.05).
Conclusion: Current study showed that health subsidies and medical bill discounts were not commensurate with patients’ social and economic status. In fact, patients who had good conditions in terms of these characteristics, benefited more than other groups.
 

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Background and purpose: An organization's safety culture is the product of its values, attitudes, beliefs, and behavioral patterns that define the organization's commitment and framework for managing safety and health. The purpose of evaluating the safety culture is to identify the current state of the safety culture raise the awareness of the employees in this field evaluate the interventions related to safety and track the changes that have been made. The present study was conducted to analyze the status of patient safety culture among the employees of hospitals covered by Mazandaran University of Medical Sciences in 2022.
Materials and methods: The current descriptive, analytical, and cross-sectional study was conducted in 1401 on 440 employees of medical and educational hospitals covered by Mazandaran University of Medical Sciences. The sample size was calculated using Cochran's formula and the sampling method was simply random. The tool used in the Standard Patient Safety Culture Questionnaire (HSOPSC) The questionnaire had 42 questions, and 12 dimensions of the patient safety culture including dimensions of general understanding of the patient, organizational learning and continuous improvement, discipline within hospital departments, non-punitive policy in cases of errors, issues Work related to staff, manager/supervisor expectations and actions to promote patient safety, open communication channels, feedback and exchange of information about errors, hospital management support, teamwork among hospital departments, hospital handovers and transfers, and frequency of incident reporting. Unwantedness was measured based on a five-point Likert scale. The average score of less than 2.5 indicates a low patient safety culture, between 2.5 and 3.75 an acceptable state of safety culture, and 3.75 and above indicates the patient safety culture is a strength of the hospital. The study was conducted with IR.TUMS.SPH.REC.1400.289 code of ethics. Analysis was done using Spss 24 software and independent t-tests, one-way analysis of variance, and Friedman.
Results: Most of the participants (47%) were 30 to 40 years old and had work experience of 1 to 10 years (44.6%). Also, most of the studied people (59%) were on rotating shifts. The overall status of patient safety culture in hospitals covered by Mazandaran University of Medical Sciences was 64.4% with an average of 3.22±0.43, so 86.1% of the participating employees considered the patient safety status as an average. Among the dimensions of patient safety culture, the highest and lowest scores are respectively related to the dimensions of "teamwork within hospital departments" with a mean and standard deviation of 3.90±0.79 (78 percent) and "hospital delivery and transfers" with a mean, and the standard deviation was 2.75±0.92 (55%). According to the single-sample independent parametric T-test, the score obtained from the status of patient safety culture in covered hospitals was higher than the average standard score of 3 (P<0.05). Patient safety culture in people with higher service experience had a better condition than people with less experience (P<0.05). No significant difference was observed in the status of patient safety culture in different work shifts of the participants (P<0.05). Also, teaching hospitals had a better average patient safety culture than non-teaching hospitals (P<0.05).
Conclusion: Based on the findings, hospital transfers were identified as one of the weakest areas. The implementation of appropriate training courses, such as workshops and in-service training, for correct patient transfer and handover is recommended. Additionally, empowering staff to freely question and critique decisions and actions of senior personnel regarding patient safety concerns is crucial.

 

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Background and purpose: This study aims to examine the challenges within the management structures of public hospitals, particularly how these challenges impede the achievement of executive goals. If the consequences of these challenges are not adequately addressed, they may result in significant issues in the management of medical and hospital services. These issues could have a detrimental impact on various stakeholders, including patients, hospital staff, and administrators. Therefore, this research identifies the key administrative challenges faced by public hospitals from the perspective of multiple stakeholders and proposes potential solutions to improve hospital management and service delivery.
Materials and methods: This mixed-method study (quantitative and qualitative) involved two primary groups: healthcare providers and hospital managers/senior professionals, including 14 senior staff from a public hospital. In the qualitative phase, semi-structured interviews were conducted to identify the challenges in public hospitals. In the quantitative phase, a questionnaire was developed based on the qualitative findings and the opinions of 363 experts. Exploratory factor analysis was performed using SPSS and AMOS software (version 24).
Results: According to stakeholders, the challenges in managing public hospitals were identified across four key categories: financial, procedural and decision-making, human resources, and infrastructure. The results of the data analysis revealed that procedural and decision-making challenges had a coefficient of 0.89 with a significance level of 7.881; financial challenges had a coefficient of 0.79 with a significance level of 6.994; human resource challenges had a coefficient of 0.75 with a significance level of 6.641; and infrastructure challenges had a coefficient of 0.43 with a significance level of 3.807.
Conclusion: The study results indicate that procedural and decision-making challenges in public hospitals are key factors significantly affecting the achievement of hospital operational goals and have a broad influence on other critical aspects of public hospital services, including patient satisfaction and service efficiency. Additionally, financial constraints, human resource limitations, and infrastructure challenges diminish hospitals' capacity to effectively meet patients' needs and organizational goals in both quantitative and qualitative terms, posing serious barriers to healthcare quality and accessibility.
 

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Background and purpose: The transition of hospitals from non-teaching to teaching institutions has been increasing in recent years. This study aimed to investigate the key processes involved in this transition.
Materials and methods: This research was conducted using a mixed-methods qualitative approach. The first step involveddocument analysis, the multiple voting technique, and scenario and process development. The second step employed a comparative qualitative study using data extraction tables.
Results: In the first step, 195 processes were identified, and after prioritization, 19 were selected. Then, 67 documents were reviewed to categorize the content related to each type of hospital. Workstations and flowcharts were compared, leading to the identification and mapping of seven new processes introduced by the addition of the teaching mission, as well as the strengthening of 12 existing processes. The changes include the involvement of new personnel in activities, an increase in the number of process steps and processes, and a greater number of individuals responsible for executing these steps. Also, the complexity of teaching processes increases due to clinical training, requiring the simultaneous presence of students and medical staff.
Conclusion: Considering the involvement of new personnel and the changes in the number and variety of responsible individuals, special attention should be given to employee resistance, potential conflicts, and both individual and group communication. The doubling and prolonging of processes require careful consideration of hospital performance, patient satisfaction, and the clinical training of future healthcare professionals. The simultaneous presence of students and medical staff highlights the need for increased supervision and attention to patient safety and quality. Two key processes from the total reviewed processes are related to patient acceptance and assignment, making it crucial to focus on these as the first point of contact and key communication channels for providing services and preventing quality and performance gaps, based on the findings of this study.