per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 85 85 article 1 2 No Abstract http://mshsj.ssu.ac.ir/article-1-282-en.pdf No Keywords per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 86 96 article Hossein Ebrahimi Pour 1 Elahe Pourahmadi 2 Reza Vafayinezhad 3 Shapour Badie Aval 4 Zahra Keyvanlou 5 Akbar Javan Biparva 6 Associate Professor, Research Center for Social Factors Affecting Health, Department of Management Science and Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran MSc student in Health Economics, Research Center for Social Factors Affecting Health, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran Assistant Professor, Emergency Medical Services (EMS) Center, Mashad University of Medical Sciences, Mashhad, Iran Assistant Professor, Department of Chinese and Complementary Medicine, School of Traditional and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran MSc student in Healthcare Management, Research Center for Social Factors Affecting Health, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran MSc student in Healthcare Management, Research Center for Social Factors Affecting Health, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran Background: Pre-hospital care plays an important role in managing patients who require emergency services and preserving human life. The aim of this study was to evaluate the cost of completed public pre-hospital emergency missions according to the activity-based costing model and to compare it with the cost of private pre-hospital emergency services in Mashhad in 2016. Methods: In this applied and descriptive cross-sectional study, the data were collected using a researcher-made form 4 major groups of costs were identified to estimate the total costs: 1- Personnel salaries, 2- Current expenses 3- Medical consumables 4- Depreciation. The cost of providing pre-hospital services was calculated based on the activity-based costing. Eventually, the cost of pre-hospital emergency services was compared between the public and private sectors. To investigate the cost-effective factors for missions, multiple regression analysis, Breusch-Pagan, Ramsey RESET, Swilk, and Linktest diagnostic tests were used by  Stata 11.0 software. Results: The average cost of each mission was equal to 2114337 ± 217786 thousand Rials in 58 emergency medical centers of Mashhad in 2016. Of this cost, 78.51 %, (1660129 ± 1578445 Rials) was related to employees' salaries, 19.24 % (406842 ± 375083 Rials) was related to the current costs of each center, 0.23 % (4796 ± 4476 Rials) was related to depreciation, and 2/02 % (42761 ± 42822 Rials) was related to medical consumables in each pre-hospital emergency mission. The value of contract with an emergency pre-hospital emergency was 1104000 Rials for each mission in 2016, which is almost half of the cost related to the public pre-hospital. Results of the regression model estimation also showed that among the variables of the model, the fuel cost variable was identified as an effective variable on the cost of each mission (p = 0.0001). Conclusion: The private sector provides pre-hospital emergency services at a lower cost. Moreover, before establishing a pre-hospital pre-service center, the cost-effectiveness of establishing a center in each region should be checked. http://mshsj.ssu.ac.ir/article-1-283-en.pdf Total cost Pre-hospital emergency care Public sector Private sector per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 97 113 article Mohammad Hashem Botshekan 1 Mohammad Ali Dehghan Dehnavi 2 Mohammad Javad Mohagheghnia 3 Hosein Aslipour 4 Seyyed Mohammad Abbasnia 5 Associate Professor, Department of Finance & Banking, School of Management & Accounting, Alame University, Tehran, Iran Assistant Professor, Department of Finance & Banking, School of Management & Accounting, Alame University, Tehran, Iran Assistant Professor, Department of Finance & Banking, School of Management & Accounting, Alame University, Tehran, Iran Assistant Professor, Department of Governmental Management, School of Management & Accounting, Alame University, Tehran, Iran Ph.D. student of Financial Management, School of Management & Accounting, Alame University, Tehran, Iran Background: To achieve the objectives of social security and health system, it is essential to enhance the level of efficiency of social insurance funds. To hit this target, the challenges of regulation improvement should be identified and addressed in these funds. Therefore, the present study aimed at identifying the key challenges of regulation and modeling the network of management and its effective factors. Methods: This was a cross-sectional qualitative study. In the qualitative part, a systematic review and thematic analysis were conducted using MaxQDA 10 software. Qualitative data were collected by reviewing the relevant documents and related studies. In the quantitative part, the structural-interpretative modeling and Mick-Mac analysis methods were employed. The data were collected by referring to the 14 experts selected by targeted sampling method using a questionnaire. Results: 9 factors were identified as the key challenges in regulation of social insurance funds, including 1) management inconsistency; 2) non-clear insurance approach in population coverage; 3) multiplicity of insurance funds; 4) failure to organize the funds; 5) lack of integrity of rules and regulations; 6) weakness of regulatory authority; 7) weak policy making in management of financial resources; 8) inconsistencies in the country’s insurance tariff system; and 9) insurance cover for informal jobs. The content network was formed in a 4-level model by structural- interpretative modeling method. Conclusion: Regulation challenges of the social insurance funds include a combination of factors showing the need for the formation of a unit regulator to organize these funds. The aim is to meet the key challenges in 4 layers of the proposed model and modify the regulatory and supervisory structure with a comprehensive, impartial, and specialized approach. http://mshsj.ssu.ac.ir/article-1-284-en.pdf Government’s regulation Retirement Social insurance Social economy factors per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 114 124 article Ozhan Karimi 1 Zeinab Abokhamsi 2 Mohammad Saki 3 Assistant Professor, Department of Commerce Management, School of Economics, Tehran Payame Noor University, Tehran, Iran MSc in EMBA, Beqaee 2 Hospital, Jundishapur University of Medical Sciences, Ahvaz, Iran MSc in EMBA, Deputy of treatment, Jundishapur University of Medical Sciences, Ahvaz, Iran Background: In modern organizations, establishment and utilization of the entrepreneurial thinking are inevitable. Entrepreneurial thinking is considered as the insight and ability of the founders as well as the cause of the organizations' birth and death. In order to develop and strengthen the entrepreneurial spirit in organizations, appropriate facilities should be provided, such as organizational structures and formations. The purpose of this study was to investigate the effect of organizational structure on the entrepreneurial spirit of the staff working in the vice-chancellor for treatment of Ahvaz Jundishapur University of medical sciences (AJUMS), Ahvaz, Iran. Methods: This descriptive-analytic and correlational study was conducted on all the staff of vice-chancellor for treatment of AJUMS in 2017 (n = 260). The randomized cluster sampling method was applied and 152 employees were selected. Data collection tools were the Robbins Standard Organizational Structure questionnaires and a researcher-made questionnaire on organizational entrepreneurship. The  reliability coefficients of these 2 questionnaires were calculated as 0.85 and 0.81 using Cronbach's alpha, respectively. Descriptive and inferential statistics (Pearson correlation coefficient, univariate t test, regression coefficient) were used to analyze the data with SPSS 19. Results: The results indicated that the mean scores of the organizational entrepreneurship components in the studied university were higher than the average. The organizational structure had a positive and significant relationship with organizational entrepreneurship (r = 0.08) and formalization had a positive and significant relationship with entrepreneurship (r = 0.20). Furthermore, the complexity had a negative and reverse relationship with entrepreneurship (r = 0.16) and concentration had a positive and insignificant relationship with entrepreneurship (r = 0.11). Conclusion: It can be argued that reduction of complexity, horizontal and vertical segregation in the structure of the vice-chancellor for treatment, and effective utilization of the standard procedures and guidelines can be used as a suitable and beneficial strategy for innovation in providing health services in hospitals and affiliated centers. http://mshsj.ssu.ac.ir/article-1-285-en.pdf Organizational structure Organizational entrepreneurship Employees per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 125 135 article Zahra Maesoumi 1 Mehdi Sanei 2 Hadi Hematian 3 Ph.D. student of Public Administration, Semnan Branch, Islamic Azad University, Semnan, Iran Assistant Professor, Department of Public Administration, Shahrood Branch, Islamic Azad University, Semnan, Iran Assistant Professor, Department of Public Administration, Semnan Branch, Islamic Azad University, Semnan, Iran Background: Policies will be communicated to administrators after being drafted and approved. Sometimes, they undergo changes at the implementation stage that remove them from their goals. The aim of this study was to provide a model to improve the quality of policy implementation in the health system of Iran. Methods: This qualitative study was conducted in 2018. In order to collect the required information, a library method was used by not taking tool and in the second field stage, exploratory interviewing tool was applied. The study population consisted of the senior managers in the Ministry of Health, heads of the medical universities, and government hospitals. In this research, targeted and snowball sampling methods were used to select the interviewees. A total of 33 interviews were conducted. For analysis of the data, the database analysis was used and for modeling a system attitude was applied. Also, for the purpose of model testing, narrative interviews were used. Results: After recording the collected data and removing the repetitive components of the exploratory interviews and research background, 115 statements were identified. After the open encryption, 115 concepts were introduced. Finally, by axial and selective encodings, 9 components were determined: general culture, structure, information, policy quality, implementation style, rules and regulations, resource allocation, empowerment, and environment. Each of these components had dimensions and characteristics, which made a total of 46 indicators associated with capacity building of the health system policies. Conclusion:  Improved quality of the policies' implementation in various layers of the health system leads to a mutual trust between the health system of Iran and various levels of the target community, increases motivation, strengthens the spirit of cooperation, improves sharing efforts and teamwork among the executives, and provides an optimal context for emergence of creativity and innovation in implementation of policies, promotes health indicators in the community, and gains credibility for the health system of Iran. http://mshsj.ssu.ac.ir/article-1-286-en.pdf Policy making Policy implementation System model per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 136 147 article Monireh Sadeqi Jabali 1 Maryam Jahanbakhsh 2 Sedigheh Torki 3 Fatemeh Peykani Qarneh 4 Fatemeh Safari Mohammadi 5 MSc in Education Medical Record, Health Management and Economy Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Assistant Professor, Health Information Technology Research Center, Department of Health Information Management & Technology, School of Health Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran MSc in Education Medical Record, Statistics and Information Technology Office, Isfahan University of Medical Sciences, Isfahan, Iran BSc in Medical Record, Shahid Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran BSc in Medical Record, Naein Healthcare Network, Isfahan University of Medical Sciences, Naein, Isfahan, Iran Background: Hospital, as one of the most important organizations for health promotion, requires efficient and effective human resources. Health information management staffs are responsible for storing, processing, and distributing information used to improve the quality of healthcare services. This study aimed to investigate the relationship between quality of work-life and productivity of health information management staff. Methods: This descriptive analytical cross-sectional study was conducted on 165 staffs of health information management department in an educational hospital of Isfahan in 2017.  The data were collected using Walton Work Quality life Questionnaire and Gold Smith's Manpower Productivity Questionnaire. Data were analyzed using descriptive and analytical statistics, including Pearson correlation coefficient, independent t-test, Spearman correlation coefficient, analysis of variance and linear regression analysis by SPSS 18. Results: Average scores for the quality of work life and productivity were 2.65 ± 0.51 and 2.64 ± 0.42, respectively. According to one-sample t-test, these scores had a significant difference with the moderate level (p < 0.05). Based on the Pearson correlation test, the quality of work life had a direct and significant relationship with the productivity of staff (r = 0.73 and p < 0.05). Independent t-test showed that the average score of productivity in men was significantly higher than women (p < 0.05). Conclusion: Considering the direct and significant relationship between the quality of work life and productivity in the staff of health information management department as well as the low level of these two components, the relevant authorities should take appropriate measures. These approaches include safe physical design of workspace and establishment of a fair payment system in accordance with the working conditions of this department. The quality of work life should be improved since it affects the quality of service delivery and staff productivity. http://mshsj.ssu.ac.ir/article-1-287-en.pdf Quality of life Efficiency Teaching hospital Personnel Hospital per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 148 159 article Mohammad Javad Kabir 1 Hasan Ashrafian Amiri 2 Zahra Hassanzadeh-Rostami 3 Reza Momtahen 4 Rasoul Zafarmand 5 Seiyed Davoud Nasrollahpour Shirvani 6 Assistant Professor, Health Management & Social Determinants Research Center, Golestan University of Medical Sciences, Gorgan, Iran Internal Disease Specialist, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran Ph.D. student of Nutrition Sciences, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Pharmacologist, Directorate of Health Insurance of Fars Province, Shiraz, Iran MD, Directorate of Health Insurance of Mazandaran Province, Sari, Iran Assistant Professor, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran Background: Urban family physician program is one of the relatively large reforms in Iran's health care system implemented in Fars and Mazandaran provinces since 2012. Nearly five years after implementation of the program, this study aimed to identify the achievements and challenges of this program from the viewpoints of managers and administrators. Methods: This cross-sectional study was conducted in winter of 2016. The research population included administrators and experts monitoring the urban family physician program and representatives of the family physicians and health care providers selected using the census method. The data collection tool was a two-part researcher-made questionnaire containing 15 questions with confirmed validity. To collect data, 29 panels of experts were held and the collected information was analyzed by SPSS 23 using independent t-tests and ANOVA. Results: Among the total of 647 participants in 2 provinces, 1540 achievement cases, 2387 challenge cases, and 1641 strategies were found. The average numbers of achievements, challenges, and strategies stated by each person were 2.38 ± 2.0, 3.70 ± 2.7, and 2.54 ± 2.0, respectively. The most frequent achievements, challenges, and strategies were increased disease detection and care (430), untimely payment to physicians (198), and providing sustainable resources for timely payments (119).  The means of achievements, challenges, and strategies had significant relationship with some of the individual and social variables (p < 0.05). Conclusion: This study showed that increasing the rate of detection was the most important achievement and lack of timely payment was the biggest challenge of the program, which should be considered by policy makers. http://mshsj.ssu.ac.ir/article-1-288-en.pdf Achievement Challenges Family Physician Urban Family Physician Viewpoint of Managers Viewpoint of Administrators. per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 160 172 article Arman Bahari 1 Farzaneh Asadi 2 Assistant Professor, Department of Industrial Engineering, School of Industry and Mining, University of Sistan and Baluchestan, Zahedan, Iran Ph.D. student of Industrial Engineering, School of engineering, Islamic Azad University Branch of Lahijan, Lahijan, Iran Background: Simulation is an appropriate technique for analyzing and evaluating the dynamic behavior of complex systems. The present study aimed to develop an integrated model using a simulation approach based on designing experiments to analyze performance of the admission queue system of patients, who referred to the emergency department of the Modarres hospital. Methods: In this descriptive-analytical research, effective variables on resource efficiency empowerment were identified and analyzed using inferential statistics and one-way ANOVA. Later, effects of the effective factors were estimated. Furthermore, performance of the emergency department system was simulated using the Visual Paradigm software. Results obtained from implementation of the simulation model were used as input for designing an experiment. A fully factorial 2-level experiment design was also used with central points. The independent variables studied in the simulation model included practical nurse, emergency secretary, nurse, cardiologist, and hospital bed. The dependent variable was the patients' waiting queue in the studied emergency department. Results: According to Prob > F value, the acceptable effects were determined based on the results of variance analysis for the model. The value of R2 indicated that 82.35% of the model explains all variability of the response-level data around the mean. Therefore, it can be concluded that the design space was in accordance with the estimated model based on the results of variance analysis. Conclusion: In the present study, performance analysis of the emergency department queue system was conducted using simulation and experiment design. The nonlinear regression model was able to predict the queue length. Moreover, this model can be used to predict dependent variables considering acceptable factors. According to the results, minimum length of the queue is obtained when the number of emergency secretaries is at a high level and the number of practical nurses and nurses is at a low level. http://mshsj.ssu.ac.ir/article-1-289-en.pdf Emergency Simulation Optimization Optimizing simulation model Factorial design per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2019-09 4 2 173 183 article Narjes alsadat Nasabi 1 Farideh Jalali 2 Najmeh Bordbar 3 Hamed Fasihi Nia 4 Pegah Ansari 5 Peivand Bastani 6 Ph.D. of Human Resources Management, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran MSc in Healthcare Management, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Ph.D. student of Healthcare Management, Student Research Committee, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran MD, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran MSc in Healthcare Management, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Associate Professor, Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Background: Management transport occurs in organizational hierarchy commonly; so, succession planning is of a great importance. In this regard, identification of the effective methods for succession planning leads to organizational success in health care systems. This study aimed to identify the dimensions of succession and formulate the components of health network managers' selection. Methods: This qualitative research was conducted by applying the content analysis approach in 2018. To glean the information, 42 semi-structured interviews were conducted using the snowball sampling method. Data was analyzed by framework analysis applying Max QDA 10 software. Results: The main effective factors for achieving the health network administrator management rank contained 4 main themes of managerial education and skills, specified education and skills, educational methods, and performance evaluation mechanism. Moreover, we identified the main applied points in monitoring the health network managers' duties. Conclusion: The basic criteria should be defined  for selecting appropriate people and improving the quality of services. It also can lead to a framework for succession planning and is helpful in organizational decision making improvement. http://mshsj.ssu.ac.ir/article-1-290-en.pdf Succession planning Component Health network manager