Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Positive Economic Consequences of Flood in Spring 2019 277 280 FA Amir Jafari MA in Governmental Management, School of Public Health, Baqiyatallah University of Medical Sciences, Tehran, Iran Ali Mehrabi Tavana Professor, Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran At the beginning of new year in Iran) Nowruz 1398), the precipitation system has caused floods in the north, northwest, and south of the country. The system has affected 24 provinces, 213 cities, 209 districts, and 5900 villages in total. These rains have been occurring for several consecutive periods. The first period began on March 26, 2019 and involved Qom, Golestan, Ilam, and North Khorasan provinces. As a result, floods covered Aq Qala and Gomishan in Golestan province. The second period of rainfall, from 4 to 6 of April 2019， caused floods. The third period of rainfall began on April 11, 2019 and reached its peak in the following day. The positive aspects of the recent floods were discussed in this letter to editor.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Managerial Intelligence of Hospital Managers in Sari, Iran 281 294 FA Ali Mohammad Mosadeghrad Associate Professor, Health Management and Economics Department, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Mahdi Abbasi Ph.D. student of healthcare management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Background: Managers’ performance mainly depends on their intelligence, knowledge, skills, personality and organization’s structure, culture and resources. Managerial intelligences is vital for hospital managers’ success. This study aimed to measure the managerial intelligence of hospital managers in Sari, Iran. Methods: This descriptive and cross sectional study was conducted in 2017 in Sari, Iran. 294 managers at various managerial levels of hospitals participated in this study. A questionnaire was developed, tested and used for measuring management quotient (MQ). The questionnaire had 3 dimensions including intelligence quotient (IQ), emotional quotient (EQ), and political quotient (PQ). The MQ index ranges between 0 and 1. Higher MQ score indicates better managerial intelligence. SPSS 19 software was used for data analysis. Descriptive statistics such as Mean, Standard deviation, Frequency and Percentage, as well as analytic statistics such as T-test, Spearman correlation and Regression was used. Results: The mean score of hospital managers MQ was 0.74 (good). The mean of IQ, EQ and PQ scores were 0.70, 0.77 and 0.75 respectively. A meaningful statistical correlation was observed between IQ and EQ and also between EQ and PQ. Male mangers, top managers, those with higher educational background and those working in logistics departments reported higher MQ. Conclusion: Hospital managers reported high MQ in Sari, Iran. The MQ assessment should be considered as a perquisite for recruiting hospital managers.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 An Optimization Algorithms-based Approach to District Health System Population Areas in Iran 295 312 FA Javad Tayyebi Assistant Professor, Department of Industrial Engineering, Faculty of Computer and Industrial Engineering, Birjand University of Technology, Birjand, Iran Sobhan Mostafayi Darmian MSc of Industrial Engineering , Faculty of Engineering, University of Kurdistan, Sanandaj, Iran Background: One of important subject in the operations' management fields is partitioning matter that was investigated in the study. This topic has recently received more attention from researchers of the healthcare management systems' field. This subject is important because planning about improvement of the healthcare system structure is considered as one of the most important management problems in each society. The goal of solving this problem was to district a society into several areas, so that each area can cover its  health services completely. Methods: This fundamental-applied study was conducted based on the Genetic optimization algorithm, particle swarm, and differential evolution to improve the current structures with regard to the existing health structure in Iran. Moreover, the health system strategic model was applied to categorize the population regions into 10 partitions. According to nature of the investigated problem, the objective function is maximizing the equilibrium amount in each district. The constraints included exclusive assignment and not-existing unusual assignment. Unusual assignment is defined as existence of no contiguity and holes in partitions. Results: According to the obtained results, the particle swarm algorithm had the most efficiency, while differential evolution had the lowest efficiency. However, the stated constraints were satisfied completely in all algorithms, which represented appropriate efficiency of the modified algorithm in the generation solutions. Conclusion: The results obtained from solving this problem can be used as a useful tool in improving the existing healthcare system in Iran.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Marginalization of Professionalism in Clinical Settings; A qualitative study at Tehran University of Medical Sciences 313 327 FA Fatemeh Alipoor Associate Professor, Professionalism Office & Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran Zahra Shahvari Assistant Professor, Midvifery Department, School of Nursing and Midwifery, Islamic Azad University of Gachsaran,Gachsaran, Iran Background: Management-level challenges are among the factors that undermine the individuals' adherence to professional behavior in clinical settings. This study investigated glitches of the management system in clinical settings from the perspective of staff, faculty members, and medical students/residents in hospitals affiliated to Tehran University of Medical Sciences. Methods: This qualitative study was conducted in 2 parts by exploring the viewpoints of personnel and physicians. In this regard, 8 focus group discussions were performed with 85 faculty members, clinical residents, and interns. Furthermore, 15 focus group discussions were held with 165 staffs. Available sampling method was applied to collect the participants and the data were analyzed using the content analysis method. Results: A total of 22 focus-group discussions were conducted with 250 participants; Participants' age ranged from 24 to 65 years. Participants' education levels varied from diploma to postgraduate for the staff and from medical student to sub-specialist for the physicians. Finally, management-level barriers, which undermine the staffs' ability to adhere to professional behavior in clinical settings were explained with 315 codes, 12 subcategories, and 2 main categories of "macro management issues " and "hospital management issues". Conclusion: Managers are required to consider providing a proper context for enforcing the professional behavior law, selecting middle managers based on their empowerment in performing the professional behaviors, prioritizing the professional behavior in policy making, and promoting the professional behavior in an administrative system consistent with the health system. In selecting the hospital managers, authorities are recommended to consider the managers' professional behavior and power in implementing the professionalism leadership. Moreover, the possibility of conducting professional behavior should be considered in making the policies.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Performance Indicators of Hospitals Affiliated to Iran University of Medical Sciences and Comparing them with Performance Indicators of Ministry of Health and Medical Education 328 336 FA Nader Tavakoli Associate Professor, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran Aziz Rezapour Associate Professor, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Arsalan Gholami Somarin MSc in Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Hosein Ameri Assistant Professor, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Reza Mohammadi MD, Executive Vice President of Educational Complex, Firouzabadi Therapeutics, Tehran, Iran Saeed Bagheri Faradonbeh Ph.D. in Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran Background: Hospital indicators are among the most important factors in hospital performance. The aim of this study was to measure the performance of hospitals covered by Iran University of Medical Sciences and to compare them with the national indicators. Methods: In the present cross-sectional descriptive study, performance indicators of all hospitals covered by Iran University of Medical Sciences were compared descriptively in 2018-2019. Data were collected from the Medical Record of treatment deputy of Iran University of Medical Sciences. The collected information was analyzed using descriptive tools, Excel software, and the Ministry of Health and Medical Education standard index tables. Results: The average bed occupancy index, average hospital stay index, and patient registration ratio per bed were 69.17, 4.30, and 75.18 in the hospitals covered by Iran University of Medical Sciences in 2018-2019, respectively. These rates show average, undesirable, and desirable status by national standards, respectively. Conclusion: Given that the average length of stay indicator was at an inappropriate level in this study, hospital authorities are recommended to take the necessary measures to identify the reasons and improve the hospital performance in this regard.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Identification of Effective Factors related to Implementation of Electronic Health Records in Imam Khomeini Hospital, Tehran 337 349 FA Nader Sheikh Eslami Assistant Professor, Department of Economics and Management, School of Economics and Administrative Sciences, Islamic Azad University, Tehran Branch, Tehran, Iran Soheila Sardar Assistant Professor, Department of Information Technology Management, School of Economics and Administrative Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran Nahid Abbasabadi MSc student in Management of Information Technology, School of Economics and Administrative Sciences, Islamic Azad University, Tehran Branch, Tehran, Iran Background: With the advancement of science and emergence of new technologies for solving human health and medical problems, one of the most important applications of technology in the field of health care is creation of electronic health records. The purpose of this study was to determine the effective internal and external factors related to successful implementation of the electronic health records in Imam Khomeini Hospital of Tehran, Iran. Methods: This descriptive-analytic research was carried out in 2018-2019. The statistical population consisted of 15 experts from Azad University of Tehran and Imam Khomeini Hospital selected by targeted sampling method. The main data collection tool was a researcher-made questionnaire designed to identify and rank the effective factors. Data were analyzed using SPSS 22, Excel, and Matlab software to perform a structural-interpretive approach. Results: Based on the findings, 6 criteria were identified related to the internal factors affecting successful implementation of the electronic health records. These factors included education, culture, comprehensiveness, safety and confidentiality, constructive communication, and participation approved by experts. According to the experts, 4 criteria were identified as effective external factors: technology / Economic, social / cultural factors, management / structural factors and legal factors. Conclusion: implementation of an electronic health record needs to take into educational, cultivation, comprehensiveness, safety & privacy, constructive communication, collaboration, technology / economic, social / cultural, management / structural, and legal factors.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Reviewing the Status and Experience of Outsourcing Policy in Healthcare: A review study 350 359 FA Elahe Ahmadizadeh MSc in Healthcare Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Maryam Tajvar Assistant Professor, Department of Management Sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Batoul Ahmadi Associate Professor, Department of Management Sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Background: Outsourcing is a method and tool for delivering services to increase effectiveness and efficiency. Regarding the outsourcing policies, identifying experiences and outsourcing records is essential. In this regard, the present study aimed at examining the status and experience of outsourcing policy in the health sector as a review study. Methods: The present systematic review was carried out by searching Persian language articles from sources such as Magiran, SID, Hospital and Medical Education Magazines, Handouts, and Announcements and English language articles from sources indexed in Google scholar, PubMed, Scopus databases. The authors search for English and Persian language articles from 2000 until 2018. The following keywords were used in the search outsourcing, private sector, purchasing, contracting, public-private participation. A total of 25 articles were entered in the final analysis according to the inclusion criteria. Results: Based on the results, outsourcing improves the quality, satisfaction of patients, and efficacy in most cases. The findings also suggested that outsourcing policies needed to be prescriptive and should be taken into consideration. Conclusion:Hospitals should note that in the case of assigning a unit and transferring it to other parts not related to their expertise, it is not really possible to accept the transfer's general and absolute success in improving efficiency and effectiveness and reducing costs. The outsourcing policies need to relevant assumptions and requirements to succeed.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 Benefits and Challenges of Policy Options in Rationing the Hospital Radiology Services: A Case Study 360 369 FA Hasan Jafari Assistant Professor, Health Policy and Management Research Center, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Ranjbar Assistant Professor, Health Policy and Management Research Center, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Hamideh Mahjoub MSc student in Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Hamed Ghoshoni MD student, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Baghi MD student, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Elham Miankoohi MSc student in Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Objective: In many countries, limiting the financial and budgetary resources is a challenge in the health system. One of the most costly parts of the health system is undoubtedly the radiology department of hospitals. Therefore, this study aimed to determine the benefits and challenges of the policies proposed for rationing hospital radiology services. Information sources and selected methods for study: In this narrative or literature review study, Persian (SID, Magiran, Barkat Knowledge network system, Irandoc), and Latin (Google Scholar, PubMed, Scopus, ISI web of sciences) databases were searched. The applied keywords were radiology, rationing, distribution, priority setting, resource allocation, and policy brief. In the initial search, 145 articles were studied. Subsequently, after reviewing the titles and abstracts, 65 studies were selected and investigated. Finally, 44 related studies were thoroughly investigated. The inclusion criteria covered the studies in Persian or English. The exclusion criteria included the studies that did not have full texts. Our search included the studies conducted from 1/1/2000 to 1/1/ 2017. Results: The present study examined the benefits and challenges of radiology services rationing. Policy options were presented at 3 levels of provider, organizational, and system. The provider level consisted of training clinical and non-clinical personnel to use and maintain the medical equipment and requiring the physicians to use clinical guidelines. The organization level included reviewing imaging tariffs, entering insurance in controlling supply and demand for radiology services, and assessing equipment by the Institute for Health Technology Assessment. The system level contained assignment of radiological services to the private sector. Conclusion: As health care costs are rising and resources are increasingly constrained by ever-increasing demands, policy makers and officials can use the proposed solutions with regard to contextual conditions to design a rationing model. Services at the macro level of the health system and operationalization of the rationing process reduce the gap between supply and demand of the health services.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 4 4 2020 3 1 East Asia's Strategies for Effective Response to COVID-19: Lessons Learned for Iran 370 373 FA Leila Doshmangir Associate Professor, Department of Health Management and Policy, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Alirez Mahbub Ahari Associate Professor, Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Kamal Qolipour Assistant Professor, Department of Health Management and Policy, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Saber Azami-Aghdash Ph.D. in Health Education and Promotion, Public Health Center, Tabriz University of Medical Sciences, Tabriz, Iran Leyla Kalankesh Associate Professor, Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran Parinaz Doshmangir Ph.D. in Health Promotion, Health Vice-Chancellor, Tabriz University of Medical Sciences, Tabriz, Iran Khorshid Mobasseri Ph.D. student of Gerontology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran Rahim Khodayari-Zarnaq Assistant Professor, Department of Health Management and Policy, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran The spread of the new Corona virus, known as COVID-19, has raised concerns and problems for many countries, and its out-of-China exposure is worryingly increasing. This trend is increasing in our country as well and has reached a critical point in some of the infected cities. This article attempts to provide appropriate strategies for controlling the virus for Iran based on the East Asia countries response that have had the first and most exposure to the virus.