Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 One Verse, One Concept 1 2 FA Milad Shafii Assistance Professor, Hospital Management Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 Investigation of Disorders and Problems caused by Shift Work in Selected Nurses of Public-Educational Hospital of Shiraz University of Medical Sciences, 2015 3 11 FA Zahra Kavosi Associate Professor, Health Management and Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Fatemeh Dehghan Meymandi BSc in Healthcare Management, Health Management and Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Erfan Kharazmi Ph.D. of Healthcare Management, Health Management and Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Background: Shift work as a social phenomenon is one of the effective factors on operation of health workers which can have significant impacts on their health. Hence, the current study was conducted to determine the effect of shift working on health problems and the risk factors causing these disorders among nurses. Methods: This cross-sectional study was carried out on 189 nurses selected randomly from Shahid Namazi and Shahid Faghihi hospitals. The data collection tool was the "Survey of Shift Worker" standard questionnaire. Data were then analyzed by SPSS 16 software using Pearson coefficient of correlation test. Results: The results showed that the highest prevalence of problems caused by shift work was related to individual, family, and social life disorders. Moreover, the compulsory selection of shift work system has reduced job satisfaction (p = 0.001). Conclusion: Based on the findings, shift working could be associated with physical complications such as cardiovascular diseases and disturbances in circadian rhythm, as well as mental disorders in nurses. Therefore, it is necessary for nursing authorities to plan shifts more precisely regarding factors such as employees' age and job experience.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 Correlation of Leadership Style with Job Satisfaction and Happiness among the Staff of Petroleum Industry Health Organization 12 19 FA Bita Zamanzadeh MSc in Rehabilitation Administration, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Vahid Rashedi Ph.D., Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Mahshid Foroughan Associate Professor, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Background: Expert human resources have a key role in development of the community; among the multiple factors influencing this development, the community leaders who are organizing the resources have the most prominent role. This study aimed to investigate the relationship of leadership style with job satisfaction and happiness among the health personnel of the Oil Industry Health Organization. Methods: The present applied study is a descriptive-analytical one which was implemented cross- sectionally on all 290 health personnel of the Oil Industry working in the Provinces of Markazi and Lorestan. The Fiedler Leadership Style questionnaire, Chrome's Job Satisfaction questionnaire, and Oxford Happiness questionnaire were used to gather the data. The data were then analyzed by Pierson's correlation test. Results: The correlation-oriented leadership (66.15 ± 22.04) was the dominant leadership style which had a significant association with job satisfaction (176.58 ± 32.49) of the rehabilitation, treatment, and care staffs of oil industry in Markazi and Lorestan provinces, (r = 0.579, p < 0.01). Conclusion: The relationship-oriented leadership style has a significant association with job satisfaction. So, designing and implementing interventions to promote relationship – oriented style of leadership is recommended. More extended studies in the similar contexts could be helpful.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 The Impact of Selected Health, Environment, and Economics Indicators on Health Expenditure in Developed and Developing Countries 20 28 FA Mohammad Amin Bahrami Associate Professor, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohsen Pakdaman Assistant Professor, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Mohammad Ranjbar Assistant Professor, Department of Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Setare Yousefzade MSc student in Health Economics, Department of Management, Economy and policy, School of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran Mahmood Kazeminasab BSc student in Surgical Technologist, Department of Anesthetics and the Operating Room, School of Paramedical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Reyhane Izadi MSc student in Healthcare Management, Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mehdi Mokhtari Assistant Professor, Environmental Science and Technology Research Center, Department of Environmental Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Background: Rise in health expenditures is one of the main concerns of householders and policymakers. In this regard, many studies were conducted to assess the determinants of expenditures and environmental quality from a macroeconomic point of view. The goal of this paper was to examine the relationship of health expenditure with environmental quality and economic growth in developed, developing, and less developed countries. Methods: This analytical and correlational study examines the impact of environmental, health, and economic indicators on health expenditure. The required data for 109 countries were collected from the World Health Organization from 1995 to 2011. The collected information was then analyzed with econometric techniques and software Stata 13. Results: According to the results, access to sanitary sewage systems index – 3.27, (p = 0.00) and energy intensity index – 2.42, (p = 0.01) affected the per capita health expenditure in developed countries. Access to sanitary sewage systems index had effect on per capita health expenditure; - 9.71, (p = 0.00) in developing countries. However,  in less developed countries, none of the variables had significant relationship with per capita health expenditures. Conclusion: According to the results, it can be said that investing in maintenance and improvement of environmental quality can lead to reduced health care costs.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 Evaluating the Efficiency of Intensive Care Unit Departments in Hospitals Affiliated with Yazd University of Medical Sciences Using Data Envelopment Analysis 29 38 FA Mahdieh Abedi MSc student in Healthcare Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd , Iran Roohollah Askari Assistant Professor, Hospital Management Research Center, Shahid Sadoughi University of Medical Sciences, Yazd , Iran Mohammad Amin Bahrami Associate Professor, Hospital Management Research Center, Shahid Sadoughi University of Medical Sciences, Yazd , Iran Background: Despite the resources allocated to hospitals, there is a gap between resources at hand and those needed in hospitals. This study aimed to evaluate the efficiency of intensive care unit departments of hospitals affiliated with Yazd University of medical sciences in 2012. Methods: This descriptive, analytical, cross-sectional, and retrospective study employed data envelope analysis (DEA) to examine efficiency in a sample of ICU departments in 7 selected hospitals. In this study, input variables included the number of physicians, nurses, beds, and medical equipment (Ventilators), while the output variables consisted of the number of discharged healthy patients, bed occupancy rate, economical information such as bed price, as well as physicians and nurses' fees.  Data were collected through the study of documents, then, they were imported into the DEAP 2.1 software and various efficiencies were calculated. Results: The efficiency means of scale, managerial, technical, allocative, and economic calculated for ICU wards were respectively about 0.991, 0.890, 0.883, 0.956, and 0.866 in 2012. Conclusion: Excess human and capital resources costs are a heavy burden for hospitals to bear and surplus production factors paly a substantial role in decreasing hospitals’ costs. So, intensive care units with efficiencies of less than 1 are recommended to decrease their excess resources to achieve the optimal efficiency.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 Factors Affecting Discharge Against Medical Advices: A Case-Control Study in a Treatment-Teaching Hospital 39 47 FA Zhila Najafpour Ph.D. student of Healthcare Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohamad Reza Jafari M.D., Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Maryam Hatamizadeh MSc in Healthcare Management, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Sousan Rahimi BSc in Healthcare Management, School of Paramedical, Tehran University of Medical Sciences, Tehran, Iran Zahra Bigdeli BSc in Healthcare Management, School of Paramedical, Tehran University of Medical Sciences, Tehran, Iran Abbas Homauni Ph.D. student of Healthcare Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Background: Discharge against medical advices is leaving hospital despite medical advice, which can be a sign of the patient's dissatisfaction and a significant challenge for health system managers. This study examined the reasons for discharge against medical advices and compared the results with the control group (discharge with the doctor's opinion). Methods: The present study is a case-control study in which 280 samples were selected randomly in two groups of patients discharged against medical advices and those who discharged with doctor's opinion. Data were collected through  the questionnaire measuring patient-companion satisfaction in different wards of the hospital. Data were then analyzed using Chi-square and linear regression tests by SPSS 16 software. Results: Results showed that patient's age, having basic and complementary insurance, day of referring to hospital, education, and occupation made significant differences between the two groups. Among these factors, the most effective ones for discharge against medical advice were basic insurance (p = 0.020), age (p = 0.020), and occupation (p = 0.030). The most important reasons for discharge against medical advice from patients' viewpoints were failure to determine the patient's status, personal problems, feeling relative relief and partial recovery, as well as lack of physicians' considerations in that hospital. Conclusion: It seems that patients decide to discharge against medical advices due to lack of necessary supervision over the performance of medical and nursing services, and also lack of motivation in personnel to prevent from this event. In order to earn patients' satisfaction, managers are required to improve the hospital's services.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 The Relationship between Gender Inequality Index and Indicators Related to Children in Countries with Different Income Levels: An Ecologic Study 48 56 FA Nahid Hatam Professor, Department of Healthcare Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran Elham Siavashi Ph.D. student of Healthcare management, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Mohammad Ghorbani Ph.D. student of Epidemiology, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Alireza Yusefi Ph.D. student of Healthcare management, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Background: Gender inequality index shows reduction in human development due to inequality between men and women, which results in vulnerability to diseases. Therefore, this study aimed to investigate gender inequality in all countries with different levels of income and analyze the relationship between gender inequality index and indicators related to children. Methods: The present ecological study assessed all countries of the world in terms of gender inequality index and indicators related to children. All countries were analyzed by census method. The collected data were related to year 2013 and were extracted from the reports of World Bank and United Nations. Spearman correlation coefficient and one way ANOVA tests were used to check the relationship between variables. Data were analyzed using SPSS 20 software. Results: There was a significant difference in terms of gender inequality in countries with different levels of income (p < 0.05). The results further showed a significant positive relationship between gender inequality index and infants' (children younger than five years) mortality rate in countries with different income levels. No statistically significant relationship was found between gender inequality index and the percentage of children vaccinated against measles in OECD countries and non OECD countries (p = 0.932, p = 0.389). Conclusion: Increase in gender inequality can enhance the mortality of infants and children less than five years; it also can decrease the percentage of vaccination coverage in children. However, gender inequality happens more in countries with less income. Therefore, to reduce child mortality, not only health interventions, but also socio-cultural and economic activities are required. Hence, Cross-sectoral policies should be developed and implemented.

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 Priorities of Research in Health Management, Economic, and Policy Fields: A Qualitative Study in Iran 57 66 FA Amin Torabipour Assistant Professor, Department of Healthcare Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Hamed Nazari MSc student in Health Economics, School of Medicine, Shahed University of Medical Sciences, Tehran, Iran Somayeh Karimi MSc students in Healthcare Management, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran Reza Jahangiri MSc students in Healthcare Management, School of Management and Medical Informatics, Iran University of Medical Sciences, Tehran, Iran Background: Effective and efficient use of health system resources requires prioritization of research issues. The aim of this study was to determine research priorities in the fields  of health management, economic, and policy. Methods: This qualitative study was conducted based on content analysis method in 2015. The population included 30 health managers, experts, and teachers of health economic, management, and policy at national level. Data were collected through a semi-structured interview. Then, results were categorized based on different themes and domains.  Results: After taking all comments into account, 89 topics were determined as research priorities. These topics included: 42 topics in health services management field, 24 topics in health economics field, and 23 topics in health policy field. Conclusions: The results showed that research priorities of health services administration, health economic, and health policy fields were compatible with the current problems and challenges of Iranian health system.  

Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2 1 2017 6 1 Demographic Predictors of Job Satisfaction among Nurses 67 77 FA Masoumeh Hasanlo Instructor, Department of Surgical Technology, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran Mansour Mohajeri MSc in Research, Zanjan University of Medical Sciences, Zanjan, Iran Razzagh Osfori BSc in Nursing, Education and Treatment Center of Mousavi, Zanjan University of Medical Sciences, Zanjan, Iran Background: The implementation effect of nurses' efficiency improvement law on their job satisfaction is still not clear. Therefore, the aim of this study was to investigate nurses' job satisfaction after execution of the efficiency improvement law among them. Methods: This analytic study was carried out among 410 clinical nurses selected through a convenient and accessible sampling method and based on the assigned ratio in each of the hospitals. A questionnaire designed in 2 parts of demographic information and job satisfaction dimensions was applied to collect data. Data were analyzed using SPSS 20 software through descriptive (mean and frequency) and analytical (regression) statistics. Results: Based on the results, most nurses were in the emergency department and their job satisfaction score was evaluated with the mean score of 43.46 ± 12.74. The highest mean scores (61.80 ± 18.50) was related to communication factors; while the lowest score (18.90 ± 7.18) was attributed to management style. In multiple linear regression analysis, important predictors of job satisfaction were age, gender, and income, which were statistically significant. (p = 0.00) Conclusion: Regarding the relationship between care quality and job satisfaction of nurses, annual evaluation of job satisfaction and its related factors is recommended to increase the satisfaction and survival of human resources , improve the management style of the organization, and standardize the rights and benefits, especially for people with long work experience in this occupation.