Journal of Education and Health Promotion

Abstract BACKGROUND: Patient relationship management (PRM), in addition to saving costs, increases
patient loyalty and creates a satisfactory environment for the patient and the service provider. This
study aimed to design a model of PRM in general hospitals using the combination of the analytic
hierarchy process and interpretive structural modeling (ISM).
METHODS: This was an applied and cross‑sectional study conducted in 2020 at three stages. At
the first stage, using a systematic review, factors affecting PRM were identified. In the second stage,
these factors were prioritized based on the pair‑wise comparisons. In the third stage, the interaction
levels of the factors were modeled for the general hospitals using ISM through the use of the MICMAC
technique and Excel 2007 software.
RESULTS: The results showed that “integrated information system,” “registration of the patient’s
essential information,” and “right data at the correct time” were the first to third priority in implementing
PRM in the general hospitals. In the final model of ISM, three levels of effective factors were extracted,
and 10, 4, and 6 factors were identified in the first, second, and third levels, respectively.
CONCLUSION: Establishing the PRM strategy in the hospital, in addition to executive and managerial
requirements, depends on the existence of an electronic customer relationship management system,
and the choice of new technology, as well as the integration of information systems and technology
culture, should be given special attention by managers.

Abstract INTRODUCTION: The most important goal of a proper health‑care system is to provide good health.
Today, patients do not consider hospitals as simply a place of rehabilitation; rather, they compare
the hospital with a hotel in terms of environment, facilities, services, and quality of accommodation.
This study aims to use DEMATEL approach to extract factors affecting the hoteling quality.
METHODS: This was a descriptive, cross‑sectional study conducted in 2018. The study was carried
out in two steps. In the first step, the factors affecting the hoteling quality were extracted, and in
the second step, the DEMATEL technique was used to analyze and rank the cause and effect. The
study population consists of all experts in the fields of medicine and health care (hospital managers,
deputies, and faculty members familiar with accreditation and hoteling), among which twenty experts
were selected using purposeful sampling and a questionnaire designed by the researcher consisting
of 11 dimensions was distributed among them. The reliability of the questionnaire was calculated
using Cronbach’s alpha coefficient which was equal to 0.85 while its validity was confirmed using
Delphi technique. DEMATEL approach was used for data analysis.
RESULTS: The results show that among factors, human factors and economical–financial factors
and, among subfactors, maintaining human dignity and quick action in providing emergency services
are among the most important factors affecting the hoteling quality. Maintaining human dignity and
speed of action in providing emergency services to patients was identified as the most important
factor in improving hoteling quality.
CONCLUSION: The results of this study can be used to evaluate the quality of accommodations
and health facilities, medical equipment, and building quality of hospitals, which can lead to effective
actions and improvement of patient satisfaction and the eventual success of health transformation plan.

Abstract CONTEXT: The success of the health system research and technology management in the 21st century
can play an important role in advancing the country toward becoming a scientific power.
AIMS: The study aimed to increase knowledge and identify factors affecting the health system
research and technology, as well as to provide solutions for improving the status of health science
and technology.
MATERIALS AND METHODS: This was an applied and descriptive study conducted in 2018 using
cross‑impact analysis. The factors affecting the Iranian Health System Research and Technology
Management and their influences on each other were identified using an expert panel. The key‑driven
factors were determined using the MICMAC software.
RESULTS: The input, stake, target, resultant, excluded, and regulating factors were identified. The
degree of fill rate the matrix was 58.9%. Financial annex of the health scientific map (S = 206),
roadmap (S = 206), governmental laws and regulations (S = 198), and sufficient governmental budget
allocation (S = 194) earned the highest potential influence scores by 2025. Furthermore, scientific
authority (S = 216), international communication (187), university relationship with industries (S = 187),
and competitive infrastructure (S = 178) obtained the highest potential dependence scores by 2025.
CONCLUSIONS: The success of the Iranian Health System Research and Technology Management
by 2025 requires the development of the financial annex of the comprehensive scientific health map,
the development of the road map, and the allocation of sufficient governmental budget for health
research. Policy‑making in health system research and technology management requires more
attention to these factors and the dynamics of relationships among factors in the model.

Abstract CONTEXT: Iranian National Health Scientific Map is a national plan the implementation of which
remarkably influences the progress of the country, though it is facing challenges in its implementation
phase.
AIMS: The present study has been conducted with the main aim of identifying the challenges facing
the comprehensive scientific health map of Iran.
SETTING AND DESIGN: This is an applied and qualitative study.
SUBJECTS AND METHODS: The study was done in 2017 with the content analysis approach
among experts of research and technology management. Some 18 people were selected and were
deeply interviewed, meanwhile observing the credibility of research.
STATISTICAL ANALYSIS USED: Data analysis was performed based on content analysis and
using ATLAS.ti software.
RESULTS: Data analysis resulted in the identification of 427 codes, 84 subthemes, and 12 themes.
Twelve themes were specified including policy‑making, management, university autonomy,
quantitative development, consideration of science production chain, designing and monitoring of
science map, finance, qualitative assessment, human resources, research ethics, as well as allocating
attention to the infrastructure and communication.
CONCLUSION: The scientific map of health challenges are indicative of the need for modification
of the scientific map and adhering to solutions in line with the removal of the identified challenges.
Today, paying attention to the solutions capable of meeting such challenges is a must.

Abstract BACKGROUND: Innovation is a competitive advantage, with its preservation and continuity dependent
on the organizational innovation capability. This study was conducted with the aim of determining the
innovation capability dimensions and components in medical sciences universities of Iran.
METHODS: The present study is a qualitative study with content analysis approach, undertaken
in 2016–2017. The data processing included 10 deep interviews with the experts of the health
innovation domain in top management of the three types of the medicine sciences universities of
Iran with >5 years of experience. Targeted data sampling was performed using snowball method and
continued until the saturation of the data. Data analysis was performed using conventional content
analysis method using Maxqda 12 software.
RESULTS: Data analysis resulted in the extraction of 28 categories and 8 main themes including
communications and interactions, innovation climate, university setting, policy factors (policy‑making,
rules and regulations), organizational culture, organizational resources, management and leadership,
and organizational learning in two university internal and external dimensions.
CONCLUSION: To accelerate innovation in medical sciences universities, recognizing the potential
of innovation capability is essential.

Abstract Context: One of the challenges in the fiercely competitive space of health organizations is
responding to customers and building trust and satisfaction in them in the shortest time, with
best quality and highest productivity. Hence the aim of this study is to survey the impact of
customer relationship management (CRM) on organizational productivity, customer loyalty,
satisfaction and trust in selected hospitals of Isfahan (in Iran). Materials and Methods: This
study is a correlation descriptive research. Study population was the nurses in selected hospitals
of Isfahan and the sampling has been conducted using stratified random method. Data collection
tool is a researcher‑made questionnaire of CRM and its effects (organizational productivity,
customer loyalty, satisfaction and trust) which its validity and reliability has been confirmed
by researchers. Structural equation method was used to determine the impact of variables.
Data analysis method was structural equation modeling and the software used was SPSS
version 16 (IBM, SPSS, 2007 Microsoft Corp., Bristol, UK) and AMOS version 18 (IBM, SPSS,
2010 Microsoft Corp, Bristol, UK). Results: Among the dimensions of CRM, diversification
had the highest impact (0.83) and customer acquisition had the lowest (0.57) CRM, had the
lowest impact on productivity (0.59) and the highest effect on customer satisfaction (0.83).
Conclusions: For the implementation of CRM, it is necessary that the studied hospitals
improve strategies of acquiring information about new customers, attracting new customers
and keeping them and communication with patients outside the hospital and improve the
system of measuring patient satisfaction and loyalty.

Abstract Introduction: Medical errors in hospitals kill more people every year than AIDS, breast cancer and
auto accidents combined. Widespread consensus exists that health care organizations can reduce
patient injuries by improving the environment for safety from implementing different alternatives
from technical and managerial improvements to considering medical record data. Considering
the preventability of medical errors, the Agency for Healthcare Quality and Research (AHRQ)
developed patient safety indicators (PSIs). This study analyzes the PSIs calculated in Alzahra
Hospital of Isfahan. Materials and Methods: This study was conducted retrospectively using the
inpatient medical record data of hospitalized patients in a six month period, from October 2010
to March 2011. An experienced team in the fields of medical record, health management and
health information technology was involved in data reviewing. Based on a prior consultation and
reviewing, some PSIs were selected. Indicators were calculated considering AHRQ guidelines.
Excel software and hospital information system software were used. Results: Across all studied
medical records of patients, out of 25,164 discharges, below measures were calculated.
‑8 Foreign Body cases (PSI 5) (0.31 per 1000).
‑30 Postoperative Hemorrhage or Hematoma cases (PS I9) (2.2 per 1000).
‑5 Accidental Puncture or Laceration cases (PSI 15) (0.3 per1000).
‑8 Complications of Anesthesia cases (PSI 1) (2.2 per 1000).
‑96 Selected Infections Due to Medical Care cases (PSI 7) (3.8 per1000).
‑17 cases of Postoperative Wound Dehiscence (PSI 14) (3.7per1000).
‑1 Birth Trauma – Injury to Neonate case, and (PSI 17) (1.7 per 1000).
‑18 Obstetric Trauma – Cesarean Delivery cases (PSI 20) (40 per 1000) were flagged by
studied PSIs developed by AHRQ.
Conclusion: Comparing with the reported rates by other studies and AHRQ study in 2006, all
of calculated indicators have inadequate condition; i.e. these are far from empirical estimated
rates. The hospital administrators should be more sensitive to this issue and perform some
improvement programs.

Abstract Background: Considering globalization of health care and quality improvement trend to
respond to competition and customer orientation, attention to organizational structure
and its relationship with market orientation is essential. Therefore, this study reviews the
relationship between organizational structure and market orientation in selected hospitals
of Isfahan (Iran). Materials and Methods: This study was a descriptive survey. The study
population comprised nurse managers from selected hospitals (n = 80). Data collection tools
were two questionnaires (market orientation questionnaire and organizational structure) that
the validity and reliability were confirmed (r = 0.83 for market orientation questionnaire and
r = 0.87 for organizational structure). SPSS (Ver. 16) software was used for the analyses.
Results: The mean score of organizational structure was 65.4 (11.2) and total mean of
market orientation was 51.14 (17.6). All aspects of the organizational structure (Organization
Centralization, Formalization in Organization, and Organization Complication) and market
orientation (responding to competition, accountability, customer satisfaction, intelligent
organization)—except by responding to clients with Formalization in Organization—as well as
all aspects of the Systemic attitude (the system of internal coordination and communication
systems_ and market orientation (responding to competition, accountability, customer
satisfaction, intelligent organization), there was a meaningful relationship (P < 0.05).
Conclusion: Market orientation and its dimensions have a significant relationship with
organizational structure and can lead managers’ view to the analysis and recognizing elements
of success and achievement to goals. With increasing competition in markets, globalization
of health services, and presence in international markets and more attention to patients’
satisfaction, hospitals need to understand and use of market orientation in order to promote
quality and services in the health care system.

Abstract Background: Military hospitals are responsible for preserving, restoring and improving the health of
not only armed forces, but also other people. According to the military organizations strategy, which
is being a leader and pioneer in all areas, providing quality health services is one of the main goals of
the military health care organizations. This study was aimed to evaluate the service quality of selected
military hospitals in Iran based on the Joint Commission International(JCI) standards and comparing
these hospitals with each other and ranking them using the analytic hierarchy process (AHP)
technique in 2013. Materials and Methods: This was a cross‑sectional and descriptive study
conducted on five military hospitals, selected using the purposive sampling method, in 2013.
Required data collected using checklists of accreditation standards and nominal group technique.
AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the
collected data. Results: Among JCI standards, the standards of access to care and continuity of
care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership
and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in
the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and
SAB(weight = 0.066) ranked first to fifth, respectively. Conclusion: AHP is an appropriate technique
for measuring the overall performance of hospitals and their quality of services. It is a holistic
approach that takes all hospital processes into consideration. The results of the present study can
be used to improve hospitals performance through identifying areas, which are in need of focus
for quality improvement and selecting strategies to improve service quality.

Abstract Background: The achieve uses 7 variables: ability; clarity; help; incentive; evaluation; validity;
and environment, to provide leaders and staffs with the necessary tools to improve performance,
and help managers to determine cause of performance problem. And create change strategy
for solving those problems. We try to determine factors affecting the performance of nurses,
base on this model in selected hospital of Isfahan (Iran). Materials and Methods: This was a
descriptive‑correlation survey. The population of study was 85 nurses of 9 hospitals in Esfahan.
Data gathering was done via achieve questionnaire. Reliability was calculated by Cronbach’s
alpha (r  = 0.85). Data analysis was done by using SPSS 16. Result: The ability and help
variables were the most important factors in improving performance of nurses and validity and
evaluation were less important. Conclution: Today, staff effectiveness is one of the important
problems in health care organization. In fact, performance improvement is the most important
step for organization improvement.

Abstract Background: The World Health Organization (WHO) produced the Ottawa Charter for Health
Promotion (HPH) back in 1986. Then expressed the Budapest Declaration of Health Promoting
Hospitals and after determined standards for reorienting hospitals towards health promotion So,
this study evaluated Iranian hospitals based on WHO‑HPH standard. Materials and Methods: This
study was a descriptive ‑ analytical survey in selected hospitals of Iran (38 hospitals from 5
provinces). Method of data collecting was through review of documentation related to each of
the standards. WHOs self‑assessment tool for health promotion was used. Result: Overall the
mean score of health promotion standard in the state hospital was 54.1 ± 15.1 that means the
private hospitals have higher score. In general, patient information and intervention standard
had the highest score (70. 8 ± 8. 1) both in private and government hospitals and the patient
assessment standard had the lowest score (44. 2 ± 20.1). Conclution: Hospitals must design
a specific system for improving and evaluating health promotion in order to encourage
policy‑makers and health service administrators to invest resources.

Abstract Purpose: Outsourcing in healthcare is a cost-effective strategy that can lead to increase services
quality. The aim of this study was to determine the types of services that have been outsourced
in educational hospitals in Isfahan and to investigate managers’ view about the impact of
Outsourcing. Design/Methodology/Approach: A descriptive-survey study carried out in 2010.
Our samples consisted of 100 educational hospital and treatment deputy senior managers of
Isfahan University of Medical Sciences and 53 usable questionnaires were received. Survey
instrument main points were the extent to which educational hospital outsource services and the
impact of Outsourcing. Reliability and validity of the questionnaire have been verified. Data are
analyzed with SPSS18 software. Findings: The results for medical-diagnostics services showed
physiotherapy, radiology, and ultrasound that have the highest rate (33%) of being outsourced.
Between logistic and administrative activities, housekeeping, and facility engineering maintenance
services are the highest rate of outsourced (100%) and green space, CSR, laundry, and medical
records are the lowest rate of outsourced (16%). In managers’ view, in relation to advantages
of outsourcing, pay more attention to internal and external customers in private sector (57.2%)
was the highest. In relation to disadvantages of outsourcing, costs increase for the patients
(45.6%) was the highest. In relation to barriers of outsourcing, forgetting the goal of outsourcing
(efficiency) (60.6%) was the highest. Conclusion: Finally, managers’ views about outsourcing
in health services organizations were rather acceptable, but in their views, there are barriers in
implementation of outsourcing and they are focused on removing the barriers before outsourcing.
Fundamental infrastructure developments as making competing market, promoting of cultures,
education, modifying the management attitude and approach, and establishing incentive policies
are emphasized for successful implementation of outsourcing.