Journal of Education and Health Promotion

Abstract BACKGROUND: Disaster planning and management pose a serious challenge to most countries.
These challenges point to insufficient planning to deal with these events. Therefore, it is necessary
to pay attention to the methods and characteristics of the decision‑making approaches in these
events. In this study, we tried to identify most appropriate approaches for the Iranian health system
by studying disaster planning approaches.
MATERIALS AND METHODS: This study was conducted using mixed methods in 2020–2021
in two phases: qualitative and quantitative. First, we reviewed at the research literature. Our goal
was to identify studies that suggested approaches to disaster planning. The next step in this study
was a qualitative study using semi‑structured interviews. Participants in qualitative phase included
managers and employees from different parts of the Iranian health system from the provinces of
Golestan, Fars, Khuzestan, Lorestan, Kerman, Sistan, and Baluchestan.
RESULTS: By combining approaches taken from literature reviews and qualitative study, four main
approaches were identified. The results of our study have shown that disaster response planning
approaches include function, risk assessment, capability, and futuristic base.
CONCLUSION: This study provides complete overview of disaster planning approaches that enable
health professionals to use them to develop response plans. Our findings indicate that in complex
and large‑scale events such as floods and pandemics, it is necessary to combine the introduced
methods for operational planning.

Abstract BACKGROUND: Health system reform plan in public health sector in Iran in the first phase focused
on improving primary health care in suburban areas in and around big cities. The present study was
conducted to assess the implementation process challenges of the reform plan in comprehensive
health service centers at suburban areas of Isfahan in 2019.
MATERIALS AND METHODS: This qualitative study with conventional content analysis approach
was conducted in 2019. Participants were purposefully selected and interviewed at provincial
levels from Isfahan University of Medical Sciences health department and health‑care providers
of comprehensive health services centers. The saturation point was reached after 21 face‑to‑face
semi‑structured interviews. Thematic analysis was employed to analyze transcribed documents
assisted by MAXQDA version 10.
RESULTS: The results revealed four main themes; the human resource management, the executive
management, the electronic infrastructure, and the resource management.The major challenges
in the implementation planning process included: the referral system, monitoring and supervision,
electronic services infrastructure in the design and development of the EHR called the SIB system,
lack of instructions guide, salaries and benefits, inconsistent financial and human resources and
inappropriate allocation of theses resources.
CONCLUSION: Despite the achievements in the development of the Iran health system reform plan,
there were many challenges in the implementation planning process. It is recommended that theses
challenges be reviewed and amended by health system managers and policymakers.

Abstract INTRODUCTION: In the Iranian Accreditation System, leadership and management standards have
been almost ignored and not paid enough and necessary attention to the structural components
and the infrastructures standards in management and leadership sections. Governing body, medical
staff, chief executive officer (CEO), and nursing management standards are inadequate and lack
accountability. These standards could lead to reform and finally provide the context for accomplishment
of an appropriate accreditation program.
MATERIALS AND METHODS: This is a descriptive, comparative, and qualitative study. It was done
in two phases. The first phase included literature review of the standards of the selected countries
followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing
management standards to develop the primary framework for Iranian hospitals. In phase two, the
primary framework was validated true three rounds of Delphi technique.
RESULTS: Surveying the accreditation system standards in selected countries included the USA,
Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify
as governing body, medical staff, CEOs, and nursing management standards. The result of this study
provides a framework for improvement of the Iranian national accreditation program.
CONCLUSION: In regarded to the importance of the leadership and management standards in
reform and change and promotion of the health services quality, efficiency, and effectiveness, the
results of this study showed that the present standards of the Iranian accreditation assessment
system and guidelines lack the necessary infrastructures for implementing a successful national
accreditation program.

Abstract OBJECTIVE: Exercise evaluation is one of the most important steps and sometimes neglected in
designing and taking exercises, in this stage of exercise, it systematically identifying, gathering, and
interpreting related information to indicate how an exercise has fulfilled its objectives. The present
study aimed to assess the most important evaluation techniques applied in evaluating health exercises
for emergencies and disasters.
METHODS: This was meta-evaluation study through a systematic review. In this research, we
searched papers based on specific and relevant keywords in research databases including ISI web
of science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar, and Persian
database such as ISC and SID. The search keywords and strategies are followed; “simulation,”
“practice,” “drill,” “exercise,” “instrument,” “tool,” “questionnaire,” “ measurement,” “checklist,” “scale,”
“test,” “inventory,” “battery,” “evaluation,” “assessment,” “appraisal,” “emergency,” “disaster,” “cricise,”
“hazard,” “catastrophe,: “hospital”, “prehospital,” “health centers,” “treatment centers,” were used in
combination with Boolean operators OR and AND.
RESULTS: The research findings indicate that there are different techniques and methods for data
collection to evaluate performance exercises of health centers and affiliated organizations in disasters
and emergencies including debriefing inventories, self‑report, questionnaire, interview, observation,
shooting video, and photographing, electronic equipment which can be individually or collectively
used depending on exercise objectives or purposes.
CONCLUSION: Taking exercise in the health sector is one of the important steps in preparation and
implementation of disaster risk management programs. This study can be thus utilized to improve
preparedness of different sectors of health system according to the latest available evaluation
techniques and methods for better implementation of disaster exercise evaluation stages.

Abstract Background: Growth and development in any country’s national health system, without an
efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the
system’s goals. The balanced scorecard (BSC) is a technique widely used to measure the
performance of an organization. The basic core of the BSC is guided by the organization’s
vision and strategies, which are the bases for the formation of four perspectives of BSC. The
goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in
Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods:
This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic
Medical Center in Isfahan University of Medical Sciences in 2011. The research populations
were hospital managers at different levels. Sampling method was purposive sampling in which
the key informed personnel participated in determining the performance indicators of hospital
as the BSC team members in focused discussion groups. After determining the conceptual
elements in focused discussion groups, the performance objectives (targets) and indicators
of hospital were determined and sorted in perspectives by the group discussion participants
. Following that, the performance indicators were calculated by the experts according to the
predetermined objectives; then, the score of each indicator and the mean score of each
perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by
the participants in the focus discussion group included five strategies, which were customer
satisfaction, continuous quality improvement, development of human resources, supporting
innovation, expansion of services and improving the productivity. Research participants also
agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community
perspective (customer), two objectives and three indicators were agreed upon, with a mean
score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed  upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives
and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial
perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%.
Conclusion: One way to create demand for hospital services is performance evaluation by
paying close attention to all BSC perspectives, especially the non-financial perspectives such
as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the
hospital managers improve their performance indicators. The learning and growth perspective
obtained the highest score, and the financial perspective obtained the least score. Since the
learning and growth perspective acts as a base for all other perspectives and they depend
on it, hospitals must continuously improve the service processes and the quality of services
by educating staff and updating their policies and procedures. This can increase customer
satisfaction and productivity and finally improve the BSC in financial perspective.