Introduction: Hospital standards are one of the most valuable conceptual elements in the organization, since they have an important role in depicting the expected performance and evaluation of hospital activities. Previous studies’ results reveal that hospital standards set by Iran’s Ministry of Health (MOH) are not efficient enough in depicting the weaknesses and shortages of healthcare centers, and hence, they need further studies. Therefore, we compared the hospital standards of MOH with those set by the Joint Commission International.

Methods: The present research is a descriptive - comparative study performed in spring and summer of 2006. Research environment consisted of the Joint Commission International hospital accreditation standards (216 statements) and hospital standards of MOH (724 questions consisting of handbook ‘A’ with 227 and handbook ‘B’ with 497 questions). Eventually, 335 questions from MOH standards were compared with 216 statements of the Joint Commission International’s standards. Data collection methods were use of the available information on the Net, e-mails (Joint Commission International’s standards), and the relevant references (MOH’s standards). Data were collected using six checklists based on Joint Commission International’s standards and were analyzed with comparative tables and descriptive statistical methods.

Results: Final collation of MOH’s standards and Joint Commission International’s standards (335 questions versus 216 statements respectively) showed that the former covered 79 statements (36.6%) of the Joint Commission completely, covered 39 statements (18.0%) partially, and did not cover the remaining 98 statements (45.4%) at all. In other words, correspondence of MOH’s standards with those of the Joint Commission was 36.6% complete, 18.0% partial, and 45.4% without any correspondence.

Conclusion: Despite of the greater quantitative aspect of the MOH’s standards for hospitals in comparison with the Joint Commission’s standards, MOH’s standards could not cover almost fifty percent (45.4 %) of the latter. In other words, 98 out of 216 statements of the Joint Commission have not had any equivalent in MOH’s standards for hospitals. This shows the fact that in compilation of hospital standards, MOH has not focused on many of the important items related to patient care process, such as continuity of care, patient and family rights, informed consent, assessment of patients, and education of patients and their families.

Hakim Research Journal 2008 10(4): 45- 52.

Introduction: The present research on hospital wastes sets out a comprehensive framework for improving waste management practices in hospitals of Tehran University Medical Sciences.

Methods: This descriptive cross-sectional study was performed in year 2006. Data were collected using a checklist and a questionnaire whose validity and reliability were verified.

Results: The medical wastes generated in these hospitals were extremely heterogeneous in composition: paper and cardboard, plastic, syringes, glass, metals, food wastes, infectious wastes, etc. Forty two percent of the wastes were collected in containers and plastic bags. In 75% of the studied hospitals, the stay-time in storage sites was about 12-24 hours. All of the medical wastes of the hospitals were collected by covered-trucks and transported out of the hospital. In 46% of the hospitals, transfer of medical wastes to temporary stations was done manually. The hazardous wastes produced in the hospital wards amounted to about 42% of the total wastes.

Conclusion: According to the results obtained in this study, in order to reduce these kinds of pollution in the hospitals, action should be taken to deal with pollutants at their source of generation, which should be focused within the hospitals. The staff members involved in waste collection and transport should practice all the personal protection measures. Of course, medical waste management cannot succeed without cooperation and participation of all groups of medical staff.

 Hakim Research Journal 2008 11(1): 40- 47.

Introduction: The goal of the present study was to assess the performance of the breast-feeding promotion project in Kohkiloyeh and Boyerahmad province.

Methods: Performance of delivery wards in hospitals affiliated with the University of Medical Sciences and with the National Oil Company of Kohkiloyeh and Boyerahmad province was assessed in terms of practicing the ten steps recommended by World Health Organization and United Nations Children's Fund. Ten percent of the mothers who had delivered a child within one month before the time of study conduct (n = 43) and 30% of the delivery wards' personnel (n=137) were selected to participate in the study. Data was collected via observation, interviews, and review of the documentations. The performance of hospitals was calculated based on the percentage of the total expected score, and a score of 90% or above was considered as the acceptable level of performance.

Results: The mean percentage (and standard deviation) of performance scores were 77.42 (and 33.19) for the Oil Company's hospital, 69.64 (and 27.68) for Imam Sajjad hospital, 67.5 (and 32.1) for Imam Khomeini hospital, and 62.97 (and 37.99) for Shahid Rajaei hospital (in decreasing order). These findings show that the hospitals were in a relatively weak position in regard with implementation of the project.

Conclusion: Performance of the baby-friendly hospitals in promotion of breast-feeding behavior of mothers is weak.

 Hakim Research Journal 2008 11(1):54– 61.

Introduction: Conflict management is regarded as a basic organizational leadership skill in the 21st century. Hospitals as the important centers of the health system need effective methods and appropriate strategies for organizational conflict resolution in order to reach their cardinal objective of communities’ health. The present research aims to determine the conflict management strategies used by managers of hospitals affiliated with Lorestan University of Medical Sciences (LUMS).

Methods: This study is descriptive-analytic. The study population consists of 177 managers from 13 hospitals affiliated with LUMS. Data was collected through interviews using questionnaire containing demographic questions and Stephen Robin’s conflict management questionnaire and was analyzed with SPSS software.

Results: Average age of managers was 36.47 ± 6.9 years, their mean years of service were 12.5 ± 8.2, and their mean years of managerial experience were 5.8 ± 5.6. Females constituted 53.1% and males constituted 46.9% of the subjects. Identified strategies of conflict management were non-intervention (49.7%), control (44.6%), and solution orientation (5.7%). Conflict management strategy and sex of managers had significant association (p = 0.36). Correlation coefficient showed significant association between conflict management strategy and age of managers (p = 0.01).

Conclusion: According to our research results, styles of conflict management are different among managers and many factors influence organizational conflict management. Therefore, determination of conflict management styles is very important in every organization, especially in complex environment of hospitals.

  Hakim Research Journal 2008 11(2): 54- 58.

Introduction: Perspective to retrieval of equity, access to services, effectiveness, efficiency, social acceptability, and strive for continuous improvement of services, Total Quality Management (TQM) has broadened new horizons in health sector. Hence it can result in efficiency and renovation of health services delivery system. Therefore we aimed to determine the influencing factors on implementation of TQM at teaching hospitals affiliated with Iran University of Medical Sciences in Tehran, Iran.

Methods: We assessed the views of all the 90 managers and supervisors of the hospitals under investigation about the eight factors influencing on implementation of TQM. In a descriptive cross-sectional study, we used an eight-part questionnaire with 75 Likert-type questions for data collection. Validity of the questionnaire was verified with Delphi method. Chi square and t tests and analysis of variance were used for statistical analysis.

Results: We assumed an average of 50% for responses indicative of desirability as the minimum acceptable level in each of the eight factors. Of the eight factors studied customer orientation (59.7%), organizational communication (55%), and appropriate organizational structure (50%) proved to be acceptable. The other five factors ranked average (40-50%). There was significant difference among the total means of influencing factors in the studies hospitals (p = 0.001).

Conclusion: After five years have passed since the implementation of TQM in the studied hospitals, attention of managers to organizational culture, staff participation, human resources development, teamwork, and leadership commitment can result in improvement of the services, effectiveness of the activities, and social acceptability of hospitals.

  Hakim Research Journal 2008 11(2): 22- 32.

Introduction: The aim of this study was to determine the key organizational dimensions that influence the autonomy of university hospitals and the level of granted autonomy in each dimension.

Methods: Six hospitals were randomly selected from those affiliated with three medical universities of Tehran, Iran and Shahid Beheshti. In this qualitative study, we interviewed 27 hospital managers (response rate of 82%). The semi-structured interview guide was developed based on the results of four initial in-depth interviews and the organizational reform model of the World Bank. We used the framework method for the analysis of qualitative data.

Results: Nine themes were identified as the key factors influencing hospital autonomy: decision right in strategic management, decision right in human resources management, decision right in financial management, decision right in physical resources management, product market exposure, procurement market exposure, financial residual claim, governance arrangements and accountability mechanisms, and social functions of the hospitals. Limited decision rights in strategic, human resources, and physical resources management were granted to hospitals. Hospitals were not the financial residual claimant, but were exposed to competitive product market. Autonomy was limited regarding the procurement market. Governance systems were hierarchical and accountability mechanisms were supervisor-supervisee oriented. Some of the social functions of the hospitals were defined, but the expenses of these functions were not totally reimbursed by the government and the insurance industry.

Conclusion: The autonomy granted to the hospitals is unbalanced and paradoxical. More decision rights should be granted for management of strategic, human resources and physical resources as well as hospitals entry to the procurement market. Hospitals need to be the financial residual claimant. The hierarchical administrative systems should be transformed to cooperative ones. Instead of supervisor-supervisee oriented control measures, Ministry of Health and Medical Education needs more regulatory mechanisms for controlling hospitals’ performance and social functions.

     Hakim Research Journal 2008 11(2): 59- 71.