Background: The hospital is a significant part of health systems that presents a complex and vital services. Therefore, performance management of hospitals should be considered especially. BSC model is so helpful and popular for performance management. In using BSC, cause and effect relations is very important, since it helps to apply non-financial to forecast financial performance. Objectives: This study aims to analysis systematic relations between key indicators of hospital performance evaluation, identifying causal relations and prioritizing indicators. Methods: Based on the 4 perspectives described by the balanced scorecard (BSC), the evaluation indicators of hospital performance and key performance indicators (KPIs) were adopted from the related literature and selected by experts' panel, respectively. Then, the decision making trial and evaluation laboratory (DEMATEL) method was employed for the determination of the cause-and-effect relationships between the indicators, differentiation of the effective and significant factors, and construction of the strategy map to ameliorate hospital performance. Results: According to the BSC perspectives, 21 KPIs were selected for evaluation of hospital performance. The highest relationship was found between bed occupancy having the largest R + D value and other indicators, thus illustrating its fundamental role among the indicators. Clinical errors with the greatest value of R-D showed the strongest impacts on the other indicators and was thus named as the "main cause factor" among the indicators. In contrast, the percentage of patient satisfaction with the smallest R-D value was most strongly influenced by the other indicators and therefore, it was known as the "main effect factor" among the indicators. Conclusions: Assessment and improvement of the hospital performance is a complex and multi-dimensional activity. In order to have a powerful assessment system and success in improving hospital performance, instead of a single-dimension, it should be paying attention to all dimensions of performance.

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Background As the strategies proposed for oral health improvement in developed countries are not adapted for developing ones, this study aimed to identify the challenges of oral health policy implementation in Iran as a low-income developing country. Methods This qualitative study was conducted in 2019 in Iran as a middle-eastern developing country. The study population consisted of experts who had experience in oral health and were willing to participate in the study. Snowball sampling was used to select 12 participants for semi-structured interviews and saturation was achieved after 16 interviews. Guba and Lincoln criteria including credibility, transferability, confirmability and dependability were used to determine reliability and transparency, and finally a five-step framework analysis method was used to analyze the data. Results The analysis of the interviews resulted in identification of 7 main themes that were categorized into 5 problems of policy implementation as proposed by the Matus framework. The main themes of executive and preventive challenges to implement oral health policies were categorized as organizational problems, the main themes of educational and resource challenges were situated as material problems, and the main themes of insurance, policy making and trusteeship challenges were considered as legal, policymaking and perspective. Conclusion The implementation of oral health policies has faced some challenges. It seems that the national coverage of oral health and integration of these services in prevention and serious attention to the private sector can be considered as the most important strategies for achieving improved oral health in Iran.

Introduction The quality of nursing services is one of the main factors accelerating patients' recovery. The present study aimed to examine patients' perceptions of the quality of nursing services in the teaching hospitals of Iran. Methods This cross-sectional research was a descriptive-analytical study conducted in 2021, in which 1067 patients were selected as the research sample. The Qualipak nursing quality questionnaire (QUALPAC) was used to collect the required data. Data were analyzed using t-test, ANOVA, and Pearson correlation coefficient using SPSS software version 23. Results From the patients' perspective, the mean and standard deviation of the quality of nursing services was 191.47 ± 19.51. Among the quality dimensions, all services quality: psychosocial (91.34 ± 9.34), physical (65.72 ± 10.18), and communication (34.41 ± 6.21) were placed at the moderate level. A significant association was found between patients’ age and nursing service quality. The perceived nursing service quality was subject to sex (P = 0.01, t = 1.921) and place of residence (P = 0.02, t = 1.873). Conclusion According to the findings, the quality of nurses 'care was "moderate" from the patients' perspectives. Planning is recommended to reinforce and promote the quality of nursing services.

Background The COVID-19 pandemic increased the need for new valid scientific evidence to support urgent clinical and policy decision making; as well as improved processes for the rapid synthesis, uptake and application of that evidence. Evidence informed policymaking (EIPM) can be considered as a way to access and use the results of evidence in practice. This study aimed to determine what effects COVID-19 had on the way Iranian health managers and policymakers use evidence in their decisions. Methods This study was conducted in 2021 applying a qualitative research design. Data was collected through semi-structured interviews. Thirty health care managers, policy makers and medical university faculty members were recruited as the study participants, initially via a purposive sample, followed by snowballing. A conventional content analysis presented by Hsieh and Shannon (2005) was applied for data analysis. Results Ten main themes emerged from the data including: 1) roles and duties of knowledge brokers (KBs); 2-5) the roles, benefits, barriers and necessities of applying Knowledge Translation Exchange (KTE) tools; 6-8) the facilitators, benefits and barriers to the application of evidence during COVID-19; 9) challenges of rapid evidence production evidence during COVID-19 and 10) consequences of not applying evidence during COVID-19. According to the present conceptual framework, KBs act as an intermediator between the large amounts of knowledge produced and decision makers. KTE tools should be applied to enhance EIPM during COVID-19. Attention should be paid to the facilitators, barriers, benefits and necessities of evidence application during COVID-19 to avoid negative consequences for the health system. Conclusions Results of this study show that developing KTE tools and activating KBs can be among the main strategies to produce applied actionable messages for policymakers to move toward EIPM; and that this applies even when rapid decision making is required, such as during the COVID-19 pandemic. It is strongly recommended to reinforce the local capacities through supporting scientific networks and relationships between research centers and local and national policymakers. At the same time, attention to local barriers to and facilitators of the application of evidence while facing a pandemic can pave the way to better identification of health system`s problems and rapid responses.

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BACKGROUND: The demographic structure of Iran as a developing country has undergone various changes in recent years. Therefore, the present study sought to analyze policy and upstream documents related to the older people health in Iran in order to identify and analyze the requirements considered by health policymakers to promote the older people health in Iran. MATERIALS AND METHODS: This is a qualitative study conducted in 2021 through national qualitative document analysis. All upstream documents published and related to older people health were reviewed between February 1979 and October 2021. The Scott's four-step method was used to extract the related documents. RESULTS: Policy requirements for promoting older people healthcare in Iran were categorized into 4 main themes in the form of a conceptual framework and 15 sub-themes. Thus, in order to ensure the health of the older people in Iran, it is necessary to take into account the four categories of managerial requirements, financing, infrastructures, and providing older people services. In other words, the sustainable financing requirements and the infrastructural requirements should firstly exist together as basic requirements. Then, geriatric health management requirements are needed to provide the older people health services along with the previous requirements and finally ensure the health of the older people in Iran. CONCLUSION: The results of this study can be helpful in the review of upstream older people health policy documents by policy makers in order to better promote the health of the older people and pave the way for new policies to enter the agenda of policy makers.