This is a pioneering study that uses Parasuraman and Zeithaml's model and CFA in a dental setting. This study provides useful insights and guidance for dental service quality assurance.

Background:Hospital pharmacy is responsible for controlling and monitoring the medication use process and ensures the timely access to safe, effective and economical use of drugs and medicines for patients and hospital staff.Objectives:This study aimed to optimize the management of studied outpatient pharmacy by developing suitable queuing theory and simulation technique.Patients and Methods:A descriptive-analytical study conducted in a military hospital in Iran, Tehran in 2013. A sample of 220 patients referred to the outpatient pharmacy of the hospital in two shifts, morning and evening, was selected to collect the necessary data to determine the arrival rate, service rate, and other data needed to calculate the patients flow and queuing network performance variables. After the initial analysis of collected data using the software SPSS 18, the pharmacy queuing network performance indicators were calculated for both shifts. Then, based on collected data and to provide appropriate solutions, the queuing system of current situation for both shifts was modeled and simulated using the software ARENA 12 and 4 scenarios were explored.Results:Results showed that the queue characteristics of the studied pharmacy during the situation analysis were very undesirable in both morning and evening shifts. The average numbers of patients in the pharmacy were 19.21 and 14.66 in the morning and evening, respectively. The average times spent in the system by clients were 39 minutes in the morning and 35 minutes in the evening. The system utilization in the morning and evening were, respectively, 25% and 21%. The simulation results showed that reducing the staff in the morning from 2 to 1 in the receiving prescriptions stage didn't change the queue performance indicators. Increasing one staff in filling prescription drugs could cause a decrease of 10 persons in the average queue length and 18 minutes and 14 seconds in the average waiting time. On the other hand, simulation results showed that in the evening, decreasing the staff from 2 to 1 in the delivery of prescription drugs, changed the queue performance indicators very little. Increasing a staff to fill prescription drugs could cause a decrease of 5 persons in the average queue length and 8 minutes and 44 seconds in the average waiting time.Conclusions:The patients' waiting times and the number of patients waiting to receive services in both shifts could be reduced by using multitasking persons and reallocating them to the time-consuming stage of filling prescriptions, using queuing theory and simulation techniques.

Objective. Medication errors are the most common types of medical errors which considerably endanger the patient safety. This survey aimed to study the factors influencing not reporting on medication errors from the nurses' viewpoints in Abbasi Hospital of Miandoab, Iran. Methods. This was a cross-sectional, descriptive and analytical study conducted in 2012 in which all nurses (n = 100) working in different inpatient units were studied using a consensus method. Required data were collected using a questionnaire. Collected data were analyzed through some statistical tests including Independent t-test, ANOVA, and chi-square. Results. According to the results, the most important reasons for not reporting on medication errors were related to the managerial factors (3.56 ± 0.996), factors related to the process of reporting (3.32 ± 0.797), and fear of the consequences of reporting (3.01 ± 1.039), respectively. Also, there was a significant relationship between employment status and fear of the Consequences of reporting on medication errors (P < 0.008). Conclusion. This study results showed that managerial factors had the greatest role in the refusal of reporting on medication errors. Therefore, for example, establishing a mechanism to improve quality rather than focus only on finding the culprits and blaming them can result in improving the patient safety.

BackgroundIdentifying perceived access barriers to preventive dental services is one of the basic steps to improve the public health.ObjectivesThis study aimed to determine the perceived barriers affecting access to preventive dental services in one of Tehran dental clinics in 2012.Patients and MethodsThis research was a cross-sectional descriptive-analytical study conducted in one of Tehran dental clinics in 2012 using decision–making trial and evaluation laboratory (DEMATEL) method. The study sample included all patients (100 patients) who had referred to the endodontic treatment department from 26 - 31 May, 2012. The required data were collected using a questionnaire. Collected data were analyzed using SPSS 18.0 and MATLAB 7.9.0 SPSSS 18.0, as well as, some descriptive and analytical tests including Mean, Standard Deviation (SD), and Independent T- Test.ResultsThe five determinants of cost, inconvenience, fear, organization, and patient-dentist relationship were determined as barriers to access to dental services among which the cost and patient-dentist relationship were identified as the first and last priorities with the coordinates (1.4 and 1.4) and (1.25 and -0.65), respectively.ConclusionsHigh cost of dental care has led to not referring patients to the clinic. Oral health costs are too high; however insurance organizations have no commitment to support such services. Policymakers, administrators, and insurance organizations have a major role in improving access to dental services. These decision-makers in making their policies can provide the required financial resources, shift the available resources towards preventive care and periodic checkups, and consider providing proper and sufficient places for dental care facilities.

The study showed that 60.87% of the studied hospitals had low performance in terms of either BOR or BTO, or both. Thus, the analysis on why that low performance may have occurred, and suggestions to enhance future performance, is provided.

Background:The healthcare organizations need to develop and implement quality improvement plans for their survival and success. Measuring quality in the healthcare competitive environment is an undeniable necessity for these organizations and will lead to improved patient satisfaction.Objectives:This study aimed to measure the quality of provided services for patients with chronic kidney disease in Kerman in 2014.Patients and Methods:This cross-sectional, descriptive-analytic study was performed from 23 January 2014 to 14 February 2014 in four hemodialysis centers in Kerman. All of the patients on chronic hemodialysis (n = 195) who were referred to these four centers were selected and studied using census method. The required data were collected using the SERVQUAL questionnaire, consisting of two parts: questions related to the patients' demographic characteristics, and 28 items to measure the patients' expectations and perceptions of the five dimensions of service quality, including tangibility, reliability, responsiveness, assurance, and empathy. The collected data were analyzed using SPSS 21.0 through some statistical tests, including independent-samples t test, one-way ANOVA, and paired-samples t test.Results:The results showed that the means of patients' expectations were more than their perceptions of the quality of provided services in all dimensions, which indicated that there were gaps in all dimensions. The highest and lowest means of negative gaps were related to empathy (-0.52 ± 0.48) and tangibility (-0.29 ± 0.51). In addition, among the studied patients' demographic characteristics and the five dimensions of service quality, only the difference between the patients' income levels and the gap in assurance were statistically significant (P < 0.001).Conclusions:Overall, the results of the present study showed that the expectations of patients on hemodialysis were more than their perceptions of provided services. The healthcare providers and employees should pay more attention to the patients' opinions and comments and use their feedback to solve the workplace problems and improve the quality of provided services. In addition, training the health staff to meet the patients' emotional needs and expectations is suggested.

Purpose Reducing informal payments (IPs) for health services has always been a top priority for health policymakers all over the world. As the newest attempts to reduce IPs, Iran’s Government applied a set of reforms in the health care system in 2014 called “Health Sector Evolution Plan” (HSEP). The purpose of this paper is to investigate the prevalence and nature of IPs one year after implementing this plan. Design/methodology/approach This descriptive and cross-sectional study was a nationwide survey on Iran's health sector informal payments carried out in 2016. To do this, a sample of 1,112 Iranain households was selected from all over the country using a multistage cluster-stratified sampling method. The prevalence and nature of IPs were determined through conducting face-to-face interviews using a standard questionnaire. Findings One year after implementing the HSEP, about 27.7 percent of sampled Iranians had at least one experience of IPs for health services. The prevalences of compulsory and voluntary IPs were 21.4 and 11.5 percent, respectively. IPs were reported by 26.1 and 12.5 percent in the inpatient and outpatient services, respectively. Originality/value According to the results, compulsory IPs are still prevalent in both the outpatient and inpatient services of Iran’s health system and it seems that the HSEP has not been completely successful in achieving the goal of eradicating IPs. It can be said that the HSEP has been the first step toward eradicating IPs in Iran and should not be the last one. The study provides useful results of the prevalence and nature of IPs after implementing the HSEP, which should be considered in designing the next steps.

ObjectivesTo determine the percentage of non-urgent (NU) visits in an Iranian emergency department (ED), to explore why patients with NU conditions refer to EDs and also to assess the association between patients’ characteristics and their visits.DesignA cross sectional study based on face to face survey.SettingA territorial, teaching and military hospital in Tehran province, Iran.Participants and data collectionAll patients who visited the ED during the 2-week period were recruited. Data were collected using a validated questionnaire.ResultsOf 1884 patients who visited the ED, 1217 (64.6%) patients were triaged as NU while 667 (35.4%) were urgent and semiurgent visits cases. The most important reasons for NU visits were seeking prompt (36.6%) and less costly care (35.9%). We found that NU visits have increased with younger patients, during weekends and night shifts, and with patients suffering from recurrent symptoms lasting in 1 week or less.ConclusionsEDs are a common source of care for NU problems in Iran. The most invaluable solution is building up special clinics for providing healthcare services to NU patients during the weekends and, in the busy and night shifts. Receiving higher fees from NU patients could also be adopted with caution. Promoting awareness and knowledge of both healthcare providers and patients about the main role of EDs will contribute in improving their performance. As a long-term solution, adopting the family physician programme and ameliorating the referral system are recommended.