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The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran.

A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010.

The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government’s strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity.

The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries.

This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.

The key factor for the success of total quality management programs in an organization is focusing on the customer. The purpose of this paper is to assess customer focus level following implementation of a quality improvement model in social security hospitals in Tehran Province.

This research was descriptive‐comparative in nature. The study population consisted of the implementers of quality improvement model in four Tehran social security hospitals. The data were gathered through a checklist addressing customer knowledge and customer satisfaction.

The research findings indicated that the average scores on customer knowledge in Shahriar, Alborz, Milad, and Varamin hospitals were 64.1, 61.2, 54.1, and 46.6, respectively. The average scores on customer satisfaction in Shahriar, Alborz, Milad, and Varamin hospitals were 67.7, 65, 59.4, and 50, respectively. The customer focus average scores in Shahriar, Alborz, Milad, and Varamin hospitals were 66.3, 63.3, 57.3, and 48.6, respectively. The total average scores on customer knowledge, satisfaction and customer focus in the investigated hospitals proved to be 56.4, 60.5, and 58.9, respectively.

The paper is of value in showing that implementation of the quality improvement model could considerably improve customer focus level.

The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU).

Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation.

In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility.

The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

The purpose of this paper is to examine the impact of quality of work life (QWL) on organizational citizenship behaviour (OCB) of employees. Also, the paper examines the role of demographic variables, i.e. gender, position and type of organization as moderators of relationship between QWL and OCB.

A survey with sample of 375 was used in this study. PROCESS tool by Hayes (2013) was used to analyze the relation between QWL, OCB and demographic variables.

QWL was found to positively influence OCB. Gender and type of organization were found to moderate the relationship, whereas position failed to moderate the relation significantly.

The study reinforced the significance of QWL practices by organizations to improve extra-role behaviours of employees. Also, importance of considering gender and the industry you are in is emphasized in using and designing the QWL programme for employees.

While many antecedents have been studied in relation to OCB, QWL is rarely discussed. The paper attempts to reemphasize QWL’s importance in doing so in light of demographic variables as moderators.

The Health Sector Evolution Plan (HSEP) is the most recent reform in Iran’s health care system that was launched in May 2014 in all university-affiliated hospitals to reduce health care expenditure for patients, while improving the efficiency and quality of hospital services. The purpose of this paper is to evaluate the impact of the HSEP on the performance of 15 hospitals affiliated with Kermanshah University of Medical Sciences (KUMS), located in the western region of Iran.

The Pabon Lasso model was used to measure the performance of hospitals before and after the implementation of the HSEP in 2013-2014 and 2015-2016, respectively. Three indicators of average length of stay (ALoS), bed occupancy rate (BOR) and bed turnover rate (BTR) were analyzed by the Pabon Lasso model.

The results showed that the average ALoS, BTR and BOR before the introduction of the HSEP were 2.59 days, 92 times and 57 percent, respectively, and the corresponding figures for these indicators after the implementation of the HSEP were 2.61 days, 98.9 times and 59.9 percent. The results indicated that before the introduction of the HESP, 40 percent of hospitals were in zone 1 (poor performance: low BTR and BOR and high ALoS), 27 percent in zone 2, 20 percent in zone 3 (good performance: high BTR and BOR and low ALoS) and 13 percent in zone 4. After the HSEP, the proportion of hospitals in zones 1-4 was 33, 27, 20 and 20 percent, respectively.

This study is the first to use the Pabon Lasso model technique to evaluate the impact of the HSEP on hospitals affiliated with KUMS.

The purpose of this paper is to examine nurses’ attitudes towards safety culture in six Saudi Arabian intensive care units (ICUs).

The study is descriptive with a cross-sectional design. The Safety Attitude Questionnaire (SAQ)-ICU version was distributed and 216 completed questionnaires were returned.

The findings provide a basis for further research on Saudi Arabian ICU safety culture. This study showed that the SAQ-ICU can be used to measure safety climate to identify areas for improvement according to nurse attitudes and perceptions. Findings indicate that ICU safety culture is an important issue that hospital managers should prioritise.

The SAQ-ICU questionnaire, used to measure safety climate in Saudi Arabian ICUs, identifies service strengths and improvement areas according to attitudes and perceptions.

To the knowledge, this is the first study to use SAQ to examine nurses’ safety culture attitudes in Saudi Arabian ICUs. The present findings provide a baseline and further details about Saudi Arabian ICU safety. Study participants represented nine nationalities, indicating the nursing workforce's diversity, which is expected to continue in the future. Such a nursing cultural heterogeneity calls for further studies to examine and evaluate attitudes and values to improve ICU safety culture.

The purpose of this study is to determine the enablers of the quality of work life (QWL) of employees working in the Garment industries.

The study was carried out in a fivefold step. In the first step, the enablers of QWL were identified through an exhaustive literature survey, in the second step identified vital few components through Pareto analysis. Then the third step was followed by exploratory factor analysis (EFA) to further, to identify the precise components and validate the same using confirmatory factor analysis in fourth step. The final step included interpretive structural modeling and Cross-Impact Matrix Multiplication Applied to Classification analysis to model the validated components and determine the interrelationships and linkages.

Predominant QWL enablers of employees working in the garment industries are training and development, satisfaction in job, compensation and rewards, relation and co-operation, grievance handling, work environment, job nature, job security and facilities.

In this study, the interpretive structural model is designed based on the opinion of the experts who are working in the garment industry considering the responses from employees in garment sectors. The framework can be extended further to the other sectors.

In future, the researchers in QWL may develop a model to quantify the level of employees’ QWL who are working in different sectors. Enablers of QWL are essential, and based on this further statistical analysis can be carried out. This study will provide limelight to the researchers in choosing the valid and reliable set of enablers for the empirical studies. Organizations can get benefit by implementing the outcome of this research for the enhancement of the QWL of employees.

The study was carried out in 133 garment industries where 851 workers constituted the final valid responses that were considered for analysis. The outcomes from the study help administrators, policy and decision-takers in taking decisions to enhance QWL.

Medicine distribution logistics pattern in pharmaceutical supply chains is a hot topic, which aims to predict applicable and efficient medicine distribution patterns so that the medicine can be distributed effectively. This research aims to propose a new method, named density-distance method, that works based on Kth proximity using patient features (including age, gender, education, inherent diseases, systemic diseases and disorders); geographical features (city, state, population, density, land area) and supply chain features (destination and transportation system).

The proposed method of this research consists of two main phases where in the first phase, quantitative data analytics will be carried out to find out the significant factors and their impacts on medicine distribution. Then, in the next phase, a new Kth-proximity density-distance-based method is proposed to determine the best locations for the wholesalers while designing a supply chain.

The findings show that the proposed method can effectively design a supply chain network using realistic features. In addition, it is found that while the distance-density aggregate index is applied, the wholesalers' locations will be different compared to classic supply chain designs. The results show that age, public hygiene level and density are the most influential during designing new supply chains.

The outcomes of this research can be used in the medicine supply chains to predict appropriate medicine distribution logistics patterns.

In this research, the machine learning method based on the nearest neighbor has been used for the first time in the design of the supply chain network.

The growing importance of risk management programmes and practices in different industries has given rise to a new risk management approach, i.e. enterprise risk management. The purpose of this paper is to better understand the necessity, benefit, approaches and methodologies of managing risks in healthcare. It compares and contrasts between the traditional and enterprise risk management approaches within the healthcare context. In addition, it introduces bow tie methodology, a prospective risk assessment tool proposed by the American Society for Healthcare Risk Management as a visual risk management tool used in enterprise risk management.

This is a critical review of published literature on the topics of governance, patient safety, risk management, enterprise risk management and bow tie, which aims to draw a link between them and find the benefits behind their adoption.

Enterprise risk management is a generic holistic approach that extends the benefits of risk management programme beyond the traditional insurable hazards and/or losses. In addition, the bow tie methodology is a barrier-based risk analysis and management tool used in enterprise risk management for critical events related to the relevant day-to-day operations. It is a visual risk assessment tool which is used in many higher reliability industries. Nevertheless, enterprise risk management and bow ties are reported with limited use in healthcare.

The paper suggests the applicability and usefulness of enterprise risk management to healthcare, and proposes the bow tie methodology as a proactive barrier-based risk management tool valid for enterprise risk management implementation in healthcare.

The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency.

A systematic literature search was conducted using both international (the Institute for Scientific Information, Scopus and PubMed) and Iranian scientific (Magiran, IranMedex and Scientific Information Database) databases. The review included original studies that used the Pabon Lasso Model to examine Iranian hospital performance, published in Persian or English. A self-administered checklist was used to collect data. In total, 12 questions were used for quality assessment.

In total, 34 studies met our inclusion criteria. The fixed-effects meta-analysis indicated that 19.2 percent (95% confidence interval (CI): 15.6–23.2 percent) of hospitals were in Zone 1 (poor performance: low bed turnover rate (BTR) and bed occupancy rate (BOR) and high average hospital stay (ALoS)), 23.7 percent (95% CI: 20.1–27.8 percent) were in Zone 2, 31.7 percent (95% CI: 27.7–36 percent) in Zone 3 (good performance: high BTR and BOR and low ALoS) and 25.4 percent (95% CI: 21.7–29.5 percent) in Zone 4.

Results help Iranian health policymakers to understand hospital performance, which, in turn, may lead to promoting greater awareness and policy attention to improve Iranian hospital efficiency.

This study indicated that most Iranian hospitals had sub-optimal performance. Further studies are required to understand factors that explain the country’s hospital inefficiency.