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This study proposes the Smart SME Technology Readiness Assessment (SSTRA) methodology which aims to enable practitioners to assess the SMEs Industry 4.0 technology readiness throughout the end-to-end engineering across the entire value chain; the smart product design phase is the focus in this paper.

The proposed SSTRA utilises the analytic hierarchy process to prioritise smart SME requirements, a graphical interface which tracks technologies' benchmarks under Industry 4.0 Technology Readiness Levels (TRLs); a mathematical model used to determine the technology readiness and visual representation to understand the relative readiness of each smart main area. The validity of the SSTRA is confirmed by testing it in a real industrial environment. In addition, the conceptual model for Smart product design development is proposed and validated.

The proposed SSTRA offers decision-makers the facility to identify requirements and rank them to reflect the current priorities of the enterprise. It allows SMEs to assess their current capabilities in a range of technologies of high relevance to the Industry 4.0 area. The SSTRA assembles a readiness profile allowing decision-makers to not only perceive the overall score of technology readiness but also the distribution of technology readiness across the main smart areas. It helps to visualise strengths and weaknesses; whilst emphasising the fundamental gaps that require serious action to assist the program with a well-balanced effort towards a successful transition to Industry 4.0.

The SSTRA provides a step-by-step approach for decision-making based on data collection, analysis, visualisation and documentation. Hence, it greatly mitigates the risk of further Industry 4.0 technology investment and implementation.

This paper aims to analyse the current state of research to identify the link between Lean Manufacturing and Industry 4.0 (I4.0) technologies to map out different research themes, to uncover research gaps and propose key recommendations for future research, including lessons to be learnt from the integration of lean and I4.0.

A systematic literature review (SLR) is conducted to thematically analyse and synthesise existing literature on Lean Manufacturing–I4.0 integration. The review analysed 60 papers in peer-reviewed journals.

In total, five main research themes were identified, and a thematic map was created to explore the following: the relationship between Lean Manufacturing and I4.0; Lean Manufacturing and I4.0 implication on performance; Lean Manufacturing and I4.0 framework; Lean Manufacturing and I4.0 integration with other methodologies; and application of I4.0 technologies in Lean Manufacturing. Furthermore, various gaps in the literature were identified, and key recommendations for future directions were proposed.

The integration of Lean Manufacturing and I4.0 will eventually bring many benefits and offers superior and long-term competitive advantages. This research reveals the need for more analysis to thoroughly examine how this can be achieved in real life and promote operational changes that ensure enterprises run more sustainably.

The development of Lean Manufacturing and I4.0 integration is still in its infancy, with most articles in this field published in the past two years. The five main research themes identified through thematic synthesis are provided in the original contribution. This provides scholars better insight into the existing literature related to Lean Manufacturing and I4.0, further contributing to defining clear topics for future research opportunities. It also has important implications for industrialists, who can develop more profound and richer knowledge than Lean and I4.0, which would, in turn, help them develop more effective deployment strategies and have a positive commercial impact.

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.

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.

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.

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.

Accreditation helps to ensure safe and high-quality services in hospitals. Different occupational groups have various hospital accreditation experiences. The purpose of this paper is to investigate nurses’ accreditation experience and its effects on Iranian teaching hospital service quality.

This was a qualitative study involving a phenomenological approach to studying nurses’ hospital accreditation experience and understanding the effects on Iranian teaching hospital service quality. Data were collected using two focus groups in which nurses were selected using purposive sampling. Transcripts were analyzed using content analysis.

Nurses’ experiences showed that hospital administrators and nurses had greater role in implementing accreditation than other occupational groups. Accreditation improved patient-centeredness, patient safety, logistics and managerial processes and decision making. However, a weak incentive system, extra documentation and work stress were negative experiences.

Nurse experience, as the most important care team member, reveals accreditation’s strengths and weaknesses and its effects on service quality.

The author used a phenomenology approach to measure accreditation effects on service quality – a valuable tool for understanding a phenomenon among those that experience hospital accreditation processes.

The purpose of this paper is to determine accreditation effects on Iranian military hospital health service quality through nurses’ viewpoints.

The paper is a cross-sectional questionnaire-based study. Sampling drew from a hospital nurse census (n=160). Descriptive statistics were used to analyze participant demographics and nurses’ views. Linear regression analysis determined the independent variables’ overall effect on the accreditation quality results dimension (dependent variable).

From the nurses’ viewpoints, accreditation effects on services quality mean score was 3.60±0.61. Linear regression analysis showed that leadership and quality management were identified as the most important accreditation quality predictors. The R² value (0.698) showed that nearly 70 percent of the dependent variable changes were affected by the independent variables.

This study gives hospital managers a deeper insight into accreditation and its effects on military hospital service quality. Military hospitals benefit from military organization such as hierarchy and command chain, so managers should employ these characteristics to adopt appropriate policies to promote human resource management as a competitive advantage. Furthermore, results will guide public and private hospital managers on how to manage organizational variables that benefit from accreditation.

Accreditation was introduced as a hospital quality improvement program. However, implementing accreditation programs should be cost-effective. Hospital managers and employees should feel that accreditation can improve service quality. Nurses had positive viewpoints about accreditation and its effects on military hospital service quality.

Strategic planning is the best tool for managers seeking an informed presence and participation in the market without surrendering to changes. Strategic planning enables managers to achieve their organizational goals and objectives. Hospital goals, such as improving service quality and increasing patient satisfaction cannot be achieved if agreed strategies are not implemented. The purpose of this paper is to investigate the factors affecting strategic plan implementation in one teaching hospital using interpretive structural modeling (ISM).

The authors used a descriptive study involving experts and senior managers; 16 were selected as the study sample using a purposive sampling method. Data were collected using a questionnaire designed and prepared based on previous studies. Data were analyzed using ISM.

Five main factors affected strategic plan implementation. Although all five variables and factors are top level, “senior manager awareness and participation in the strategic planning process” and “creating and maintaining team participation in the strategic planning process” had maximum drive power. “Organizational structure effects on the strategic planning process” and “Organizational culture effects on the strategic planning process” had maximum dependence power.

Identifying factors affecting strategic plan implementation is a basis for healthcare quality improvement by analyzing the relationship among factors and overcoming the barriers.

The authors used ISM to analyze the relationship between factors affecting strategic plan implementation.

According to the great importance of community health as well as the ever-increasing development of health technologies, the importance of designing an interactive model of factors affecting health technology assessment (HTA) can be highlighted. The purpose of designing and implementing the framework of health information system assessment is to ensure that the required accurate data which are necessary to measure the main health indicators are available. The purpose of this paper is to design an interactive model of factors affecting HTA.

This is a cross-sectional, descriptive-analytic study conducted in the Iran Ministry of Health and Medical Education in the second half of 2017. A sample of 60 experts and professionals working in the field of health technologies are selected using purposive and snowball sampling methods. Two researcher-made questionnaires are used to collect the required data. The collected data are analyzed using decision-making trial and evaluation laboratory (DEMATEL) and MATLAB R2013a.

The results showed that “Legal dimension,” “safety,” “Effectiveness” and “Social dimension” were the affecting factors and net causes, and “Current application,” “Knowledge of technology,” “Ethical dimension,” “Costs” and “Organizational dimension” were the affected factors and net effects in the interactive model. Furthermore, “Legal dimension” with the coordinates C: [1.88, 1.27] and “Ethical dimension” with the coordinates C: [1.75, −75] were known as the most affecting and most affected factors in the interactive model, respectively.

The DEMATEL model is an appropriate tool for managers and policy makers to structure and prioritize factors influencing the HTA. Policy makers and decision makers can use this model for identifying relationships among factors and prioritize them. Because health policy makers and managers have a major role in formulating the regulations and guidelines related to the HTA, they should pay more attention to the legal considerations in their decisions and use the management tools to move the available resources toward implementing and enforcing rules and guidelines related to the HTA.

This study aims to identify and prioritize barriers to the implementation of medical equipment (ME) marketing strategies using the analytic hierarchy process (AHP).

This was an applied, cross-sectional and descriptive-analytic study conducted in 2017 in Iran. The study population included 30 medical equipment experts working in the Ministry of Health and Medical Education. A researcher made pair-wise comparison questionnaire was used for collecting the required data. The validity and reliability of this questionnaire were confirmed through getting five related experts’ opinions and inconsistency ratio (IR = 0.04). The AHP technique and Expert Choice 10.0 software were used to prioritize the barriers to the implementation of ME marketing strategies.

The results showed that among four categories of barriers to the implementation of ME marketing strategies, “managerial and strategic barriers” (FW = 0.339) and “structural barriers” (FW = 0.139) were the most important and the least important barriers, respectively.

This study, for the first time, has identified and prioritized barriers to the implementation of medical equipment marketing strategies using the AHP.

Hospital accreditation has been adopted internationally as a way and solution for healthcare quality improvement in hospitals. The purpose of this study was to review and knowledge mapping of bibliographic data about “Hospital Accreditation” and assess the current quantitative trends.

Scientometric methods and knowledge visualization using the coword analysis techniques conducted in three steps based on the data related to the field of hospital accreditation from 1975 to 2018 obtained from the MEDLINE database. Bibliographic data for titles, abstracts and keywords articles were saved in CSV format and MEDLINE templates by applying filters. Data extracted were exported into an Excel spreadsheet and were preprocessed. The authors applied the text mining and visualization using VOSviewer software.

Hospital accreditation studies have been increased rapidly over the past 30 years. 6,661 documents in the field of hospital accreditation had been published from 1975 to 2018. Hospitals or organizations active in the field of hospital accreditation were in the United States, Italy and Canada. The 10 most productive authors identified in the area of hospital accreditation with a higher influence were identified. “The United States”, “accreditation”, “Joint commission on accreditation” and “quality assurance, healthcare” had, respectively, the highest frequency. The cluster analysis identified and categorized them into four major clusters. Hospital accreditation field had a close relationship with the quality improvement, patient safety, risk and standards.

Hospital accreditation had focused on the scopes of implementation of accreditation programs, adherence to JCI standards, and focus on safety and quality improvement. Future studies are recommended to be conducted on design interventions and paying attention to all dimensions of hospital accreditation.