Background: Quality is a key factor in the distinction of services, and it is a potential source of sustainable competitive advantage to increase productiveness and patient satisfaction. The identification of strengths and weaknesses in quality of provided services can help to recognize priorities and develop improvement strategies.
Objectives: Using importance-performance analysis (IPA) method, this study aimed to evaluate the quality of services provided in hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Iran.
Methods: Using stratified random sampling, this descriptive-analytical and cross-sectional study included 307 patients admitted to five Educational Hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2016. Data collection tool was a standard questionnaire proposed by Tomes & Chee Peng Ng (1995), which included demographic information and questions regarding the quality of services provided in seven factors. In addition to IPA, data were analyzed using descriptive statistics, analysis of variance (ANOVA), Pearson’s correlation, and chi squared test in SPSS software version 21.
Results: Total scores of quality factors were estimated as “important” in our research. In quality performance, “food”, “physical environment” and “dignity” factors were estimated as “relatively inappropriate” by mean scores of 2.50 ± 0.95, 2.90 ± 0.97 and 2.94 ± 1.05, respectively. These three factors were located in the second region of the IPA matrix. While the other four factors, including “empathy”, “relationship of mutual respect”, “understanding of illness” and “religious needs,” with mean scores higher than 3 were estimated as “appropriate” and located in the first region of this matrix. In all quality factors, scores of performance were lower than importance, and the gap between importance and performance in these seven factors ranged from 0.82 to 1.52. There was a significant relationship between age and education of respondents with the quality of services.
Conclusions: Given that the largest gap was related to the tangible dimensions of quality (including food and physical environment) and in order to improve the quality of services and competitive position, hospital managers must consider tangible dimension as a priority.

Background: Healthcare facilities are dependent on hospital information systems due to the high volume and variation of information in different fields. These systems are a prerequisite for effective and high-quality healthcare provision in hospitals.
Objectives: The present study intended to prioritize the executive barriers to these systems in patient payment reduction and visitation quality improvement packages of the health system reform plan (HSRP) from the perspectives of users and experts in selected university hospitals of Yazd, Iran, in 2019.
Methods: The population of this descriptive-analytical study included 110 participants, including experts of information technology (IT) unit, hospital managers, and personnel of the administrative and medical units dealing with the hospital information system. The data collection tool was a researcher-made questionnaire based on similar studies, the validity of which was evaluated by a committee of experts. Also, the reliability of the questionnaire was investigated and confirmed before the study using the Cronbach’s alpha method and a sample of 30 participants. Data analysis was performed using SPSS software version 21.
Results: Among the six barrier dimensions, the highest mean score belonged to the professional factors (3.46 ± 1.03), followed by human barriers (3.44 ± 0.83). Among professional barriers, the lack of motivation of the personnel in IT learning and get training on the IT-related skills had the highest mean score of 3.67.
Conclusions: According to the results, outsourcing such services and special budget allocation for hardware and software update and support, holding conferences, and provision of practical training in this field are suitable strategies for better implementation of such systems.

Introduction: Spiritual competence in personal and work life increases compatibility, adaptation, problem solving skills, finding meaning in life events, inner and outer peace, dynamism and vitality and can have positive effects on other aspects of life. The first step to improve the status of spiritual competence in society is to evaluate it, which currently has few tools in Persian to measure it, so the purpose of this study is to translate and validate the Spiritual Competence Questionnaire.

Methods: After Persian translation, the formal validity of this questionnaire was inference using the opinions of nine experts based on Waltz and Basel and Lawshe's theory. Also, 179 people completed the research questionnaire to inference the reliability and perform exploratory factor analysis. Excel and SPSS24 software were used for statistical analysis.

Results: The validity of this questionnaire in two dimensions was 90% CVI = (simplicity of questions = 88%, relevance of questions = 96%, clarity of questions = 87%) and 97% CVR = standard. The reliability of this tool, which was calculated based on Cronbach's alpha test, was 89%. The KMO index in exploratory factor analysis was 88% and the mean-variance for seven factors was 67%.

Conclusion: In addition to proper reliability and validity, this tool; is quite simple and fluent. Also, with the ability to complete in 15 to 20 minutes, it has the necessary features to assess the spiritual worthiness of people in different age groups.

Background: Improving the quality of clinical nursing education requires continuous review of the current situation to address weaknesses. Students are the best sources to identify clinical education problems.
Objectives: This study aimed to extend our knowledge about students’ views on the problems related to effective clinical education.
Methods: Following a qualitative approach, the current study was conducted on nursing students in selected teaching hospitals in Mahabad, Iran, in 2019. Twenty students were selected using purposive sampling. Data were collected through in-depth interviews based on the real experiences of nursing students of learning in a clinical education environment with answers to nine open-ended questions. The qualitative content analysis method was used to analyze the data.
Results: All interviews were transcribed to identify conceptual codes. Four general concepts and sub-concepts were identified, which included factors related to the clinical education environment, learners, clients, and clinical education instructors.
Conclusions: Those who are responsible for making nursing education policies can use the findings to improve the quality of clinical education and develop students’ competencies to better care for patients, mainly by emphasizing clinical learning environments (e.g.,facilities, empowering educational instructors, increasing students’ self-confidence, and client-to-student trust), which will translate into more interested and motivated students.

Background: Emerging infectious diseases are contagious illnesses made of a newfound lineage of a microorganism.
Objectives: This survey aimed to evaluate the knowledge, attitudes, and practices (KAP) of health science students regarding emerging and re-emerging infectious diseases.
Methods: This cross-sectional survey was conducted on 462 randomly selected students from several constituent colleges of Birjand University of Medical Sciences, including nursing, medicine, dentistry, and paramedical colleges (from October to March 2019) who had just passed their microbiology courses. A simple random sampling method was used to avoid bias that could influence the validity of the results. Moreover, participation was entirely voluntary. For data collection, a structured knowledge, attitude, and practice questionnaire was used, whose validity was checked by experts. In the end, the collected data were analyzed by SPSS V.19 using the independent t-test and one-way analysis of variance (ANOVA).
Results: Totally, 462 medical science students (mean age = 20.27 ± 3.69 years) participated in this survey. According to the collected data, the mean scores for KAP were at a medium level, which was not ideal, and showed that there were several weaknesses in the curriculum. The mean knowledge scores for medicine, dentistry, laboratory science, and nursing students were 42.53 ± 15.78, 46.24 ± 20.99, 39.63 ± 15.35, and 40 ± 19.43, respectively. The mean attitude scores were 60.25 ± 6.13, 59.68 ± 5.86, 58.60 ± 5.06, and 57.77 ± 6.59, and the practice mean scores were 58.99 ± 25.11, 67.80 ± 25.72, 62.46 ± 24.48, and 62.29 ± 21.08, respectively.
Conclusions: According to the collected data, paying more attention to the microbiology courses is recommended in all medical and paramedical disciplines. Moreover, it is necessary to provide further education for the students to prepare them to take appropriate measures to prevent the spread of infection.

Background: Reporting of medical errors is an approach to identify and prevent errors in hospitals.
Objectives: The purpose of this study was to determine the barriers to error report from the nurses’ viewpoints in Ahvaz Educational hospitals.
Methods: This descriptive-analytical study was done on 206 nurses working in educational hospitals of Ahvaz selected by stratified random sampling. The measurement tool used in this study was a researcher-made questionnaire, which its validity was confirmed by content validity, and its reliability using Cronbach’s alpha was calculated to be 0.84. Data collection was performed from April to June 2019.
Results: The causes of failure to error reporting included educational, attitudinal, process, structural, and managerial factors. The total mean score of the factors causing non-reporting of errors was 3.88 ± 0.53, which was between 3 and 4 (“important”). Also, educational, attitudinal, and process factors were reported as “very important” for nurses. Structural and managerial factors were rated reported “important” by nurses over 90% of nurses rated educational, attitudinal, and process factors as important and very important, and more than 70% of them rated structural and managerial factors as important and very important. Nurses with different levels of education or work experiences had different scores in reasons for not reporting errors.
Conclusions: Some educational, attitudinal, process, structural, and managerial factors were critical reasons for not reporting errors. In order to reduce same errors in the future and promoting health care quality, officials need to develop strategies to remove barriers and consider the reasons for not reporting errors in nurses’ educational programs using team-based and forward-looking approaches, adopting an impersonal and systematic approach, and finally, modifying error reporting rules.

Background: Health systems are making reforms to ensure and promote public health. Measuring the effects of reform is one way to determine its effectiveness and consequences.
Objectives: This study was aimed at investigating the effect of the Iranian Health Sector Evolution Plan (HSEP) implementation with a focus on the type of delivery on maternal and neonatal health indicators in East-Azerbaijan Province.
Methods: This descriptive-analytical study was conducted in 2017. The data of 800 patients were randomly selected through the dataset of eight hospitals equally in the two time periods of before and after the HSEP implementation. A researcher-made checklist was used for data extraction. Data were analyzed by SPSS version 22 using descriptive statistics, t-test, and chi-square.
Results: The mean age of the mothers in both periods was 27 years. Most of the participants did not have a previous delivery and had a diploma or a lower level of education. The rate of natural childbirth increased from 34.5% (before the HSEP) to 44.2% (after the HSEP) (P <0.05). Maternal and neonatal mortality rates decreased from 0.3 and 0.8% to 0.0 and 0.5%, respectively. Maternal and neonatal mortality and stillbirth rates were not significantly different based on the study period and type of delivery (P > 0.05).
Conclusions: The findings indicated a significant increase in the rate of natural childbirth after the HSEP implementation. Maternal and neonatal mortality rates had also decreased. These results can guide policymakers in deciding whether to continue or review the reform.

Context: Healthcare supply chain management is the regulation of the flow of medical goods and services from manufacturers to patients. Supply chain management encompasses the planning and managing of all activities involved in sourcing and procurement, conversion, and all logistics management activities. Therefore, it greatly helps material managers to manage through continuous improvement efforts while maintaining the quality of care. Moreover, reinforcing healthcare logistics information technology (IT) architecture immediately leads to more patient satisfaction.
Objectives: This study aimed to develop an architecture for designing efficient software aiding with the management of the healthcare supply chain.
Methods: This study showed the role of digital services in the improvement of the clinical regime of patients by presenting different approaches with distinguishing the main types of hospital logistics, such as physical flow management, food safety, and cold chain management approaches (e.g., “moving forward”), and modeling these components using the solution architecture principles of ITs, such as Business Process Model and Notation.
Results: This study proposed a hospital enterprise architecture by modeling a system to have a base for building a digital catering service that improves the clinical regime of patients.