BackgroundEvaluating hospital efficiency is a process to optimize resource utilization and allocation. This is vital due to hospitals being the largest financial cost in a health system. To limit avoidable uses of hospital resources, it is important to identify the sources of hospital inefficiencies and to put in place measures towards their reduction and elimination. Thus, the purpose of this research is to examine the sources of hospital inefficiency in the Eastern Mediterranean Region, and existing strategies tackling this issue.MethodsIn this study, the electronic databases MEDLINE (via PubMed), Web of Science, Embase, Google, Google Scholar, and reference lists of selected articles, were explored. Studies on inefficiency, sources of inefficiency, and strategies for inefficiency reduction in the Eastern Mediterranean region hospitals, published between January 1999 and May 2018, were identified. A total of 1466 articles were selected using the initial criteria. After further reviews based on the inclusion and exclusion criteria, 56 studies were eligible for this study. The chosen studies were conducted in Iran (n = 35), Saudi Arabia (n = 5), Tunisia (n = 5), Jordan (n = 4), Pakistan (n = 2), the United Arab Emirates, Palestine, Iraq, Oman, and Afghanistan (n = 1 each). These studies were analyzed using content analysis in MAXQDA 10.ResultsThe analysis showed that approximately 41% of studies used data envelopment analysis (DEA) to measure hospital efficiency. Sources of hospital inefficiency were divided into four categories for analysis: Hospital products and services, hospital workforce, hospital services delivery, and hospital system leakages.ConclusionThis study has revealed some sources of inefficiency in the Eastern Mediterranean Region hospitals. Inefficiencies are thought to originate from excess workforce, excess beds, inappropriate hospital sizes, inappropriate workforce composition, lack of workforce motivation, and inefficient use of health system inputs. It is suggested that health policymakers and managers use this evidence to develop appropriate strategies towards the reduction of hospital inefficiency.

Purpose Although strategic planning promised to boost organizational performance, many health care managers found it difficult to implement it successfully. The purpose of this paper is to investigate the success of strategic planning in health care organizations of Iran. Design/methodology/approach This descriptive and cross-sectional study was conducted in 2016 using a valid and reliable questionnaire completed by 99 health care managers in Tehran province, Iran. Findings Strategic planning was positively related to organizational performance including employees' and patients' satisfaction and organizational productivity. However, strategic planning was moderately successful in enhancing organizational performance of Iranian health care organizations (score of 2.84 out of 5). The most and least success was observed in the planning and employee management constructs of organizational performance. Process management, organizational culture and customer management constructs had the most effect on the success of strategic plans in health care organizations. Practical implications Strategic planning is effective and provides a clear focused direction for health care organizations. Understanding the success factors of strategic planning would enable managers to develop more effective methods for developing, implementing and evaluating strategic plans in health care organizations. Originality/value This paper highlights the relationship between strategic planning and organizational performance and offers suggestions on how to develop and implement strategic plans to achieve higher organizational performance.

Aims Breast cancer is among the most prevalent cancers in women and has mental and emotional effects, leading to declined quality of life. The current this study aimed to determine the prevalence rate of depression in Iranian women with breast cancer. Methods & Materials This study was conducted using a meta-analysis method at Zabol University of Medical Science in March 2019. Six electronic databases were searched and evaluated for original research papers published on the prevalence of depression in Iranian women with breast cancer. Finally, 15 articles were selected and analysed using Comprehensive Meta-Analysis software. Findings Overall, the prevalence rate of depression in Iranian women with breast cancer was 18.5% (95% CI: 14.2%-23.7%). The highest reported prevalence of depression in Iranian women with breast cancer was 35% in Babol City, in 2013, (95% CI: 27.8%-43%); the lowest prevalence of depression in this population was measured as 3.4% in Qom City, in 2017 (95% CI:1.2%-9%). A significant correlation was observed between the prevalence rate of depression, and sample size, year, and mean age (P<0.05). Conclusion Depression affects approximately one-fifth of women with breast cancer. Therefore, it is essential for the healthcare staff to treat the physical conditions and psychological disorders associated with breast cancer.

Background. Breast cancer is one of the most common cancers in women and has mental and emotional effects, which lead to a decline in their quality of life. This study is aimed at determining the prevalence of severe depression in Iranian women with breast cancer. Methods. This meta-analysis study was conducted at Zabol University of Medical Sciences in 2019. Seven electronic databases were searched and evaluated for original research papers published on the prevalence of severe depression in Iranian women with breast cancer. Finally, 13 articles were selected and analyzed via Comprehensive Meta-Analysis software. Results. Overall, the prevalence of severe depression in Iranian women with breast cancer was 11% (95% CI (7.2, 16.5)). The highest prevalence was 44% in Tehran City in 2015 (95% CI (31, 57.9)), and the lowest prevalence was 0.8% in Qom City in 2017 (95% CI (0.01, 6.2)). A significant statistical correlation was observed between the prevalence of severe depression and sample size (p<0.05). Conclusion. According to the results of this study, the prevalence of severe depression affects more than one-tenth of women with breast cancer.

BACKGROUND: Induced demand is a major challenge for financing health promotion, whereby providers exploit patients' information gap to manipulate their demand for health care. The purpose of this study was to identify the factors associated with induced demand for health-care services in hospitals affiliated with Iran University of Medical Sciences (IUMS) in 2018. MATERIALS AND METHODS: In this qualitative study, semi-structured interviews were conducted with 20 participants from IUMS hospitals, including faculty members, physicians, public hospital managers, patients, and researchers with academic and practical experience. Inductive content analysis was used to analyze the data. RESULTS: Overall, 24 subthemes or factors were identified and classified into the health system, the insurer, health-care provider, and health-care recipient themes. Poor monitoring and control, the fee-for-service payment system, limited role of insurance companies, insufficient monitoring of insurance companies, the educational nature of our health centers, health-care providers' interests, and patients' information gap were some important factors in induced demand for health-care services. CONCLUSION: Our results showed that there are many factors that contribute to induced demand for health care. Given the four levels of factors identified in this study, health policymakers and managers must develop strategies at each level to reduce induced demand for health care.