Background: This study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field. Methods: A scoping review was conducted of all English language studies, from January 2000 to October 2018 in the main bibliographic databases. Review selection and characterization were performed by two independent reviewers using pretested forms. Results: Following a keyword search and an assessment of fit for this review, 37 studies were analyzed. Based on the findings and considering the ISO31000 model, a comprehensive yet simple framework of risk management is developed for the executive levels of HCOs. It includes five main phases: establishing the context, risk assessment, risk treatment, monitoring and review, and communication and consultation. A set of tools and techniques were also suggested for use at each phase. Also, the status of risk management in the executive levels of HCOs was determined based on the proposed framework. Conclusion: The framework can be used as a training tool to guide in effective risk assessment as well as a tool to assess non-clinical risks of healthcare organizations. Managers of healthcare organizations who seek to ensure high quality should use a range of risk management methods and tools in their organizations, based on their need, and not assume that each tool is comprehensive.

BACKGROUND: Ensuring about the patient's safety is the fi rst vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care. METHODS:In this study, in combination (qualitative action research and quantitative crosssectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis (HFMEA). To classify the failure modes from the "nursing errors in clinical management model (NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics (total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used. RESULTS:In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identifi ed by HFMEA. 25 (11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors (54.7%) and knowledge and skill (9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy.CONCLUSION: "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.

Background: Due to its role in identifying educational, research, health problems and providing a solution to prevail upon the problems related to public health, the research in the Medical Sciences University has a special importance. The present research aims to determine the restraining factors of doing research from the viewpoint of professors and students of the Medical Sciences University of Ardabil; it was conducted in 2014. Methods: In this descriptive cross-sectional study, 250 individuals from between the professors (50 individuals) and students (200 individuals) of the various academic disciplines of medical sciences were selected by way of completely random sampling. The data collection tool was a researcher-made questionnaire containing 3 parts: demographic information, individual barriers (10 questions) and organizational and environmental barriers (25 questions) based on the binary scale (Yes or No). By using the descriptive statistics and student t-test, data were analyzed with the significance level of 0.05, in the software SPSS19. Results: In the area of organizational factors, the most important restraining factor of the research activities of students was the lack of access to information sources (73.2%) and in the area of individual factors the main obstacle was lack of domination in English (68.6%). Also, the administrative restrictive regulations (73.3%) as the most important organizational restraining factor and lack of time due to job preoccupation (68.9%) as the main individual barrier were recognized for doing research in view of professors. There is not any statistical significant difference between the view of students under study in all the influential individual barriers other than the being unimportant of research from my view and having the negative attitude towards the research works in the view of professors. Also, there is a significant difference between students' view in all effective organizational barriers other than lack of research in the chapter heading of courses of most of fields and the professors' view. In total the score of organizational barriers was more than that of the individual barriers. Conclusion: Organizational barriers and personal barriers have an important role in doing the research in the Medical Sciences University of Ardabil; these barriers can be passed through. The availability of consulting forces and sufficient and necessary counseling, teaching know-how and attitude correction, compensating the lack of facilities and equipment, creating the motivation by the authorities and educating and empowering as executive working procedures are recommended for overcoming the research barriers in the universities.

BackgroundPatient’s Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013.MethodsIn this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level.ResultsSixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: “gratitude” (43.75%), satisfaction with health services provided” (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were “no request for informal payments” (98.14%), “not affording to pay for informal payments” (73.33%) and “paying the hospital expenses by taking out a loan” (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient’s health priority, 40.71% would also “search for other alternative solutions” and 27.33% “accepted the demand as a kind of gratitude culture”. Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05).ConclusionDespite the widespread prevalent belief about informal payments in public hospitals —particularly to the well-known physicians — such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.

<p class="abstract"><strong>Background:</strong> Knee pain is one of the most common complains which cause patients to visit a doctor and Magnetic Resonance Imaging (MRI) is one of the common diagnostic methods which are common to find the cause of Knee pain. This study aim to determine knee MRI appropriateness, in Valiasr hospital of Birjand in 2014.</p><p class="abstract"><strong>Methods:</strong> In this study descriptive – analytical study, 150 patients referred to MRI unit were selected using convenient sampling method. Data were gatherers using a Questionnaire and then analyzed by SPSS16 using descriptive statistics and Pearson, chi-square and Fisher's exact tests.  </p><p class="abstract"><strong>Results:</strong> Of 150 cases, 70 (46.7%) were considered inappropriate, 7 (4.7%) were uncertain, and 73 (48.7%) were deemed to be appropriate. The economic burden of inappropriate prescriptions was 46200000 Rails. A statistical significant relation was observed between appropriateness of prescription with sex, jobs, education, physician specialist and referring institution.</p><strong>Conclusions:</strong> Considering the high rate of inappropriate prescriptions, it is necessary to find the causes. Developing, customization, and perform clinical guidelines in all of our country may help reducing this rate.