Decomposition Analysis of Socioeconomic Inequalities in Utilization of Oral Health Services: A Population-Based Study in Urban and Rural Households of Ahvaz.

Background: Inequality in the use of dental services is a primary concern of global health, and few studies have been done in this field in Iran. Therefore, the present study aimed to conduct a decomposition analysis of socioeconomic inequalities in the utilization of oral health services. Methods: This was a cross-sectional study in which 715 households, including 2680 people living in Ahvaz, were included using a stratified-cluster sampling. Data were collected using a questionnaire. For data analysis and estimating the elasticity of the influencing factors, the logistic model and Stata software were used. The social and economic disparities in oral health variables were broken down into determinant components using the Van Doorslaer and Wagstaff technique. Results: The key factors determining social and economic inequalities in the utilization of these services were insurance status, education level, income quintile, and occupation. Nearly 31% of utilization inequalities can be attributed to the insurance status of households. In addition, the education level of household members (about 28%) was the second factor of inequality. The variables of income quintile and occupation are also considered as the third factor, and the age of household members had a negative role in the socioeconomic inequality. Conclusion: The utilization of oral health services can be improved by improving economic and social variables in society. Therefore, including oral health services in insurance plans and primary health care services and supporting people with low-income levels can play an important role in reducing these inequalities.

An analysis of the challenges in recruiting clinical teachers in Iranian medical universities: A qualitative analysis.

BACKGROUND: Employing appropriate and deserving staff is goal of human resource management (HRM). A group of staff at medical science universities are clinical teachers. Considering the position and importance of these peoples, this study addresses the challenges of recruiting clinical teachers. MATERIALS AND METHODS: This is a qualitative study of the conventional content analysis done in Isfahan medical university in 2018. The participants were selected through intensity sampling of purposive sampling method, and data were obtained through semi-structured interviews conducted to survey 23 experts and clinical faculty members concerning the challenges involved in employing clinical teachers. Data were analyzed using conventional content analysis method and OneNote 2013. RESULTS: Two main categories and ten subcategories were classified as follows: HRM inadequacy in educational departments with six subscales such as indefiniteness of the workforce status for HR managers, reluctance of educational departments to increase human resources, nonproportionality of the teacher-student ratio, recruitment of faculty based on the needs in the treatment sector, weakness of the infrastructure to use nonfaculty teachers, and reduced public interest in employment as a faculty and weakness of the selection process with four subscales based on data analysis such as undesirable manner of selection, recruitment based on the score given by the national board of medical examiners, purpose-based calls to recruit predefined individuals, and personal and emotional issues, rather than managerial standards, governing cooperation with teachers. CONCLUSION: Recruitment process is part of HRM tasks. Employment system in a medical sciences university must be considered to improve the clinical faculty recruitment. HRM inadequacy in educational departments and weakness of the selection process are challenges that affect the employment system. According to these findings, it is necessary to review the regulations and tasks of HRM in medical sciences universities.

Clinical instructors' recruitment callenges: Interpretive Structural Modeling approach.

CONTEXT: Universities of medical sciences are responsible for educating and training human resources (HRs) that provide services to all members of the community. Clinical educators play a significant role in the promotion of health and education in medical sciences universities. AIMS: The aim of this study was to prioritize and develop a model to illustrate the relationship between faculty recruitment challenges in medical sciences universities. SETTINGS AND DESIGN: Interpretive structural modeling (ISM) is a system design method initially introduced by Warfield (1974). This method helps create order in the complex interconnections between components of a system by interpreting the opinions of a group of experts. It both determines the priority of elements influencing one another and uncovers the association between the elements of a multipart set in a hierarchical structure. SUBJECTS AND METHODS: In this method, the identified challenges were built into a paired comparison questionnaire to be completed by policymakers and experts. By the same token, the obtained results were analyzed with the ISM technique. STATISTICAL ANALYSIS: The four steps include identified variables related to the issue, structural self-interaction matrix, initial reachability matrix, and final reachability matrix was used for analysis. According to these steps, the ISM model was portrayed. RESULTS: The ISM model was developed in ten levels that divided into three parts including key challenges, strategic challenges, and dependent challenges. CONCLUSION: Health promotion and quality of education in medical sciences universities is dependent on quality of faculty recruitment system. According to the results, it is imperative that HR managers and policymakers improve existing rules and develop policies to solve the challenges in this area.

The analysis of the trend of educational system in orthotics and prosthetics in Iran and the world: A step toward the foresight.

BACKGROUND: Along with the growth of science and technology, the orthotics and prosthetics (O and P) have been changing since the past as a dynamic profession and the role of a specialist in O and P has also undergone a change due to needs of society and the growth of technologies. To illustrate the future direction of an educational system, it is necessary to have a trend analysis of what weaknesses and strengths have existed in the past and the present. MATERIALS AND METHODS: In this analysis, two methods of scoping review and interview were conducted. For the purpose of scoping review, database searches of PubMed, ERIC, SID, and Web of Science in combination with a search on websites of key organizations, including universities, World Health Organization, and International Society of O and P were conducted. RESULTS: Various trends have been formed from different aspects in the health education system due to multifaceted nature of the O and P. The areas include health and education services, technology, curriculum, educational programs, and accreditation. CONCLUSION: The debate on monitoring and evaluation of O and P educational systems has been also developed along with the progress made in the training of O and P. The training of individuals by setting minimum standards leads to a professional competency in line and is considered as other issues arisen in the field of education; however, in recent years, improvements in this field have not been significant.

Challenges of Iranian national health scientific map.

CONTEXT: Iranian National Health Scientific Map is a national plan the implementation of which remarkably influences the progress of the country, though it is facing challenges in its implementation phase. AIMS: The present study has been conducted with the main aim of identifying the challenges facing the comprehensive scientific health map of Iran. SETTING AND DESIGN: This is an applied and qualitative study. SUBJECTS AND METHODS: The study was done in 2017 with the content analysis approach among experts of research and technology management. Some 18 people were selected and were deeply interviewed, meanwhile observing the credibility of research. STATISTICAL ANALYSIS USED: Data analysis was performed based on content analysis and using ATLAS.ti software. RESULTS: Data analysis resulted in the identification of 427 codes, 84 subthemes, and 12 themes. Twelve themes were specified including policy-making, management, university autonomy, quantitative development, consideration of science production chain, designing and monitoring of science map, finance, qualitative assessment, human resources, research ethics, as well as allocating attention to the infrastructure and communication. CONCLUSION: The scientific map of health challenges are indicative of the need for modification of the scientific map and adhering to solutions in line with the removal of the identified challenges. Today, paying attention to the solutions capable of meeting such challenges is a must.

Curriculum management/monitoring in undergraduate medical education: a systematized review.

BACKGROUND: Monitoring and management of undergraduate medical education (UME) curricula are crucial contributors to successful medical education. This systematized review explores the different approaches that medical schools have to UME curriculum management or monitoring in order to provide a basis for curriculum managers. METHODS: PubMed, Science Direct, Scopus, and ERIC were searched with no time limitation using the keywords curriculum, medicine, management, monitoring, and alignment. Advanced search options and Boolean operators 'AND' and 'OR' were also used to find more relevant records. RESULTS: From a total of 673 records, 14 articles along with 7 papers from hand searching and snowballing were included in the review. Documents were categorized into 3 groups of UME curriculum management: developing computerized tools, surveying curriculum stakeholders and reviewing curriculum documents, and introducing managerial structures. CONCLUSIONS: Different approaches are reported for UME curriculum management/monitoring at different levels. Managerial structures and computerized tools are most frequently used at the college level because of the large number of faculty members who are responsible for the UME curriculum delivery and the large amount of complex curriculum information. Surveys and reviews of curriculum documents are used mostly to manage a part of a UME curriculum or to monitor teaching of a certain subject during all or some of the educational years.

An assessment of implementation and evaluation phases of strategic plans in Iranian hospitals.

OBJECTIVES: To assess the implementation and evaluation phases of strategic plans in selected hospitals. METHODS: We conducted a cross-sectional study of implementation and evaluation of strategic plan in 24 hospitals in 2015, using a questionnaire which consisted of two separate sections for strategic implementation and strategic evaluation. Data were analyzed with SPSS version 18. RESULTS: Nearly one-third of hospitals claimed that they allocate their budget based on priorities and strategic goals. However, it turned out that although goals had been set, no formal announcements had been made. Most of the hospitals stated that they used measures when evaluating the plan. For hospital staff, clarifying the hospital's priorities was the most important advantage of a strategic plan. CONCLUSION: There is no clear definition for strategic management in Iranian hospitals, which results in chaotic implementation and control of strategic planning.

Key success factors of health research centers: A mixed method study.

BACKGROUND: In order to achieve success in future goals and activities, health research centers are required to identify their key success factors. OBJECTIVE: This study aimed to extract and rank the factors affecting the success of research centers at one of the medical universities in Iran. METHODS: This study is a mixed method (qualitative-quantitative) study, which was conducted between May to October in 2016. The study setting was 22 health research centers. In qualitative phase, we extracted the factors affecting the success in research centers through purposeful interviews with 10 experts of centers, and classified them into themes and sub-themes. In the quantitative phase, we prepared a questionnaire and scored and ranked the factors recognized by 54 of the study samples by Friedman test. RESULTS: Nine themes and 42 sub-themes were identified. Themes included: strategic orientation, management, human capital, support, projects, infrastructure, communications and collaboration, paradigm and innovation and they were rated respectively as components of success in research centers. Among the 42 identified factors, 10 factors were ranked respectively as the key factors of success, and included: science and technology road map, strategic plan, evaluation indexes, committed human resources, scientific evaluation of members and centers, innovation in research and implementation, financial support, capable researchers, equipment infrastructure and teamwork. CONCLUSION: According to the results, the strategic orientation was the most important component in the success of research centers. Therefore, managers and authorities of research centers should pay more attention to strategic areas in future planning, including the science and technology road map and strategic plan.

Benefits, barriers, and limitations on the use of Hospital Incident Command System.

Hospital Incident Command System (HICS) has been established with the mission of prevention, response, and recovery in hazards. Regarding the key role of hospitals in medical management of events, the present study is aimed at investigating benefits, barriers, and limitations of applying HICS in hospital. Employing a review study, articles related to the aforementioned subject published from 1995 to 2016 were extracted from accredited websites and databases such as PubMed, Google Scholar, Elsevier, and SID by searching keywords such as HICS, benefits, barriers, and limitations. Then, those articles were summarized and reported. Using of HICS can cause creating preparedness in facing disasters, constructive management in strategies of controlling events, and disasters. Therefore, experiences indicate that there are some limitations in the system such as failure to assess the strength and severity of vulnerabilities of hospital, no observation of standards for disaster management in the design, constructing and equipping hospitals, and the absence of a model for evaluating the system. Accordingly, the conducted studies were investigated for probing the performance HICS. With regard to the role of health in disaster management, it requires advanced international methods in facing disasters. Using accurate models for assessing, the investigation of preparedness of hospitals in precrisis conditions based on components such as command, communications, security, safety, development of action plans, changes in staff's attitudes through effective operational training and exercises and creation of required maneuvers seems necessary.

Iranian clinical trials: An analysis of registered trials in International Clinical Trial Registry Platform (ICTRP).

OBJECTIVE: This study investigated and analyzed Iranian clinical trials registered in the ICTRP portal by the end of 2015. The goal was to determine which diseases are currently being studied and whether these are diseases that carry the greatest burden of disease according to regional and WHO statistics. MATERIALS AND METHODS: Information on clinical trials carried out in Iran was downloaded from the portal of the International Clinical Trials Registry website. By the end of 2015, 10,341 studies were registered from Iran. After removing duplicate and observational studies, 10,211 studies remained for analysis. The 2016 edition of the International Classification of Diseases was used to classify the diseases. RESULTS: The frequency of studies was found to be mental and behavioral disorders (10.44%), diseases of the genitourinary system (10.2%), and endocrine, nutritional, and metabolic diseases (10.01%). Gastrointestinal and dermatologic diseases made up more than 12% of studies, but bear only 0.84% of the burden of disease in Iran. CONCLUSION: The results showed that, despite an increase in registration of clinical trials in Iran, most studies registered were conducted on diseases, which form only a small percentage of the total disease burden of the country.

Studying the Effectiveness of One Type of Iranian Traditional Massage on Lumbar Radiculopathy.

BACKGROUND: Low-back pain is one of the most common human morbidities worldwide, which is damaging individually, socially and economically. Recent studies have shown that its prevalence is rising. Most of the low-back pains are non-specific though specific ones need more complicated and more expensive treatments. Sciatica or lumbar radiculopathy is one of these specific low-back pains and is explained in Iranian traditional medicine textbooks in detail. Massage is one of the therapeutic modalities, advised for sciatica. Due to different aspects of sciatica in modern medicine, massage is not indicated as treatment, but it is advised in Iranian traditional medicine. In Iran, many patients resort to traditional massage for sciatica and are satisfied. Thus, the effectiveness of one type of Iranian traditional massage "Kermanshahi family" and conventional treatment were compared based on three outcomes of pain, disability, and quality of life score. METHODS: A total of 50 patients were observed in two groups (25 per group) of case (massage) and control (classic treatment) in a non-randomized controlled clinical trial. Patients suffering from lumbar radicular pain for 8 weeks or longer, before referring to each center (neurosurgery or traditional massage clinic), were enrolled continuously. In the case group, patients underwent traditional massage sessions whereas in the control group they were prescribed as routine. Three outcomes were observed during three periods of before intervention, 1-month, and 3-month after intervention. RESULTS: The mean difference of pain severity decrease in both groups was meaningful (P=0/007). The mean difference of disability decrease in both groups was meaningful (P=0/003). However, the mean difference of quality of life increase in both groups was not meaningful. CONCLUSION: Iranian traditional massage may be useful for the treatment of non-acute sciatica, but more studies are required to confirm and clarify the protocols.

Barriers Against Implementing Blunt Abdominal Trauma Guidelines in a Hospital: A Qualitative Study.

INTRODUCTION: Clinical practice guidelines are structured recommendations that help physicians and patients to make proper decisions when dealing with a specific clinical condition. Because blunt abdominal trauma causes a various range of mild, single-system, and multisystem injuries, early detection will help to reduce mortality and resulting disability. Emergency treatment should be initiated based on CPGs. This study aimed to determine the variables affecting implementing blunt abdominal trauma CPGs in an Iranian hospital. METHODS: This study was conducted as a qualitative and phenomenology study in the Family Hospital in Tehran (Iran) in 2015. The research population included eight experts and key people in the area of blunt abdominal trauma clinical practice guidelines. Sampling was based on purposive and nonrandom methods. A semistructured interview was done for the data collection. A framework method was applied for the data analysis by using Atlas.ti software. RESULTS: After framework analyzing and various reviewing and deleting and combining the codes from 251 codes obtained, 15 families and five super families were extracted, including technical knowledge barriers, economical barriers, barriers related to deployment and monitoring, political will barriers, and managing barriers. CONCLUSION: Structural reform is needed for eliminating the defects available in the healthcare system. As with most of the codes, subconcepts and concepts are classified into the field of human resources; it seems that the education and knowledge will be more important than other resources such as capital and equipment.

Determining Equity in Household's Health Care Payments in Hamedan Province, Iran.

BACKGROUND: Financial protection of household against the consequences of the health care expenditures is one of the most important functions of health care systems. The objective of this study was to determine the equity in health care payments and determining factors among households in Hamedan, a province in Iran. METHODS: In this cross-sectional study, 772 families of patients, who were being discharged from hospitals in Hamedan, were selected for study by using a stratified random sampling method. Required data regarding households' health and non-health expenditures were collected through World Health Organization standard questionnaire by interviews and observation method. RESULTS: According to the findings, 20.7% of households experienced catastrophic health expenditure. The incidence of impoverishment due to out-of-pocket payments for health care was 2.8% among studied households. The highest incidence rate of out-of-pocket health payment indices occurred in the first quintile (poorest or Q1). Variables such as having members under 6 years or over 60 years in household, household size, employment of household head, households' income quintile, existence of the disabled member in households and the education level of the household's head are the most important factors that affect the incidence of out-of-pocket health payment indices. CONCLUSION: There is considerable inequity in health care financing as well as households' health payments. This requires designing and implementing the operative and protective programs for understanding the important factors that affect equity in health financing, especially for poor households, against the unexpected health expenditures through the health care system.

Presentation of a model-based data mining to predict lung cancer.

BACKGROUND: The data related to patients often have very useful information that can help us to resolve a lot of problems and difficulties in different areas. This study was performed to present a model-based data mining to predict lung cancer in 2014. METHODS: In this exploratory and modeling study, information was collected by two methods library and field methods. All gathered variables were in the format of form of data transferring from those affected by pulmonary problems (303 records) as well as 26 fields including clinical and environmental variables. The validity of form of data transferring was obtained via consensus and meeting group method using purposive sampling through several meetings among members of research group and lung group. The methodology used was based on classification and prediction method of data mining as well as the method of supervision with algorithms of classification and regression tree using Clementine 12 software. RESULTS: For clinical variables, model's precision was high in three parts of training, test and validation. For environmental variables, maximum precision of model in training part relevant to C&R algorithm was equal to 76%, in test part relevant to Neural Net algorithm was equal to 61%, and in validation part relevant to Neural Net algorithm was equal to 57%. CONCLUSION: In clinical variables, C5.0, CHAID, C & R models were stable and suitable for detection of lung cancer. In addition, in environmental variables, C & R model was stable and suitable for detection of lung cancer. Variables such as pulmonary nodules, effusion of plural fluid, diameter of pulmonary nodules, and place of pulmonary nodules are very important variables that have the greatest impact on detection of lung cancer.

Evaluation Indexes of Military Hospitals From the Experts' Perspective: A Qualitative Study.

Given the importance of evaluation in an organization and considering the objectives and missions of military hospitals, we aimed to extract some indexes (in addition to common evaluation indexes) for use in evaluating military hospitals. This was an applied-type qualitative study. The participants were 15 health experts who were first chosen by a purposeful sampling, which was then continued by theoretical sampling. The data obtained were analyzed by using MAXQDA11 software and the content analysis method. After 290 obtained codes were analyzed, 17 indexes in 6 domains were extracted, including capacity development for crisis periods, equipment and facilities, training and research, passive defense, treatment, and services, from which 8 indexes were related to capacity development for crisis periods and equipment and facilities (4 indexes each), 3 indexes were related to services, and 6 indexes were related to training and research, passive defense, and treatment (2 indexes each). The results of the present research, as a supplement to current evaluation methods such as accreditation, can be used for the comprehensive evaluation of military hospitals.

The relationship between learning style preferences and gender, educational major and status in first year medical students: a survey study from iran.

BACKGROUND: Identifying and employing appropriate learning styles could play an important role in selecting teaching styles in order to improve education. OBJECTIVES: This study aimed to determine the relationship between learning styles preferences and gender, educational major and status in first year students at Isfahan University of Medical Sciences. PATIENTS AND METHODS: A cross-sectional study employing the visual-aural-read/write-kinesthetic (VARK) learning style's questionnaire was done on 184 first year students of medicine, pharmacy, dentistry, nursing and health services management at Isfahan University of Medical Sciences in 2012. The validity of the questionnaire was assessed through experts' views and reliability was calculated using Cronbach's alpha coefficients (α = 0.86). Data were analyzed using the SPSS ver.18 software and x(2) test. RESULTS: Out of 184 participants who responded to and returned the questionnaire, 122 (66.3%) were female; more than two-thirds (68.5%) of the enrolled students were at the professional doctorate level (medicine, pharmacy, dentistry) and 31.5% at the undergraduate level (nursing and health services management). Eighty-nine (48.4%) students preferred a single-modal learning style. In contrast, the remaining 95 students (51.6%) preferred multi-modal learning styles. A significant relationship between gender and single modal learning styles (P = 0.009) and between status and learning styles (P = 0.04) was observed. CONCLUSIONS: According to the results, male students preferred to use the kinesthetic learning style more than females, while, female students preferred the aural learning style. Knowledge about the learning styles of students at educational institutes is valuable and helps solve learning problems among students, and allows students to become better learners.

The financing of the health system in the Islamic Republic of Iran: A National Health Account (NHA) approach.

BACKGROUND: The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? METHODS: The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey; while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. RESULTS: The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). CONCLUSION: The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.

Performance improvement through proactive risk assessment: Using failure modes and effects analysis.

INTRODUCTION: Cognizance of any error-prone professional activities has a great impact on the continuity of professional organizations in the competitive atmosphere, particularly in health care industry where every second has critical value in patients' life saving. Considering invaluable functions of medical record department - as legal document and continuity of health care - "failure mode and effects analysis (FMEA)" utilized to identify the ways a process can fail, and how it can be made safer. MATERIALS AND METHODS: The structured approach involved assembling a team of experts, employing a trained facilitator, introducing the rating scales and process during team orientation and collectively scoring failure modes. The probability of the failure-effect combination was related to the frequency of occurrence, potential severity, and likelihood of detection before causing any harm to the staff or patients. Frequency, severity and detectability were each given a score from 1 to 10. Risk priority numbers were calculated. RESULTS: In total 56 failure modes were identified and in subsets of Medical Record Department including admission unit dividing emergency, outpatient and inpatient classes, statististic, health data organizing and data processing and Medical Coding units. Although most failure modes were classified as a high risk group, limited resources were, as an impediment to implement recommended actions at the same time. CONCLUSION: Proactive risk assessment methods, such as FMEA enable health care administrators to identify where and what safeguards are needed to protect against a bad outcome even when an error does occur.

Attitude of Iranian physicians and nurses toward a clinical decision support system for pulmonary embolism and deep vein thrombosis.

This research project sought to design and implement a computerized clinical decision support system (CDSS) that was able to identify patients who were at risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), as well as produce reminders for prophylactic action for these diseases. The main purpose of the CDSS was to attempt to reduce the morbidity and mortality caused by embolism and thrombosis in patients admitted to hospitals. After implementation of this system in one of the large educational hospitals of Iran, a standard questionnaire was used, and interviews were conducted with physicians and nurses to evaluate the performance of the designed system for reducing the incidence of pulmonary embolism and thrombosis. From physicians and nurses' point of view, a system which assists the medical staff in making better decisions regarding patient care, and also reminds pulmonary embolism and thrombosis preventive procedures with timely warnings, can influence patient care quality improvement and lead to the improved performance of the medical staff in preventing the incidence of pulmonary embolism and thrombosis.

Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran.

BACKGROUND & AIM: Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. METHODS: The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. RESULTS: All the investigated hospitals had a strategic plan. The obtained percentages for the items "the rate of the compliance to requirements" and "the quantity of planning facilitators" (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). CONCLUSION: According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.