Objective(s): Document and comprehensive health plan was compiled with the focus of the province's Health and Food Security High Council and the participation of public institutions and organizations in a five-year period. Therefore, this study conducted based on systemic view to deal with the analysis and implementation of the document. Methods: This qualitative study was conducted in 2022 with content analysis method in Yazd province, Iran. This study included the evaluation of the progress of the province's comprehensive health plan with the aim of identifying the province's health problems and solutions and providing suggested interventions for the next 5 years. Participants were selected purposefully using the snowball approach. The data was collected via semi-structured interviews. After conducting 25 interviews with managers and experts, the data saturation was achieved. The data was analyzed using qualitative MAXQDA12 Software. Results: The content of the interviews was categorized into 8 main categories and 44 subcategories. The common problems of the province in the ten priorities as well as the proposed interventions for the better implementation of the compiled document were identified according to the role of each executive body. Conclusions: Reforming the governance system is one of the key prerequisites for the implementation of the comprehensive provincial health plan of the Yazd Province, Iran. The implementation of the document requires the establishment of an expert team that is exclusively focused on the implementation of the document and with sufficient authority to monitor and evolution the performance.

Objectives: Self-care is a preventive strategy, which improves physical and psychological health and is influenced by parenting and family relationships, including parent-child relationship. This study aimed to assess this relationship. Method: This was a cross sectional study. Participants completed the Hilburn Family Emotional Climate Questionnaire, the Parent-Child Relationship Rating Questionnaire (PCRS), and the Self-Care Questionnaire. The relationship between survey variables was assessed using the pathway analysis. Findings: The results showed that self-care was directly related to the quality of the mother-child relationship (p=0. 029), the quality of the father-child relationship (p = 0. 014), and the emotional atmosphere of the family (p < 0. 001). Family emotional climate also indirectly mediated mother-child relationships, father-child relationships, and quality of self-care (p<0. 01). Conclusion: The findings suggest that there are direct and indirect relationship between self-care and the mother-child, the father-child and the emotional climate of the family.

Objectives: Due to the importance of the health transformation plan in delivery of the effective health services and the efficient response to the health needs of population, present study aimed to identify solutions in order to strengthen the health transformation plan and resolve its existing challenges. Methods: This was a qualitative study conducted through two focus group discussions. A purposeful sample of 18 managers and health executives of Kurdistan health system participated in the study. Data analysis was done using MAXQDA version 12 and was based on the content analysis method. Results: Four themes and eighteen sub-themes emerged from analysis. The topics included education and information, modification of service packages, reforms in the physical structure, human resources and financial resources of the project and changes in policy and governance perspectives. In this regard, informing the society about the importance of the health transformation plan, especially from preventive outlooks, gaining the support of other institutions affecting health, the effective implementation of family physician plan and the referral system, developing a monitoring and evaluation system, modification of the software and electronic structures of the program, amendments in the payment system, more support given to the health sector from the Ministry of Health, and promoting inter, intra relationships in the health sector were suggested in this study. Conclusion: In order to overcome existing challenges in the path of health transformation plan, it is necessary to adopt strategies focusing on strengthening the health transformation plan from the health promotional and preventive dimensions, allocate stable income of the government to health plans, monitor and evaluate health services continuously.

Objective: The payment system of specialist physicians has significant effects on the country's health costs and the provision of medical care at a fair, sufficient and high-quality level. This study was conducted to design the payment system's implementation guidelines for providing specialized services in the electronic referral system. Methods: A qualitative study was conducted in 2021. The participants were hospital managers, top managers and experts in charge of health, treatment and development departments of Ministry of Health and Golestan University of Medical Sciences, Health Insurance Organization of Golestan province, specialist physicians and faculty members. Fourteen focus group discussion and six in-depth individual interviews were conducted. The content analysis method was used to analyze the data. Results: The requirements for the establishment of an efficient and effective payment system were classified into 6 main themes (legal, political, managerial, executive, economic, cultural and social) and 32 subcategories. The executive mechanism was classified into 3 main themes (executive structure, executive process and monitoring and evaluation method) and 16 subclasses. Conclusion: The implementation of the designed instruction can lead to increasing the access and benefit of services, improving the quality of providing specialized services, cost management and finally increasing the satisfaction of service providers and receivers.

Objective(s): Respiratory diseases affect patients' quality of life, but various, accessible and understandable education such as infographics, can play a major role in preventing these diseases, improving patients' quality of life, and reducing costs. The aim of this study was developing the informational packages for respiratory patients by infographic method. Methods: Informational packages for respiratory patients were prepared by infographics using a qualitative method. The four stages of study included: 1) identifying common respiratory patients based on prevalence,2) providing appropriate scientific contents,3) developing the infographics,and 4) providing the final content, face validity of Infographics. Data analysis and evaluation was performed simultaneously with data collection and during the infographic design process. For the accuracy of the data, face, content and the structure of infographics, pulmonologists, medical library and information science specialists, technology and medical informatics specialists, and respiratory patients were examined. Results: According to the hospital's health information system and interviews with patients, six respiratory diseases or related symptoms were identified, including: shortness of breath, pneumonia, pulmonary edema, respiratory distress, asthma, and bronchitis and two types of visual and textual infographics were designed for each. Conclusion: With professional cooperation between medical librarians and clinical specialists to prepare health informational packages, it is possible to increase the awareness of patients and save the time of the clinical team to provide information to patients.

Dear Editor: Similar to many countries, Iran is committed to achieving universal health coverage. As such several laws have been approved regarding rehabilitation services. Examining these laws shows that there are many legal challenges in the functions of the health system including procurement, financing, resource production, service delivery and accountability, and service quality. Also, the problems of governance in Iran include unbalanced policies and laws, irresponsible intervention, weak all-round supervision, lack of thoughtful and compassionate management, and inconsistency within and between departments. In addition, rehabilitation financing in Iran is unbalanced. In the third chapter of the law of the sixth development plan, the challenges and problems of supportive institutions, especially the lack of credit and coverage gaps were brought into attention. It was emphasized that the needs cannot be met with direct support approaches. Contrary to many countries that have specific laws for recording and analyzing information for disabled people, Iran is in its initial stages of forming a database for them. Furthermore, the comprehensive law on the protection of the rights of the disabled in 2013 is not a right-oriented law emphasizing the recognition, and does not guarantee their rights equal to ordinary people,instead, it has a welfare perspective on the issue. The presence of government organizations such as Ministry of Cooperatives, Labor and Social Welfare, and the National Welfare Organization has caused the law to become a support-economic with the dominant discourse of rehabilitation instead of empowering disabled people and becoming a budget-oriented law.

Objective(s): The purpose of this study was to explain and present a model of managerial competencies affecting the performance of social security hospitals in Tehran, Iran. Methods: This was a qualitative study. A purposive sampling was applied. The participants were senior managers of social security medical centers and experts in hospital management and administration. Data was collected through in-depth semistructured interviews and continued until saturation. A thematic approach was used to analyze the data. Results: The results led to the identification of 4 comprehensive themes, 10 organizing themes and 40 basic themes. Comprehensive and organizing themes included knowledge and work experience (specialized knowledge, general knowledge, work experience), individual characteristics (moral characteristics, personality traits), interactive competencies (communication skills, internal-organizational communication, external-organizational communication), and executive competencies (managerial competencies, leadership competencies) Conclusion: The use of identified themes can be useful in employing competent managers or be used as the basis of routine inservice training courses for hospital managers in medical centers.

Objective(s): Fatigue is the most common and annoying complaint in patients undergoing chemotherapy Therefore, it seems necessary to implement low-risk and low-cost methods such as art therapy to control fatigue in children with cancer. The present study was conducted with the aim of investigating the effect of painting art therapy on the fatigue of children with cancer undergoing chemotherapy. Methods: This clinical trial study was carried out on 65 children with cancer who were admitted to a teaching hospital in Isfahan for chemotherapy. The samples were randomly assigned to two groups: intervention group (n = 32) and the control group (n =33). Children in the intervention group did free drawing for 6 sessions. The data before and after the intervention were collected by using the multidimensional scale of children fatigue. The data were analyzed by SPSS version 16 software using descriptive and inferential statistical tests. Results: There was no significant difference in fatigue score between the intervention group 73. 41) ±, 8. 81) and the control group 68. 11 ±, ) 10. 51) at baseline (P=0. 53). The t-test showed that the mean fatigue in children was significantly decreased in the intervention group 62. 21 (±, 12. 23) as compared to the control group 70. 02 )±, 10. 61) (P<0. 001). The paired t-test also showed that the mean fatigue score in children in the intervention group 62. 21 )12. 23) compared to baseline 73. 41 ±, )8. 81) significantly decreased (P<0. 001). Conclusion: The findings of the study showed that painting can have a significant effect on reducing the fatigue of children with cancer undergoing chemotherapy.

Objective(s): One of the most significant influencing factors in patient safety is the existence of a patient safety culture in the hospital. Patient safety culture is one of the important topics and one of the important concerns of managers and policy makers of the health system. This systematic review was conducted with the aim of determining the status of patient safety culture in Iranian hospitals. Methods: In this systematic review study, electronic search in Farsi and English using keywords Patient Safety, Hospital, Patient safety culture, in databases Medline, Google Scholar, Elsevier Direct Science, Ovid, PubMed and patient safety culture, patient safety and The hospital was conducted in the database of Jihad University Scientific Database (SID), Iran Nursing Publications Bank (Nindex), Magiran and Iranmedex between 2010 and 2020. Articles were extracted in 2021. Results: A total of 182 articles were extracted and finally 23 articles were analyzed. In most hospitals, the overall scores of patient safety culture were reported as low and moderate. The highest score was related to the dimensions of the manager's expectations and actions in the direction of patient safety and the transfer of important patient information between different departments and shifts, team work within the department and organizational learning, and the lowest score was related to the dimensions of non-punitive response to events and the dimension of openness of communication channels. Conclusion: valuing patient safety can be effective in the development and progress of hospitals in the country in order to improve the culture of patient safety. Improving relationships and teamwork within hospital units and creating a non-punitive environment can be effective in improving patient safety in the hospital.