title: The productivity and its barriers in public hospitals: case study of ran.
abstract: BACKGROUND
  Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study.
  
  
  METHODS
  In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, inputoriented and variable return to scale assumptions were applied and Deap2.1 software was used.
  
  
  RESULTS
  The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked.
  
  
  CONCLUSIONS
  Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful.
authors.affiliation: Associate Professor of Health Services Management, Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran. bnabil@umsu.ac.ir.
authors.forename: Bahram
authors.initials: B
authors.lastname: Nabilou
authors.affiliation: Assistant Professor of Health Economics, Department of Public Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran. hyusefzade2010@gmail.com.
authors.forename: Hassan
authors.initials: H
authors.lastname: Yusefzadeh
authors.affiliation: Assistant Professor of Health Economics, School of Health Management and Information Sciences and Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. rezapoor_a57@yahoo.com.
authors.forename: Aziz
authors.initials: A
authors.lastname: Rezapour
authors.affiliation: Professor of Health Services Management, Department of Public Health, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. f-ebadi@iums.ac.ir.
authors.forename: Farbod
authors.initials: F
authors.lastname: Ebadi Fard Azar
authors.affiliation: MSc in Health Services Management, Department of Public Health, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran. p_safi2003@yahoo.com.
authors.forename: Parviz
authors.initials: P
authors.lastname: Salem Safi
authors.affiliation: MSc in Public Management, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. Sarabi.a@iums.ac.ir.
authors.forename: Ali
authors.initials: A
authors.lastname: Sarabi Asiabar
authors.affiliation: MSc Management Systems and Efficiency, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran. nahalahmadzadeh@yahoo.com.
authors.forename: Nahal
authors.initials: N
authors.lastname: Ahmadzadeh
keywords: Efficiency; Hospital; Malmquist index; Productivity