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Studies show that economic sanctions have had major negative impacts on health systems during the past years. The aim of this study is to identify the impacts of US sanctions on the performance of public hospitals in Iran.

A qualitative research study was conducted between October 2019 and September 2020 in Kermanshah Province, Iran. Semi-structured, face-to-face interviews, lasting between 25 and 90 min, were carried out with 20 participants in seven public hospitals affiliated to the authors’ institution in Kermanshah Province. Inductive thematic analysis was used to identify themes in the data.

Five main themes emerged from the analysis: resource management challenges; financial restrictions; interruptions in planning; reductions in the quality of service delivery; and changes in organizational relationships.

The results of the present study demonstrate that US economic sanctions have considerably reduced access to necessary medical equipment and medicines for public hospitals in Iran. Policymakers should monitor the distribution of equipment and pharmaceutical products within public hospitals in Iran and take actions to ameliorate shortages during times of economic sanctions.

Resilient hospitals have the vital role in reducing mortality, severity of injuries by providing required emergency services during accidents and disasters. This study aims to identify and prioritize key indicators on hospital resilience.

This cross-sectional study was conducted in 2019. The draft of the indicators obtained from the systematic review of the previous study was finalized, with three expert panel sessions and 14 experts in resilience fields. The outputs of these sessions were divided into three domains including constructive resilience, infrastructural resilience and administrative resilience, 17 sub-domains and 71 indicators. Then fuzzy analytic network process method was used to weight and prioritize the final indicators of hospital disaster resilience.

Administrative resilience, logistic and financial management and strategic outsourcing agreement allocated the highest weight as domain, sub-domains and indicators, respectively. The weight of each sub-domain and indicator was also determined.

Investigating the weight of domains, sub-domains and indicators shows the importance of managerial and operational issues in hospital resilience. By using the indicators and relative weights, a tool for measuring hospital disaster resilience can be created in further studies. The output of these assessments is effective in promoting safety and increasing awareness of hospital managers and health policymakers.

This research seeks to evaluate the impact of applying lean construction principles on the performance of reinforcement operations using a discrete-event simulation (DES) approach.

Process mapping of reinforcements operations was first established through field observation and interviews with construction managers involved in the selected project. Subsequently, quantitative data were gathered and then used to identify the best probabilistic density functions for each activity duration based on the fit-quality tests. Upon testing the validity of the real-world model, a lean simulation model was developed, using ARENA software, to investigate the impact of lean construction principles on the performance of such processes.

Lean principles are effective in enhancing the performance of the selected construction process. Output performance measurements for real-world model and lean model revealed that lean construction principles led to 41% improvement in process productivity, 14% enhancement in process efficiency and 17% reduction in cycle time.

The statistical findings only represent the process under study (reinforcement process) and cannot be generalized to other construction activities. In order to draw generalizable conclusions, future works are needed to extend this study to different project sizes and more complex construction processes (e.g. bricklaying process and concrete pouring operations). Moreover, there are other factors such as labor skills, rework and uncertainty, site conditions that require further analyses for leaner construction projects.

The methodology and the techniques presented in this work can be used for decision making by analyzing various lean construction scenarios and evaluating their impacts on performance outcomes of any construction process prior to real-world implementation.