Volume 28, Issue 3 (12-2025)
jha 2025, 28(3): 28-48 |
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Shamsi D, Mohammadian Saravi M, Mohammadzadeh K A, Ashrafi A. The causal relationship pattern of factors affecting good governance in Iran's healthcare system. jha 2025; 28 (3) :28-48
URL: http://jha.iums.ac.ir/article-1-4633-en.html
URL: http://jha.iums.ac.ir/article-1-4633-en.html
1- Ministry of Health and Medical Education, Tehran, Iran.
2- Department of Public Administration, Faculty of Management and Social Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran. ,Mo.Mohammadian@iau.ac.ir
3- Department of Health Services Management, Faculty of Management and Social Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran.
4- Department of Public Administration - Resource Management, Faculty of Management and Social Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran.
2- Department of Public Administration, Faculty of Management and Social Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran. ,
3- Department of Health Services Management, Faculty of Management and Social Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran.
4- Department of Public Administration - Resource Management, Faculty of Management and Social Sciences, Islamic Azad University, North Tehran Branch, Tehran, Iran.
Abstract: (23 Views)
Introduction: Good governance in the healthcare system plays a fundamental role in improving service quality, enhancing equity, and increasing efficiency. However, identifying the factors influencing it remains a major challenge. This study aims to identify the causal relationships between factors affecting good governance in the Iranian health system.
Methods: This study was conducted using a mixed-methods approach. In the qualitative phase, data were collected through semi-structured interviews with 17 academic experts and healthcare managers selected via the snowball sampling method. The data were analyzed using thematic analysis. In the quantitative phase, the causal relationships among the identified components were analyzed using the DEMATEL method.
Results: The thematic analysis revealed that good governance is influenced by seven key dimensions: effectiveness, efficiency, equity, transparency and accountability, participation, legality, and leadership, each comprising multiple related components. The DEMATEL analysis indicated that "rapid accountability" had the highest degree of influence, while "process optimization and technology utilization" exhibited the highest degree of dependency. Additionally, some components, such as goal achievement, patient satisfaction, and productivity, were identified as causal factors, whereas others, including infrastructure development, decision-making transparency, and strategic leadership, were classified as dependent factors.
Conclusion: The study provides a framework for improving good governance in Iran's healthcare system. The results highlight the necessity of focusing on rapid accountability, productivity, infrastructure development, and process optimization to enhance healthcare governance. This framework can assist policymakers in formulating effective strategies for healthcare system reforms and serve as a foundation for future research in healthcare governance.
Methods: This study was conducted using a mixed-methods approach. In the qualitative phase, data were collected through semi-structured interviews with 17 academic experts and healthcare managers selected via the snowball sampling method. The data were analyzed using thematic analysis. In the quantitative phase, the causal relationships among the identified components were analyzed using the DEMATEL method.
Results: The thematic analysis revealed that good governance is influenced by seven key dimensions: effectiveness, efficiency, equity, transparency and accountability, participation, legality, and leadership, each comprising multiple related components. The DEMATEL analysis indicated that "rapid accountability" had the highest degree of influence, while "process optimization and technology utilization" exhibited the highest degree of dependency. Additionally, some components, such as goal achievement, patient satisfaction, and productivity, were identified as causal factors, whereas others, including infrastructure development, decision-making transparency, and strategic leadership, were classified as dependent factors.
Conclusion: The study provides a framework for improving good governance in Iran's healthcare system. The results highlight the necessity of focusing on rapid accountability, productivity, infrastructure development, and process optimization to enhance healthcare governance. This framework can assist policymakers in formulating effective strategies for healthcare system reforms and serve as a foundation for future research in healthcare governance.
Type of Study: Research |
Subject:
Health Policy
Received: 2025/04/12 | Accepted: 2025/09/20 | Published: 2025/12/8
Received: 2025/04/12 | Accepted: 2025/09/20 | Published: 2025/12/8
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