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Bajoulvand R, Imani-Nasab M, Jafarnezhad A, Ahmadi Teymourlouy A. Management measures in the face of the COVID-19 epidemic: a phenomenological study. jha 2026; 29 (1) :1-15
URL: http://jha.iums.ac.ir/article-1-4644-en.html
URL: http://jha.iums.ac.ir/article-1-4644-en.html
Razyeh Bajoulvand1 
, Mohammad-Hasan Imani-Nasab2 , Aboubakr Jafarnezhad3 , Ahmad Ahmadi Teymourlouy4
, Mohammad-Hasan Imani-Nasab2 , Aboubakr Jafarnezhad3 , Ahmad Ahmadi Teymourlouy4
1- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Public Health, School of Health and Nutrition, Lorestan University Of Medical Sciences, Khorramabad, Iran.
3- Department of Community Medicine, School of Medicine, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. ,ahmadiseyed@gmail.com
2- Department of Public Health, School of Health and Nutrition, Lorestan University Of Medical Sciences, Khorramabad, Iran.
3- Department of Community Medicine, School of Medicine, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. ,
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Figure 1. WHO building blocks framework [11]
Health information systems: For data collection, four management actions were undertaken: separating hospitalization statistics for stays of less than six hours versus more than six hours, completing standardized forms, designing a specific form within the statistical automation system to collect information on COVID-19 patients, and using colored labels for COVID-19 patient records. Interviews also indicated that measures were taken to facilitate data transfer and reporting, including uploading patient information to the Medical Care Monitoring Center (MCMC) system and transferring information from the MCMC to the statistical automation system.
Access to essential medicines: The provision of medicines was one of the most critical measures in the treatment of COVID-19. Measures included need-based purchasing, stockpiling medicines during periods of reduced case numbers, direct purchase by the hospital, and purchasing according to the established protocols. In most interviews, participants noted that COVID-19 medicines were procured during periods of decling cases, based on the projected needs derived from previous waves. Each COVID-19 referral center received a specific medication quota from the Ministry of Health (MOH), but hospital managers indicated that they did not rely solely on this allocation and instead directly consulted pharmaceutical companies to ensure timly procurement. On the other hand, all medicine procurement was conducted in accordance with protocols issued by the MOH.
Financing: Several interviewees noted that the hospital’s internal revenue increased following the reactivation of operating rooms and the outpatient pharmacy. At the beginning of the COVID-19 pandemic, trauma patients were referred to other hospitals due to space constraints, infection prevention measures, resulting in the suspension of operating room activities and a decrease in hospital revenue. Therefore, after a while, trauma patients were admitted to this hospital, and the reactivation of operating rooms led to an increase in revenue. Additionally, revenue increased with the activation of the outpatient pharmacy. It was also noted that budget appropriations are typically allocated to predefined categories, each designated for specific expenditures; however, during the COVID-19 pandemic, funds were reallocated across budget lines to address urgent priorities. Donors represent a significant source of financial supports for health systems, especially during crisis when resource shortages intensify pressure on organizations; this study also noted that hospital managers effectively utilized this capacity.
Leadership and governance: According to the interviewees, preparation and planning involved three actions: holding meetings to identify needs and develop plans, establishing a clear plan and vision, and ensuring continuous monitoring and follow-up by responsible officials. In most interviews, the active presence of hospital officials on the front lines was highlighted. Improving staff welfare was identified as another step of the leadership activities. It was also emphasized that the officials maintained a continuous presence across hospital and, by addressing staff concerns, motivated them to continue their activities. According to the participants, managerial empathy and awareness were demonestrated through attentiveness to staff requests, provision of psychological support, reduction of unnecessary fear, and honesty with staff. In two interviews, assigining experienced staff at the onset of the epidemic was described as a key decision that served as a role model for others and helped reduce staff stress.
Discussion
This phenomenological study examined hospital management during the COVID-19 pandemic in an Iranian referral center using the WHO health system framework, identifying six core domains and multiple management strategies. A two-stage triage system improved rapid patient identification, resource utilization, and timely care, while a comprehensive care approach addressing clinical, educational, nutritional, and psychosocial needs enhanced patient outcomes, consistent with international evidence [12]. However, psychosocial support remains insufficiently institutionalized in domestic crisis management [13].
Workforce preparedness was enhanced through immediate and virtual training, addressing previously reported gaps [14], while staff safety measures such as PPE use, physical distancing, and balanced shifts reduced infection risk and burnout [15]. Strengthened health information systems improved decision-making, although telehealth services were not implemented, unlike in other contexts [16]. Adequate procurement of medicines and equipment ensured care continuity and staff safety [17], while financial flexibility and philanthropic support contributed to sustainability, in line with global evidence [18]. Supportive leadership, effective communication, and attention to staff well-being were essential to maintaining workforce resilience and cohesion during the pandemic [19].
Limitations
This study has several limitations. First, conducting the study in a single referral health center limits the generalizability of the findings, and the experiences of other hospitals with different structural conditions may vary. Second, the data are based on self-reported narratives from managers, which may be influenced by organizational considerations, personal perceptions, or recall bias. Third, because the study focused only on managers’ perspective, the experiences of other stakeholder groups such as healthcare staff, patients, or families were not examined, which may have introduced bias. Additionally, some managerial dimensions were explored in less depth due to time constraints and the focus of the interviews.
Conclusion
It is essential to address all components of health systems during disasters. Human resources, as one of the most important pillars of the health system, require strengthened occupational safety measures, psychological support, and motivation programs. Strengthening health information systems through the development of integrated systems can improve data flow and communication during crises. Furthermore, planning for the timely provision of essential equipment and medicines, along with establishing sustainable financial mechanisms, such as allocating a dedicated emergency budget is essential for organizational preparedness. The role of leadership in facing crises is very decisive; the active presence of managers on the front lines, calm and principled management, and accurate and timely decision-making can prevent tension and inefficiency. The WHO’s health systems framework is considered an approperiate tool for the comprehensive and systematic assessment of hospital performance during epidemics. Accordingly, policymakers and managers are encouraged to
Full-Text: (87 Views)
Introduction
COVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020 [1] and represents the third major pandemic of the 21st century after SARS and MERS [2]. By 2025, approximately 779 million cases and seven million deaths were reported worldwide [1]. Beyond its severe impact on public health, the pandemic caused significant economic, social, and political consequences, including notable global GDP losses ]3.[ Healthcare systems faced major challenges due to increased workload, resource shortages, and psychological distress among healthcare workers, particularly nurses and nurse managers, whose roles expanded and who experienced considerable physical and mental strain ]4[. Effective management of COVID-19 required targeted strategies, creating unprecedented challenges for hospitals [5]. Countries implemented multi-level responses based on their health system capacities, including triage systems, contact tracing, digital health services, and workforce reorganization [6]. Despite these efforts, hospital-level management experiences during the COVID-19 pandemic remained unexplored. Given the complex and novel nature of crisis management, phenomenology is an appropriate qualitative approach to capture managers’ lived experiences and decision-making processes [7]. Therefore, this study aimed to identify and describe hospital management actions during the COVID-19 pandemic in a COVID-19 referral center in Iran using a phenomenological approach.
Methods
This study employed a qualitative phenomenological approach. According to Sandlowski [8], this approach is preferred for researchers seeking to provide a direct description of a phenomenon or an event. The study participants included senior, middle, and operational managers in one of the referral centers for COVID-19 patients in Iran in 2022. Purposive sampling was conducted among senior, middle, and operational managers. A snowball sampling method was also applied to identify managers who had previously involved in the pandemic management at this center but were working in other units at the time of the study. The final participants consisted of four senior managers, six middle managers, and 15 operational managers. Inclusion criteria included at least six months of managerial work experience in one of the managerial positions of this center during the COVID-19 pandemic and willingness to participate. The exclusion criteria included unavailability for interview or withdrawal from the study.
The data were collected through interviews. The purpose of the study was explained to each participant and informed consent was obtained. The interview time was scheduled according to the participant’ availability. Interviews were initiated using an interview guide and an open-ended question, followed by semi-structured questions focusing on management measures adapted to the COVID-19 pandemic. All interviews were audio-recorded and transcribed verbatim. The researcher also recorded the participants' non-verbal cues by taking notes during the interviews. The average interview duration was 35 minutes and varied depending on participants' willingness to provide their experiences. Interviews continued until data saturation. The Colaizzi method was used for code extraction. MAXQDA (version 20) software was used to manage and analyze the data.
The framework analysis method was used to analyze the data. This method is suitable for generating action-oriented findings and policy design [9]. In this study, data were analyzed using the WHO’s building blocks framework, a comprehensive model for health system assessment. The analysis process included familiarization, identification of the analytical framework, coding, charting, and mapping and interpretation [10]. The building blocks of this framework include service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance (Figure 1) [11].
COVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020 [1] and represents the third major pandemic of the 21st century after SARS and MERS [2]. By 2025, approximately 779 million cases and seven million deaths were reported worldwide [1]. Beyond its severe impact on public health, the pandemic caused significant economic, social, and political consequences, including notable global GDP losses ]3.[ Healthcare systems faced major challenges due to increased workload, resource shortages, and psychological distress among healthcare workers, particularly nurses and nurse managers, whose roles expanded and who experienced considerable physical and mental strain ]4[. Effective management of COVID-19 required targeted strategies, creating unprecedented challenges for hospitals [5]. Countries implemented multi-level responses based on their health system capacities, including triage systems, contact tracing, digital health services, and workforce reorganization [6]. Despite these efforts, hospital-level management experiences during the COVID-19 pandemic remained unexplored. Given the complex and novel nature of crisis management, phenomenology is an appropriate qualitative approach to capture managers’ lived experiences and decision-making processes [7]. Therefore, this study aimed to identify and describe hospital management actions during the COVID-19 pandemic in a COVID-19 referral center in Iran using a phenomenological approach.
Methods
This study employed a qualitative phenomenological approach. According to Sandlowski [8], this approach is preferred for researchers seeking to provide a direct description of a phenomenon or an event. The study participants included senior, middle, and operational managers in one of the referral centers for COVID-19 patients in Iran in 2022. Purposive sampling was conducted among senior, middle, and operational managers. A snowball sampling method was also applied to identify managers who had previously involved in the pandemic management at this center but were working in other units at the time of the study. The final participants consisted of four senior managers, six middle managers, and 15 operational managers. Inclusion criteria included at least six months of managerial work experience in one of the managerial positions of this center during the COVID-19 pandemic and willingness to participate. The exclusion criteria included unavailability for interview or withdrawal from the study.
The data were collected through interviews. The purpose of the study was explained to each participant and informed consent was obtained. The interview time was scheduled according to the participant’ availability. Interviews were initiated using an interview guide and an open-ended question, followed by semi-structured questions focusing on management measures adapted to the COVID-19 pandemic. All interviews were audio-recorded and transcribed verbatim. The researcher also recorded the participants' non-verbal cues by taking notes during the interviews. The average interview duration was 35 minutes and varied depending on participants' willingness to provide their experiences. Interviews continued until data saturation. The Colaizzi method was used for code extraction. MAXQDA (version 20) software was used to manage and analyze the data.
The framework analysis method was used to analyze the data. This method is suitable for generating action-oriented findings and policy design [9]. In this study, data were analyzed using the WHO’s building blocks framework, a comprehensive model for health system assessment. The analysis process included familiarization, identification of the analytical framework, coding, charting, and mapping and interpretation [10]. The building blocks of this framework include service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance (Figure 1) [11].
Figure 1. WHO building blocks framework [11]
To enhance credibility, peer review was conducted by two professors with extenseive experience in qualitative studies. Feedback was obtained from 20% of participants regarding data interpretation to ensure the accurate representation of their perspectives, and their comments were used to improve data interpretation. To ensure reliability, the entire data were independently analyzed by another qualitative research expert familiar with the research literature, and discrepancies were resolved through discussions. To enhance transferability, the sampling method, participant characteristics, data collection method, and the entire process of the study and analysis were described in detail.
Results
In this study, 56% of the 25 participants were male. The mean age was 44.16 and the mean work experience was 10.08 years.Based on the conceptual framework, six main themes were identified, including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. Form the interviews, 32 sub- themes and 100 codes were extracted (Table 1).
Service delivery: Interviewees indicated that, at the onset of the COVID-19 pandemic, the hospital implemented rapid and two-stage triage, outpatient admission for COVID-19 patients, hospitalization based on pulmonary involvement, and strict separation of COVID-19 and non-COVID-19 cases, thereby facilitating effective bed management. The establishment of dedicated COVID-19 outpatient services and dynamic allocation of physical spaces and beds between COVID-19 and trauma patients were among the earliest service delivery measures. Clinical care was strengthened through multidisciplinary teams in intensive care units, while nutritional support was enhanced through dietary modifications and improved food quality. Infection control strategies included infectious waste disposal and regular surface disinfection. Discharge processes were optimized by facilitating earlier discharge of clinically stable patients, continuing care at home, transferring patients to outpatient services, reducing length of stay for non-COVID patients, and utilization of interns to expedite bed turnover during periods of high demand.
Health workforce: Interviewees reported that workforce training was conducted through simulation exercises, orientation programs for new staff and volunteers, experience sharing sessions, and virtual education, with simulation training implemented prior to the admission of the first COVID-19 patient. Workforce shortages were addressed by recruiting students, redeploying staff from other hospitals, extending service contracts, implementing short-term recruitment, and involving volunteers. To ensure staff safety, managers prioritized identifying and reassigning high-risk personnel, enforcing the use of personal protective equipment (PPE), promoting vaccination, balancing shift schedules, improving staff nutrition, and maintaining physical distancing in administrative areas. Workforce organization measures included increasing staffing levels in selected units, assigning anesthesia residents, designating dedicated personnel for discharge processes, and allocating specific staff to manage outpatient services.
Table 1. Themes and subthemes extracted from the interviews
Results
In this study, 56% of the 25 participants were male. The mean age was 44.16 and the mean work experience was 10.08 years.Based on the conceptual framework, six main themes were identified, including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. Form the interviews, 32 sub- themes and 100 codes were extracted (Table 1).
Service delivery: Interviewees indicated that, at the onset of the COVID-19 pandemic, the hospital implemented rapid and two-stage triage, outpatient admission for COVID-19 patients, hospitalization based on pulmonary involvement, and strict separation of COVID-19 and non-COVID-19 cases, thereby facilitating effective bed management. The establishment of dedicated COVID-19 outpatient services and dynamic allocation of physical spaces and beds between COVID-19 and trauma patients were among the earliest service delivery measures. Clinical care was strengthened through multidisciplinary teams in intensive care units, while nutritional support was enhanced through dietary modifications and improved food quality. Infection control strategies included infectious waste disposal and regular surface disinfection. Discharge processes were optimized by facilitating earlier discharge of clinically stable patients, continuing care at home, transferring patients to outpatient services, reducing length of stay for non-COVID patients, and utilization of interns to expedite bed turnover during periods of high demand.
Health workforce: Interviewees reported that workforce training was conducted through simulation exercises, orientation programs for new staff and volunteers, experience sharing sessions, and virtual education, with simulation training implemented prior to the admission of the first COVID-19 patient. Workforce shortages were addressed by recruiting students, redeploying staff from other hospitals, extending service contracts, implementing short-term recruitment, and involving volunteers. To ensure staff safety, managers prioritized identifying and reassigning high-risk personnel, enforcing the use of personal protective equipment (PPE), promoting vaccination, balancing shift schedules, improving staff nutrition, and maintaining physical distancing in administrative areas. Workforce organization measures included increasing staffing levels in selected units, assigning anesthesia residents, designating dedicated personnel for discharge processes, and allocating specific staff to manage outpatient services.
Table 1. Themes and subthemes extracted from the interviews
| Theme | Subtheme |
| Service delivery |
Admission of COVID-19 and non-COVID-19 patients |
| Education for patients and their companions | |
| Allocation of physical space | |
| Clinical and nursing care | |
| Proper nutrition for patients | |
| Motivating patients | |
| Control of patient visits | |
| Infection control | |
| Timely discharge of patients | |
| Health workforce |
Staff training |
| Provision of necessary manpower | |
| Staff safety | |
| Staff organization | |
| Health information systems | Data collection |
| Data transmission and reporting | |
| Data monitoring and analysis | |
| Access to essential medicines | Timely supply of medicines |
| Timely supply of equipment | |
| Proper medication management | |
| Insurance coverage of COVID-19 medicines | |
| Financing | Increasing dedicated income |
| Managing financial resources | |
| Using the capacity of health donors | |
| Leadership and governance | Preparation and planning |
| Respectful communication with employees | |
| Collaboration with employees | |
| Inspiration and influence | |
| Leadership presence | |
| Empathy and awareness | |
| Appropriate decision-making | |
| Systems thinking/sense-making | |
| Implicit skills |
Health information systems: For data collection, four management actions were undertaken: separating hospitalization statistics for stays of less than six hours versus more than six hours, completing standardized forms, designing a specific form within the statistical automation system to collect information on COVID-19 patients, and using colored labels for COVID-19 patient records. Interviews also indicated that measures were taken to facilitate data transfer and reporting, including uploading patient information to the Medical Care Monitoring Center (MCMC) system and transferring information from the MCMC to the statistical automation system.
Access to essential medicines: The provision of medicines was one of the most critical measures in the treatment of COVID-19. Measures included need-based purchasing, stockpiling medicines during periods of reduced case numbers, direct purchase by the hospital, and purchasing according to the established protocols. In most interviews, participants noted that COVID-19 medicines were procured during periods of decling cases, based on the projected needs derived from previous waves. Each COVID-19 referral center received a specific medication quota from the Ministry of Health (MOH), but hospital managers indicated that they did not rely solely on this allocation and instead directly consulted pharmaceutical companies to ensure timly procurement. On the other hand, all medicine procurement was conducted in accordance with protocols issued by the MOH.
Financing: Several interviewees noted that the hospital’s internal revenue increased following the reactivation of operating rooms and the outpatient pharmacy. At the beginning of the COVID-19 pandemic, trauma patients were referred to other hospitals due to space constraints, infection prevention measures, resulting in the suspension of operating room activities and a decrease in hospital revenue. Therefore, after a while, trauma patients were admitted to this hospital, and the reactivation of operating rooms led to an increase in revenue. Additionally, revenue increased with the activation of the outpatient pharmacy. It was also noted that budget appropriations are typically allocated to predefined categories, each designated for specific expenditures; however, during the COVID-19 pandemic, funds were reallocated across budget lines to address urgent priorities. Donors represent a significant source of financial supports for health systems, especially during crisis when resource shortages intensify pressure on organizations; this study also noted that hospital managers effectively utilized this capacity.
Leadership and governance: According to the interviewees, preparation and planning involved three actions: holding meetings to identify needs and develop plans, establishing a clear plan and vision, and ensuring continuous monitoring and follow-up by responsible officials. In most interviews, the active presence of hospital officials on the front lines was highlighted. Improving staff welfare was identified as another step of the leadership activities. It was also emphasized that the officials maintained a continuous presence across hospital and, by addressing staff concerns, motivated them to continue their activities. According to the participants, managerial empathy and awareness were demonestrated through attentiveness to staff requests, provision of psychological support, reduction of unnecessary fear, and honesty with staff. In two interviews, assigining experienced staff at the onset of the epidemic was described as a key decision that served as a role model for others and helped reduce staff stress.
Discussion
This phenomenological study examined hospital management during the COVID-19 pandemic in an Iranian referral center using the WHO health system framework, identifying six core domains and multiple management strategies. A two-stage triage system improved rapid patient identification, resource utilization, and timely care, while a comprehensive care approach addressing clinical, educational, nutritional, and psychosocial needs enhanced patient outcomes, consistent with international evidence [12]. However, psychosocial support remains insufficiently institutionalized in domestic crisis management [13].
Workforce preparedness was enhanced through immediate and virtual training, addressing previously reported gaps [14], while staff safety measures such as PPE use, physical distancing, and balanced shifts reduced infection risk and burnout [15]. Strengthened health information systems improved decision-making, although telehealth services were not implemented, unlike in other contexts [16]. Adequate procurement of medicines and equipment ensured care continuity and staff safety [17], while financial flexibility and philanthropic support contributed to sustainability, in line with global evidence [18]. Supportive leadership, effective communication, and attention to staff well-being were essential to maintaining workforce resilience and cohesion during the pandemic [19].
Limitations
This study has several limitations. First, conducting the study in a single referral health center limits the generalizability of the findings, and the experiences of other hospitals with different structural conditions may vary. Second, the data are based on self-reported narratives from managers, which may be influenced by organizational considerations, personal perceptions, or recall bias. Third, because the study focused only on managers’ perspective, the experiences of other stakeholder groups such as healthcare staff, patients, or families were not examined, which may have introduced bias. Additionally, some managerial dimensions were explored in less depth due to time constraints and the focus of the interviews.
Conclusion
It is essential to address all components of health systems during disasters. Human resources, as one of the most important pillars of the health system, require strengthened occupational safety measures, psychological support, and motivation programs. Strengthening health information systems through the development of integrated systems can improve data flow and communication during crises. Furthermore, planning for the timely provision of essential equipment and medicines, along with establishing sustainable financial mechanisms, such as allocating a dedicated emergency budget is essential for organizational preparedness. The role of leadership in facing crises is very decisive; the active presence of managers on the front lines, calm and principled management, and accurate and timely decision-making can prevent tension and inefficiency. The WHO’s health systems framework is considered an approperiate tool for the comprehensive and systematic assessment of hospital performance during epidemics. Accordingly, policymakers and managers are encouraged to
develop implementation protocols, design readiness assessment checklists, and conduct periodic maneuvers.
Declarations
Ethical considerations: This research was conducted with the approval of the Ethics Committee of Iran University of Medical Sciences (Ethics Code: IR.IUMS.REC.1400.1237). Before starting the interview, informed consent was obtained from all participants, and the interview files were kept anonymous and confidential with the researcher. The names of the study participants were not published in all stages of the research.
Funding: This study was conducted without receiving external funding and solely with the institutional support of Iran University of Medical Sciences. No organization involved in the study design, data collection, analysis, writing, or decision to publish.
Conflict of interest: The authors declare that there is no financial, organizational, or personal conflict of interest in connection with this study.
Authors' contributions: Razyeh Bajoulvand: Conceptualization, study design, data curation, methodology, software, validation, data analysis, resources, data management, writing– original draft, writing– review & editing, final approval. Mohammad-Hasan Imani-Nasab: Conceptualization, study design, methodology, data analysis, writing– original draft, project administration, final approval. Aboubakr Jafarnezhad: Writing– original draft, writing– review & editing, visualization, final approval. Ahmad Ahmadi Teymourlouy: Conceptualization, study design, methodology, data analysis, writing– original draft, writing– review & editing, supervision, project administration, final approval.
Consent for publication: None
Data availability: None
AI declaration: None
Acknowledgements: This article is extracted from the master dissertation in health services management at Iran University of Medical Scienses approved in 2022 with code: 1401-1-37-23092. The authors would like to thank all senior, middle, and operational managers of the the studied hospital who helped us advance this study by dedicating their time and providing valuable experiences. The cooperation of the medical records, infection control, and nursing office units is also appreciated.
Declarations
Ethical considerations: This research was conducted with the approval of the Ethics Committee of Iran University of Medical Sciences (Ethics Code: IR.IUMS.REC.1400.1237). Before starting the interview, informed consent was obtained from all participants, and the interview files were kept anonymous and confidential with the researcher. The names of the study participants were not published in all stages of the research.
Funding: This study was conducted without receiving external funding and solely with the institutional support of Iran University of Medical Sciences. No organization involved in the study design, data collection, analysis, writing, or decision to publish.
Conflict of interest: The authors declare that there is no financial, organizational, or personal conflict of interest in connection with this study.
Authors' contributions: Razyeh Bajoulvand: Conceptualization, study design, data curation, methodology, software, validation, data analysis, resources, data management, writing– original draft, writing– review & editing, final approval. Mohammad-Hasan Imani-Nasab: Conceptualization, study design, methodology, data analysis, writing– original draft, project administration, final approval. Aboubakr Jafarnezhad: Writing– original draft, writing– review & editing, visualization, final approval. Ahmad Ahmadi Teymourlouy: Conceptualization, study design, methodology, data analysis, writing– original draft, writing– review & editing, supervision, project administration, final approval.
Consent for publication: None
Data availability: None
AI declaration: None
Acknowledgements: This article is extracted from the master dissertation in health services management at Iran University of Medical Scienses approved in 2022 with code: 1401-1-37-23092. The authors would like to thank all senior, middle, and operational managers of the the studied hospital who helped us advance this study by dedicating their time and providing valuable experiences. The cooperation of the medical records, infection control, and nursing office units is also appreciated.
Type of Study: Research |
Subject:
Health Services Management
Received: 2025/10/10 | Accepted: 2026/03/28 | Published: 2026/04/28
Received: 2025/10/10 | Accepted: 2026/03/28 | Published: 2026/04/28
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