Journal of Modern Medical

Introduction
Today, most of advanced organizations are involved in strategic planning for the development of their organization [1]. The increasing complexity of activities has made the use of strategic planning as a necessity in organizations [2]. One of the important necessities of health systems is to develop appropriate strategies and implement them effectively [3]. Hospitals are one of the most important components of the health system and, in terms of resources, account for about half of health care expenditures [4]. A teaching hospital is not only one of the important institutions providing healthcare services [5], but also is an educational environment for medical students [6]. The most important way to increase efficiency is the correct and logical use of available resources [7]. Therefore, to improve the performance of the hospital, appropriate strategies in all fields should be developed by hospital managers [8]. There are challenges and inadequacies in hospitals in Iran, such as the dominance of hospitals managers’ tastes in hospital administration, the lack of evidence-based management decisions, the weakness in formulating, implementing, and evaluating the organizational goals and plans, and the lack of performance monitoring and program control systems [9]. In addition, not having a suitable planning model is one of the most important barriers to planning in the Iranian hospitals [10]. In this study, we aim to develop a strategic planning model for hospitals affiliated to the Islamic Azad University in Iran.

Methods
In this applied study, review, comparative, quantitative and qualitative methods were used. In the review stage, valid models of strategic planning were collected by literature review, of which 7 models were selected. Then, the different dimensions of these models were listed in a comparative table; based on this table, the initial study model was designed. In the second stage, a questionnaire with items about each component of the initial model, implementation stages, and the planning team in the hospital was designed whose content validity was confirmed by 10 experts in strategic planning. In the next step, using the Delphi method, experts were surveyed about the proposed model. In the quantitative stage, in order to prepare the final model, the questionnaire was sent to 30 experts. The items were rated on a 5-point Likert scale. To test the hypothesis, one-way analysis of variance was used. Finally, the experts’ opinions were categorized and the data were analyzed in SPSS software, version 22. If the items had a score >3.75, they would be included in the final model.

Results
The results of survey about the strategic planning team in hospitals are given in Table 1.


The final model of strategic planning is illustrated in Figure 1.
Discussion
The results of the survey showed that the components of “formation of planning team”, “beginning of the planning process and agreeing to do it”, “holding educational programs”, “creating culture and scientific ability for planning in managers and employees” had the highest score according to the experts. In this regard, Jafari [3] and Bahadari [17] in their study also considered the awareness and participation of the head of the organization, organizational culture, creation and maintenance of team participation, and acceptance of employees and organizational structure to be important in the process of strategic planning. Another important components in the current study were the appointment of the head of the hospital as the team leader and the selecting an expert in planning from outside the hospital, if necessary. Khosravi also suggested the use of a person or institution to direct the strategic planning [21]. Examining the external environment of the hospital and the current and expected conditions of the hospital, identifying strategic problems and prioritizing them, and determining choices and formulating relevant strategies were other dimensions of the study model. These results are consistent with the findings of studies by Pourrashidi [24], Mostafapour [25], Shortell [26] and Khosravi [21]. Continuous monitoring, evaluation and improvement of performance according to the plan by internal hospital managers and external supervisor was another dimension. In this regard, Mosadegh Rad [10], Mostafapou [25], Rezaei [6], and Balqis Ferry [29] also concluded that the existence of employee evaluation systems and programs can take them out of the rhetorical and non-operational state.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by Mashhad University of Medical Sciences (Code: IR.MUMS.REC.1401.068).

Funding
This article was extracted from a research project approved by Islamic Azad University of Kashmar branch. It was not funded by any organization.

Conflicts of interest
The author declared no conflict of interest.

Acknowledgements
The authors would like to thank all the experts participated in this study for their cooperation.

References

1. Tabibi SJ, Maleki MR. [Strategic planning (Persian)]. Tehran: Termeh Publication; 2018. [Link]
2. Asefzadeh S, Rezapour A. [Health planning (Persian)]. Qazvin: Qazvin University of Medical Sciences and Health Services Publications; 2018. [Link]
3. Jafari M, Sadeghifar J, Raadabadi M, Jorvand R. [Designing a tool related to strategic control in hospital centers (Persian)]. J Health Adm. 2020; 23(1):74-86. [DOI:10.29252/jha.23.1.74]
4. Wu W, Liang D, Yu B, Yang Y. Strategic planning for management of technology of China’s high technology enterprises. J Technol Manag China. 2010; 5(1):6-25. [DOI:10.1108/17468771011032769]
5. Barouni M, Rahbar A, Abarazeh A, Hamidi Parsa H. [The estimation of technical efficiency of public hospitals in Qom using data envelopment analysis approach (Persian)]. J Sabzevar Univ Med Sci. 2015; 22(2):238-45. [Link]
6. Rezaei D, Alipour A. [Identifying the effective factors on ERP implementation in maritime science education institutions case study: Universities of marine sciences in the north of the country (Persian)]. 2019; 6(2):68-88. [Link]
7. Khamseh A, Agha Mohammadi S, Kazemi E. [Assessing the main factors affecting waiting times referred to specialized clinics on one of the public hospital of Tehran (Persian)]. J Sabzevar Uni Med Sci. 2013; 20(1):62-71. [Link]
8. Nafari E, Rezaei B. Relationship between human resources strategies and organizational performance based on the balanced scorecard in a public hospital in Iran: A cross-sectional study. BMC Health Serv Res. 2022; 22(1):363. [DOI:10.1186/s12913-022-07767-z] [PMID] [PMCID]
9. Zamani S, Montazeri M. [The relationship between job security and mental health staff of railway Hormozgan (Persian)]. Paper presented at: The First National Conference of Sustainable Development and Urban Management with the Approach of Citizen Relaxation. 17 May 2017; Sirjan, Iran. [Link]
10. Mosadeghrad A, Dargahi H, Mahtab Rozbahani M. [Identifying the futurism dimensions in Mazandaran University of Medical Sciences (Persian)]. J Med Spiritual Cultiv. 2020; 28(4):69-80.[Link]
11. Stoner J, Freeman A. Management. [A. Parsaian, SM. Arabi, Persian trans]. Tehran: Commercial Printing and Publishing Company: 1996. [Link]
12. Bryson JM. Strategic planning process for government and non-profit organizations. [M. Khademi Gerashi, Persian trans]. Tehran: Mehraban Book Publisher; 2019. [Link]
13. Goodstein LD, Nolan TM, Pfiffer JW. Applied strategic planning: A comperhensive Guide. New York: Mc Graw-Hilll; 2010. [Link]
14. Swayne LE, Duncan WJ, Ginter PM. Strategic management of health care organizations. Hoboken: John Wiley & Sons; 2012. [Link]
15. Besharati R, Hijazi A. [Developing a strategy and preparing the fifth development plan of the Islamic Azad University, Kashmer and Bardskan branch in the vision of 1404 (Persian)]. Research Project. [Unpublished]. 2012.
16. Besharati R. [Designing an operational planning model for hospitals affiliated to the ministry of health and medical education of Iran (Persian)]. Nurs Midwifery J. 2019; 17(2):154-67. [Link]
17. Bahadori M, Teymourzadeh E, Tajik H, Ravangard R, Raadabadi M, Hosseini SM. Factors affecting strategic plan implementation using interpretive structural modeling (ISM). Int J Health care Qual. 2018; 31(5):406-14. [DOI:10.1108/IJHCQA-05-2017-0075] [PMID]
18. Salimi M. [Survey of effect HRM to agriculture ministry workers (Persian)]. [MSc theies]. Tehran: Islamic Azad University; 2014. [Link]
19. Mapetere D, Mavhiki S, Nyamwanza T, Sikomwe S, Mhonde C. Strategic role of leadership in strategy implementation in Zimbabwe’s state owned enterprises. Int J Bus Soc Sci. 2012; 3(16):271-6. [Link]
20. Pascuci LM, Meyer V, Crubellate JM. Strategic management in hospitals: Tensions between the managerial and institutional lens. Braz Adm Rev. 2017; 14(2):e160092. [DOI:10.1590/1807-7692bar2017160092]
21. Habibi F, Sharifi M, Khosravi B. [Hospitals strategic and operational plans: Unwillingness, lack of success, and prosperity: A letter to the editor (Persian)]. J Hosp. 2021; 20(2):89-91. [Link]
22. Čater T, Pučko D. Factors of effective strategy implementation: Empirical evidence from Slovenian business practice. J E Eur Manag Stud. 2010; 2010:207-36. [DOI:10.5771/0949-6181-2010-3-207]
23. Davood Abadi S, Ahmadpour MH, Nasiripour AA, Shahnavazi H. [Investigating the effect of strategic planning on human performance from the perspective of the staff of Shohada Tajrish Hospital in Tehran (Persian)]. J Hosp. 2021; 20(1):50-9. [Link]
24. Pourrashidi Z. The mediating role of knowledge management and organizational learning in the impact of human resource development activities on staff innovation (case of Shahid Bahonarkerman University staff). Manag Educ Perspect. 2021; 3(2):49-76. [DOI:10.22034/jmep.2021.296856.1063]
25. Mostafapour Z, Rahimian H, Abbaspour A, Ghiasi S, Khorsandi Taskoh A. [Planning the education process away to equalization the quality of universities (Persian)]. J Educ Plann Stud. 2020; 9(17):326-51. [DOI:10.22080/EPS.2021.3195]
26. Shortell SM, Rundall TG, Blodgett JC. Assessing the relationship of the human resource, finance, and information technology functions on reported performance in hospitals using the Lean management system. Health Care Manage Rev. 2021; 46(2):145-52. [DOI:10.1097/HMR.0000000000000253] [PMID]
27. Ziad Z, Hala KY. Strategic planning in lebanese hospitals. Paper presented at: EURAM 2016, Manageable Cooperation. 1-4 June 2016; Paris, France. [Link]
28. Ghasemi K, Sadat M. [Effect of strategic HRM to iram Meli Bank workers (Persian). [MSc thesis]. Tehran: Islamic Azad University Tehran Markaz Branch; 2014. [Link]
29. Ferry AB, Sidin I, Wahyu A. An analysis of the effects of human resources management on healthcare innovation in hospital: A scoping review. J Asian Multicult Res MedHealth Sci Stud. 2021; 2(2):70-83.  [DOI:10.47616/ jamrmhss .v2i2.141]