طراحی مدل ارزیابی اثربخشی اجرای خط‌مشی خودگردانی در بیمارستان‌های دانشگاه علوم پزشکی اصفهان: یک مطالعه کیفی

Abstract
Introduction: Hospital autonomy is among the most significant structural reforms of Iran's health system, designed to reduce reliance on public budgets, enhance managerial independence, and improve service quality. Despite years of implementation, its effectiveness has been heterogeneous, and a comprehensive evaluation model covering structural, processual, human, and contextual dimensions simultaneously has yet to be proposed. This study aimed to design a comprehensive model for evaluating the effectiveness of the hospital autonomy policy in hospitals affiliated with Isfahan University of Medical Sciences.
Methods: This qualitative study employed Attride-Stirling's thematic network analysis. Fourteen managers and experts with substantial experience in hospital autonomy were purposively selected. Data were collected through in-depth semi-structured interviews and analyzed using MAXQDA software. Trustworthiness was established through member checking and peer review.
Results: From 234 initial codes, 101 basic themes, 27 organizing themes, and five global themes emerged: 1) Clinical Governance and Institutional Agility, 2) Financial Intelligence and Economic Resilience, 3) Human Capital and Organizational Motivation, 4) Customer Orientation and Service Excellence, and 5) Technology and Information Rationalism. The resulting thematic network, besides confirming significant interrelationships among these five dimensions, demonstrates their complete alignment with Stufflebeam's CIPP framework.
Conclusion: Grounded in five core dimensions and aligned with the CIPP theoretical framework, the proposed model can serve as a comprehensive, valid tool for evaluating hospital autonomy effectiveness. Beyond its theoretical contributions, this model aids policymakers in more effective policy formulation and implementation while paving the way for developing quantitative instruments and empirical validation in future research.