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

Introduction: Hospital autonomy is one of the most significant structural reforms in 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 framework covering structural, processual, human, and contextual dimensions simultaneously has not yet been proposed. This study aimed to design a comprehensive framework for evaluating the effectiveness of the hospital autonomy policy in hospitals affiliated with Isfahan University of Medical Sciences, with a special emphasis on the role of health information infrastructures.
Methods: This qualitative study employed Attride-Stirling's thematic network analysis. Fourteen managers and experts with substantial experience in hospital autonomy were purposively selected using a maximum variation approach. Data were collected through semi-structured interviews and analyzed using MAXQDA 2020 software. Trustworthiness was established through member checking and peer review.
Results: From 234 initial codes, 101 basic themes, 28 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-Driven Decision Making. The resulting thematic network, besides confirming significant interrelationships among these five dimensions, demonstrates meaningful theoretical alignment with Stufflebeam's CIPP framework.
Conclusion: Grounded in five core dimensions and aligned with the CIPP theoretical framework, the proposed conceptual framework can serve as a comprehensive framework for evaluating hospital autonomy effectiveness. Beyond its theoretical contributions, this framework aids policymakers in more effective policy formulation and implementation while paving the way for developing quantitative instruments and empirical validation in future research.