Journal of Police Medicine

fa وضعیت تعالی سازمانی بیمارستان‌های ایران با تأکید بر مدل EFQM: یک مطالعه متاآنالیز Organizational Excellence Status of Iranian Hospitals with Emphasis on EFQM Model: A Meta-Analysis Study مدیریت طب انتظامی Police Medicine Management مروری سيستماتيک Systematic Review <div style="text-align: justify;"> اهداف: پایش عملکرد سیستم‌های مراقبت بهداشتی، الزام حیاتی برای بهبود کیفیت خدمات بهداشتی و درمانی است. در این پژوهش مروری بر نتایج مطالعات اخیر در حوزه تعالی سازمانی در بیمارستان‌های ایران که با مدل EFQM انجام شده بودند، صورت گرفت. مواد و روش‌ها: پژوهش حاضر در سال ۱۴۰۱ برای مرور مقالات چاپ‌شده در مجلات فارسی و انگلیسی موجود در پایگاه‌های SID، Google Scholar، ProQuest، PubMed، Elsevier، ISI، Scopus، IranMedex، Science Direct، Spring و CIVILICA مرتبط با ۱۵ سال اخیر انجام شد. جستجوی مقالات با بهره‌گیری از واژگان کلیدی سرآمدی، تعالی سازمانی، ارزیابی یا ارزشیابی عملکرد، مدل تعالی بنیاد اروپایی مدیریت کیفیت، بیمارستان، نظام سلامت یا معادل انگلیسی آنها یعنی Organizational Excellence، Performance Assessment or Evaluation، EFQM، Hospital و Health system انجام شد. تحلیل منابع اطلاعاتی بر مبنای تحلیل کیفی و متاآنالیز با استفاده از پکیج‌های “Metafor version ۳.۸-۱” و“Meta version ۶.۱-۰” در زبان برنامه نویسی R انجام شد. یافته‌ها: در دوره مورد بررسی، ۱۴ مقاله به مطالعه مقوله تعالی سازمانی (کیفی و کمی) در بیمارستان‌های ایران پرداخته بودند که ۱۳ مورد آنها به ارزیابی کمی مؤلفه‌های تعالی سازمانی اختصاص داشتند. در این مطالعات، شاخص توانمندسازی برای ۱۶ بیمارستان و شاخص نتایج برای ۱۳ بیمارستان گزارش شده بود. برآورد کلی شاخص تعالی سازمانی برای مطالعات صورت‌گرفته برابر با ۵۳۳ در بازه اطمینان ۹۵ درصد (۶۰۲-۴۶۴) به‌دست آمد. شاخص تعالی سازمانی در مطالعات بین ۳۶۷ الی ۷۰۰ متغیر بود که این ناهمگونی به لحاظ آماری معنادار بود (<m:omath><m:r><m:rpr><m:scr m:val="roman"><m:sty m:val="p"></m:sty></m:scr></m:rpr>Q=۳۷.۵, p-value<۰.۰۰۱, </m:r><m:ssup><m:ssuppr><m:ctrlpr></m:ctrlpr></m:ssuppr><m:e><m:r><m:rpr><m:scr m:val="roman"><m:sty m:val="p"></m:sty></m:scr></m:rpr>I</m:r></m:e><m:sup><m:r><m:rpr><m:scr m:val="roman"><m:sty m:val="p"></m:sty></m:scr></m:rpr>۲</m:r></m:sup></m:ssup><m:r><m:rpr><m:scr m:val="roman"><m:sty m:val="p"></m:sty></m:scr></m:rpr>=۶۲.۶%</m:r></m:omath> ). مقدار برآورد کل برای توانمندسازها و نتایج به ترتیب برابر با ۲۷۶ و ۲۴۶ به‌دست آمد. همچنین مقدار ناهمگونی در گزارش این شاخص‌ها به ترتیب برابر با ۷۸ درصد و ۵۹ درصد بود که از نظر آماری معنادار بود. نتیجه‌گیری: وضعیت تعالی سازمانی در بیمارستان‌ها، حاکی از لزوم بازنگری در الزامات استقرار سیستم‌های حاکمیت بالینی و اعتباربخشی با محوریت ابعاد تعالی سازمانی، در راستای بهبود کیفیت خدمات بهداشتی درمانی دارد. </div> <div style="text-align: justify;"> Aims: Monitoring the performance of health care systems is a vital requirement for improving the quality of health care services. This review research was conducted on the results of recent studies in the field of organizational excellence in Iranian hospitals that were conducted with the EFQM model. Materials and Methods: The current research was conducted in 2022 to review the articles published in Persian and English journals available in SID, Google Scholar, ProQuest, PubMed, Elsevier, ISI, Scopus, IranMedex, Science Direct, Spring, and CIVILICA related to the last 15 years. Articles were searched using the keywords of organizational excellence, performance assessment or evaluation, EFQM, hospital, and health system or their Persian equivalent. Information sources were analyzed based on qualitative analysis and meta-analysis using "Metafor version 3.8-1" and "Meta version 6.1-0" packages in the R programming language. FINDINGS: In general, in the investigated period, 14 studies dealt with organizational excellence in hospitals, one of which was devoted to the qualitative study of organizational excellence and 13 to the quantitative evaluation of organizational excellence. Out of 13 studies, two studies were only limited to the evaluation of enablers. The articles' specifications and the quantitative results of organizational excellence components were presented (2006 to 2021) in Tables 2 and 3. Examining the time trend of studies shows that organizational excellence has not been a topic of interest to researchers in recent years, and no growing trend was observed in relation to the number of articles. Figure 2 is the forest diagram for the meta-analysis results of organizational excellence values on 13 studies. The overall estimate of the organizational excellence index for the mentioned studies was equal to 533 in the 95% confidence interval (464-602). In addition, the weight of each of the mentioned studies in the overall estimate of the analysis was reported as a percentage, and the two studies by Malekzadeh et al. [19] and Motaghi et al. [20] had the highest weight in the final result of this analysis with weights of 12.48 and 11.84, respectively (the large and bold square shape inside the confidence interval lines indicates the greater weight of that study). The index of organizational excellence in these studies varied between 367 and 700, and the range of changes based on random effects in the meta-analysis was estimated at 63%, indicating relatively significant changes among studies. This heterogeneity was also statistically significant (Q=37.5, P-value<0.001, I²=62.6%). The funnel diagram was used to check the publication bias in the meta-analysis in Figure 3. This graph shows that 3 of the 13 analyzed studies showed publication bias with 95% confidence and Egger's test (p-values <0.05). Notably, all three mentioned studies had a higher sample size than others, and the estimated effect in the two cases was lower and in one case was higher than the overall effect estimated in the meta-analysis. The score of the enablers dimension was equal to 500, therefore the index obtained for this dimension of organizational excellence in different studies was divided by 500 to obtain the desired effect size of the analysis as a ratio of the total score. Sixteen studies reported the enablers index score that was used for analysis. The total estimated value for enablers was equal to 276. Also, the amount of heterogeneity in the report of this index was estimated to be equal to 78%, which showed a statistically significant heterogeneity (p<0.001). Therefore, this heterogeneity in the report of the enablers index was evaluated as very severe (Figure 4). The score of the dimension of the results was equal to 500, therefore the index obtained for this dimension of organizational excellence in different studies was divided by 500 to obtain the desired effect size of the analysis as a ratio of the total score. Thirteen studies reported results index scores that were used for analysis. The total estimated value for the results was equal to 246. Also, the amount of heterogeneity in the report of this index was estimated to be 59%, which shows a statistically significant heterogeneity (p=0.001). Therefore, this heterogeneity in the results index report in different studies was evaluated at an average level (Figure 5). To investigate the publication bias in the enablers dimension report, according to the respective Funnel charts, the reports of 6 studies were beyond the range of 95% changes, which exactly the same 3 of the studies that showed the publication bias of the total organizational excellence index (Figure 4) were repeated in this list (Figure 6). To check the publication bias in the results dimension report, according to the relevant Funnel charts, only 3 studies were out of this range, which were exactly the same studies that had publication bias in the total organizational excellence index (Figure 7). Conclusion: The state of organizational excellence in hospitals indicates the need to review the requirements for establishing clinical governance and accreditation systems, focusing on the dimensions of organizational excellence to improve the quality of healthcare services. Clinical & Practical Tips in POLICE MEDICINE: The results of the current research indicated that the level of service quality of hospitals in the country is not in a favorable condition. In addition, the lack of studies in the field of performance evaluation of the police hospitals was evident. Therefore, studies based on the evaluation of the level of service quality of the police hospitals should be carried out in order to achieve organizational excellence with the aim of improving employee motivation, increasing patient satisfaction, and ultimately improving the level of physical and mental health of the police personnel. Acknowledgments: The present study is obtained from the doctoral thesis of the first author. The article's authors sincerely thank all those who have cooperated in the implementation of the research. Conflict of Interest: The article's authors stated that there is no conflict of interest in the present study. Authors Contribution: Mohammad Ali Adish, presentation of the idea and design of the study, data collection, data analysis; Ruhollah Alikhan Gorgani, presentation of the idea and design of the study, data analysis; Karim Kiakajuri, presentation of the idea and design of the study. All authors have participated in the initial writing of the article and its revision, and all of them accept the responsibility for the accuracy and correctness of the article's contents with the final approval of this article. Funding Sources: This article was written without any financial support.   <div style="text-align: center;"> Table 1) An example of the search algorithm used in the Scopus database</div> <table align="center" class="TableGrid3" dir="rtl" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-width: 1px; border-style: solid; border-color: black; width: 626px; padding: 0cm 7px; text-align: center;" valign="top"></td> </tr> </tbody> </table> <table align="center" class="TableGrid3" dir="rtl" style="border-collapse:collapse; border:none"> <tbody> <tr> <td style="border-width: 1px; border-style: solid; border-color: black; width: 626px; padding: 0cm 7px; text-align: center;" valign="top">TITLE-ABS-KEY(“organizational excellence”) OR TITLEABS-KEY(“performance evaluation”) OR TITLEABS-KEY(“EFQM”) AND TITLE-ABS-KEY(“hospital”) AND TITLEABS-KEY(“health system”) AND PUBYEAR > 2006 AND (LIMIT-TO (DOCTYPE, “ar”) OR LIMIT-TO (DOCTYPE, “re”)) AND (LIMIT-TO (LANGUAGE, “English”)) AND (LIMIT-TO (SRCTYPE, “j”)).</td> </tr> </tbody> </table> <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-1.png" style="width: 601px; height: 519px;" > Figure 1) Steps of selecting articles   <div style="text-align: center;"><div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div>Table 2) A summary of the final reviewed studies</div> <table align="center" class="Table" style="width:94.1%; border-collapse:collapse" width="94%"> <thead> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:16px; border-top:1px solid black; border-right:none; border-left:none">Row</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:16px; border-top:1px solid black; border-right:none; border-left:none">Authors/year/reference</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:16px; border-top:1px solid black; border-right:none; border-left:none">Type of study</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:16px; border-top:1px solid black; border-right:none; border-left:none">Title</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:16px; border-top:1px solid black; border-right:none; border-left:none">Number and statistical population</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:16px; border-top:1px solid black; border-right:none; border-left:none">Data collection tool</td> </tr> </thead> <tbody> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">1</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Hashemi et al./2016/[30]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">qualitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Examining the explanation of the model of human resource empowerment and organizational excellence among the emergency workers of Gilan, Iran universities hospitals</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">195 people from emergency units of Rasht University hospitals</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">2</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Maleki and Izadi/2007/[41]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">The status of enablers in Tehran's social security hospitals based on the model of organizational excellence</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">15 managers and experts in each hospital</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">3</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Kalhor et al./2010/[24]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Performance evaluation of Qazvin Shahid Rajaei Hospital based on EFQM organizational excellence model EFQM</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">60 hospital managers</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">4</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Tabatabai et al./2011/[42]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Performance evaluation of Mehr hospital in Mashhad based on EFQM organizational excellence model</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">48 hospital managers</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">5</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Torabipour and Rekab Islamizadeh / 2011/ [25]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Self-evaluation of EFQM organizational excellence model in selected hospitals of Ahvaz city in Iran</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">50 managers in each hospital (including senior managers and their deputies, matrons and heads of units and departments)</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Standard and valid self-assessment questionnaire of the European Quality Management Federation</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">6</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Sadeghi and Hejazi/2012/[26]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Self-evaluation of the performance of educational hospitals in Bojnord based on the EFQM model of organizational excellence</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">18 members of the quality improvement committee in Imam Ali hospital and 8 members of the quality improvement committee in Imam Reza hospital in Bojnord city.</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Standard performance evaluation questionnaire based on organization excellence model</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">7</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Shahin and Sanayei/2012/[27]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Evaluation of the performance of Shahid Sadouqi Hospital in Yazd based on the EFQM model of organizational excellence</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">A sample of 302 employees working in different departments of Shahid Sadoughi Hospital in Yazd</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">8</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Parham et al./2012/[43]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Performance evaluation of Shahid Beheshti Hospital in Qom based on EFQM organizational excellence model</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">10 hospital managers</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">9</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Eghbal et al./2013/[28]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Areas of improvement based on the model of excellence in Imam Musa Kazem hospital.</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">15 experts and senior managers of the hospital</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">10</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Rahimi et al./2015/[29]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Evaluation of Shahid Rahimi Khorramabad Hospital based on EFQM Organizational Excellence Model</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">26 senior, middle, and basic managers of the hospital, including the hospital manager, hospital deputies according to the organizational chart, and managers of nursing units, human resources, financial affairs, performance evaluation, and IT</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">11</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Asadi et al./2018/[44]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Applying the EFQM model for performance evaluation (a case study in a public hospital)</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">18 hospital employees</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">12</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Malekzadeh et al./2019/[31]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Performance evaluation of Imam Khomeini (RA) Hospital in Sari with organizational excellence model and operational planning approach</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">33 people from the managers and supervisors of the hospital</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">13</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Malekzadeh, et al./2020/[19]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Examining and comparing hospital performance using "accreditation model", "organizational excellence model" and "program chain model"</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">180 senior, middle and operational managers of five medical training centers under Mazandaran University of Medical Sciences</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Iran Hospital Accreditation Questionnaire, EFQM Organizational Excellence Questionnaire, and Program Chain Model Questionnaire</td> </tr> <tr> <td style="border-bottom:1px solid black; width:4%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">14</td> <td style="border-bottom:1px solid black; width:17%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Motaghi et al./2020/[20]</td> <td style="border-bottom:1px solid black; width:9%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">quantitative</td> <td style="border-bottom:1px solid black; width:38%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">Performance evaluation of the model of the European Foundation for Quality Management of Organizational Excellence of Shahid Beheshti Yasouj Hospital in Iran</td> <td style="border-bottom:1px solid black; width:18%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">126 hospital employees</td> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none"></td> </tr> </tbody> </table> <table align="center" class="Table" style="width:94.1%; border-collapse:collapse" width="94%"> <tbody> <tr> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none"></td> </tr> </tbody> </table> <table align="center" class="Table" style="width:94.1%; border-collapse:collapse" width="94%"> <tbody> <tr> <td style="border-bottom:1px solid black; width:12%; padding:0cm 7px 0cm 7px; height:44px; border-top:none; border-right:none; border-left:none">EFQM Organizational Excellence Standard Questionnaire</td> </tr> </tbody> </table> <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <div style="text-align: center;"> Table 3) Quantitative evaluation results of organizational excellence components in studies</div> <table class="Table" style="width:181.4%; border-collapse:collapse" width="181%"> <thead> <tr> <td nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:15px; border-top:1px solid black; border-right:none; border-left:none">Row</td> <td nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:15px; border-top:1px solid black; border-right:none; border-left:none" valign="top">Authors/references</td> <td rowspan="2" style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:15px; border-top:1px solid black; border-right:none; border-left:none" valign="top">place of study </td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:15px; border-top:1px solid black; border-right:none; border-left:none"></td> <td colspan="4" style="border-bottom:1px solid black; width:27%; padding:0cm 7px 0cm 7px; height:15px; border-top:1px solid black; border-right:none; border-left:none">توانمندسازها (۵۰۰)</td> <td colspan="4" style="border-bottom:1px solid black; width:27%; padding:0cm 7px 0cm 7px; height:15px; border-top:1px solid black; border-right:none; border-left:none">نتایج (۵۰۰)</td> </tr> <tr> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">leadership (100)</td> <td style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">Employees (90)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">Policy and strategy (80)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">process (140)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">Partners and sources (90)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">Employee results (90)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">Customer results (200)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">Community results (60)</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:93px; border-top:none; border-right:none; border-left:none">performance results (150)</td> </tr> </thead> <tbody> <tr> <td nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">1</td> <td nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none" valign="top">Maleki and Izadi/ [41]</td> <td style="border-bottom:none; width:11%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none" valign="top">Alborz Karaj Social Security Hospital</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">41.6</td> <td style="border-bottom:none; width:7%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">40.75</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">40.5</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">85.5</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">41.5</td> <td colspan="4" nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:27%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">Not evaluated</td> </tr> <tr> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none" valign="top">Panzdah Khordad Varamin Hospital</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">38.1</td> <td style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">42.65</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">40.16</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">70</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">44.55</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">2</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none" valign="top">Kalhor et al./[24]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none" valign="top">Qazvin Shahid Rajaei Hospital</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">35.08</td> <td style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">30.69</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">27.17</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">50.52</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">40.53</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">22.48</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">75.64</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">21.14</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:18px; border-top:none; border-right:none; border-left:none">64.45</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">3</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none" valign="top">Tabatabai et al./[42]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none" valign="top">Mehrshahr hospital of Mashhad</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">40.7</td> <td style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">47.2</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">32.3</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">54.2</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">54.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">43.5</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">81</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">25.1</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">90.01</td> </tr> <tr> <td nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">4</td> <td rowspan="2" style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none" valign="top"> Torabipour and Rakab Islamizadeh/[25]</td> <td style="border-bottom:none; width:11%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none" valign="top">Imam Ahvaz Hospital</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">66.8</td> <td style="border-bottom:none; width:7%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">65.5</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">66</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">63.9</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">70.4</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">60.6</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">62.3</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">53.6</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:6px; border-top:none; border-right:none; border-left:none">68.6</td> </tr> <tr> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none" valign="top">Ahvaz Oil Hospital</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">72.44</td> <td style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">66.4</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">67.4</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">65.07</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">63.4</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">54.4</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">62.84</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">59.45</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:28px; border-top:none; border-right:none; border-left:none">45.94</td> </tr> <tr> <td nowrap="nowrap" rowspan="2" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">5</td> <td rowspan="2" style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none" valign="top"> Sadeghi and Hejazi/[26]</td> <td style="border-bottom:none; width:11%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none" valign="top">Imam Ali Bojnord Hospital</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">71</td> <td style="border-bottom:none; width:7%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">84</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">80</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">79</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">77</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">60</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">61.9</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">54.3</td> <td style="border-bottom:none; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">53</td> </tr> <tr> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none" valign="top">Imam Reza Bojnord Hospital</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">61</td> <td style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">52</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">63</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">70</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">75</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">47</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">68</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">57</td> <td style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:16px; border-top:none; border-right:none; border-left:none">70</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">6</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none" valign="top">Shahin and Sanayeei/[27]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none" valign="top">Shahid Sadoughi Hospital, Yazd</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">34.86</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">31.25</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">31.13</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">51.95</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">35.86</td> <td colspan="4" nowrap="nowrap" style="border-bottom:1px solid black; width:27%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">Not evaluated</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">7</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none" valign="top">Parham et al./[43]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none" valign="top">Shahid Beheshti Hospital, Qom</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">48.4</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">43.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">35.9</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">65</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">44.6</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">34.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">84.3</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">26.4</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:19px; border-top:none; border-right:none; border-left:none">67.3</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">8</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none" valign="top">Eghbal et al</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none" valign="top">Imam Musa Kazem Hospital, Isfahan</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">60</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">61</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">47</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">78</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">54</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">54</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">116</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">38</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">91</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">9</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none" valign="top">Rahimi et al./[29]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none" valign="top">Shahid Rahimi Hospital, Khorramabad</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">78.69</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">64.22</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">61.53</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">93.9</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">65.62</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">54.78</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">141.1</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">35.2</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:23px; border-top:none; border-right:none; border-left:none">105.1</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">10</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none" valign="top">Asadi et al./[44]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none" valign="top">One of Tabriz government hospitals</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">73.6</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">54.1</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">46.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">59.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">41.9</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">23.76</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">66</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">40.2</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:27px; border-top:none; border-right:none; border-left:none">71.35</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">11</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none" valign="top">Malekzadeh et al./[31]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none" valign="top">Imam Khomeini Hospital, Sari</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">65.2</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">54.18</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">49.4</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">92.68</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">58.32</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">58.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">132</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">35.28</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:26px; border-top:none; border-right:none; border-left:none">90.3</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">12</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none" valign="top">Malekzadeh et al./[31]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none" valign="top">5 educational-therapeutic centers covered by Mazandaran University of Medical Sciences</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">64.8</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">57.33</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">51.84</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">97.16</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">55.17</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">56.2</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">131.1</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">33.82</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:40px; border-top:none; border-right:none; border-left:none">87.4</td> </tr> <tr> <td nowrap="nowrap" style="border-bottom:1px solid black; width:5%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">13</td> <td style="border-bottom:1px solid black; width:21%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none" valign="top">Motaghi et al./[20]</td> <td style="border-bottom:1px solid black; width:11%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none" valign="top">Shahid Beheshti Yasouj Hospital</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">35.08</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:7%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">30.69</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">27.17</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">50.52</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">40.53</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">22.48</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">75.64</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">21.14</td> <td nowrap="nowrap" style="border-bottom:1px solid black; width:6%; padding:0cm 7px 0cm 7px; height:35px; border-top:none; border-right:none; border-left:none">64.45</td> </tr> </tbody> </table> <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-2.png" style="width: 634px; height: 411px;" > Figure 2) Forest diagram of values of organizational excellence in Iranian hospitals <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-3.png" style="width: 608px; height: 393px;" > Figure 3) Funnel diagram of bias in the publication of organizational excellence studies in Iranian hospitals <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-4.png" style="width: 620px; height: 443px;" > Figure 4) Forest diagram of values of organizational excellence in the dimension of enablers in Iranian hospitals <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-7.png" style="width: 616px; height: 345px;" > Figure 5) Forest diagram of values of organizational excellence in the dimension of results in Iranian hospitals <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-5.png" style="width: 735px; height: 420px;" > Figure 6) funnel diagram of bias in the dimension of enablers in organizational excellence studies of Iranian hospitals <div aria-label="Page Break" class="cke_pagebreak" contenteditable="false" data-cke-display-name="pagebreak" data-cke-pagebreak="1" style="page-break-after:always" title="Page Break"></div> <img alt="" src="./files/site1/images/image-20230411091105-6.png" style="width: 623px; height: 334px;" > Figure 7) Bias funnel diagram in the dimension of results in organizational excellence studies of Iranian hospitals   </div> کیفیت خدمات بهداشتی درمانی,بیمارستان,متاآنالیز, Quality of Health Care,Hospital,Meta-Analysis, 1 22 http://jpmed.ir/browse.php?a_code=A-10-1271-2&slc_lang=fa&sid=1 Mohammad Ali Adish محمدعلی آدیش psharif71@yahoo.com 100319475328460013995 100319475328460013995 No Department of Public Administration, Rasht Branch, Islamic Azad University, Rasht, Iran گروه مدیریت دولتی، واحد رشت، دانشگاه آزاد اسلامی، رشت، ایران Ruhollah Alikhan Gorgani روح‌الله علیخان گرگانی aruhollah@yahoo.com 100319475328460013996 100319475328460013996 Yes Department of Public Administration, Rasht Branch, Islamic Azad University, Rasht, Iran گروه مدیریت دولتی، واحد رشت، دانشگاه آزاد اسلامی، رشت، ایران Karim KiaKojouri کریم کیاکجوری karim_kia@ut.ac.ir 100319475328460013997 100319475328460013997 No Department of Public Administration, Bandar Anzali Branch, Islamic Azad University, Bandar Anzali, Iran گروه مدیریت دولتی، واحد بندر انزلی، دانشگاه آزاد اسلامی، بندر انزلی، ایران