per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 172 174 article Fahimeh Shojaeifar shojaefar2013@gmail.com 1 Instructor, Nursing and Midwifery Care Research Center, Comprehensive Research Institute of Maternal and Child Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran The health facility environment is more than a backdrop to care; it is a key contributor to the quality of health care as perceived by patients. Evidence-based design—through lighting, layout, and wayfinding—reduces stress, enhances safety, and boosts satisfaction. These environmental cues also act as subtle forms of marketing of health services, signaling organizational values and patient-centeredness. This review highlights how hospital design shapes patient experience and influences nonverbal perceptions of care.   http://mshsj.ssu.ac.ir/article-1-894-en.pdf Patient experience Hospital environment design Implicit healthcare marketing per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 175 187 article Mohammad Hossein Ronaghi mh_ronaghi@shirazu.ac.ir 1 Seyed Mostafa Ghorashi m.ghorashi1380@gmail.com 2 Associate Professor, Department of Management, School of Economics Management and Social Sciences, Shiraz University, Shiraz, Iran MA in Business Management, Department of Management, School of Economics Management and Social Sciences, Shiraz University, Shiraz, Iran Background: A Digital Twin (DT) is a digital replica of a physical object, person, system, or process, contextualized in a digital version of its environment. DTs can serve as a powerful tool to optimize processes, enhance the efficiency of healthcare systems, and create new opportunities for improving care delivery. Accordingly, this study aims to provide a comprehensive insight into DT technology and to examine its applications, opportunities, and challenges in the healthcare domain. Methods: In this study, articles were retrieved by searching the keywords Digital Twin Technology, Health System, Digital Health, and Digital Technology. Relevant studies published between 2020 and 2025 were collected from reputable databases including PubMed, Web of Science, Google Scholar, and Scopus. Out of 87 initially collected articles, 21 were included in this review and analyzed. Finally, following the PRISMA framework, a systematic review of the existing literature was conducted. Results: The results showed that digital twin technology can play a role in the areas of personalized medicine, remote monitoring, precision medicine, predictive analytics, preventive interventions, clinical operations optimization, training, simulation, and optimization of hospital management and resources. Conclusion: Despite the identification of various applications of digital twins in the health system, this technology is still an emerging technology in health systems. Health policymakers, especially in the education sector, can provide a suitable platform for learning educational courses and facilitating medical service processes by investing in the implementation of digital twin technology.   http://mshsj.ssu.ac.ir/article-1-856-en.pdf Disruptive Technology Healthcare Systems Digital Health Digital Technology per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 188 198 article Zahra Kondori mehdinezhad@gmail.com 1 Vali Mehdinezhad valmeh@ped.usb.ac.ir 2 MA student in Educational Administration, Department of Educational Sciences, School of Education and Psychology, University of Sistan and Baluchestan, Zahedan, Iran Associate Professor, Department of Educational Sciences, School of Education and Psychology, University of Sistan and Baluchestan, Zahedan, Iran Background: Positive thinking is one of the healthy patterns in society. Positive thinking managers provide the basis for the growth of their organization by providing a clear horizon and increasing the motivation of their employees. The purpose of this research was to investigate the effect of positive thinking on job performance with the mediation of social responsibility in employees of the health system. Methods: The descriptive-correlation research method based on the structural equation modeling approach was used. The target population of the research was all the health employees of Zahedan University of Medical Sciences, totalling 4839 subjects. The sample size was estimated to be 367 subjects based on Singh and Masuku's sample size table. A stratified sampling method was used according to the volume (according to gender) and convenience sampling. Three questionnaires of positive thinking, social responsibility and job performance were used to collect data. The reliability of the questionnaires was obtained using Cronbach's test as 0.94, 0.78 and 0.86 respectively. The obtained data were analyzed using SPSS 25 and AMOS 24 software by structural equation modeling method. Results: The results showed that positive thinking has a positive and significant effect on job performance in the health system. Also, responsibility had a positive and significant effect on job performance in the health system. In addition, the mediating effect of responsibility in the relationship between positive thinking and job performance in the health system was positive and direct. Conclusion: Managers of healthcare organizations should emphasize creating a work environment based on positivity and social responsibility, and use it as a strategic tool to improve employee job performance, thereby helping to improve the quality of health programs.   http://mshsj.ssu.ac.ir/article-1-861-en.pdf Optimism Work performance Social responsibility Delivery of health care per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 199 210 article Nasrin Moradi nasrin.moradi.2009@gmail.com 1 Leila Rastkhadive 2 Mahshid Lotfi 3 Erfan Kharazmi erfankh2001@yahoo.com 4 Ph.D. of Healthcare Services Management, School of Health Management and Information Science, Shiraz University of Medical Sciences, Shiraz, Iran Midwifery Expert and Health Care Worker, Enghelab Health Center, Shiraz University of Medical Sciences, Shiraz, Iran Assistant Professor, Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Assistant Professor, Department of Healthcare Services Management, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Background: Primary health care services’ resilience in managing pandemics can play an important role in the management of health centers Since health centers, by utilizing multipurpose infrastructure, high flexibility, and effective coordination, have been able to play a vital role in controlling the crisis and reducing pressure on hospitals, therefore; the present study has identified successful experiences in primary health care’s resilience in health centers. Methods: The present study was conducted with a qualitative approach in 2025. The study’s sample size was purposefully selected from 16 senior, middle, operational managers and employees of health and treatment centers and health centers of towns affiliated with Shiraz University of Medical Sciences who had experienced working during the pandemic. Data collection was carried out through semi-structured interviews. Then, the data were analyzed based on the Graniham-Lodman method and using MaxQDA 2020 software. Results: According to the participants' viewpoints, six main themes were identified in successful experiences of primary health care services’ resilience, which include human factors, physical and infrastructure, management, public informing and participation, strengthening of virtual infrastructure and education, planning and policy-making. From the participants' perspective, the most important factor related to strengthening of virtual infrastructure and education was identified. Conclusion: According to the results of this study, successful experiences of primary health care services’ resilience in managing pandemics show that health centers have been able to play an important role in controlling the disease and maintaining the continuity of services by adopting comprehensive and flexible solutions such as strengthening physical infrastructure, management factors, and rational and timely planning.   http://mshsj.ssu.ac.ir/article-1-869-en.pdf Pandemic Community health care centers Primary health care networks Resilience per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 211 224 article Seyyedeh Maryam Haeri 1 Ghanbar Amirnejad g.amirnejad@iau.ac.ir 2 Mansour Zarra-Nejad 3 Gholamreza Memarzade 4 Ph.D. student of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran Associate Professor, Department of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran Professor, Department of Economics and Social Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran Professor, Department of Public Administration, S.R.C., Islamic Azad University, Tehran, Iran Background: Health system governance, as one of the most critical domains of public health management, plays a decisive role in enhancing efficiency, transparency, accountability, and inter-institutional coordination. In many countries, the inclusion of civil institutions within the framework of health governance has been introduced as an effective mechanism for improving the legitimacy and effectiveness of decision-making processes. Despite the growing body of research on health governance, the specific role of civil institutions within an indigenous model has received limited scholarly attention. Therefore, the present study aimed to design a model of health system governance with an emphasis on civil institutions. Methods: This study employed a mixed-methods approach using an exploratory sequential design, conducted between October 2024 and June 2025, in three stages. In the first stage, the Fuzzy Delphi Technique was applied through three iterative rounds to identify the principal dimensions and key components. The statistical population consisted of 15 experts from the fields of health and civil society, including senior policymakers, Ministry of Health consultants, NGO managers, senior experts in health insurance organizations, and representatives of patient associations, particularly support groups for individuals with chronic conditions. Participants were selected through the snowball sampling method. Data collection instruments included a Delphi questionnaire, an expertise checklist, and a researcher-developed questionnaire comprising five dimensions and 24 components in the quantitative phase. A stratified random sampling method was employed, and sample size included 386 individuals. Data were analyzed using structural equation modeling (SEM), path analysis, and confirmatory factor analysis (CFA) via SmartPLS 4 software. Results: The results revealed that health system governance, focusing on civil institutions, consists of five major dimensions: network governance, collaboration and participation, financial resource management, transparent governance, and monitoring and evaluation. Furthermore, all components of the model showed statistically significant relationships with the main construct, with network governance demonstrating the highest factor loading, and public participation being identified as its key component. Conclusion: According to the findings, civil-society–based health governance can substantially enhance transparency, improve efficiency, and strengthen inter-organizational collaboration. The novelty of this study lies in its emphasis on the role of civil institutions in health governance and the integrated use of the Fuzzy Delphi technique and structural equation modeling. It is recommended that policymakers promote the institutional position of civil organizations, increase the transparency of financial mechanisms, and establish continuous feedback systems to create the necessary conditions for achieving excellent health governance.   http://mshsj.ssu.ac.ir/article-1-858-en.pdf Governance Health System Civil institutions per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 225 239 article Samaneh Zarin Khalili Samaneh.zarinkhalili@iau.ac.ir 1 Kambiz Hamidi hamidi@iau.ac.ir 2 Zahra Shirazian 3 Ali Asghari Sarem a.sarem@basu.ac.ir 4 Javad Niknafs 5 Ph.D. student of Public Administration, Department of Management, Ha.C.,Islamic Azad University, Hamedan, Iran Assistant Professor, Department of Management, Ha.C.,Islamic Azad University, Hamedan, Iran Assistant Professor, Department of Management , Mal.C., Islamic Azad University, Malayer, Iran Associate Professor, Department of Management, School of Management and Accounting, Bu-Ali Sina University, Hamedan, Iran Assistant Professor, Department of Management, Ha.C.,Islamic Azad University, Hamedan, Iran Background: Generational differences in today's work environments, especially in hospitals, can affect organizational interactions, employee motivation, and the effectiveness of health services. The present research was conducted with the aim of identifying and explaining effective strategies in implementing multi-generational gravity in hospitals of Hamadan University of Medical Sciences to provide a practical framework for managing generational synergy. Methods: This study was conducted as a qualitative research using a content analysis approach. The target population consisted of senior and middle managers of hospitals affiliated with Hamadan University of Medical Sciences. Participants were selected through purposive sampling, and the sample size was determined based on the data saturation principle (30 individuals). Data were collected through semi-structured interviews and, after verbatim transcription, analyzed using qualitative content analysis. The validity and reliability of the data were assessed based on Lincoln and Guba’s criteria. Results: The results led to the identification of six main themes, including focus on motivation and reward, flexibility and adaptability to changes, intergenerational guidance and adaptive structure, organizational learning and knowledge sharing, communication networks and participation-oriented and organizational justice and coordination. These strategies were recognized as key components in forming multi-generational gravity in hospitals. Conclusion: The results of this research led to the identification of strategies that can be a theoretical basis for designing and formulating a structured approach in implementing multi-generational gravity in the future. The simultaneous application of these strategies can strengthen the interaction between generations, increase productivity, improve the quality of treatment services and create justice in resource allocation. The presented framework can be a basis for human resources managers' policy-making and designing organizational development programs in hospitals and provide the basis for realizing generational synergy and improving the performance of the health system.   http://mshsj.ssu.ac.ir/article-1-866-en.pdf Intergenerational Relations Employees Participation Cooperative Behavior Hospital per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 240 256 article Seyed Mohsen Hosseini Goorab hoseini.mohsen@tamin.ir 1 Mehrdad Hosseini Shakib Mehrdad.shakib@kiau.ac.ir 2 Abbas Khamseh abbas.khamseh@iau.ac.ir 3 MSc in Industrial Management, Department of Industrial Management, Ka.C., Islamic Azad University, Karaj, Iran Associate Professor, Department of Industrial Management, Ka.C., Islamic Azad University, Karaj, Iran Professor, Department of Industrial Management, Ka.C., Islamic Azad University, Karaj, Iran Background: The Fourth Industrial Revolution, with the integration of physical, digital, and biological technologies, has confronted global healthcare systems with numerous challenges and opportunities. The objective of this research is to design a readiness model for healthcare systems to enter the fourth generation of the industry. Methods: This study was conducted using a mixed methods (qualitative-quantitative) approach in an exploratory sequential design. In the qualitative section, 39 relevant articles (2016-2025) were content analyzed. Then, using the fuzzy Delphi method with the participation of 12 experts, the dimensions and components of the model were refined through three survey rounds. In the quantitative section, 245 healthcare system experts and specialists were selected using convenience sampling. The data collection instrument was a researcher-made questionnaire with confirmed validity and reliability. Data analysis was performed using confirmatory factor analysis. Results: The final healthcare system readiness model includes 7 dimensions and 48 components. The identified dimensions, in order of importance, are: Collaboration and integration, smart processes and services, technology and digital infrastructure, data management and artificial intelligence, governance and policy making, security and privacy, and human resources and skills. The resulting model has appropriate fit and all factor loadings were significant. The model was able to explain 93 percent of the variations in the healthcare system readiness variable. Conclusion: Healthcare system readiness for entering the fourth generation of industry requires simultaneous attention to various technical, human, procedural, data management, governance, security, and especially collaboration and integration dimensions.   http://mshsj.ssu.ac.ir/article-1-859-en.pdf Digital health Industry Healthcare system Information technology per Shahid Sadoughi University of Medical Sciences Management Strategies in Health System 2476-6879 2538-1563 2025-12 10 3 257 269 article Mohsen Forghani forghani_mnik@yahoo.com 1 Elham Alsadat Dashti elham.dashti7150@gmail.com 2 Assistant Professor, Department of Industrial Engineering, Payam Noor University, Tehran, Iran MSc in Public Administration, Department of Public Administration, Payam Noor University, Tehran, Iran Background: Today, organizational commitment is regarded as one of the most important motivational issues in organizations. Organizational commitment refers to the extent of employees’ psychological attachment, loyalty, and willingness to invest effort on behalf of their organization. This construct comprises three primary dimensions: acceptance of organizational values and goals (affective commitment), tendency to contribute to the organization (normative commitment), and a strong desire to remain with the organization (continuance commitment). Accordingly, the present study aims to examine the effects of different dimensions of organizational trust on the three core components of organizational commitment among employees of Mortaz Hospital in Yazd City, while considering the moderating role of national identity. Methods: This study adopts a descriptive–survey design and is classified as applied research in terms of its objective. The statistical population comprises 400 employees (including managers and professional staff) of Mortaz Hospital in Yazd, from whom a sample of 196 respondents was determined using Cochran’s formula; they were selected through simple random sampling. Data were collected using a standardized questionnaire consisting of 46 items, the validity and reliability of which were confirmed at acceptable levels. Data analysis was conducted using structural equation modeling (SEM), employing Smart PLS 3 and SPSS 21 software packages. Model fit was subsequently assessed using established goodness-of-fit indices. Results: The findings indicate a significant and positive effect of employees’ perceived organizational trust at Mortaz Hospital in Yazd on all three dimensions of: affective commitment, continuance commitment, and normative commitment. Conclusion: The moderating role of national identity in the relationship between organizational trust dimensions and the three components of affective, continuance, and normative commitment—among employees of Mortaz Hospital in Yazd was not supported. This finding suggests that, within such organizational contexts, internal organizational factors like trust play a more prominent role than cultural or social characteristics in shaping organizational commitment. Consequently, enhancing organizational trust may serve as a more effective strategy for improving employee performance and reducing turnover rates.   http://mshsj.ssu.ac.ir/article-1-840-en.pdf Organizational trust Organizational commitment National identity Mortaz Hospital in Yazd