Hospitals have a vital role in the future of health systems with upcoming structure, resources, and process changes. Identifying the potential aspects of change helps managers proactively approach them, use the opportunities, and avoid threats. This study presents a mind map of future changes in Iranian hospitals to develop a base for further related studies or prepare evidence for interventions and future-related decisions.
Methods
This study is a qualitative-exploratory one, conducted in two phases. In the first phase, in-depth and semi-structured interviews were conducted to identify future hospital changes over 15 years. The interviews were analyzed using the content analysis method and MAXQDA 2018 software and holding two expert panels to develop the mind map using the 2016 Visio software.
Results
In the first phase, 33 interviews led to 144 change patterns. In the second phase, a mind map of changes was drawn according to experts’ opinions with ten categories: structure and role, knowledge management and research, service delivery, health forces, political and legal, economic, demographic and disease, technological, and values and philosophy, and environmental.
Conclusions
Many changes affecting hospitals rooted in the past continue to the future, but the point is the increasing intensity and speed of changes. Healthcare systems need a systematic approach to monitoring the environment to be updated, agile and proactive. These monitoring systems are essential in providing evidence for Macro-level decision-makers.
Hospitals are one of the main components of the health system and play an essential role in caring for patients and completing other system functions. They support primary health care providers and the training of health care professionals and researchers. Achieving universal health coverage (UHC) and sustainable development goals requires the commitment of all layers of the health system, including hospitals [1].
Driving forces can challenge hospitals in their strategic and clinical processes while increasing the uncertainty of the future [2]. Trends like rising costs, epidemiological transmission, antimicrobial resistance, the incidence of chronic diseases, aging, urbanization, increasing demand, social and cultural changes, changes in economic conditions and the health market, and competition for attraction and retention of talents and new organizational structure models affect the future of hospitals [3,4,5,6,7,8]. We are encountering emerging health-related technologies in medical equipment, surgical techniques, various drugs, biological products, and information systems [9]. Health literacy has become more highlighted and is an important public health goal for the twenty-first century [10]. Mixed markets are emerging where general and private hospitals compete to attract public funds and respond to needs [11]. In the past years, attention has been paid to health service providers such as hospitals through collaborative networks [12]. The growth of medical tourism and patients traveling to other countries to receive health services has created new forms of health services. It is changing hospitals’ architecture, design, management, and organization [13].
The mentioned cases are examples of hospital changes regarding the future. This institution’s future has many scopes, dispersion, and changes. It will be vital for managers and decision-makers of the health system to identify and monitor the upcoming changes to manage them proactively. In the past years, Iranian hospitals have undergone many changes, including financial and structural reforms, decentralization, changing payment mechanisms, outsourcing, and increasing the participation of the public and private sectors [14]. Along with the changes, the hospitals have faced challenges like increasing costs more than three times in recent years, which have limited access to services [15]. From a structural perspective, reforms, that mostly have happened regarding dealing with upcoming changes needed to be more comprehensive and aligned with each other or other sections of the health system [16]Human resource management also has changed regarding financing models, work processes, inter-sectoral and intra-sectoral collaboration, and performance evaluation standards [17].
This study tries to identify the future drivers of change that affect hospitals via a systemic approach and map the elements as a mind map. Classifying the drivers into main categories helps analyze the consequences more comprehensively and systematically, and visualizing the data in the form of a mind map enhances visualization of the data and transferring critical messages to the audience.
Methods
Study setting
In the present study, Iran hospitals were selected for investigation from the public and private sectors. Iran, with a population of about 85 million people in 2021, is one of the most populous countries in the Middle East region [18, 19]. There are 58 universities of medical sciences under the MOHME that provide services with 935 hospitals and 121,941 beds. Iran has 935 hospitals with 121,941 beds,the ratio is 1.54 beds per 1000 people.
Study phases
This study is a qualitative deductive one with an exploratory approach trying to identify the future drivers of hospitals in Iran consisting of two main phases. The first phase was collecting qualitative data and determining the coming changes in hospitals, and the second was mapping the elements as a mind map. The stages and their steps are presented as follows.
Collecting qualitative data and determining the future changes in hospitals
To collect future changes in hospitals, open and semi-structured interviews were conducted. All the participants were selected using a purposeful and snowball approach in five groups: Ministry of Health and Medical Education (MOHME), health insurance (HI), Health care providers (HP), Hospital Management (HM), and Researchers and members (RFM). Five experts, one per category, were identified to start the snowball method, and interviews continued till saturation. In determining the participants, the main inclusion criterion was to cover the health system sub-systems as much as possible. The following criterion was having more than five years of related work experience or being active in research or education in the health system’s future. The interviews were virtually using Microsoft Team, Sky roam, and phone, and in-person and the interviewer were in the Kerman province of Iran.
At the beginning of this phase, in-depth interviews were conducted with the purposeful sampling approach. The main question of the in-depth interview was: What are the main aspects of hospital changes in the next 15 years? The reason for choosing a 15-year time horizon is that numerous studies have worked on determining the future changes in the health system and hospitals; they chose the time range between 12 and 20 years for their research and pointed out that the horizon is suitable for examining future changes [20,21,22]. After content analyzing the interviews, the following interviews were semi-structured. All interviews were conducted between April and July 2021. The duration of the interviews varied from 22 to 80 min. At the beginning of all the interviews, the participants were aware of the purpose of the study, and informed consent was obtained from them. The interviewing continues till saturation and the transcription of the recorded interviews was analyzed with content analysis, the approach suggested by Erlingsson and his colleagues [23], and using MAXQDA 2018. All the authors were involved in the development of the interview guide. The peers did audio taping, transcribing and coding.
Developing the mind map
A mind map model helps provide efficient, accurate, and creative solutions. This tool can expand thinking in all fields of education, work, and human life [24] by visualizing insights related to the subject of study and developing relationships between ideas. Concepts, keywords, colors, and images can be used to prepare a mind map while the vital concept is placed in the center, and other concepts branch from it [25, 26]. A mind map is rooted in cognitive structures, and understanding this map is easier for the audience than writing texts [27].
The purpose of the second phase was to categorize the ideas and draw a cognitive map of future hospital changes. Two expert panels were held in October 2021, and the second was 11 days apart virtually with the sky room platform. The participants in this phase were selected purposefully among the first phase participants based on the inclusion and exclusion criteria.
The first panel presented the changes resulting from phase one to experts. The experts categorized the changes and labeled them by the facilitator’s guide. With permission, note-taking was done during the meeting by two researchers. After finishing the first panel, the research team drew a mental map of the hospital’s future changes using Visio 2016.
After mapping the mind map, the second meeting of the expert panel was held. The drawn map was presented during the second session, and the participants were issued potential enhancement or edition points. Finally, the amendments were applied according to the expert’s opinion.
Results
To determine the future changes affecting the hospitals, 33 people were interviewed in the first phase 19 were male, and 14 were female, with an average age of 45. By content analyzing the interviews, 144 elements of change were identified, presented in Table 3. Repetition in subcodes shows that some characteristics of future hospitals are multifaceted and affected by several aspects of changes. The characteristics of the participants in this phase are shown in Table 1.
Table 1 Characteristics of participants in phase one
In the second phase, 12 experts were selected among the participants of the first phase. Table 2 shows the participants’ characteristics in the panel of experts presented in Table 2.
Table 2 Details of participants in the expert panel
To prepare the mind map framework, the experts categorized the future changes into ten main categories of: 1) structure and role; 2) knowledge and research management; 3) service delivery; 4) Health forces; 5) political and legal issues; 6) economic; 7) population and disease; 8) technological issues; 9) values and philosophy; and 10) environmental issues. The explanations of each category and its map is mentioned as follows. The whole map consisting all the categories is presented in Fig. 1 and the codes and themes are presented in Table 3.
This code defines the changes that modify the structure of the future hospitals and their roles regarding different stakeholders like society. The related codes are presented in Fig. 2. Participants stated that hospitals would become smaller but more specialized in the future. "…hospitals will only focus on patients for whom the other health system providers will not have the necessary facilities and expertise, and patients with complex conditions will be referred to them from other levels, and simpler cases will also be at other levels. To be treated…" (MoH).
Hospitals will have an active, patient-oriented, and user-friendly social role." Providing services will not be limited to hospitals. Hospital teams in the community will actively promote the lifestyle and treatment of patients in their homes…” (HP). "Due to factors such as the growth of technology and information; The quality and safety of services will increase, the preferences of patients will be taken into account in the design of spaces, processes, and services of hospitals…" (HM).
Knowledge and research
This category examines the evolving roles and position of future hospitals in the realm of knowledge management and research. As knowledge continues to rapidly advance, future hospitals must adapt and restructure accordingly. In order to remain relevant, they will need to transform into knowledge-producing centers that prioritize interprofessional learning. To achieve this, hospitals will need to activate environmental scanning units, which will enable them to stay abreast of new developments and emerging trends. The items related to changes in knowledge and research are shown in Fig. 3. "Hospital administrators will be aware of the importance of political, social, and economic changes in the hospital environment and will monitor them. I believe future hospitals will establish active environmental monitoring units" (HM).
This category shows the changes in providing services in future hospitals. The map of the service delivery section is presented in Fig. 4. The future services of hospitals will focus more on home care, palliative care, personalized care, and reduced length of stay. "Th future hospitals will be smaller, the length of stay will be shorter, and they will only accept patients with complex conditions, and the rest will be sent to providers of other levels" (M 35).
This theme refers to the changes that will happen regarding the health workforce in the future and the way that that affects the future of hospitals. The health forces will change in the number and nature of their work processes. There will be an increase in the patient’s and health force’s mobility. "Due to megatrends such as globalization or trends of increasing immigration and urbanization, we will see patients and health workers with different cultures from different cities and countries every day…" (RFM). Also, A modification in the characteristics of the health workforce will occur. "With the arrival of the millennial generation, we will see rapid and large changes in employees’ expectations from work environments. The retirement age will increase to compensate for the lack of workforce and skills" (MoH). Health forces codes are presented in Fig 5.
The political and legal elements of change are presented in Fig. 6. Changes in developed countries will happen faster than in developing countries. Also, the rate of change has increased compared to the past." In my opinion, due to trends such as globalization and international communication, several changes are common between developed and developing countries, such as technologies; the only difference is that usually, these changes in those [developed] countries have either already happened or their speed and intensity are more significant than in developing countries…, another point that comes to my mind is the speed of changes. We constantly change in the workforce. Or we had the expectations of the patients, but the only thing that has happened now is that due to the growth of technologies such as the media and the Internet, their speed has now increased…" (RFM). Another point that can be extracted from interviews is that some changes will facilitate and accelerate other changes. For example, developing health monitoring technologies will enable the development of home care services for patients.
The codes of the economic theme are presented in Fig. 7, like changes in public and private role. The role of the private sector and attention to financial efficiency will increase due to the lack of resources and the increase in technological costs. "Hospitals will increase partnerships with private sectors and non-governmental organizations to attract more resources…, strategic purchasing will be done more carefully" (HI).
The demographic and diseases-related elements are presented in Fig. 8, like changes in the composition and pattern of diseases. "Clearly, due to the increase in life expectancy and the population aging, it can be predicted that the burden of chronic diseases will increase, even in my opinion, the state of multiple diseases and physical and mental diseases will increase together…" (RFM). "Climate changes, drought or global warming and even water and food insecurity that we are witnessing now, can potentially change the patterns of chronic and infectious diseases" (RFM). "The experience of Covid-19 also showed that the threats of emerging and re-emerging infectious diseases can always exist, so future hospitals should not neglect these issues" (MoH).
The technological-related elements of the map are presented in Fig. 9. The growth of technology will move forward faster and affect all sectors of the healthcare system. "In my opinion, using cryptocurrencies and technologies such as blockchain will increase hospitals’ financial and information transfers. It would help if you considered that with the growth of big data and the increase in its use, blockchain could be used to maintain this information in the health system" (HI).
"In the past years, we consider a significant growth in health technologies, wearable health sensors that help patients control health parameters are one of them. I hope hospital information systems will use this information in the future" (HP). "The development of information analysis methods such as cloud computing can greatly help health systems analyze big data" (RFM).
The values and philosophy-related elements are presented in Fig. 10, consisting of change in norms and values. "Associations supporting patients’ rights will become more and more active. Due to the growth of social networks, patients will be able to form a network with each other and express their expectations loudly" (RFM). "The problems of life and the rush and stress that people have now will cause them mental issues; in my opinion, attention to spiritual health will also increase" (HP).
Green hospitals will be considered and on the other side the crisis like drought, climate change and pollution will increase the burden of diseases like mental health related ones. More information of the environmental future changes are presented in Fig. 11. "Climate changes, drought and global warming and even food and water insecurity that we are witnessing now have the ability to potentially change the patterns of chronic and infectious diseases" (M 24).
The speed of changes in the twenty-first century is faster than in previous years [28]. Healthcare is not excluded from these changes and is one of the most complex and growing industries worldwide [29]. Hospitals are also one of the critical components of health systems. Hospital services constitute about 50% of health costs [11]. It is necessary to pay attention to hospitals to improve the overall performance of the health system [30]. The present study showed that the future of hospitals is affected by many factors interacting inside and outside the hospital’s scope and health system.
Structure and role
In the future, hospitals will become more specialized and smaller where services will be provided merely by their service providers. Less technical and palliative services will be transferred to primary care providers, nursing centers, or patients’ homes. In the health system profile of Iran, developed by WHO, home-care services are emphasized due to aging and increasing chronic diseases [31]. Besides, integrating specialized services in hospitals will keep them in the service delivery line to meet society’s needs. Their number will be reduced, or they will not be constructed without a needs assessment. Barber also points out in his study that establishing hospitals will be slower in the future, and they will probably face stricter controls on construction and size [32]. Also, the congestion in hospitals will decrease over time. However, diseases and more complex treatment methods will remain in the future hospital, making them more specialized and smaller [33] while they use their expanded networks for some kinds of services.
Future hospitals will network with other healthcare providers to share knowledge, experiences, and resources. They will collaborate to identify and respond to community health needs. The network structure allows for economies, proper consumption of resources, development of innovative capabilities of hospitals, reduction of the negative aspect of competition between hospitals, creation of a sustainable market-based health system, and ensuring effective care of patients [12, 34]. The map of the related structural and role elements is presented in Fig. 8. The next aspect of future hospitals is the way they create and use knowledge.
Knowledge and research
Future hospitals will play a more active role in knowledge production by using different research methods and knowledge translation. These hospitals will provide the context of the activities of researchers and facilitate start-ups. Attention to social medicine and educational issues will be strengthened. Health environmental monitoring units will be established to identify and manage existing and future changes and trends. Due to rapid growth and progress in the health system, the field of "health innovation" will be supported, and it examines and monitors health developments and innovations at the global level to increase confidence and reduce risks [35]. The knowledge and research-related elements of the future changes are presented in Fig. 9 as follows. The third feature of future hospitals is the variation in their service delivery structure.
Service delivery
Hospitals will continue their service delivery through multidisciplinary teams and teamwork-based. Patient-centered and providing teamwork services will be necessary to meet the needs of the future [36]. Absolute coordination with other providers is another point. Schurr quotes Thomas Bodenheimer "Patients with multiple chronic diseases are likely to see about 16 doctors a year. In the meantime, treatments and diagnostic processes may be repeated by doctors, which is dangerous and also costly for patients" [37]. One example of lacking the integrated model of services delivery is patient mortality, about one-third of deaths in the United States are due to acute myocardial infarction in the post-hospital discharge phase [38]. These problems need even more coordination between hospitals and health service providers in the future to ensure the population’s health and prevent and reduce errors. Obviously, the service delivery change needs variation in health forces and also a new generation of forces will emerge.
Health forces
In the future, hospital staff will come from new generations with different characteristics than those in the past. Generation Z, born after 1995, has grown up in the digital age and is accustomed to using technology. As depicted in Fig. 10, they tend to be self-reliant, value freedom, rely heavily on technology, and prioritize speed. They spend most of their time online and have limited interaction with the real world, which is reinforced by the metaverse. This generation seeks a work-life balance, values friendly relationships in the workplace, desires support for personal development, and looks for opportunities to flourish and prove themselves [39]. To attract and retain them, managers must create appealing work environments that offer factors like flexible working hours and remote work arrangements.
One of the critical issues that the health system workforce will face in the future is the need for interdisciplinary competencies and the ability to work in collaborative teams. In recent years, there has been increasing pressure in higher education to train graduates in health systems who can effectively collaborate across disciplines to solve complex problems. An approach to interprofessional education has been developed for this purpose [40].
In addition, there will be an increased emphasis on improving health literacy among hospital staff. High health literacy among healthcare workers is assumed to lead to improved health literacy among patients. There is a positive correlation between health literacy and the health status of the population, and a negative association with health inequalities [41]. Therefore, hospital and university managers must take steps to improve the health literacy of the future health system workforce. The following section will discuss the political and legal changes that will affect hospitals in the future.
Political and legal
According to Rechel [28], regulating hospitals and their services is not solely a technical or managerial issue, but also a political decision. Various political and legal trends will impact the future of hospitals. Experts have highlighted that given the location of the Middle East and continuous conflicts and terrorism in the region, planners of future hospitals should always consider the threats caused by these factors. In recent years, political communication and exchanges between countries have grown, expanding the phenomenon of globalization. While globalization can potentially increase access to healthcare, it can also indirectly affect society’s health by increasing competition among companies and impacting working conditions and wages. Moreover, globalization increases the possibility of spreading infectious diseases like COVID-19 but can also improve low-income countries’ health quality [42]. Today, governments try to communicate with each other and use their growth and development potential. Globalization provides an opportunity for developing countries’ health systems to learn from best practices worldwide or attract resources for their growth by establishing active health diplomacy.
Economical
As presented in Fig. 11, individuals without insurance have a higher mortality rate from cancer [43]. This underscores the importance of ensuring that all individuals have access to affordable and comprehensive health insurance coverage, especially for chronic diseases like cancer. Moreover, society’s demand for insurance coverage for chronic and palliative diseases is expected to increase with the rise in the population’s average age and elderly-related ailments.
Marketing skills will also be a crucial tool for success in healthcare systems, particularly hospitals, in the future. Service research, design, and strategic marketing are vital components of designing and providing effective healthcare services [44]. Consequently, it is essential for managers and decision-makers in the healthcare industry to support and empower their workforce with these skills to gain a competitive edge in the market.
Overall, both insurance coverage and marketing skills play critical roles in shaping the future of healthcare delivery. By investing in these areas, healthcare organizations can improve patient outcomes and stay ahead of the curve in an ever-changing healthcare landscape.
Population and disease
The risk of emerging and spreading infectious diseases is rapidly increasing due to global environmental changes and increased migration [45]. The COVID-19 pandemic has shown that emerging diseases can quickly become a global issue and impact all aspects of life, including social, economic, and health. Therefore, planning and designing future hospitals based solely on chronic or elderly-related diseases would be too simplistic. The COVID-19 pandemic has taught us the importance of hospital flexibility for potential upcoming challenges.
In addition to considering infectious diseases, it is a fact that the world’s population is aging due to declining fertility rates and increased life expectancy [46]. According to the World Health Organization, approximately 40 million people require palliative care every year, with about 78% residing in low-income and middle-income countries. Shockingly, only about 14% of people who require palliative and end-stage care receive it. Over the past few decades, end-of-life care in hospitals has become increasingly complex [47]. In the future, special attention must be given to hospitals to provide services to chronic patients and palliative care. It will be necessary for hospitals to collaborate with informal providers inside patients’ homes and care centers outside the hospital and support them technically.
Antimicrobial resistance poses another challenge for the future of global health. This challenge has the potential to cost billions of dollars annually to the global economy and endanger the lives of ten million people by 2050 [7]. Hospitals must constantly be reminded of these issues and leverage their scientific potential, equipment, and staff to proactively address future challenges.
Technology
Technology development is one of the most emphasized future changes for hospitals and is advancing faster than ever. Digital health is considered one of the main drivers of change in the future of healthcare systems [48]. Wearable sensors, mobile health technologies, information technology, telemedicine, and network systems have made it possible to provide health services and remotely monitor health parameters, particularly for chronic patients. This results in effective disease management and improved patient quality of life [49, 50]. The convergence of different branches of technology will change service processes as well as physical design [51]. Comprehensive health systems use intelligent technologies that enable patients to self-manage their health symptoms, improve treatment decisions at the right time, and enhance medication adherence [49].
Thanks to new, more effective and personalized medicine, patients are living longer, and many previously incurable diseases are now well-managed as chronic conditions [37]. While technology has many advantages, it is important to note that it can also significantly increase healthcare costs. Additionally, these technologies do not always lead to improved clinical outcomes, and safety must be considered [52]. In future hospitals, it will be necessary to have a systematic, transparent, and impartial evaluation of health technology. The technological-related elements of the map are presented in Fig. 6.
Values and philosophy
The concepts, principles, and values of different stakeholders in hospitals have already begun changing and will continue to do so. Patients are no longer passive recipients of services but active participants with increasing expectations for value, satisfaction, and experience [44]. Laurent Gille and colleagues recognize that the determinants of healthcare demand will change, and believe that in the medium and long term, focus will shift from the right to effective treatment to the duty of being healthy [53].
In the future, hospitals will increasingly involve patients in treatment processes. One option being considered is changing the name of hospitals from "Hospital" to "Health Homes." Empowering and improving patients’ living conditions will be one of the missions of hospitals, with the aim of improving health outcomes and reducing the workload of hospitals. Ahn also highlights that empowering people with chronic diseases to manage their conditions independently would improve health while lowering costs [54].
Environmental
The pollution of air, water, and soil has increased significantly in recent years due to industrial reasons and the use of vehicles. If there is no intervention, this trend is predicted to continue. Most notably, low and middle-income countries and rapidly industrializing nations are expected to experience the most significant increase in pollution [55]. Air pollution also poses a considerable health challenge in developing countries such as Iran [56]. Unfortunately, Iran ranks fifth globally in terms of plastic consumption, with nearly half a million tons of plastic used annually, producing about 5000 tons of waste daily. Pollution caused by plastic particles can have severe health risks [57]. All forms of pollution were responsible for about 9 million premature deaths in 2015, accounting for 16% of all deaths worldwide. Additionally, it is estimated that pollution causes around 268 million disability-adjusted life-years (DALYs) [58].
Climate change is another challenge that has intensified in recent decades, affecting communities’ health through various means. These include climate change’s effect on the spread of infectious diseases, changes in workforce capacity, and food security [59]. Unfortunately, Middle Eastern countries will be more affected by the negative consequences of climate change than other regions [60]. By the year 2100, the average temperature in most parts of Iran is expected to increase by more than 4 degrees Celsius [61]. Therefore, diseases related to pollution and climate change are expected to become a significant concern for future hospitals.
Conclusions
Many changes in the healthcare system have been ongoing and will continue to do so, with increasing intensity and speed. This study focused on Iran as a developing country and had a time horizon of 15 years. However, wild card events may occur that could significantly impact the trends mentioned in this study. Future studies should identify these wild cards and evaluate their effects on future changes. The changes described in this study have synergies and interactions that can shape different future scenarios. It is recommended to conduct further research in this regard.
Additionally, establishing environmental monitoring units at both the macro level of the health system and within hospitals is suggested to monitor these changes for informed decision-making and planning. The main limitation of this study was the Covid-19 outbreak, which caused difficulties in conducting interviews and holding expert panels. However, the research team utilized virtual communication facilities to overcome these issues.
This study categorized future changes in hospitals using a mind map, which has several advantages. We hope that hospital managers and future leaders of the healthcare system will use a forward-thinking approach when planning for the future. As Erwin noted, hospital managers should ask themselves whether their current management approach is optimal [2].
Limitations of the study
COVID-19 made the research team use virtual interviewing, which made the interviewing process more complex and time-taking. Due to the objection of some interviewees to audio recording, their interviews were recorded in writing, and it restricted access to some participants, Which required many follow-ups.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Abbreviations
MOHME:
Ministry of Health and Medical Education
UHC:
Universal health coverage
HI:
Health insurance
HP:
Health care Provider
HM:
Hospital Management
RFM:
Researchers and faculty members
References
Huntington D and Krishna H. eds. “Public Hospital Governance in the Asia Pacific Region — Drivers of Change.” Public Hospital Governance in Asia and the Pacific. World Health Organization, 2015. http://www.jstor.org/stable/resrep28456.3.
Erwin CO, Landry AY, Livingston AC, Dias A. Effective governance and hospital boards revisited: Reflections on 25 years of research. Med Care Res Rev. 2019;76(2):131–66.
Kalhor R, Amini S, Sokhanvar M, Lotfi F, Sharifi M, Kakemam E. Factors affecting the technical efficiency of general hospitals in Iran: data envelopment analysis. J Egypt Public Health Assoc. 2016;91(1):20–5.
Khalifa M. Perceived Benefits of Implementing and Using Hospital Information Systems and Electronic Medical Records. Stud Health Technol Inform. 2017;238:165–8.
Mossialos E & Le Grand, J. (Eds.). Health Care and Cost Containment in the European Union (1st ed.). Routledge. 1999. https://doi.org/10.4324/9780429426971
Santiago N, Baro X, Riera A. The competency-based management model as a springboard for transformation in health care social care organisations. World hosp Health services. 2019;55(2):1947–68.
Walsh AP, Harrington D, Hines P. Are hospital managers ready for value-based healthcare? A review of the management competence literature. Int J Organ Anal. 2019;28:49–65.
Lin X, Lu L, Pan J. Hospital market competition and health technology diffusion: an empirical study of laparoscopic appendectomy in China. Soc Sci Med. 2021;1(286): 114316.
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.
Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Inappropriate rate of admission and hospitalization in the iranian hospitals: a systematic review and meta-analysis. Value Health Reg Issues. 2020;1(21):105–12.
Sohrabi R, Tourani S, Jafari M, Joudaki H, Doshmangir L, Moghri J, Bragazzi NL. A scoping review of public hospitals autonomy in Iran: from budgetary hospitals to corporate hospitals. BMC Health Serv Res. 2021;21:1–6.
Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So near, so far: four decades of health policy reforms in Iran, achievements and challenges. Arch Iran Med. 2019;22(10):592–605 PMID: 31679362.
Irajpour A, Khorasani P, Bagheri M, Eshaghian A, Ziaee ES, Saberi Z, Afshari A. The framework for developing nursing specialist roles in the health care system of Iran. Nurs Outlook. 2020;68(1):45–54.
Braithwaite J, Mannion R, Matsuyama Y, Shekelle PG, Whittaker S, Al-Adawi S, Ludlow K, James W, Ting HP, Herkes J, McPherson E. The future of health systems to 2030: a roadmap for global progress and sustainability. Int J Qual Health Care. 2018;30(10):823–31.
Fellows J., Edwards, M. Future skills and competences of the health workforce in Europe. Funded by the Health Programme of the European Union. European Commission. 2016. Available online: http://www.healthworkforce.eu
Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. Afr J Emerg Med. 2017;7(3):93–9.
Chen J. The using of mind map in concept design. In 2008 9th International Conference on Computer-Aided Industrial Design and Conceptual Design. Beijing: IEEE; 2008. p. 1034–37.
Buzan T, Abbot S. The Ultimate Book of Mind Maps: Unlock Your Creativity. boost Your Memory, Change Your Life. London: Thorsons; 2005.
Dhindsa HS, Roger Anderson O, et al. Constructivist-visual mind map teaching approach and the quality of students’ cognitive structures. J Sci Educ Technol. 2011;20(2):186–200.
Rechel B, Wright S, Edwards N. Investing in hospitals of the future. WHO Regional Office Europe. World Health Organization. Regional Office for Europe: 2009. https://apps.who.int/iris/handle/10665/326414.
Preker AS, Yoo K, De Roodenbeke E. Learning from the USA Affordable Healthcare Act: The New York 2016 Hospital Executive Study Tour. Manag Hosp Revenue Cycle Med Bank. 2016;1:31.
World Health Organization. Islamic Republic of Iran health profile 2018. World Health Organization. Regional Office for the Eastern Mediterranean; 2018. Available at IRA-Health-System-Profiles-2018.pdf (who.int).
Barber SL, Borowitz M, Bekedam H, Ma J. The hospital of the future in China: China’s reform of public hospitals and trends from industrialized countries. Health Policy Plan. 2014;29(3):367–78.
Dawe M, Dugdale P, Mcgann M. Grasping the health horizon: toward a virtual, interoperable platform of health innovations. World Hosp Health Serv. 2015;51(3):28–31.
Cherlin EJ, Curry LA, Thompson JW, Greysen SR, Spatz E, Krumholz HM, Bradley EH. Features of high quality discharge planning for patients following acute myocardial infarction. J Gen Intern Med. 2013;28(3):436–43.
Brewer M, Flavell H. Facilitating Collaborative Capabilities for Future Work: What Can Be Learnt from Interprofessional Fieldwork in Health. International Journal of Work-Integrated Learning. 2018;19(2):169–80.
Budhathoki SS, Pokharel PK, Jha N, Moselen E, Dixon R, Bhattachan M, Osborne RH. Health literacy of future healthcare professionals: a cross-sectional study among health sciences students in Nepal. Int Health. 2019;11(1):15–23.
Yang B, Usman M. Do industrialization, economic growth and globalization processes influence the ecological footprint and healthcare expenditures? Fresh insights based on the STIRPAT model for countries with the highest healthcare expenditures. Sustain Prod Consum. 2021;1(28):893–910.
Nolan A, May P, Matthews S, Normand C, Kenny RA, Ward M. Public health insurance and mortality in the older population: Evidence from the Irish Longitudinal Study on Ageing. Health Policy. 2022;126(3):190–6.
Lee WJ. Myong Ji Hospital MERS Preparedness and Response Project (The emergence of emerging infectious disease response system). World Hosp Health Serv. 2017;53(1):11–5.
Herrmann M, Boehme P, Mondritzki T, Ehlers JP, Kavadias S, Truebel H. Digital transformation and disruption of the health care sector: internet-based observational study. J Med Internet Res. 2018;20(3):e9498.
Rajagopalan R. Smart and pervasive health systems—challenges, trends, and future directions. In. Future of Information and Communication Conference. Cham: Springer; 2019. p. 408–19.
Bakalar RS. Telemedicine: its past, present and future. InHealthcare Information Management Systems: Cases, Strategies, and Solutions. Cham: Springer International Publishing; 2022. p. 149–60.
Sampietro-Colom L, Martin J. Hospital Based Health Technology Assessment: The next frontier. In: Sampietro-Colom L, Martin J (editors). Hospital Based Health Technology Assessment: The next frontier for health technology assessment. Pp. 3–11. Springer International Publishing Switzerland. 2016. ISBN 978–3- 319–39203–5
Gille L, Houy T. The future of health care demand in developed countries: From the “right to treatment” to the “duty to stay healthy.” Futures. 2014;1(61):23–32.
Ahn S, Basu R, Smith ML, Jiang L, Lorig K, Whitelaw N, Ory MG. The impact of chronic disease self-management programs: healthcare savings through a community-based intervention. BMC Public Health. 2013;13(1):1–6.
Lelieveld J, Evans JS, Fnais M, Giannadaki D, Pozzer A. The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature. 2015;525(7569):367–71.
Mojarrad H, FouladiFard R, Rezaali M, Heidari H, Izanloo H, Mohammadbeigi A, Mohammadi A, Sorooshian A. Spatial trends, health risk assessment and ozone formation potential linked to BTEX. Hum Ecol Risk Assess Int J. 2020;26(10):2836–57.
Abdulmuhsin MK. Global regional and national life expectancy all casue mortality and casue specific mortality for 249 causes of death. The Lancet. 2016;388(10053):1459–544.
Di Napoli C, McGushin A, Romanello M, Ayeb-Karlsson S, Cai W, Chambers J, Dasgupta S, Escobar LE, Kelman I, Kjellstrom T, Kniveton D. Tracking the impacts of climate change on human health via indicators: lessons from the Lancet Countdown. BMC Public Health. 2022;22(1):1–8.
Sharafati A, MoradiTayyebi M, Pezeshki E, Shahid S. Uncertainty of climate change impact on crop characteristics: a case study of Moghan plain in Iran. Theoret Appl Climatol. 2022;3:1–8.
We are grateful to all participants who contributed to this study.
Experimental protocols
Experimental protocols were not applicable in this study.
Funding
No funding received.
Author information
Authors and Affiliations
Department of Healthcare Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
Ali Masoud & Somayeh Noori Hekmat
Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Reza Dehnavieh
Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Vahid Yazdi-Feyzabadi & Atousa Poursheikhali
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Mohammad kazemi
Social Determinants of Health Research Center, Institute for Futures Studies in Health, University of Medical Sciences, Kerman, Iran
AM, RD, VY, AP and SN were involved in the study design, data collection, data entry, analysis, and drafted the original manuscript. AP was involved in the studydesign, analysis, translating and drafting the manuscript. MG and MK was involved indata collection and analysis. The author(s) read and approved the final manuscript.
This work was done with ethical approval and is a part of a larger one entitled “Analyzing the competence development policies of hospital managers and presenting policy packages” with the code of ethics IR.KMU.REC.1399.299. It has been approved and is being implemented at Kerman University of Medical Sciences, Iran. This work was done with consent to participate of all interviewees and informed consent was obtained from all subjects. All methods were carried out in accordance with relevant guidelines and regulations also is attached as supplementary file for interviewing and qualitative studies.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Masoud, A., Dehnavieh, R., Yazdi-Feyzabadi, V. et al. What is the mind map of the hospital’s future changes in a developing country like Iran? A qualitative study.
BMC Health Serv Res23, 732 (2023). https://doi.org/10.1186/s12913-023-09507-3
