Hospitals are important social organizations in society that deal with human life and health. Weakness in evaluating the performance of hospitals reduces the quality of service for people. To manage an organization and overcome challenges and problems, the EBP has been applied. In the current study, a model for factors affecting the EBP was designed. The results showed that clinical effectiveness has significant effects on the EBP. The results are in agreement with other studies on the effects of clinical effectiveness on evidence-based [20]. Based on items designed in the questionnaire, prevention rate of disease, mortality rate, surgical readmission and patient compliance had 0.79, 0.82, 0.67 and 0.73 effects on clinical effectiveness. The results are concur with other studies on the effects the prevention rate of disease [21], the mortality rate [22], surgical readmission [23] and patient compliance [24]. Decrease in disease, surgical readmission, mortality and also patient compliance are reasons for the improvement in clinical effectiveness that can influence the EBP. The assessment of the effects of clinical interventions is a key part of clinical governance.
The results also showed that staff requirements had significant effects on the EBP. There is not any study investigating the effects of staff requirements on the EBP. Based on items, goal-oriented, the parallel between units, professional ethics and increase in professional skills had 0.815, 0.807, 0.828 and 0.889 on staff requirements and had indirect effects on the EBP. Staff requirements mean to be a sufficient condition for the performance of staff and to be professional staff for improved performance of hospitals. Indeed, professional staff improves the performance of hospital and have significant effects on the EBP.
Strategic planning had a 28.00% effect on the EBP. The results are in agreement with other studies on the effects of strategic planning on performance in government agencies [25] and organizations [26]. The results showed that supportive service, encouraging employees for creativity and innovation, strategic view and thinking, the preparation of financial and executive programs and education of stockholders had 79.80%, 81.00%, 68.00% and 68.50% on strategic planning. The effects of strategic planning have been elucidated on performance. Strategic planning helps to identify healthcare goals based on statements and also knowing strengths, weaknesses, opportunities and threats. Using strategic planning can have beneficiary effects on managers. Other studies have reported the importance of strategic planning to improve performance [27, 28]. In fact, giving supportive service and encouraging employees to creativity and innovation to force them to innovate and improve performance. The preparation of financial and executive programs and education of stockholders improve strategic planning and subsequently influence the EBP.
Based on findings, organizations mission statement had a 39.00% effect on the EBP. The results are concur with other studies on the effects of organization mission statement on performance [29, 30]. The results showed that meritocracy in organizations, respect to professional ethics, organizational structure based on regulations, evaluation of organizational culture and updating software and hardware systems had 76.00%, 77.00%, 86.00%, 76.00% and 73.00% effects on organization mission statement. The results show that meritocracy in an organization and professional ethics can increase performance in hospitals. In addition, respect to regulations and organizational culture and access to updated information provide an updated environment and subsequently influence the EBP.
The results showed that patient-centered had a 34.00% effect on the EBP. The results are in agreement with previous studies [31, 32]. The data showed that electronic prescription, the decrease in costs, attention to values and expectations and respect for patients had significant effects on patient-centered. Managers and designers of hospitals are trying to create security based on requirements of patients. Considering patients and their requirements improve the EBP in hospital centers. On the other hand, electronic and updated systems reduce the time for patients and improve the quality of view of patients and also reduce the working load for employees.
Empowering human resources had 29.00% of the effects on the EBP. The results are in agreement with previous studies [33, 34]. Based on items, education, innovation and grouping work could have significant effects on empowering human resources.
Human capital has a significant role in an organization and needs special knowledge and expertise to provide benefits. To improve the performance of the organization, human resources need concerns in relation to education. Indeed empowered employees can improve the performance of organizations. In addition, centered-employee had a 52.00% effect on the EBP that confirming the effects of employees on the EBP.
Getting satisfaction had 37.00% effects on the EBP. The results are in agreement with other studies on the effects of satisfaction on performance [35, 36]. Satisfaction was limited to patients including the improved quality services, the survey of patients and care of patients. Satisfaction of patients has significant effects on performance in terms of quality of services. Continuous survey of patients helps to improve performance and also knowing requirements for the improvement of quality and subsequently of quality of services.
Accountability governance had 30.00% of the effects on the EBP. The findings are parallel with other studies [37, 38]. The evaluation, monitoring and responding are essential to improve performance. Responding to needs and improving and developing of the quality of service can improve performance.
Quality and safety of services could determine 36.00% of the EBP variance. The results are similar to other studies [39, 40]. It can be stated that the improved quality of services, justice in healthiness, implementation of electronic systems, increased system efficiency and the effects of medical equipment and drugs can have significant effects on the quality and safety of services. The improved services and quality leads to improve the EBP.
The results showed that hospital management had 46.00% the effects on the EBP. The results are parallel with those reported by other studies on the effects of management on performance [41, 42]. The role of managers in programming, application of human resources, organization and leadership is well known. Thus, managers can have pivotal roles in increasing the performance of hospitals. Managers can apply systems of performance evaluation, provide infrastructures, monitoring and must have skills for analyzing of the data.
Responsibility had 38.00% of the effect on the EBP. The results are in agreement with other studies [43]. Responsibility of managers and employee has a significant role in the improvement of performance. Responsibility is associated with ethics in an organization. Responsible managers and employees not only improve the quality of service but also increase satisfaction.