Background: due to the numerous and ever-changing internal and external factors affecting health care performance, it seems essential to identify and prioritize them for managers and policy makers to make decisions easier, faster and more accurate. In this regard, the Best-Worst Method (BWM) is considered as a novel and innovative way to meet such an objective.
Methods: At first, due to the large number of factors and indicators, the content validity ratio (CVR) was used to screen them. After that a Pairwise comparisons were conducted between the best and the worst criteria and the other one. Then Modeling the research problem through linear programming and finding the optimal weights.
Results: the most effective internal factors from the experts’ viewpoint were the financial indicators such as “the ratio of personnel wage costs to the total revenues”, “the ratio of the costs of drugs and medical consumer goods to the total costs”. The external macro factors (driving forces) that were most influential were the “structure of the payment system and strategic service purchasing by insurance companies based on quality and price”, “the structure of tariffs” and the “fairness of the staff payment system”.
Conclusion: The results showed that external factors had greater impacts on the performance of public hospitals than internal factors (efficiency and effectiveness). Therefore, when assessing the performance and improvement interventions of hospital, not only internal indicators should be measured, but also external factors, including political and economic policies and approaches governing the health system need to be taken into account.