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Table 1 Environmental impact matrix (micro environment)

From: A comprehensive environmental scanning and strategic analysis of Iranian Public Hospitals: a prospective approach

Dimensions

Factors

Impact of factors

Potential opportunities/threats

Customer, public and media

More inclination towards using luxurious health services

Increased costs, higher quality services, overuse of complicated expensive technologies

− 3

More demand for high quality health services

Higher costs, human resources, expensive equipment

− 2

Increase in average income

Increase in hospital income

+ 5

Increase in purchasing power

Increase in hospital income

+ 5

Education level and health literacy improvement

Decrease in hospitalization period and increase of bed turnover rate

+ 3

Organic and green products attitude

Decrease in diseases and demand for health services which will lead to quality improvement in public hospitals

+ 3

Environment protection and green energy use attitude

Increase in hospital expenses for healthy waste disposal and use of latest technologies with green energy

+ 1

Increase in people’s share in health services payments

Increase in hospital specific income

+ 3

Distributors

Unfair bed distribution

Longer patient wait times leading to disorder and lower quality of services

− 4

Unfair specialized human resources distribution

Longer patient wait times and non-responsiveness

− 5

Suppliers

Increase in prescription of drugs out of Iranian official list of drugs

Inability to supply drugs and lower quality of services

− 2

Increase in the number of prescriptions containing antibiotics

Patients’ resistance to treatment and higher doses of drugs leading to medicine supply issues

− 2

Increase in the number of prescriptions containing injections

Patients’ resistance to treatment and higher doses of drugs leading to medicine supply issues

Increase in design costs and equipping hospitals with clean rooms

− 2

Increase in the number of self-medication cases in patients

Increase in the number of patients with no appointments leading to longer patient wait times

− 3

Stakeholders

Delayed payment to hospitals by insurance companies

Hospitals being indebted and therefore unable to supply medicine and consumer products or purchasing low quality products that in turn will lead to patient dissatisfaction. In addition, delay in personnel reimbursement can result in lack of satisfaction and motivation to provide high quality care.

− 5

Full-time status of clinical faculty members (non-permissibility of simultaneous work in both public and private sectors)

Shorter patient wait times and more responsiveness

+ 4

Freedom of speech in media, multiplicity of political parties, civil rights, meetings or campaigns to support or ban health policies (social - political)

Compromised reputation of public hospitals due to myriad economic and political issues

− 2

Competitors

More inclination towards receiving home care and nursing care

Shorter wait times and improved quality of services and opportunities for launching home care

+ 3

Growth in usage of health promotion software

Decreased rate of referring to hospitals and shorter wait times

+ 2

Growth of clinics and private hospitals

Shorter wait times in public hospitals and improved quality of services

+ 5

Important basic infrastructures (facilities and installations) in Iran and the city in which the hospital is located

Remote medical services and electronic medical record option

+ 5

Good academic and knowledge developments in Iran and the city in which the hospital is located

Improved treatment processes and quality of services and patient satisfaction

+ 3

A chance to make the required investments for research and development in Iran

Improved treatment processes and quality of services and patient satisfaction

+ 4

Good developments in high-end technologies in hospitals

Improved treatment processes and quality of services and patient satisfaction

+ 3

Availability of high-end technologies in the relative industry of hospitals

Higher hospital expenses

− 2

Available required communication structures

Good developments in information and communication technology

Remote medical services and electronic medical record option

+ 5

Electronic commerce option for hospitals

Income generation

Growth of medical tourism industry

+ 4

Using social media to promote hospital products

Income generation

+ 4