Objective(s): The Social Security Organization (SSO), as one of the largest healthcare providers in Iran, requires an indigenous competency model to improve the quality of hospital services. This study aimed to design and validate a general and specific competency model for treatment positions in hospitals of the SSO.
Methods: This sequential exploratory mixed-methods study was conducted in three phases. In the qualitative phase, 25 experts including hospital managers, polyclinic heads, nursing service heads, and heads of pharmacy, laboratory, and imaging departments participated in semi-structured and event-based (CBI/BEI) interviews. Data were analyzed using thematic analysis with three-stage coding (open, axial, selective). Content validity was assessed using CVR and CVI based on the opinions of 10 experts. In the quantitative phase, a questionnaire was developed based on the extracted competencies. Its reliability was calculated using Cronbach's alpha based on a pilot study of 30 eligible individuals. The questionnaire was distributed using a complete census method among all employees of 9 treatment positions in SSO hospitals (n=687). In the final phase, the model's fit and construct validity were evaluated using confirmatory factor analysis (CFA) with AMOS version 26 software.
Results: Seven common general competencies (effective leadership, strategic decision-making, clinical crisis management, effective communication, specialized teamwork, professional ethics, and accountability) and twenty-six specific competencies (including patient safety and quality management, healthcare human resource management, medical equipment management, and clinical crisis management) were identified. The largest competency gaps were observed in "clinical crisis management" and "mastery of modern health technologies." Cronbach's alpha coefficients were 0.89 for general competencies and ranged from 0.81 to 0.90 (mean: 0.86) for specific competencies. The model's fit indices were: χ²/df = 2.41, CFI = 0.962, GFI = 0.89, NFI = 0.88, IFI = 0.91, RFI = 0.87, TLI = 0.954, RMSEA = 0.058, all within acceptable to excellent ranges, indicating a good fit.
Conclusion: The proposed two-level competency model (general and specific) can serve as a foundation for establishing a meritocracy system, performance evaluation, continuous education, and succession planning in SSO hospitals.