Development and Validation of Financial Key Performance Indicators for Iranian Public Hospitals

Abstract

Background: There is no consensus on appropriate financial key performance indicators (FKPIs) for Iran’s public hospitals. Objectives: This study aimed to identify and validate a context-specific set of indicators for evaluating financial performance. Methods: A modified Delphi technique was used in Iran in 2025. In Phase 1, a preliminary list of financial indicators was identified through a comprehensive review of the literature and relevant documents. In Phase 2, a three-round Delphi study involving 25 experts, including financial managers, senior hospital administrators, and health economics specialists, evaluated the relevance and importance of the indicators to achieve consensus on the final FKPI set. Data were collected using a researcher-developed questionnaire with a 5-point Likert scale and analyzed using the median and interquartile range (IQR). Results: Initially, 25 financial indicators were identified through a literature review; after Round 1 and expert feedback, this number increased to 45. Based on predefined consensus criteria, 33 indicators were ultimately selected and organized into five domains: liquidity and working capital management, revenue management, cost management, human resource and compensation management, and operational and service efficiency. Context-specific indicators, including the insurance deduction ratio, the dedicated revenue-to-total revenue ratio, and the staff incentive payment-to-personnel cost ratio, were among the most important measures identified. Conclusions: This study developed and validated a set of FKPIs for Iranian public hospitals. Based on scientific evidence and expert consensus, this framework may support the evaluation of financial performance and managerial decision-making.