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Using 44 carefully selected indicators (12 inputs, 17 outputs, 14 links) for 2019–2022, the study assesses indicator suitability via a systematic two-stage process and derives departmental inefficiency sources.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/the-novel-additive-star-ndea-model-for-hospital-performance-evaluation/452454/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/the-novel-additive-star-ndea-model-for-hospital-performance-evaluation/452454.png","ImageObject",300,407,{"name":42,"@type":43},"jay","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":33},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What problem does the additive star-NDEA model address in hospital evaluation?","Question",{"text":62,"@type":63},"It targets hospital performance assessment in uncertain environments by evaluating interdepartmental efficiency and identifying specific inefficiency sources more effectively.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How was the model applied in this study and what data period was used?",{"text":67,"@type":63},"The study applied the additive star-NDEA model to 26 hospitals within Isfahan University of Medical Sciences, using data from 2019 to 2022.",{"name":69,"@type":60,"acceptedAnswer":70},"What indicators and structure were used in the analysis?",{"text":71,"@type":63},"The analysis used 44 indicators, organized as 12 inputs, 17 outputs, and 14 links selected through a systematic two-stage process.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},452454,1792169399,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":33,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},3985747858866,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Hadian etal. BMC Health Services Research (2026) 26:23 BMC Health Services Research  \n[https://doi.org/10.1186/s12913-025-13819-x](https://doi.org/10.1186/s12913-025-13819-x)  \nRESEARCH Open Access  \nThe novel additive star-NDEA model for hospital performance evaluation  \nShirin Alsadat Hadian 1, Reza Rezayatmand 1*, Saeedeh Ketabi2, Ahmad Reza Pourghaderi3 and Nasrin Shaarbafchizadeh4  \nAbstract  \nBackground In the context of healthcare systems, evaluating hospital performance usign appropriate quantitative models is essential. This paper introduces a novel approach for assessing hospital performance in uncertain environments.  \nMethods In this study, we applied an additive star network data envelopment analysis (star-NDEA) model to evaluate the interdepartmental efficiency of 26 hospitals whithin Isfahan University of Medical Sciences (MUI) using visual analytis tools. The analysis, based on data from 2019 to 2022, utilized 44 indicators (12 inputs, 17 outputs, 14 links), which were carefully selected as model variables. The relevance and suitability of these indicators were assessed through a systematic two-stage process,  \nResults This study indicated that the additive star-NDEA model identifies the specific sources of inefficiency and more accurately captures the inefficiencies of hospitals, reflecting the internal parameters of departmental-level performance evaluation. Across all the studied hospitals, the logistics department consistently had the highest efficiency score (approximately 0 . 9) among the eight departments evaluated over the four years. The highest efficiency scores for specific departments were recorded as follows: surgical inpatient wards in 2019 (0 . 64), imaging department in 2020 (0 . 56), clinic department in 2021 (0 . 59) and surgical inpatient wards again in 2022 (0 . 63) . In contrast, the departments with the lowest efficiency scores were, the internal inpatient ward in 2019 (0 .43), the clinic department in 2020 (0 . 33), and, the imaging department in both 2021 and 2022 (around 0.40) . Overall, the efficiency scores derived from additive star-NDEA model were lower than those obtained using the classical additive DEA model.  \nConclusion The model presented in this study is well-suited for assessing the efficiency of hospital s and their internal departments. These findings highlight the importance of hospitals adopting advanced quantitative models to improve to enhance performance, optimize resource utilization, plan targeted interventions, improve service delivery and ultimately increase overall technical efficiency.  \nKeywords Hospital, Efficiency, Performance evaluation, Data envalopment analysis, Additive star-NDEA model  \n*Correspondence:  \nReza Rezayatmand  \n[reza. rezayatmand@gmail.com](reza. rezayatmand@gmail.com)  \n1Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran  \n2Department of Management, Faculty of Administrative Sciences and Economics, University of Isfahan, Isfahan, Iran  \n3School of Public Health and Preventive Medicine, Monash University, Victoria, Australia  \n4Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in","cbCailv1YR979YZH","https://ap.wps.com/l/cbCailv1YR979YZH","pdf",2762264,17,"English","# Abstract\n## Background\n## Methods\n## Results\n## Conclusion\n# Data Envelopment Analysis (DEA)\n## Healthcare efficiency measurement\n## Core DEA concepts and models","[{\"question\":\"What problem does the additive star-NDEA model address in hospital evaluation?\",\"answer\":\"It targets hospital performance assessment in uncertain environments by evaluating interdepartmental efficiency and identifying specific inefficiency sources more effectively.\"},{\"question\":\"How was the model applied in this study and what data period was used?\",\"answer\":\"The study applied the additive star-NDEA model to 26 hospitals within Isfahan University of Medical Sciences, using data from 2019 to 2022.\"},{\"question\":\"What indicators and structure were used in the analysis?\",\"answer\":\"The analysis used 44 indicators, organized as 12 inputs, 17 outputs, and 14 links selected through a systematic two-stage process.\"}]","The novel additive star-NDEA model for hospital performance evaluation | PDF",1790737128,43]