We recently read an article entitled “Evaluation Indexes of Military Hospitals From the Experts’ Perspective: A Qualitative Study” in your prestigious journal owing to our interest in qualitative studies.Reference Ameryoun, Haghdoost and Zaboli 1 Although this article is an innovative one in terms of its topic, it seems that some issues should be further taken into consideration. The authors of this article have stated that quality is not improved by performing accreditation, while according to the results of another study, performing accreditation can improve the quality.Reference Devkaran and O’Farrell 2 The authors mentioned that the available models of performance evaluation such as accreditation are not perfect and complete for evaluating hospitals’ performance. However, accreditation has been considered a useful tool for evaluating the managerial and organizational performance of a hospital and does not only evaluate the quality of medical practices.Reference Pomey, Francois and Contandriopoulos 3
Some items in this article are unclear, as follows. It is unclear which approach to content analysis was used. Overall, content analysis has 3 approaches: conventional, directional, and summative. However, as mentioned above, the type of content analysis, as well as the analysis unit, meaning unit, and condensation are unclear in this study. Regardless of the names of the authors, it is not clear in which country this study was conducted. The characteristics of the people who were interviewed are not clear, although the base of a qualitative study is the characteristics of the study population.Reference Bahadori 4 Furthermore, in the Abstract, it was mentioned that version 11 of the software was used; however, in the Methods, the version of the software is stated as 10; the validity of the code is unclear. Also, “290 primary concepts” is wrong; the proper form is “290 meaning units.” “Crisis” has not been defined clearly. The strategy of coding is ambiguous. Have the researchers used open coding or axial coding?
The method of qualitative studies is more an inductive one and moves from the more specific to the more general. That is, the inductive method moves from specific observations to broader generalizations and theories, and there should be a semantic relationship between the themes and subthemes. However, in this study, there is no semantic relationship between the themes of services, treatment, and passive defense.
The authors have not provided any definition of the military hospital. In Iran, military hospitals are mostly in urban areas and provide services similar to those provided by other civilian hospitals. The only differences between these 2 kinds of hospitals are that in the military hospitals, the military personnel and their families have higher priorities, and persons covered by the armed forces medical insurance do not pay for receiving services. Military hospitals, like other hospitals, are also accredited by the Ministry of Health and Medical Education on the basis of compliance with national standards.
The aim of the study is unclear. It is not clear if the researchers sought to develop some indicators for evaluating military hospitals in emergency situations or if they wanted to provide new models and indicators for evaluating military hospitals in Iran. In fact, no specific indicators or criteria are provided for evaluating military hospitals in Iran. According to which scientific references and documents do the authors of this article state that the role of military hospitals is more important than that of civilian hospitals in emergency situations? All that was mentioned in the coding and provided in the themes and subthemes was that integrated system of crisis management are now available for military and civilian hospitals in emergency situations. It seems better to replace the evaluation indicators with evaluation dimensions. Finally, there is no discussion of the findings, and it seems that the findings are not generalizable even for Iran, and that the evaluation of military hospitals cannot be carried out based on what is stated in this article.Reference Bahadori, Ravangard and Yaghoubi 5
