who makes decisions in hospital? a scoping review and meta-synthesis

Context: the aim of this study was to identify decision-making issues and key decision-makers within the hospital. methods: this scoping review was conducted by searching the databases of web of science, scopus, and pubmed in january 2024. additionally, articles related to newhouse's main article were searched on google scholar to identify decision-makers in the hospital and their areas of decision-making. the 37 articles were analyzed using the framework analysis technique with atlas-ti software. results: decision-makers addressed 160 issues, which were identified and categorized into 7 areas: strategic management, human resource management, financial management, physical resource management, employee compensation payment, service delivery management, and hospital reputation. additionally, 21 decision-makers were identified and classified into 6 categories: group of managers, group of physicians, group of nurses, board of directors, government, and political groups. hospital managers were identified as the primary decision-makers, responsible for making decisions independently in three areas and jointly with the board of directors in one area. conclusions: it can be concluded that no single decision-maker holds a dominant role in the decision-making process. several decision-makers exert varying degrees of influence depending on the issue. among these decision-makers, managers play a more significant role in decision-making than others.