Tab. II.

The challenges of the Iranian health system in fighting COVID-19; organizational factors.

Themes	Line-managers	Staff-managers	Sub-themes and related codes
Processes and instructions	✓	✓	Executive instructions	Dispersion, lack of transparency, and executive capacity of some of the laws and instructions proposed by the Ministry of Health and the World Organization
	✓	✓		Repetitive changes in the protocols especially in the early stage of the pandemic
		✓		Delay in sending instructions by the Ministry of Health
	✓	✓		Choosing a hospital as the referral hospital
	✓	✓	Medical and pharmacological protocols	Lack of treatment method or standard drug for the disease
	✓	✓		Repetitive changes in the treatment and medication protocols
	✓	✓	Intra-sector and extra-sector coordination	Lack of intra-sector and extra-sector coordination in the early stages of the pandemic
		✓		The time-consuming process of attracting new human forces
		✓		Lack of coordination and agreement among the different deputies of the university about human force attraction
Infrastructural factors		✓	Staff	Lack of experience in hospitals to fight with such prevalent respiratory diseases
		✓		The change in the human force structure in the area of treatment of (non-communicable diseases) compared to hygiene in the recent years
	✓	✓		Lack of specialist forces in some regions especially in the area of infectious diseases, ICU, pulmonary, and internal diseases
	✓	✓	Information technology	Lack of virtual education infrastructures
	✓	✓		Lack of a comprehensive centralized system for registering the positive cases of coronavirus and failure to analyze the data on time for proper decision making
		✓		Lack of electronic health records and previous records and information of the patients’ underlying diseases
		✓	Physical	Lack of proper diagnostic infrastructures in the country
	✓	✓		Lack of the necessary infrastructure to prepare a large amount of the consumer and protective equipment
	✓			Lack of readiness of drug distribution network of Food and Drug Administration
	✓			Lack of protective equipment producing companies in the country