Table 4 Statistics on extracted factors and related variables

Implementation

Idealistic standards

4.23

0.502

15.901

0.898

Tunnel vision

3.75

0.598

Unreal presentation of facilities

3.51

0.610

Rush in implementation

3.99

0.711

Lack of awareness personnel

3.55

0.654

Lack of cultural infrastructure

3.96

0.622

Shortage of staff

4.15

0.838

Lack of financial resources

3.81

0.766

Lack of commitment of doctors and managers

3.83

0.486

Evaluation

Thought clash

3.56

0.665

10.499

0.815

Subjective evaluation by inspectors

3.34

0.709

Bias in evaluation

2.95

0.780

Lack of skills of inspectors

3.18

0.677

The beneficiary of the evaluation device

2.74

0.507

Inappropriate behavior of inspectors

2.32

0.764

Content

Disregard for results and attention to structures

3.65

0.736

10.390

0.793

Inappropriate scoring scale

3.63

0.701

Disparities and balance of measures

3.72

0.702

Ignoring cross-department communications

3.22

0.511

Structure

Emphasis on documentation

4.35

0.727

10.349

0.844

The large number of standards

4.37

0.640

Ambiguity of measures

3.99

0.631

Paying less attention to patients

4.22

0.546

Disregard for the patients’ mental needs

3.49

0.571

Reducing the time of direct nursing care

3.98

0.617

Psychological

Stress in the staff

4.30

0.737

9.389

0.806

Physical and mental fatigue

4.30

0.831

Lack of time to implement standards

4.39

0.686

Management

Integration of the evaluation and payment system

3.42

0.704

6.574

0.681

Lack of proper financial feedback

3.86

0.509

Establishing unequal competition in hospitals

3.92

0.733

63.20