the productivity and its barriers in public hospitals: case study of iran

background: due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. thus, increasing the level of productivity must become the main aim of any hospital. objective of this study is to determine the total factor productivity and its components over the period under the study. methods: in this cross sectional study, total factor productivity changes of hospitals affiliated to tehran university of medical sciences were measured according to malmquist index over the period 2009-2014. to estimate total productivity changes using data envelopment analysis method, input-oriented and variable return to scale assumptions were applied and deap2.1 software was used. results: the mean value of total productivity changes was 1.013. it means that during the study period the productivity experienced a 1.3% decrease. technological efficiency changes have the greatest influence on productivity decrease than the other factors. scale efficiency, managerial efficiency and technical efficiency changes were ranked. conclusion: lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful.