Background: Performance is a multi-dimensional and dynamic concept. During the past 2 decades, considerable studieswere performed in developing the hospital Performance concept. To know literature key concepts on hospitalPerformance, the knowledge visualization based on co-word analysis and social network analysis has been used.Methods: Documents were identified through “PubMed” searching from1945 to 2014 and 2350 papers entered thestudy after omitting unrelated articles, the duplicates, and articles without abstract. After pre-processing and preparingarticles, the key words were extracted and terms were weighted by TF-IDF weighting schema. Support as an interestingnessmeasure, which considers the co-occurrence of the extracted keywords and "hospital Performance" phrasewas calculated. key word having high support with "hospital Performance" are selected. Term-term matrix of theseselected keywords is calculated and the graph is extracted.Results: The most high frequency words after “Hospital Performance” were “mortality” and “efficiency”. The majorknowledge structure of hospital Performance literature during these years shows that the keyword “mortality” had thehighest support with hospital Performance followed by “quality of care”, “quality improvement”, “discharge”, “lengthof stay” and “clinical outcome”. The strongest relationship is seen between “electronic medical record” and “readmissionrate”.Conclusion: Some dimensions of hospital Performance are more important such as “efficiency”, “effectiveness”, “quality” and “safety” and some indicators are more highlighted such as “mortality”, “length of stay”, “readmissionrate” and “patient satisfaction”. In the last decade, some concepts became more significant in hospital Performanceliterature such as “mortality”, “quality of care” and “quality improvement”.

Background: The hospital is a significant part of health systems that presents a complex and vital services. Therefore, Performance management of hospitals should be considered especially. BSC model is so helpful and popular for Performance management. In using BSC, cause and effect relations is very important, since it helps to apply non-financial to forecast financial Performance. Objectives: This study aims to analysis systematic relations between key indicators of hospital Performance evaluation, identifying causal relations and prioritizing indicators. Methods: Based on the 4 perspectives described by the balanced scorecard (BSC), the evaluation indicators of hospital Performance and key Performance indicators (KPIs) were adopted from the related literature and selected by experts’ panel, respectively. Then, the decision making trial and evaluation laboratory (DEMATEL) method was employed for the determination of the cause-and-effect relationships between the indicators, differentiation of the effective and significant factors, and construction of the strategy map to ameliorate hospital Performance. Results: According to the BSC perspectives, 21 KPIs were selected for evaluation of hospital Performance. The highest relationship was found between bed occupancy having the largest R +Dvalue and other indicators, thus illustrating its fundamental role among the indicators. Clinical errors with the greatest value of R-D showed the strongest impacts on the other indicators and was thus named as the “ main cause factor” among the indicators. In contrast, the percentage of patient satisfaction with the smallest R-D value was most strongly influenced by the other indicators and therefore, it was known as the “ main effect factor” among the indicators. Conclusions: Assessment and improvement of the hospital Performance is a complex and multi-dimensional activity. In order to have a powerful assessment system and success in improving hospital Performance, instead of a single-dimension, it should be paying attention to all dimensions of Performance.