Our Purpose is to examine a moderated-mediation model in the relationship between the effectiveness of the internal control system and hospital performance through the considering role of intra-organizational information quality, organizational ethical behaviors, and the organizational mindfulness. The research model is empirically tested using survey data from 384 managers of public sector hospitals in Iran. We used Partial Least Squares Structural Equation Modeling (PLS-SEM) to test this model. We demonstrated that the internal control structure positively and significantly affects hospital performance through the effectiveness of the internal control system. Additionally, the effectiveness of the internal control system positively impacts intra-organizational information quality and organizational ethical behaviors, which in turn improves hospital performance (mediating role). Furthermore, we showed that organizational mindfulness is not effective alongside the internal control system structure in enhancing its effectiveness (non-confirmation of the moderating role), but it can indirectly enhance the effectiveness of the internal control system by influencing the internal control structure. Overall, our study's evidence fills the gap in the literature on internal control systems and hospital performance.
Hadavi et al. (2025) studied this question.