Qom University of Medical Sciences Journal

Introduction
Productivity is a common measure of economic or management performance. The attempt to improve and use various resources, such as labor, capital, materials, energy, and information, effectively and efficiently is the goal of all managers in organizations. Appropriate organizational structure, efficient operational methods, safe equipment and tools, a balanced work environment, and, most importantly, competent and worthy human resources (HR) are the necessities that must be taken into account by managers in order to achieve optimal productivity. Since organizations have limited resources and facilities, and many resources are non-renewable or rare, and it takes many years to replace them and requires spending a lot of money, it is not possible to satisfy unlimited needs by relying on such resources and facilities. Therefore, the only logical and feasible way is to obtain maximum efficiency and benefit from the existing resources. This is related to the concept of productivity. 
The HR productivity is the most important criterion of productivity. It refers to the optimal use of the potential talents and abilities of employees in order to increase the quantity and quality of production and reduce losses in an organization. Considering the importance of this subject, the present study aims to develop an HR productivity model for healthcare workers in the health center of Qom province, Iran.
Methods
This is a qualitative study based on the grounded theory. The participants were 11 specialists and experts in the fields of educational management, productivity, health education, and health promotion in Iran, who were selected using a purposive sampling method until reaching data saturation. A semi-structured interview was used to collect data. The grounded theory method was used to analyze the data. In this regard, open, axial, and selective coding were used. In the open coding stage, the transcriptions were read several times, and the key statements were extracted and recorded. In axial coding, categories were connected to their subcategories to provide more detailed and complete explanations about the phenomenon. In the selective coding stage, the categories were integrated and refined to form the theoretical framework. During this process, 201 open codes (concepts), 20 axial codes (dimensions and components), and 6 selective codes (main themes) were extracted and their characteristics were identified.
Results
The theme “integrated HR management system” had four axial codes: “HR recruitment and supply system”, “HR maintenance system”, “HR training and improvement system”, and “HR utilization system”. The causal conditions in the productivity model had three categories: “Structural conditions”, “cultural conditions” and “organizational processes”. The background conditions in the productivity model included three categories: “Infrastructure factors”, “focus on organizational values”, and “managerial factors”. The intervening conditions in the productivity model consisted of four categories: “support and environmental dynamics”, “political-legal factors”, “socio-cultural factors”, and “economic factors”. The strategies included “reform of management structure”, “reform of regulations”, and “institutionalization of HR management system”. Finally, the consequences included “individual”, “organizational” and “transorganizational” categories.
Conclusion
The productivity model of healthcare workers includes four main components: HR recruitment and supply system, HR maintenance system, HR training and improvement system, and HR utilization system. The productivity of healthcare workers is affected by different causal, background, and intervening conditions. The strategies to improve their productivity include reforming the management structure, reforming regulations, and institutionalizing the HR management system. It can have individual, organizational and transorganizational consequences.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Islamic Azad University, Babol Branch (Code: R.IAU.BABOL.REC.1399.085). Informed consent was obtained from all participants. They were assured of the confidentiality of their information.
Funding
This article was extracted from doctoral dissertation of Narges Firouzi, at Islamic Azad University, Babol Branch. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
The authors contributed equally to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.