Tabriz University of Medical Sciences Depiction of Health 2008-9058 16 4 2025 11 20 Presenting the Interpretive Structural Model of Fearless Organization Drivers in Social Security Hospitals 360 380 10.34172/doh.2025.29 EN Fatemeh Sadat Vahabzadeh Moghadam https://orcid.org/0000-0002-0472-567X Ahmad Vedadi https://orcid.org/0000-0003-1110-5281 Karam Allah Daneshfard https://orcid.org/0000-0003-0344-9279 Journal Article 10.34172/doh.2025.29 2025 08 16 2025 12 03 Background. Today, psychological security, the prevalence of a supportive organizational climate, and the transformation of organizations into secure environments are of paramount importance. The purpose of this research is to present an interpretive-structural model of the drivers of fearless organization in Social Security hospitals. Methods. This applied developmental study used an exploratory mixed-methods design. In the qualitative phase, a meta-synthesis approach based on Sandelowski and Barroso was conducted to review relevant literature published between 1980 and 2023. In the quantitative phase, Interpretive Structural Modeling (ISM) was applied using data obtained from pairwise comparisons provided by 12 senior managers of Tehran Social Security Hospitals. Results. A total of 40 drivers for establishing a fearless organization were identified and categorized into five overarching components: Managerial Behavior, Employee Behavior, Organizational Culture, Infrastructure, and Processes. The stratification of these components revealed that managerial behavior has the greatest influence, while employee behavior and organizational culture exhibit the least. Furthermore, 'Managerial Behavior' and 'Infrastructure' were identified as fundamental (independent) components. 'Employee Behavior' and 'Organizational Culture' were classified as dependent components, whereas 'Processes' occupy an intermediate position. Conclusion. To accelerate the establishment of a fearless organization, managers should prioritize the forty identified drivers outlined in this study. Notably, managerial behavior is more significant and influential than other drivers and can serve as a pivotal starting point for creating a fearless organization. The findings of this research can provide a foundation for future studies and the development of a comprehensive model of fearless organizations across various organizational contexts.