Introduction
The most important factor of productivity and growth in organizations and society is human resource [1], which is more evident in organizations such as hospitals that depend on their staff for providing services [2]. One of the serious weaknesses in hospitals is the lack of attention to or neglect of using a correct model in the subject for teaching the Hopstal incident command system (HICS) staff [3]. The HICS is a system for managing emergency events or crisis in hospitals [4]. For teaching the HICS staff, professional educational programs should be held in different formats on how to deal with possible incidents, but a study showed that the training courses of hospitals do not have the necessary effectiveness in many staff [5] and there is a need for a systematic revision of the entire training process [6] and assessing the pathology of this process for planning to ensure the quality and effectiveness of training [7]. Various models have been presented for the this purpose. The most suitable method is the three-pronged approach [8]. 

Methods
This is a qualitative-quantitative study (a mixed method). The study population in the qualitative phase included expert in planning, development, and training of the HICS staff. In the quantitative phase, the study population included all managers and staff of the HICS in the hospitals of Guilan Province (n=548). The sampling method in the qualitative phase was the purposive method, while the cluster random method was used in the quantitative phase. According to the principle of data saturation, the sample size in the qualitative phase was 15. In the quantitative phase, sample size was determined 226 based on Cochran’s formula. The data collection tool was a semi-structured interview in the qualitative phase and a researcher-made questionnaire based on a five-point Likert scale in the quantitative phase. The face validity of the questionnaire was confirmed in a pilot study and the content validity was confirmed based on the opinions of experts. The reliability of the questionnaire using Cronbach’s α coefficient was 0.84. For data analysis, MAXQDA software, version 2020 was used in the qualitative phase and SPSS software, version 26 was used in the quantitative phase.

Results
In the qualitative phase, after analyzing the codes extracted from the interviews with experts (55 open codes, 25 axial codes, and 6 selective codes), physical-infrastructure, strategic (organizational structure), policy-making and executive, organizational and educational processes, management and support, and organizational goals and specialized measures were extracted, which were classified in three branches of the three-pronged model, i.e. structures, processes, and context. In the quantitative phase, the results showed that the mean amount of failure in the training of staff in all three domains was higher than the average. Among the domains, the percentage of variance (impact) was higher in the processes domain (0.262). The final model of the study based on the three-pronged approach is shown in Figure 1.

Conclusion
Based on the findings, physical-infrastructure, strategic (organizational structure), policy-making and executive, organizational and educational, managerial and support, and organizational goals and specialized measures were the factors that negatively affected the process of training for the HICS staff of hospitals in Guilan Province and led to the inappropriate use of staff against accidents and crisis. The most important areas of failure in proper training of the HICS staff of hospitals in Guilan Province were related to the processes and structure.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Islamic Azad University, Ardabil Branch (Code: IR.IAU.ARDABIL.REC.1400.050). Obtaining informed consent from the participants and ensuring the confidentiality of their information were considered in this study.

Funding
This article was extracted from PhD thesis of Arezou Porkar, Department of Educational Sciences, Faculty of Humanities, Ardabil Branch, Islamic Azad University, Ardabil, Iran. 

Authors' contributions
Conceptualization and study design and critical revision of the manuscript for important intellectual content: All authors; Data acquisition, data analysis and drafting of the manuscript: Arezou Porkar and Sadraddin Sattari; Statistical analysis, administrative, technical, or material support: Arezou Porkar and Mohammad Taghi Moghadamnia; Supervision: Sadraddin Sattari and Mohammad Taghi Moghadamnia.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the experts for their guidance and assistance in this research. 


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