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Introduction: The financial stability of hospitals directly impacts their ability to fulfill their primary mission of enhancing healthcare. This study identifies and prioritizes cost reduction and revenue enhancement strategies for Iranian hospitals., Method: This investigation employed a mixed-methods design, incorporating both qualitative and quantitative approaches. A systematic review of scholarly articles was initially conducted to identify key strategies for cost reduction and revenue enhancement in hospitals. Insights from hospital administrators regarding successful practices and recommended financial improvement measures were subsequently collected through surveys. The combined strategies from these phases were then assessed and ranked using the TOPSIS technique., Findings: This study identified 12 primary strategies and 71 sub-strategies across four dimensions. Notably, strategies aimed at enhancing the quality of care (0.9030), refining process quality (0.7926), and bolstering care provision infrastructure (0.7910) were deemed the most critical. Among the sub-strategies, priority was given to implementing a comprehensive health information system (HIS) (0.7926), identifying and reducing the causes of cancelled surgeries and visit appointments (0.7919), and developing strategies to decrease hospital infection rates (0.7854)., Conclusion: Enhancing the quality of care and upgrading service delivery processes are crucial for improving hospitals' economic performance. Elevating service quality not only improves the economic performance of hospitals but also enhances their financial metrics., Competing Interests: Declarations. Ethics approval and consent to participate: The ethics committee of the Baqiyatallah University of Medical Sciences (BUMS) approved this study (Approval ID: IR.BMSU.REC.1399.205). Informed consent was obtained from all participants prior to their involvement in the study. All participants were provided with detailed information regarding the study's purpose, procedures, and potential risks, and they were assured of their right to withdraw at any time without any negative consequences. Their consent was documented through signed consent forms. All experiments were performed in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)