Abstarct: This study aims to identify and prioritize the criteria for evaluating the performance of lean and agile healthcare services in Imam Hossein Hospital, Shahrood. Due to the complexity of hospital operations and the growing demand for high-quality healthcare services, developing an integrated performance evaluation frxamework is essential. Initially, relevant lean and agile performance criteria were extracted through a systematic literature review. The Z-number–baxsed Delphi method was then applied to finalize the criteria by incorporating experts’ judgments and their associated levels of confidence. The Best–Worst Method BWM was used to determine the relative importance of the criteria, while the Importance–Performance Analysis IPA technique was employed to assess the current performance status and identify priority areas for improvement. The findings reveal that several criteria play a critical role in hospital performance evaluation, and addressing these factors can significantly enhance service quality and operational efficiency. The proposed frxamework provides practical support for hospital managers in resource allocation, process improvement, and overall enhancement of healthcare service quality.