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This study aims to investigate the effect of the Diamond Justice model on self-efficiency with the mediating role of job stress among the staff of Qazvin hospitals affiliated with Qazvin University of Medical Sciences. This study is a cross-sectional descriptive-analytical study conducted among the staff of Qazvin hospitals affiliated with Qazvin University of Medical Sciences in 2020.

Sampling was performed using the structural equation method. Data collection tools included three sections: demographic information, justice and self-efficiency questionnaire and job stress questionnaire. Data were finally analyzed using SPSS software version 26 and AMOS version 23 at a significance level of 0.05.

The structural equation model’s standard estimation coefficients show that all existing paths are at a significant level. Finally, the regression analysis showed that justice is inversely related to stress level (ß = −0.185, p = 0.015). Justice is directly related with self-efficiency (ß = 0.282, p < 0.001).

Justice, stress and self-efficacy have been measured in various studies among health workers. However, a fitting model showing these three variables’ interaction was necessary. Therefore, this study tries to conceptualize the multifaceted relationships of the components of these concepts by presenting a model.

Strategic orientation is one of the critical principles affecting the marketing and strategy selection of an organization’s activities, reflecting the strategic tendencies implemented by the organization to create behaviours, leading to organizational efficiency and better employee performance. Therefore, this paper aims to study the relationship between strategic orientation and performance in Qazvin teaching hospitals through green supply chain management (SCM) to improve employees' performance.

This was a descriptive– analytical and cross-sectional study. The total number of employees in medical centres was 2,256 people. According to Morgan’s table, the required number of samples was 328, including 10% of the sample loss. The questionnaire was given to 365 staff in different hospitals in proportion to the number of staff. Two statistical software, SPSS24 and AMOS23, were used to evaluate the results.

All three variables were relatively moderate in the hospitals. The results of evaluating the structural model of the research showed that all the studied hypotheses were significant, except for the relationship between organizational performance and strategic orientation hypothesis. The results also show that this model had a good fit.

The findings can lead to saving the environment, creating a better social image and reducing costs and profitability, allowing managers to know the strategic orientations rather than depending on institutional pressure issues and monitoring guidelines.

Considering the significant relationship between the dimensions of green SCM and the hospitals’ performance, the authors suggest: establishing multilateral co-operation in environmental issues, improving the environmental status of hospitals, reducing waste rates and paying attention to social responsibility of hospitals. In addition, the findings help hospital management to comprehensively understand the strategies for implementing green SCM procedures.