Journal of Foresight and Health Governance In Press 2026 11 10 Pathological Analysis of the Selection and Appointment System for Foresight-Oriented Managers in Public Healthcare Organizations, with an Emphasis on Health Governance Pathological Analysis of the Selection and Appointment System for Foresight-Oriented Managers in Public Healthcare Organizations, with an Emphasis on Health Governance EN Journal Article Introduction: The selection and appointment of forward-looking managers in public health organizations require a reliable system for identifying managerial talent, assessing professional competencies, evaluating strategic thinking capabilities, and preparing individuals for appropriate managerial responsibilities. Any gap between the stated objectives of future manager identification programs and the assessment tools employed may affect the effectiveness of these programs. Objective: This study aims to diagnose the weaknesses in the selection and appointment process of future managers at the Social Security Organization in 2019, with an emphasis on health governance and using Mirzaei Ahranjani’s Three-Branch Model. The main areas of investigation include eligibility requirements for participating in the examination, the alignment of qualification criteria with different managerial levels, the absence of a comprehensive assessment center, the role of relevant academic qualifications and specialized pre-appointment training, and the failure to require a proposed managerial plan as evidence of forward-looking capabilities. Methods: In terms of purpose, this research is applied; methodologically, it is a qualitative case study employing a descriptive-analytical approach. Data were collected through two complementary sources: an examination of the document specifying the examination eligibility requirements and information obtained from semi-structured interviews with participants. The findings were analyzed within the structural, behavioral, and contextual dimensions of Mirzaei Ahranjani’s Three-Branch Model. Relevant scientific literature on assessment centers, the validity of selection methods, health management competencies, managerial training, and scenario-based planning was also used to interpret the findings. Findings: Data analysis identified several structural factors, including insufficient differentiation between general and specific requirements for different managerial levels, the absence of a comprehensive assessment center, failure to request a proposed managerial plan, insufficient attention to relevant academic qualifications, and the lack of a clear link with pre-appointment training. Behavioral factors included excessive reliance on written examinations, conflation of managerial potential with readiness for appointment, and the possibility of subjective assessment. Contextual factors included the diversity of occupational roles within the organization, the complexity of hospital management at senior levels, and changes in the healthcare environment. Conclusion: The findings highlight the need to design an integrated system for identifying, assessing, developing, and appointing forward-looking managers. Such a system should distinguish general eligibility requirements from position-specific qualifications, employ multiple methods to assess competencies, evaluate academic qualifications and specialized training in accordance with managerial responsibilities, assess forward-looking managerial proposals, and link appointment decisions to reliable evidence of individual readiness. These reforms could contribute to strengthening meritocracy, accountability, and the effectiveness of health governance.