Hospitals are facing many environmental changes and to provide better services to the community, the need for strategic management in the hospital is inevitable. Therefore, the present study investigates and identifies barriers to the creation, establishment, and growth of strategy in hospitals in Qom province. The present study is descriptive in terms of applied purpose and in terms of data collection. The statistical population of the study included hospital managers and university experts specializing in the field of research. Two separate questionnaires were used to collect the required data. The first questionnaire was completed by ten experts in the field of the present study. Then, Delphi method was used to identify obstacles and BWM method was used to determine the weights of obstacles and prioritize them. Based on the results of fuzzy Delphi method, among the obstacles derived from the theoretical texts of the research, six obstacles to strategy development, nine obstacles to strategy establishment and six obstacles to strategy growth were identified in hospitals of Qom province. Then, in the last step, the priority of obstacles in each of the three stages of creating, establishing, and developing the strategy was determined. Based on prioritization through BWM method, management and leadership in strategy creation, lack of appropriate organizational culture in strategy implementation and lack of proper training in strategy development were identified as the most important obstacles. The findings showed that the role of top management or leadership from the creation to the growth of strategies is very vital and the lack of support of top managers can create many obstacles in the creation, establishment, and growth of strategy in hospitals in Qom province.