Passive defense is a set of preventive, design-oriented, and managerial measures aimed at reducing vulnerability and ensuring the continuity of vital activities without the use of weapons. In hospitals, this approach is essential for resilience against disasters such as earthquakes, floods, fires, and cyberattacks. Its implementation including structural reinforcement, logistics planning, and staff training ensures the protection of patients and the continuity of medical services. This study was conducted to investigate the integrated levels of passive defense in metropolitan hospitals, focusing on the spatial-functional hierarchy, with a case study of Taleghani Hospital in Kermanshah. Employing a mixed-method research approach (qualitative and quantitative) and techniques such as fuzzy Delphi, interviews, and a researcher-developed questionnaire, four key dimensions (physical-spatial, functional-process, managerial-organizational, and human resources) were assessed. Data analysis was performed using SPSS and AMOS software, along with statistical tests including one-sample t-test, Pearson correlation, and confirmatory factor analysis. The findings revealed an unbalanced status of these dimensions in Taleghani Hospital. While the human resources and managerial-organizational dimensions, with high mean scores (4.15 and 3.5, respectively), were identified as system strengths, the physical-spatial dimension, with a low mean score (2.92), was recognized as the main weakness. Correlation analysis confirmed a very strong and significant relationship between all factors and the integrated levels of passive defense. The results emphasize the need for an integrated approach to all dimensions, prioritizing physical retrofitting and logistics strengthening alongside the preservation of human capital. The present study offers a testable and developable framework for enhancing the resilience of metropolitan hospitals.