Rahim Sohrabi1,2, Sogand Tourani3, Mehdi Jafari3, Hossein Joudaki4, Leila Doshmangir5, Javad Moghri6, Nicola Luigi Bragazzi7. 1. Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. sohrabi.rah@iums.ac.ir. 2. Iranian Social Security Organization, Zanjan Province Health Administration, Zanjan, Iran. sohrabi.rah@iums.ac.ir. 3. Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. 4. Department of Health Economics and Planning, Iranian Social Security Organization, Tehran, Iran. 5. Department of Health Policy & Management, Tabriz Health Services Management, School of Management & Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. 6. Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 7. School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Abstract
BACKGROUND: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals. OBJECTIVE: The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies. METHOD: This review's methodology was inspired by Arksey and O'Malley's methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020. RESULTS: Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study's objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature. CONCLUSIONS: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results.
BACKGROUND: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals. OBJECTIVE: The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies. METHOD: This review's methodology was inspired by Arksey and O'Malley's methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020. RESULTS: Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study's objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature. CONCLUSIONS: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results.
Entities:
Keywords:
Board of trustees; Governance; Health policy; Hospital; Iran; Organizational reform
Authors: Jafar Sadegh Tabrizi; Elaheh HaghGoshayie; Leila Doshmangir; Mahmood Yousefi Journal: Prim Health Care Res Dev Date: 2018-01-09 Impact factor: 1.458
Authors: Micah D J Peters; Christina M Godfrey; Hanan Khalil; Patricia McInerney; Deborah Parker; Cassia Baldini Soares Journal: Int J Evid Based Healthc Date: 2015-09