Abstract
BackgroundOrganizational 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.ObjectiveThe 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.MethodThis 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.ResultsTwenty 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.ConclusionsThe 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.
Highlights
Governments around the world are implementing health reforms, in order to cope with issues like rising costs, user dissatisfaction with services, and problems that are often associated with public hospitals such as technical and allocation inefficiencies, low productivity, non-accountability to patients, waste, fraud, and corruption [1]
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 hospitals were autonomous in theory, but various studies showed that this autonomy was limited by a variety of factors, including the appointment of the university chancellor as the chair of the board and the key decision making authority [18], the insignificant role of the other board members, the lack of a specific process for decision making, and the strong presence and political pressure of lobbyists and interest groups [24], absence of civil societies such as municipalities and governorates in board sessions [16], and centrally imposed constraints on human resource management by hospitals [21], and the government still maintains its authority in board of trustees (BT) hospitals
Summary
Governments around the world are implementing health reforms, in order to cope with issues like rising costs, user dissatisfaction with services, and problems that are often associated with public hospitals such as technical and allocation inefficiencies, low productivity, non-accountability to patients, waste, fraud, and corruption [1]. 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
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