Outsourcing in Iranian hospitals: Findings from a qualitative study

Developing decision model for the outsourcing of medical service delivery in the public hospitals

BACKGROUND

The decision to outsource an activity is one of the most complex organizational decisions. This decision is also influenced by several factors and components. In order to facilitate and optimize it, for the first time in this study, a decision model for outsourcing medical service delivery in public hospitals has been developed.

METHODS

We conducted this cross-sectional study in 3 stages: 1) We identified the factors affecting the outsourcing decisions, 2) an expert panel identified the influential factors. After standardization, we distributed 220 questionnaires among university staff managers and heads, nursing managers, and managers of the research units, and 3) Structural Equation Model applied to evaluate the relationship between the variables on AMOS22, at 0.05 significant level.

RESULTS

Findings indicated the optimal level of all fit indices. The path coefficient between all identified factors with the outsourcing decision was positive (t > 1.96). Factors ranging from the most effective to least effective included monitoring and control, service type, human resource, economic and financial, executive capability, external environment, and terms and conditions.

CONCLUSION

The proposed model provides unit evaluation to make the appropriate decision on outsourcing or non-outsourcing. Control and monitoring were the most determining factors. We recommend performing monitoring continuously as a guide and deterrent to error. We also recommend continuous monitoring and control over the quality of outsourced units and stakeholder satisfaction.

Outsourcing of healthcare services in a smart city of Eastern India

Purpose

Owing to the rising costs and shrinking budgets; inefficiency can be observed in the financing and delivery of health service both in the private and public sectors, which is not only causing organizations to reconsider their management patterns but also to use new strategies to achieve competitive merits in the current world of business. Outsourcing is one of the best alternates. The purpose of this paper is to study: the nature and magnitude of outsourcing of health-care services in a Smart City of Eastern India; the motives behind outsourcing: and the factors affecting outsourcing decisions.

Design/methodology/approach

The study was conducted in Bhubaneswar, a Smart City of Eastern India and capital of Odisha State. Data relating to the outsourcing of health-care services were collected from 40 hospitals (each having a minimum of 10 beds) through a structured schedule. Descriptive statistics were calculated through Statistical Package for Social Science to substantiate the objectives.

Findings

Most of the clinical services were outsourced by small hospitals, while a significant portion of non-clinical services were outsourced by large and medium hospitals. Reduction in cost and better management control were the major driving forces of outsourcing. Loss of control over service providers and quality of measurement were considered as the main disadvantages in the decision-making process of not outsourcing the services by hospitals.

Originality/value

The study is the first-ever survey based on empirical evidence about the state of facilities management services outsourced in public and private hospitals in Odisha, India. The paper concluded that the effect of outsourcing did not synchronize successfully as shown in international literature.

A model for key success factors for outsourcing in project-based companies: integrating soft and dynamic approaches

Purpose

The purpose of this study is to achieve the dynamic model of outsourcing success factors in project-based companies.

Design/methodology/approach

This study is descriptive-survey in terms of method and practical in terms of purpose. To achieve the dynamic model of outsourcing success, 1,000 outsourcing articles published in high-status journals from 2017 to 2019 were first text-mining. Then, using the clustering technique, the factors affecting the success of outsourcing were obtained. To achieve the key variables, the variables obtained by interpretive structural modeling (ISM) were then leveled. Then, the strategic options development and analysis (SODA) technique has been used to achieve a consensus and coordination on factors relationships. Finally, the dynamic model of outsourcing success in GHODRAT CONTROL PARS Company has been modeled and implemented.

Findings

In total, five clusters and nine factors were extracted (strategy, management, performance, market, R&D, supplier, product, organizational data and outsourcing findings). In central and domain analysis, two factors, “Strategy” and “R and D,” were recognized as factors that have the most interaction and centrality. The result of the dynamic model indicate that the organization will significantly reduce the construction time of the power plant by improving the “R and D” factor.

Originality/value

In this study, various techniques have been combined. Therefore, one of the aspects of innovation in the present study is the combination of methods that have not been used earlier. The second aspect of this study’s innovation is using SODA technique to design the dynamic model of outsourcing success factors. Given that the scope of this study is the component affecting the success of outsourcing, so extensive research has been conducted in the field of articles worked in the field of outsourcing to get a comprehensive view of the components affecting the success of outsourcing, which has not been reviewed in other articles. In this study, in addition to identifying the effective factors, their identified and also how these variables affect the successful performance of outsourcing in the form of a dynamic model, and then analyzed.

Developing competent public hospital managers: a qualitative study from Iran

Purpose

Hospitals need highly trained and competent managers to be responsible for the strategic development, overall operation and service provision. The identification and confirmation of core management competency requirements is a fundamental first step towards developing the competent management workforce for sustainable hospital service provision. This paper reports on the finding of a recent study focusing on identifying managerial competencies required by middle and senior-level managers in the public hospitals in Iran.

Design/methodology/approach

The qualitative research design included position description analysis and focus group discussions with middle and senior-level public hospital managers in Iran. When analysing the identified knowledge, skills and attitudes, the validated MCAP framework was used to guide the grouping of them into associating management competencies.

Findings

The study identified 11 to 13 key tasks required by middle and senior-level managers and confirmed that the position descriptions used by current Iranian hospitals might not truly reflect the actual core responsibilities of the management positions. The study also confirmed seven core managerial competencies required to perform these tasks effectively. These core competencies included evidence-informed decision-making; operations, administration and resource management; knowledge of healthcare environment and the organisation; interpersonal, communication qualities and relationship management; leading people and organisation; enabling and managing change and professionalism.

Research limitations/implications

Competencies were identified based on managers' perceptions. Views and experiences of other stakeholders were not captured.

Practical implications

The seven core management competency identified in the current study provides a clear direction of competency development among senior and middle-level managers working at the Iranian public hospitals. The study also confirms that position descriptions do not reflect the actual responsibilities of current hospital managers, which are in need to urgent review.

Originality/value

This is the first study that has identified the core managerial competencies required by middle and senior-level hospital managers in Iran.

Is it worth outsourcing essential public health services in China?-Evidence from Beilin District of Xi'an

BACKGROUND

Essential public health services (EPHS) is general welfare public health interventions led by the Chinese government and provided by the primary medical institutions to all residents. In Beilin District, Xi'an, EPHS producers can be divided into outsourced institutions and public institutions.

OBJECTIVE

Can outsourcing EPHS reduce costs and improve efficiency and quality? There is still no definite answer to this question. This paper compares the performance of outsourced institutions and public institutions in terms of efficiency and quality, explains the reasons for this phenomenon.

METHODS

This paper uses a theoretical and two-stage DEA model Based on a "triple subject" research framework.

RESULTS

The results show that the difference between public institutions and outsourced institutions is mainly reflected in service quality. When the quality is not measured, outsourced institutions' production efficiency is higher than that of public institutions. When there are quality measurements, the production efficiency of outsourced institutions is lower than that of public institutions.

CONCLUSIONS

Outsourced institutions perform worse than public institutions. The reason is that a bilateral monopolistic market structure has formed between local governments and outsourced institutions. This situation makes it difficult for the government to replace poor quality outsourced institutions under the constraints of a limited budget.

Attitudes Towards Accreditation and Quality Improvement Activities Among Hospital Employees in Iran: A Quantitative Study

Purpose

The hospital accreditation system in Iran is relatively young, having been introduced in 2012. Therefore, there is a real need for research on the status and impact of hospital accreditation in Iran. The purpose of this study was to evaluate and compare attitudes towards accreditation and quality improvement activities among hospital employees, specifically the attitudes towards the impact of accreditation on the quality of healthcare and its benefits in Iran.

Materials and Methods

A cross-sectional survey was carried out at 23 teaching hospitals in three metropolises in Iran, all of which successfully passed national accreditation surveys. Some 1213 hospital managers, administrative staff, nurses, and para-clinical staff participated in the survey. The main outcome measures were quality results, and the activities related to quality improvement include senior managers' commitment and support, strategic quality planning, education and training, rewards and recognition, quality management, use of data, the involvement of professionals in accreditation, and accreditation benefits. The questionnaire was applied using a 5-point Likert scale ranging from 1 “strongly disagree” to 5 “strongly agree”. One-way analysis of variance (ANOVA) was used to compare mean values between respondent groups.

Results

Among nurses and managers, there was low support for accreditation and even less among para-clinical staff who fail to see accreditation having a positive impact on healthcare quality. Also, nurses' attitudes toward the accreditation benefits were more positive compared with the two other groups. Staff stated that the main reasons for low support were a lack of education and training to act upon the accreditation survey results and a lack of management visibility and support for quality improvement.

Conclusion

Improving quality through means of hospital accreditation is a complex process with high demands for management and employees. Questionnaires on employees’ attitudes and perceptions of the impact of accreditation and quality improvement-related activities in the hospitals can provide valuable information on the current problems of a hospital accreditation program.

Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis

OBJECTIVE

Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method.

METHODS

A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework.

RESULTS

Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism.

CONCLUSION

This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

Challenges of implementation of hospital accreditation in Iran: an exploratory factor analysis

BACKGROUND

Today, accreditation is considered as the most commonly used health assessment approach. Considering the importance and application of the process of this approach in the hospital, this study aimed to investigate the challenges of implementation of hospital accreditation in Iran using exploratory factor analysis.

METHODS

A cross-sectional study design was carried out from July to December 2017, consisting of 200 managers in the seven hospitals accredited by the MOH in Tehran, Iran. Samples were selected through the purposive sampling method, and data were collected using a structured questionnaire in which validity and reliability were confirmed. Likert's five-choice range was used for the rating of items. Exploratory factor analysis was used to categorize the identified challenges and extract the mathematical model on them.

RESULTS

Exploratory factor analysis identified six dimensions (implementation, evaluation, content, structural, psychological, and managerial) with 40 items using a 5-point Likert scale. Each dimension accounted for greater than 63.20% of the total variance. The scale had strong content validity (indices = 0.84). Each dimension of Cronbach's alpha ranged from 0.74 to 0.94. Implementation, evaluation, content, structural, psychological, and managerial components also formed the final identified areas.

CONCLUSION

The present study showed that there were major challenges in the path to successful deployment of Iranian hospital accreditation, requiring serious action by managers and policymakers in this field.

Developing a Model for Accreditation of Iranian Teaching Hospitals: A Qualitative Study

BACKGROUND

Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran.

METHODS

This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method.

RESULTS

Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71.

CONCLUSION

This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.

Hospital performance and clinical leadership: new evidence from Iran

Purpose

There is growing interest in the potential need for clinical involvement in leadership and management of hospitals. Most studies of clinical leadership use US and European data. This paper contributes the first evidence for the country of Iran. It examines three different forms of hospital system: public, private and social security organisation, and these include teaching and non-teaching hospitals. This study adds to a small but growing literature that examines the possible value of ‘expert’ clinical leaders.

Method

This study uses data from 72 general hospitals in the city of Tehran. The data were collected for years 2015 and 2016. Data Envelopment Analysis is used to assess hospital performance. Hospitals’ chief operating officers are divided into two groups: clinicians, the majority of whom are physicians (doctors), and non-medically trained managers.

Findings

The average performance scores for hospitals with clinical managers and non-clinically trained managers are equal to 96.68±5.50 and 89.78±7.20, respectively (p<0.001). Performance is thus higher under clinical managers. Outcome differences are observed in each of the three types of ownership and in teaching and non-teaching hospitals. The advantage in performance-score varies, when comparing the clinically led institutions and managerially led institutions, by between 5 and 10 points on a 0–100 scale. These differences remain after regression-equation adjustment for other influences.

Practical implications

Succession planning and targeted leadership development is made more efficient with greater awareness about the kinds of leaders and managers that enhance organisational performance.