Document Type : Original Article
Authors
Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Abstract
INTRODUCTION: Outsourcing, as one of the important managerial strategies to improve performance,
has become one of the main areas of research in hospital management studies. The aim of this
study was to identify the challenges of outsourcing hospital services in Iran.
METHODS: This research was conducted in a qualitative manner with the aim of determining the
challenges of outsourcing hospital services in Iran. The research community consisted of managers
and experts in the field of outsourcing. 21 managers and staff experts of the Ministry of Health,
universities, and hospitals affiliated to Iran University of Medical Sciences, Tehran, and Shahid
Beheshti, were selected as the target for the interview. Finally, the data were analyzed using content
analysis method.
RESULTS: Outsourcing challenges were extracted and reported in the form of 6 theme topics and
40 subthemes. The main issues included legal and political challenges, finance, human resources,
organizational, managerial, and private sector.
CONCLUSION: Outsourcing hospital services in all six areas faced serious challenges. To this
end, partnership between the private and government sectors through outsourcing requires the
continuous development of effective political, organizational, and managerial capacity in order to
guide and manage this process properly and efficiently to ensure that the goals and policies in the
field of health. It is clearly understood and not forgotten or neglected.
Keywords
- Mosadeghrad AM, Shahebrahimi SS, Ghazanfari M. Exploring
the relationship between accreditation and hospital performance:
Using data mining approach. SJSPH 2018;16:33‑50.
2. Asadi Piri Z, Bavi S, Bajoulvand R, Nouraei Motlagh S,
Imani Nasab M, Asadi H, et al. Models of “public‑private
partnership” and their effects on hospital mid‑indicators: A critical review. J Health Adm 2019;21:89‑105.
3. Abbasi Rostami J, Mahmoudi G, Nikpour B, Khademloo M.
Performance evaluation of hospitals inductee and non‑inductee
health Evolution projection by Baldrige Excellence Model in
Mazandaran. J Health Breeze 2017;5:16‑25.
4. Shaarbafchizadeh N, Rezayatmand MR, Etemadi G. The impact
of public‑private partnerships on hospital Performance: A review
study. Manage Strat Health Syst 2019;4:265‑76.
5. World Health Organization. The World Health Report 2000:
Health Systems: Improving Performance. Switzerland, Geneva:
World Health Organization; 2000. Available from: https://www.
who.int/whr/2000/en/. [Last accessed on 2020 May 31].
6. Sadeghi A, Bastani P, Jafari H, Barati O. Implementation of
public‑private partnerships in development of hospital service
from the viewpoint of public and non‑public managers in Shiraz.
Tolooebehdasht 2019;18:24‑45.
7. Tabibi S, Kakhani M, Ehsani Chimeh E. An evaluation of the
outsourcing strategy in supportive services in the hospitals
affiliated to the Ministry of Health and Medical Education.
J Health Adm 2008;10:59‑66.
8. Tourani S, Maleki M, Ghodosi‑Moghadam S, Gohari MR.
Efficiency and effectiveness of the Firoozgar teaching hospital’s
pharmacy after outsourcing, Tehran, Iran. J Health Adm
2009;38:59‑71.
9. Mousazadeh Y, Jabaribeirami H, Janati A, Asghari Jafarabadi M.
Identifying and prioritizing hospital’s units for outsourcing based
on related indicators: A qualitative study. J Health 2012;4:122‑33.
10. Hsiao CT, Pai JY, Chiu H. The study on the outsourcing of
Taiwan’s hospitals. BMC Health Serv Res 2009;4:5‑6.
11. International Association of Outsourcing Professionals. The
Global Outsourcing 100. International Association of Outsourcing
Professionals; 2011. Available from: https://www.iaop.org/
content/19/165/2040/. [Last accessed on 20111 Oct 25].
12. Kurdi MK, Abdul‑Tharim AH, Jaffar N, Azli MS, Shuib MN,
Ab‑Wahid AM. Outsourcing in facilities management – A
literature review. Procedia Eng 2011;20:445‑57. [doi: 10.1016/j.
proeng.2011.11.187].
13. Ferdosi M, Farahabadi SM, Mofid M, Rejalian F, Haghighat M,
Naghdi P. Evaluating the outsourcing of nursing services in
Kashani Hospital, Isfahan, Iran. Health Inf Manage 2013;9:989‑96.
14. Tribble DA, Kastango ES. Key considerable in pharmacy
outsourcing: Understands risks and managing liability. Hosp
Pharma 2012;47:112‑7.
15. Towers K. Outsourcing NHS pharmacy services: Good or
bad idea? Pharma J 2015;3:199. Available from: https://
www.pharmaceutical‑journal.com/news‑and‑analysis/
outsourceing‑nhs‑pharmacy‑services‑good‑or badidea/11080250.
article?firstPass=false. [Last accessed on 2020 May 31].
16. Barati O, Dehghan H, Yusefi A, Najibi M. A study of the status
before and after outsourced pharmacies of Shiraz University of
medical sciences: A case report, Journal of Rafsanjan University
of Medical Sciences. 2017;16(7):691‑700.
17. Piachaud BS. Outsourcing in the pharmaceutical manufacturing
process: An examination of the CRO experience. Technovation
2002;22:81‑90.
18. Alizadeh Z, Torabipour A. The obstacles of outsourcing in
educational hospitals: A qualitative study. J Qual Res Health Sci
2018;7:230‑9.
19. KennedyFJ, HoltDT, WardM, RehgMT. The Influence of Outsourcing
on Job Satisfaction and Turnover Intentions of Technical Managers;
March, 2002. Available from: https://www.semanticscholar.
org/paper/The‑Influence‑of‑Outsourcing‑on‑Job Satisfactionof‑Kennedy‑Holt/bd4c9686d3b16cd5f39c475fe6b084fe0fecd43e.
[Last accessed on 2020 May 31].
20. Tabibi SJ, Maleki MR, Nasiripour AA, Barzegar M. Comparative
study of public‑private Partnership in hospitals of Iran and other
selected countries. Indian J Fund Appl Life Sci 2015;5:1589‑97.
21. Ravaghi H, Salari Hamzehkhani M, Aryankhesal A. designing a
tool for evaluation of the outsourcing process in laboratories of
non‑educational hospital. Health Dev J 2019;7:353‑67.
22. Joudaki H, Heidari M, Geraili B. Outsourcing of hospitals services:
Lessons learned from the experience. HBRJ 2015;1:13‑23.
23. Avery G. Outsourcing public health laboratory services:
A blueprint for determining whether to privatize and how. Public
Adm Rev 2000;60:330‑7.
24. Gaspareniene L, Vasauskaite J. Analysis of the criterions of
outsourcing contracts in public and private sectors: Review of
the scientific literature. Procedia Soc Behav Sci 2014;156:274‑9.
25. Barrows D, MacDonald HI, Supapol AB, Dalton‑Jez O,
Harvey‑Rioux S. Public‑private partnerships in Canadian health
care: A case study of the Brampton Civic Hospital. OECD J
Budgeting 2012;12:1‑14.
26. Beyene TT. Factors for implementing public‑private partnership
in the development process: Stakeholders’ perspective from
Ethiopia. Int J Sci Res 2014;3:792‑7. Available from: https://www.
ijsr.net/archive/v3i3/MDIwMTMxMzIw.pdf. [Last assessed on
2020 May 31].
27. Alinaitwe H, Ayesiga R. Success factors for the implementation
of public‑private partnerships in the construction industry in
Uganda. J Constr Dev Countries 2013;18:1‑14. Available from:
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&sc
iodt=0%2C5&cites=6865719520349987977&scipsc=&q=Success
+factors+for+the+Implementation+of+Public‑private+Partners
hips+in+the+Construction+industry+in+Uganda&btnG=. [Last
assessed on 2020 May 31].
28. Banzon Eduardo P, Lucero JA, Ho BL, Puyat ME, Factor PA,
Young J. Assessing the Feasibility of Public‑Private Partnerships in
Health in the Philippines, Discussion Papers. 2014‑49. Philippine
Institute for Development Studies. Handle: RePEc: phd: dpaper:
dp_2014‑49.
29. Rasi V, Doosty F, Reihani Yasavoli A. The challenges of
outsourcing health services to the private sector from the
viewpoint of employees of Mashhad University of medical
sciences: A qualitative study. Tamin e Ejtemaie Soc Secur Q
2016;14:117‑34.
30. Saharkhiz H, Anoosheh M. Assessing the obstacles of outsourcing
in nursing. IJNV 2015;4:28‑35.
31. Bakker AB, Killmer CH, Siegrist J, Schaufeil WB. Effort‑reward
imbalance and burnout among nurses. J Adv Nurs 2000;31:884‑91.
32. Mashkoori A, Rahbar A, Kohpaei A, Samei Bonab K,
Chamanparvar Haghighi N. 9” national congress of occupational
health and safety. Yazd Univer Med Sci 2015;9:10‑1.
33. Gates DM, Smolarek RT, Stevenson JG. Outsourcing the
preparation of parenteral nutrient solutions. Am J Health Syst
Pharm 1996;53:2176‑8.
34. Bagheri M, Ebrahimi A, Kiani M. Design factors influencing model
in services outsourcing decision making. J Manage Improvement
2015;9:137‑66.
35. Asoshe A, Divandari A, Karami A, Yazdani H. Identifying
critical success factors is risk management of information systems
outsourcing projects in Iranian commercial banks. JITM J 2009;1:3‑18.
36. Bryson JM. Strategic Planning for Public and Non‑profit
Organizations: A Guide to Strengthening and Sustaining
Organizational Achievement. 3rd ed. Minneapolis, United State.
Wiley;2004. p. 1‑368.
37. Saeidpour J, Faridfar N, Ghaziasgar M. Factors affecting the
implementation of outsourcing in Tehran University of medical
sciences hospitals: Hospital administrators’ vision. Payavard
2019;13:142‑50.
38. Kavousi Z, Setoudehzade F, Kharazmi E, Khabiri R, Ravangard R,
Rahimi H. The level of propensity to outsource study: Based on
hospital services features by managers and staff perspective
in hospitals of Shiraz University of medical sciences. JHOSP
2011;11:10‑7. - 39. McIntosh N, Grabowski A, Jack B, Nkabane‑Nkholonqo EL,
Vian T. A Public‑private partnership improves clinical
performance in a hospital network in Lesotho. Health Aff
2015;34:954‑62.
40. Batta J. Factors Driving Outsourcing in the Public Sector.
A Dissertation Presented to the Graduate Faculty of the School
of Management Alliant International University; 2011. p. 18.
41. Jutting J, editor. Public‑Private‑Partnership and Social Protection
in Developing Countries: The Case of the Health Sector.
Paper Presented at the ILO Workshop on “The Extension of
Social Protection; Working Paper; 2002. p. 6. Available from:
https://www.researchgate.net/publication/228917813_
Public‑Private‑Partnership_and_Social_Protection_in_
Developing_Countries_The_Case_of_the_Health_Sector. [Last
assessed on 2020 May 31].
42. Tabibi SJ, Maleki MR, Nasiripour AA, Barzegar M.
Comparative study of public‑private Partnership in hospitals
of Iran and other selected countries. Indian J Fundam
Applied Life Sci 2015;5:1589‑97.
43. Salmani MR, Rashidian A, Abolhassani F, MajdzadehR. Assessing
experiences of outsourcing urban health posts: Facilities and
services offered in publicly owned and outsourced health posts
in Tehran University of Medical Sciences. Hakim Health Syst Res
2013;16:28‑34.
44. Vatankhah S, Maleki MR, Tofighi SH, Barati O, Rafiei S. The study
of management contract conditions in healthcare organizations
of selected countries. Health Inf Manage 2012;9:43‑9.
45. Wind KL. Methodology for the management of outsourced
outpatient services within the NHS pharmacy service. Eur J Hosp
Pharm 2017;24:170‑4.
46. Moschuris SJ, Kondylis MN. Outsourcing in governmental
hospitals: A Greek perspective. J Health Organ Manage
2006;20:4‑14.
47. Rezaee R, Zare S, Shirdel M. Identification and Prioritization risks
of health information technology services outsourcing: A Fuzzy
Analytical Hierarchy Process. Health Inf Manage 2017;14:167‑73.