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

  1. 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.
  2. 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.