Tue, Nov 19, 2019
Volume 18, Issue 1 (January-February 2019)                   Payesh 2019, 18(1): 7-21 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Mosadeghrad A M, Esfahani P, Afshari M. Strategies to improve hospital efficiency in Iran: A scoping review. Payesh. 2019; 18 (1) :7-21
URL: http://payeshjournal.ir/article-1-998-en.html
1- School of Public Health, Tehran University of Medical Sciences, Iran
2- School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
3- Maragheh University of Medical Science, Maragheh, Iran
Abstract:   (1145 Views)
Objective (s): Iran hospitals suffer from inefficiency. Thus, managers should take necessary actions to improve hospitals’ efficiency. The purpose of this study was to provide a comprehensive overview of relevant research regarding hospital efficiency strategies in Iran and to identify the gaps in the literature to inform future studies.
Methods: The six-stage scoping review framework developed by Arksey and O'Malley was followed. Seven electronic databases and two search engines were examined using appropriate key words to find documents published on hospital efficiency in Iran between March 1997 and October 2017. Bibliography section of the retrieved papers and related journals were also searched for papers that were not yet indexed. A total of 1395 publications were identified, of which 123 publications met inclusion criteria and were reviewed. Data was analyzed using MAXQDA software.
Results: The most studies on hospital efficiency strategies were conducted in Tehran, Isfahan and Khuzestan provinces. Forty-one strategies for improving hospital efficiency were found and were clustered into four categories: Meta (Ministry of Health), Macro (university), Mezo (hospital) and Micro (provider). The most frequently mentioned strategies to improve hospital efficiency were quality management, need-based hospital beds allocation, preventing unnecessary hospital beds expansion, economic assessment of hospital performance and providing feedback to managers, appropriate distribution of beds among hospitals and participative management.
Conclusion: Policymakers and managers should take necessary coordinated actions at Meta, Macro, Meso and Micro levels to achieve sustained desirable outcomes.
Full-Text [PDF 836 kb]   (856 Downloads)    
Type of Study: Research | Subject: Medical
Accepted: 2019/03/18 | ePublished ahead of print: 2019/04/7 | Published: 2019/04/16

1. Potrafke N. The growth of public health expenditures in OECD countries: do government ideology and electoral motives matter? Journal of health economics 2010; 29:797-810 [DOI:10.1016/j.jhealeco.2010.07.008]
2. World Health Organization. World health statistics 2018: Monitoring health for the SDGs, sustainable development goals. 1st Edition, World Health Organization, 2018
3. Rechel B, Wright S, & Edwards N. Investing in hospitals of the future. 1st Edition, WHO Regional Office Europe, 2009
4. Barnum H, Kutzin J. Public hospitals in developing countries: resource use, cost, financing. 1st Edition Baltimore: Johns Hopkins University Press: Uk, 1993
5. Mosadeghrad AM. Essentials of healthcare organization and management. 1st Edition, Dibagran Tehran: Tehran, 2015 [in Persian]
6. Mosadeghrad AM. Patient choice of a hospital: Implications for health policy and management, International Journal of Health Care Quality Assurance 2014; 27: 152-164 [DOI:10.1108/IJHCQA-11-2012-0119]
7. Mosadeghrad AM. A conceptual framework for quality of care. Materia Socio-Medica 2012; 24: 251-261 [DOI:10.5455/msm.2012.24.251-261]
8. Deily ME, McKay NL. Cost inefficiency and mortality rates in Florida hospitals. Health economics, 2006; 15:419-431 [DOI:10.1002/hec.1078]
9. McKay NL, Deily ME (2008) Cost inefficiency and hospital health outcomes. Health economics, 2008;17:833-848 [DOI:10.1002/hec.1299]
10. Clement JPVV, Bazzoli GJ, Zhao M, Chukmaitov A. Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion Health care management science 2008;11:67-77 [DOI:10.1007/s10729-007-9025-8]
11. Chisholm D, Evans DB. Improving health system efficiency as a means of moving towards universal coverage. World health report. 2010:2-10. Available at: http://digicollection.org/hss/documents/s18310en/s18310en.pdf
12. Etienne C, Asamoa-Baah A, Evans DB. Health systems financing: the path to universal coverage. 1st Edition, World Health Organization; 2010
13. Mosadeghrad, A.M. Handbook of hospital professional organization and management (2), 1st Edition, Tehran: Dibagran Tehran: Iran, 2004: [Persian]
14. Huerta TR, Harle CA, Ford EW, Diana ML, & Menachemi N. Measuring patient satisfaction's relationship to hospital cost efficiency: Can administrators make a difference? Health Care Management Review 2016; 41:56-63 [DOI:10.1097/HMR.0000000000000045]
15. Stanowski A, Simpson R, & White A. Pay for performance: Are hospitals becoming more efficient in improving their patient experience? Journal of Healthcare Management 2015; 60:268-85 [DOI:10.1097/00115514-201507000-00008]
16. Mosadeghrad AM, Esfahani P, Nikafshar M. Hospitals' efficiency in Iran: A Systematic Review and Meta-Analysis of Two Decades of Research, 2017; 11: 318-31 [in Persian]
17. Mosadeghrad AM, Dehnavi H. Evaluation of hospital performance in Iran: A systematic review and meta-analysis.Payesh 2018; 17:603-615 [in Persian]
18. Mosadeghrad, A.M. Health transformation plan in Iran. in J. Braithwaite, W. James, & K. Ludlow (Eds.) Health Systems Improvement across the Globe: Success Stories from 70 Countries, Taylor & Francis. 2017: 309-316 [DOI:10.1201/9781315586359-46]
19. Mosadeghrad AM, Afshari M, Nasrolahi R, Daneshgar S, Corani Bahador R. The impact of health transformation plan on deductions imposed on Imam Khomeini Hospital's bills. Journal of Hospital 2018; 17: 71-79 [in Persian]
20. Nejati zarnaqi B, Mohammad Ebrahimi H, khalilifar O, Shahraki S. An investigation of organizational structure in selected hospitals of tehran and its relationship with hospital performance indicators. EBNESINA- Journal of Medical. 2016;18:40-7 [in Persian]
21. Salehzadeh R, Ketabi S. Measuring the efficiency of Qom hospitals with data envelopment analysis and analytic hierarchy process. Health Information Management 2011;8:489 [in Persian]
22. Bastani P, Lotfi F, Moradi M, Ahmadzadeh M. The performance analysis of teaching hospitals affiliated with shiraz university of medical sciences before and after health system reform plan using pabon lasso model. Journal of Rafsanjan University of Medical Sciences 2016;15:781-792[in Persian]
23. Mosadeghrad AM, Ashrafi E. The effect of quality management on the efficiency of the respiratory intensive care unit in a hospital. Journal of School of Public Health and Institute of Public Health Research. 2018; 15: 303-314 [in Persian]
24. Karimi S, sajadi H, karami M, torkzad L, Bidram R. Efficiency estimation in general hospitals of Isfahan University of Medical Sciences during 2005-2006 by Data Envelopment Analysis. Journal of Health Administration 2009; 12:39-46 [in Persian]
25. Askari R, Goudarzi R, Fallahzadeh H, Zarei B, Dehqani Tafti A. Efficiency appraisal of Yazd University Of Medical Science hospitals by quantitative approach Data Envelopment Analysis (DEA). Payavard 2012; 6:215-224 [in Persian]
26. Mosadeghrad AM. Implementing strategic collaborative quality management in healthcare sector. International journal of health policy and management 2012; 4: 203-228 [DOI:10.1504/IJSCM.2012.051846]
27. Mosadeghrad AM. The role of participative management (suggestion system) in hospital effectiveness and efficiency. Research in Medical Sciences 2003; 8: 85-9 [in Persian]
28. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015;13:141-6 [DOI:10.1097/XEB.0000000000000050]
29. Arksey H, O'Malley L. Scoping studies: towards a methodological frameworkInternational Journal of Social Research Methodology 2005;8: 19-32 [DOI:10.1080/1364557032000119616]
30. Khalesi, N. and M. Mikelani, A Study of Hospital Management Performance at Isfahan Alzahra Hospital as Compared with Standard Indexes. Journal of Health Administration 2001; 4: 12-20 [in Persian]
31. Taleb-Shahrestani MA. Performamce appraisal of Iran country hospitals using bed occupancy rate, patient average length of stay and bed turnover rate and Pabon Lasso theory Feiz 1999; 3: 2-4 [in Persian]
32. De Vos P, Ordunez-García P, Santos-Pena M, Van der Stuyft. Public hospital management in times of crisis: Lessons learned from Cienfuegos, Cuba (1996-2008). Health Policy2010; 96: 64-71 [DOI:10.1016/j.healthpol.2010.01.005]
33. Available at:http://avab.behdasht.gov.ir/rbp2/Rbp2/default/Default_body.asp. [Accessed 18 February 2019]
34. Kroneman M, Siegers JJ. The effect of hospital bed reduction on the use of beds: a comparative study of 10 European countries. Social science & medicine. 2004 1;59:1731-40 [DOI:10.1016/j.socscimed.2004.01.036]
35. Hensher M, Edwards N, Stokes R. International trends in the provision and utilization of hospital care. British Medical Journal. 1999;319:845-8 [DOI:10.1136/bmj.319.7213.845]
36. Wilson DM, Truman CD. Does the availability of hospital beds affect utilization patterns? The case of end-of-life care. Health Services Management Research 2001; 14:229-239 [DOI:10.1177/095148480101400403]
37. Sheps SB, Reid RJ, Barer ML, Krueger H, McGrail KM, Green B, Evans RG, Hertzman C: Hospital downsizing and trends in health care use among elderly people in British Columbia. Canadian Medical Association Journal 2000; 163:397-401
38. Da Silva EN, Powell-Jackson T. Does expanding primary healthcare improve hospital efficiency? Evidence from a panel analysis of avoidable hospitalisations in 5506 municipalities in Brazil, 2000-2014. BMJ global health 2017;2: 242 [DOI:10.1136/bmjgh-2016-000242]
39. Rosano A, Loha CA, Falvo R, Van der Zee J, Ricciardi W, Guasticchi G, De Belvis AG. The relationship between avoidable hospitalization and accessibility to primary care: a systematic review. The European Journal of Public Health 2012; 29;23:356-60 [DOI:10.1093/eurpub/cks053]
40. Landi F, Gambassi G, Pola R, Tabaccanti S, Cavinato T, Carbonin P, Bernabei R. Impact of integrated home care services on hospital use. Journal of the American Geriatrics Society 1999 47:1430-4 [DOI:10.1111/j.1532-5415.1999.tb01562.x]
41. Al-Amin M, Makarem SC, Rosko M. Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings. Health care management review 2016, 41: 296-305 [DOI:10.1097/HMR.0000000000000076]
42. Liu X, Liu Y, Chen N. The Chinese experience of hospital price regulation. Health Policy and Planning. 2000;15:157-63 [DOI:10.1093/heapol/15.2.157]
43. Mao JW. The operation status of 3000 general hospitals in 1994. Chinese Hospital Management1995;5: 5-9
44. Dai D. A review of the health care reform. Chinese Health Economics1993;2: 26-8
45. Chen WX. 1995. The development tendency of the Chinese pharmaceutical market. Chinese Pharmacy 1995; 4: 2-3 [DOI:10.1057/9780230375505_1]
46. Louis D, Yuen E.J, BragaM. et al. (1999). Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy. Health Services Research 1991; 34: 405-15
47. Hensen P, Beissert S, Bruckner-Tuderman L, Luger TA, Roeder N, Müller ML (2008) Introduction of diagnosis related groups in Germany: evaluation of impact on inpatient care in a dermatological setting. European journal of public health [DOI:10.1093/eurpub/ckm059]
48. Coulam RF, Gaumer GL. Medicare's prospective payment system: a critical appraisal. Health Care Financing Review 1991:13:45-77
49. Busse R, Geissler A, Aaviksoo A, Cots F, Häkkinen U, Kobel C, Mateus C, Or Z, O'Reilly J, Serdén L, Street A. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals? British Medical Journal 2013;346:3197 [DOI:10.1136/bmj.f3197]
50. Rosenthal MB, Frank RG. What is the empirical basis for paying for quality in health care? Medical Care Research and Review 2006;63:135-157 [DOI:10.1177/1077558705285291]
51. Das S, Yaylacicegi U, & Menon N. M. (2011). The effect of information technology investments in healthcare: A longitudinal study of its lag, duration, and economic value. IEEE Transactions on Engineering Management 201; 58: 67-86 [DOI:10.1109/TEM.2010.2048906]
52. Jones, S. S., Rudin, R. S., Perry, T., & Shekelle, P. G. (2014). Health information technology: An updated systematic review with a focus on meaningful use. Annual Internal Medicine 2014; 160: 48-54 [DOI:10.7326/M13-1531]
53. London JD. The promises and perils of hospital autonomy Reform by decree in Viet Nam. Social Science & Medicine 2013; 96: 232-240 [DOI:10.1016/j.socscimed.2013.07.009]
54. Mosadeghrad AM. The impact of employee suggestion scheme on hospital effectiveness & efficiency. Research in Medical Sciences 2003; 8: 85-89 [in Persian]
55. Zahiri M, Abedi GH, EbadiAzar F. Asurvey on the effect of quality improvement teams (QIT) in the hospital efficiency. Health Sciences Journal 2010; 2:75-84 [in Persian]
56. Mosadeghrad AM. The role of participative management in outpatients' waiting time, visit time and satisfaction at Razi hospital, Hakim 2004; 7: 14-23 [in Persian]
57. Mosadeghrad AM. Developing and validating a total quality management model for healthcare organizations", The TQM Journal 2015; 27: 544 -564 [DOI:10.1108/TQM-04-2013-0051]
58. Mosadeghrad AM. Verification of a quality management theory: Using a Delphi study. International Journal of Health Policy and Management 2013; 1: 261-271 [DOI:10.15171/ijhpm.2013.55]
59. Mosadeghrad, AM. Implementing strategic collaborative quality management in healthcare sector. International Journal of Strategic Change Management 2012; 4: 203-228 [DOI:10.1504/IJSCM.2012.051846]
60. Mosadeghrad AM, Ashrafi E. The effect of quality management on the efficiency of the respiratory intensive care unit in a hospital. Journal of School of Public Health and Institute of Public Health Research 2018; 15: 303-314 [in Persian]
61. Joosten T, Bongers I, Janssen R. Application of lean thinking to health care: Issues and observations. International Journal for Quality in Health Care 2009; 21: 341-347 [DOI:10.1093/intqhc/mzp036]
62. Niemeijer GC, Trip A, de Jong LJ, Wendt KW, Does RJ. Impact of 5 years of Lean six sigma in a university medical center. Quality Management in Healthcare 2012; 21: 262-268 [DOI:10.1097/QMH.0b013e31826e74b7]
63. Tabibi J, Ghafari F, Mosalanejad F. The impact of removing hospital stores on Shahid Hashemi-nejad Hospital's efficiency. Healthcare Mnagement Journal 2015; 5: 7-13 [in Persian]

Add your comments about this article : Your username or Email:

Send email to the article author

© 2015 All Rights Reserved | Payesh (Health Monitor)

Designed & Developed by : Yektaweb