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Volume 18, Issue 2 (March-April 2019)                   Payesh 2019, 18(2): 127-148 | Back to browse issues page

Ethics code: IR.TUMS.SPH.REC.1396.4116

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Etemadian M, Mosadeghrad A M, Mohaghegh Dolatabadi M R, Dehnavi H. The challenges of public private partnership in hospital operations: A case study. Payesh. 2019; 18 (2) :127-148
1- Hasheminejad Kidney Center, Hospital Management Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
2- School of public health, Health information management research centre, Tehran University of Medical Sciences, Tehran, Iran
3- School of public health, Tehran University of Medical Sciences, Tehran, Iran
Abstract:   (3428 Views)
Objective (s): Public private partnership (PPP) is a good strategy to increase the capacity and efficiency of the public sector and to deliver high quality healthcare services to the community at a lower price for the government. However, there are several challenges related to PPP in Iranian health sector. Moheb-Yas hospital is one of the few hospitals built with the PPP method in Iran. The purpose of this study is to identify, explore, and explain the challenges of PPP in Moheb Yas hospital operations.
Methods This case study was carried out in 2018 using semi-structured interviews, documentation, archival records, and direct observation. Twenty-four key stakeholders involved in the establishment and operations of the hospital were purposefully selected and interviewed. Content analysis was used for data analysis.
Results: Moheb-Yas hospital PPP faced legal, structural, human related, cultural and managerial challenges. These challenges include vague and unclear model of partnership, political changes, insufficient supportive regulations and rules, design and built problems, limited utilization of the hospital capacity, lack of long term funding, employees’ low job security, unequal employees’ compensation, cultural differences, insufficient conflict management and resolution, management turnover and lack of participative management.
Conclusion: The PPP experience in Moheb-Yas hospital was unsuccessful. Political support, stable economic condition, establishing a PPP unit, strong leadership, proper planning, trust and mutual responsibility are necessary for the success of PPP in the health sector.
Full-Text [PDF 1262 kb]   (1192 Downloads)    
type of study: Research | Subject: Medical
Accepted: 2019/06/3 | ePublished ahead of print: 2019/06/9 | Published: 2019/06/9

1. Mosadeghrad, A., Essentials of healthcare organisation and management. Dibagran Tehran, 2015. [Book in Persian]
2. Ouchi WG. Markets, bureaucracies, and clans. Administrative science quarterly 1980; 25:129-41 [DOI:10.2307/2392231]
3. Lim MK. Transforming Singapore health care: public-private partnership. Annals-Academy of MedicineSingapore 2005; 34: 461-467
4. Iran Ministry of Health, Hospital beds statistics. Ministry of Health, Treatment deputy. 2018. Available at: [Access date 30/04/2019]
5. Yescombe ER. Public-private partnerships: principles of policy and finance. UK: London; Elsevier; 2011
6. Colverson S, Perera O. Harnessing the Power of Public-Private Partnerships: The role of hybrid financing strategies in sustainable development. 1st Edition, Winnipeg: International Institute for Sustainable Development: Uk, 2012
7. Barlow J, Roehrich J, and Wright S. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Affairs 2013; 32:146-154 [DOI:10.1377/hlthaff.2011.1223]
8. OECD Publishing. Dedicated public-private partnership units: A survey of institutional and governance structures. 1st Edition, OECD Pub: Uk, 2010
9. Pollock A, & Price D. Privatising primary care. British Journal of General Practice 2006; 56: 565-567
10. Koppenjan JF, & Enserink B. Public-private partnerships in urban infrastructures: reconciling private sector participation and sustainability. Public Administration Review 2009; 69: 284-296 [DOI:10.1111/j.1540-6210.2008.01974.x]
11. Farlam P. Working together: assessing public-private partnerships in Africa. Johannesburg, SA: South African Institute of International Affairs, University of the Witwatersrand, 2005. Available at: [Access date 09/06/2019]
12. Zavadskas EK, Turskis Z, Tamošaitien J. Risk assessment of construction projects. Journal of Civil Engineering and Management 2010; 16 : 33-46 [DOI:10.3846/jcem.2010.03]
13. Preker AS. and Harding A. Innovations in health service delivery: the corporatization of public hospitals. 1 st Edition, The World Bank: Uk, 2003 [DOI:10.1596/0-8213-4494-3]
14. Pollitt C. and Bouckaert G. Public management reform: A comparative analysis. 1 st Edition, Oxford University Press: USA,2004
15. Ngoma S, Mundia M, & Kaliba C. Benefits, Constraints and Risks in Infrastructure Development via Public-Private Partnerships in Zambia. Journal of Construction in Developing Countries 2014; 19: 15-33
16. Hellowell M. Are public-private partnerships the future of healthcare delivery in sub-Saharan Africa? Lessons from Lesotho. BMJ Glob Health 2019;4: 001217 [DOI:10.1136/bmjgh-2018-001217]
17. Yin RK. Case study research: Design and methods. 3 th Edition,Thousand Oaks, CA: Sage: UK,2003
18. Stake RE. The art of case study research. Thousand 1 st Edition,Thousand Oaks, CA: Sage: UK, 1995.
19. Grimsey D, Lewis M. Public private partnerships: The worldwide revolution in infrastructure provision and project finance. 1 st Editon, Edward Elgar Publishing: UK, 2007
20. Liu T, Wilkinson S. Adopting innovative procurement techniques: obstacles and drivers for adopting public private partnerships in New Zealand. Construction Innovation 2011;11:452-69 [DOI:10.1108/14714171111175918]
21. Sadeghi A, Bastani P, Barat O. Public-private partnership in the development of Iranian hospital services: Lessons learned from experience. Journal of Military Medicine 2018; 20: 371-381
22. Mosadeghrad AM. The impact of organisational culture on the successful implementation of total quality management. TQM Journal 2006; 18: 606 - 625 [DOI:10.1108/09544780610707101]
23. Gregory BT, Harris SG, Armenakis AA, Shook CL. Organizational culture and effectiveness: A study of values, attitudes, and organizational outcomes. Journal of Business Research 2009;62:673-9 [DOI:10.1016/j.jbusres.2008.05.021]
24. Mosadeghrad AM, Saadati M. Relationship between managers' leadership style and organisational structure and culture of Qazvin hospitals. Journal of Health in the Field 2018; 6: 36-45 [in Persian]
25. Mosadeghrad AM & Sokhanvar M. Organizational culture of selected teaching hospitals of Tehran. Journal of Health in the Field 2018; 5: 26-38 [in Persian]
26. Mosadeghrad AM, Occupational stress and its consequences: Implications for health policy and management. Leadership in Health Services Journal, 2014; 27: 224 - 239 [DOI:10.1108/LHS-07-2013-0032]
27. Mosadeghrad AM. Ferlie E. & Rosenberg D, (2011). A study of relationship between job stress, quality of working life and turnover intention among hospital employees. Health Services Management Research Journal 24: 170-181 [DOI:10.1258/hsmr.2011.011009]
28. Mosadeghrad AM. Quality of working life: Antecedents to employee's turnover intentions. International Journal of Health Policy and Management2013; 1: 49-58 [DOI:10.15171/ijhpm.2013.07]
29. Mosadeghrad AM. Ferlie E. & Rosenberg D . A study of relationship between job satisfaction, organisational commitment and turnover intention among hospital employees. Health Services Management Research 2008; 21: 211-227 [DOI:10.1258/hsmr.2007.007015]
30. Todnem By R. Organisational change management: A critical review. Journal of change management 2005;5:369-80 [DOI:10.1080/14697010500359250]
31. Mosadeghrad AM, & Ansarian M. Why do organizational change programs fail? International Journal of Strategic Change Management 2014; 5: 189-218 [DOI:10.1504/IJSCM.2014.064460]
32. Mosadeghrad AM. The impact of employee suggestion scheme on hospital effectiveness & efficiency. Research in Medical Sciences 2003; 8: 85-89 [in Persian]
33. Molchanova M. Public-Private Partnership in the System of Regional Healthcare Financing. Economic and Social Changes: Facts, Trends, Forecast, 2016; 2: 114-132 [DOI:10.15838/esc.2016.2.44.7]
34. Wong EL, Yeoh EK, Chau PY, Yam CH, Cheung AW, Fung H. How shall we examine and learn about public-private partnerships (PPPs) in the health sector? Realist evaluation of PPPs in Hong Kong. Social Science & Medicine 2015;147:261-9 [DOI:10.1016/j.socscimed.2015.11.012]
35. Lessard DR, Miller R. The strategic management of large engineering projects: shaping institutions, risks and governance. 1 st Editon, MIT Press: Cambridge, MA, 2001
36. Flyvbjerg B, Holm M, Buhl S, 2003. How common and how large are cost overruns in transport infrastructure projects? Transport Reviews 23 : 71-88 [DOI:10.1080/01441640309904]

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