The Experience of Implementing the Board of Trustees’ Policy in Teaching Hospitals in Iran: An Example of Health System Decentralization

Int J Health Policy Manag 2015; 4: 207–216. doi: 10.15171/ijhpm.2014.115

10 Pages Posted: 18 Mar 2015

See all articles by Leila Doshmangir

Leila Doshmangir

Tabriz University of Medical Sciences

Arash Rashidian

Tehran University of Medical Sciences

Hamid Ravaghi

Iran University of Medical Sciences

Amirhosein Takian

Tehran University of Medical Sciences

Mehdi Jafari

Iran University of Medical Sciences

Date Written: March 16, 2015

Abstract

Background

In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995), it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods

We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results

Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components), using research evidence about the policy (local and global), and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships) affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion

The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar decentralization policies in the past and their outcomes were overlooked, while the context was not prepared appropriately and key stakeholders, particularly the government, did not support the decentralization of Iran’s health system.

Keywords: Decentralization; Policy Implementation; Health Policy; Organizational Reform; Health System; Iran

Suggested Citation

Doshmangir, Leila and Rashidian, Arash and Ravaghi, Hamid and Takian, Amirhosein and Jafari, Mehdi, The Experience of Implementing the Board of Trustees’ Policy in Teaching Hospitals in Iran: An Example of Health System Decentralization (March 16, 2015). Int J Health Policy Manag 2015; 4: 207–216. doi: 10.15171/ijhpm.2014.115, Available at SSRN: https://ssrn.com/abstract=2579542

Leila Doshmangir

Tabriz University of Medical Sciences ( email )

Tabriz
Iran

Arash Rashidian

Tehran University of Medical Sciences ( email )

Number 21, Dameshg St.
Vali-e Asr Ave.
Tehran, 14195
Iran

Hamid Ravaghi

Iran University of Medical Sciences ( email )

Hemmat Hwy
Tehran
Iran

Amirhosein Takian

Tehran University of Medical Sciences ( email )

Number 21, Dameshg St.
Vali-e Asr Ave.
Tehran, 14195
Iran

Mehdi Jafari (Contact Author)

Iran University of Medical Sciences ( email )

Hemmat Hwy
Tehran
Iran

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
14
Abstract Views
308
PlumX Metrics