Lessons Learned from Hospital Outsourcing: A Case Study of Outsourcing a Government Hospital in Isfahan City

Maryam  Eshaghian; Behrooz  Madahian; Saied  Karimi; Masoud  Ferdosi

doi:10.18502/mshsj.v10i1.18936

Maryam Eshaghian MSc in Health Services Management, Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Behrooz Madahian Ph.D. student in Health Services Management, Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Saied Karimi Associate Professor, Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Masoud Ferdosi 4. Professor, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

DOI: https://doi.org/10.18502/mshsj.v10i1.18936

Keywords: Hospital, Outsourcing, Health services

Abstract

Background: Outsourcing, as an important strategy in healthcare, can also have its failures, including the case of "Z" Hospital in Isfahan Province, Iran, which engaged in an eight-year partnership between the contractor and the hospital. While the initial phase was successful, the second phase faced numerous obstacles, including legal and judicial disputes that extended until 2024. This research aims to analyze the outcomes and lessons learned from this outsourcing experience.

Methods: This applied research employed a qualitative methodology with a content analysis approach. Data were collected through interviews and a review of hospital documents. Participants in the study were selected using purposive sampling. Interviews were coded using a reductionist approach. The study's novelty lies in its simultaneous examination of multiple perspectives, including those of the client, contractor, hospital staff, and experts.

Results: The outsourcing period at "Z" Hospital was marked by considerable fluctuations, influenced by economic conditions, management changes, and consequent policy shifts at the University of Medical Sciences. The identified challenges were categorized into three main areas: client-related issues, including inadequate pre-outsourcing research, lack of a precise contract, insufficient contractor support, and client inexperience; contractor-related issues, such as poor financial planning regarding bank loans and subsequent bankruptcy; and policy-related issues, including inconsistent government policies during specific periods, such as a lack of support for outsourced hospitals during economic crises and the expropriation of certain contractors at the onset of the Health Transformation Plan.

Conclusion: Outsourcing can address management, quality, and efficiency issues in healthcare. However, without meticulous planning, implementation, and evaluation, it can create substantial challenges for both the client and the contractor. Comprehensive attention to all phases is crucial for successful outsourcing.