health systems agencies

In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran.

A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.

According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client’s costs, considering increase management team’ legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital.

Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

Hospitals, similar to other organizations, are complex social systems influenced by elements, such as staff, resources, and structures, that work to achieve specific goals. In terms of goals and missions, hospitals are divided into teaching and non-teaching categories. There are many differences in the nature and needs of these two types of hospitals that must be considered for proper operation by policymakers and managers.

The present study compared issues between non-teaching and teaching hospitalsin Iran.

A qualitative study was conducted using semi-structured interviews according to an interview guide with 40 Iranian hospital managers and policymakersselected through purposivesampling in 2021. Data were analyzed through thematic analysis with an inductive approach using the MAXQDA software (version 10).

According to the results, the main categoriesof differences between non-teaching and teaching hospitals in Iran were as follows: legal and social responsibility, cost-effectiveness and efficiency, supply of resources, empowerment of human capital, goals and missions, external and internal communications, revenue-cost management, organizational structure, customer satisfaction, organizational behavior, clinical and support departments, hospital processes, type and level of services, manpower, performance evaluation, and the organization of the teaching mission.

Practical findings of this study include understanding the complexity and instability of command unity in teaching hospitals, understanding the differences in organizational hierarchy, developing a mechanism to cover costs for clients, increasing the legal and social responsibility of the management team, prioritizing organizational goals, coordinating policy demands with providing resources, funding the teaching mission, organizing multiple supervisory organizations, establishing transparent communication between hospitals and colleges, understanding the complexity of processes, considering the change of individual and group communication, changing the performance appraisal system, and paying for performance. It is suggested that policymakers consider these issues in providing the resources and facilities needed for hospitals based on their function.

In terms of missions, hospitals are divided into teaching and nonteaching. In addition, differences in health‑care systems in countries will lead to differences in hospitals’ operation. Iran, as a specific health‑care system, is different from other countries. Hence, the present study investigated differences between teaching and nonteaching hospitals and their differences in Iran and the world.

A concurrent mixed‑methods study was conducted in two stages. The first stage was a narrative review of studies (2000–2020). Using narrative inquiry and reflective analysis, the content was analyzed and the categories were extracted. The second stage was a qualitative study conducted using semi‑structured interviews with forty Iranian hospital managers and policymakers through a purposive sampling in 2020. Content analysis was made using deductive approach, and MAXQDA 12 was used for data analysis.

According to the first stage, categories were extracted as follows: service quality, type of cases, patient satisfaction, efficiency, performance indicators, patient safety, personnel, use of drugs, access to services, technologies, justice in the type of services received, using guidelines, processes, and number of services. In the second stage, 8 main categories, 17 categories, and 45 subcategories were extracted. The extracted main categories were as follows: mission and target, management and behavioral organizations, supply chain and chain of results, human resources, costs and budget, policy demands, clients’ satisfaction and patients’ right, and integration of medical education.

Unlike other countries, in Iran, the combination of missions and the complete dependence of teaching hospitals on the government has caused differences. Reducing the treatment mission of teaching hospitals; differences in the budget and development of its indicators; lower tariffs for teaching hospitals; developing a cost–income management model and supply chain; preventing uncertainty other than medical students except medicine; considering the clients’ right to choose hospital; and organizing research missions in hospitals were the solutions for decrease differences.