Academic journal article Iranian Journal of Public Health

The Evaluation of Hospital Performance in Iran: A Systematic Review Article

Academic journal article Iranian Journal of Public Health

The Evaluation of Hospital Performance in Iran: A Systematic Review Article

Article excerpt

Introduction

Healthcare is a major concern in many countries (1). The complexity of today's health care organizations, their costs, specialization, and the importance of efficiency and effectiveness of services are among the factors encouraging the health care organizations to change their performance evaluation processes and to apply the organizational improvement models (2). Undoubtedly, evaluation is one of the broadest and most controversial issues in the management field (3). Performance evaluation or performance assessment is one of the most important managerial tasks (4).

Evaluation is the formal and regulated determination of effectiveness, efficiency and acceptability of a planned action to fulfill certain goals (5). Performance is defined as achieving the desired objectives (6). Performance evaluation refers to a set of actions and activities carried out in order to increase the optimal use of resources to achieve the goals efficiently and effectively. The measurement system should be able to compare the performance within the organization, as well as the performance among the similar organizations. The existence and application of a suitable model to evaluate the performance of hospitals can lead to the increases in the responsiveness and patients' satisfaction and the improvement of service quality (7).

Although several models have been designed to evaluate the hospital performance, most of them either, have limited application or evaluate different dimensions of the performance. Some of these models have focused more on the structural elements or inputs, some of them on the process evaluation and others on the results, and there have been few hospital performance evaluation systems included the balanced evaluation of the inputs, processes and outputs (8). Therefore, various models have been used in different studies. Some of the challenges in the design of a hospital performance evaluation system are the identification of performance evaluation objectives, the evaluation of different dimensions of the hospital performance, and the participation of stakeholders in the design and development of the performance evaluation system (7). It is not surprising that hospitals, as major consumers of the health system budgets and funds, are paid special attention by the researchers and policymakers (9).

Iranian Ministry of Health and Medical Education (MOHME) is responsible for providing most of the secondary health services. Sixty seven percent of hospitals in Iran affiliated to The MOHME, fourteen percent affiliated to the private and non-governmental sector, and nineteen percent of hospitals affiliated to other entities such as insurance organizations and other providers (10). Official method for evaluating the hospital performance is the accreditation standards of the Ministry of Health (11). Accreditation standards provide a framework used as a common model for evaluating health care throughout the world (12).

Although the design of performance evaluation system has become a necessity, the existence of several models to evaluate the performance of hospitals indicates that measurement, evaluation and improvement of the hospital performance, contrary to their appearances, are not easy (7). The use of quantitative methods of evaluating performance such as cost-benefit and costefficiency analyses and some indicators such as effectiveness, efficiency, productivity, etc. does not meet the needs of hospitals. In order to evaluate the hospital performance, there is a need for comprehensive models, which can evaluate the performance of hospitals continuously and systematically in all fields and wards according to the main criteria of performance (13).

This research aimed to systematically study and outline the methods of hospital performance evaluation used in Iran. Many studies have been conducted in order to evaluate the performance of hospitals, however, given the large number of models and methods in this area, it seems that there is no clear agreement on which model is better to be used. …

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