| Background: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing
government spending on health care, and improving the quality of services. These reforms began with hospital
autonomization and have continued with other initiatives such as formation of board of trustees, independent and
corporatized hospitals.
Objective: The purpose of this scoping review was to summarize and compare the results of studies conducted on
organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge
gaps, inform policymakers, and guide future studies and policies.
Method: This review’s methodology was inspired by Arksey and O’Malley’s methodological framework to examine
the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search
was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID,
IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020.
Results: Twenty studies were included in the review. Studies were grouped by the types of organizational reform,
study’s objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction
was used based on the types of organizational reform to present a narrative account of existing literature.
Conclusions: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective
dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate
board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction
with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational
reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the
policy formulation phase and evaluation of its results. |