Investigating the Dimensions of Autonomy of University Hospitals in Gilan

Health system Resources are limited and its expenditures are unlimited. Therefore, Use the management right strategy to maximize efficiency and productivity of system is essential. Hence, this study was performed with aim to investigate the dimensions of autonomy of university hospitals in Gilan.

This qualitative study was conducted in 11 hospitals. Semi-structured interview guide of World Bank organizational reform model was used for data collection. Interviews were conducted with 28 senior hospital managers with Purposeful sampling method. A content analysis method was used to analyze data.

The main dimensions the autonomy of hospitals include decision right in strategic management, financial resources management, human resources management, and physical resources management, financial residual claim, procurement and product market exposure, social functions, and governance structure and accountability. Decision right in strategic management, human and physical resources was limited. Hospitals compete in the product market, but their options are limited in the procurement market. The hospitals were not the financial residual claimant despite their hierarchical system and the accountability structure of the head and headquarters. The cost of their social function is not fully compensated.

Granting autonomy has improved in some dimensions such as financial resources management, product market exposure, and social functions, but has been poor in strategic management, human resources management, physical resources management, procurement market exposure, and governance structure and accountability. In these cases hospitals should be given more decision-making power.