Reasons for low efficiency in Iranian hospitals: a scoping review of two decades of research

The hospital inefficiencies impose a high cost on the countrychr('39')s health system. This study was conducted to identify the causes of low efficiency in Iranian hospitals.

To conduct this research, the scoping review was used. For this purpose, all published articles on the low efficiency of Iranian hospitals between April 1997 and March 2019 were collected in electronic databases. Out of 1593 found articles, 146 articles fulfilled the inclusion criteria, which were analyzed using version 10 of MAXQDA software.

Overall, 37 reasons for the low efficiency of Iranian hospitals were identified, which were classified into three main groups: underuse, overuse, and misuse of hospital resources. These causes were also categorized into four levels: meta- (ministry of health), macro- (university of medical sciences), meso- (hospital), and micro- (hospital service provider). The most frequent reasons for the low efficiency of the hospitals were poor knowledge and low skill of managers, inadequate distribution of beds between hospitals, inappropriate size of hospitals, the lack of using specialized hospital managers, inadequate staff training, inadequate medical tariffs, inadequate payment methods, staff shortages, unnecessary hospital development, and unnecessary patient admissions.

Various factors at the level of the ministry of health, medical universities, hospitals, and health service providers led to low, high, and incorrect use of hospital resources and, as a consequence, low efficiency of Iranian hospitals. Policy makers and managers of the health system should increase the efficiency of hospitals by implementing changes in the financing, management, and provision of health services.