Document Type : Original Article
Authors
1 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
2 Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran
3 Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
4 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
Abstract
Introduction: The Health Transformation Plan (HTP) was launched in May 2014 in hospitals affiliated with the Ministry of Health, with the objectives of financial protection, equity in access, and improvement of service quality. Hospitals, as key units of the health system, require performance evaluation using hospital indicators such as bed occupancy rate, number of surgeries, length of stay, and mortality. This study aimed to investigate the factors influencing changes in hospital performance indicators following the implementation of the HTP in both university and non-university hospitals.
Methods: A qualitative study employing a content analysis approach was conducted. Semi-structured interviews were held with 22 experts (hospital managers, faculty members, quality improvement specialists, and accreditation experts) from October to December 2023 until data saturation was reached. Sampling was conducted using a combination of purposive and snowball techniques. The data were analyzed using MAXQDA 2020 software.
Results: Fifteen main categories of influential factors were identified. These factors included support for chronic and vulnerable patients, reduction in out-of-pocket payments, increase in the number of insured individuals, increase in the elderly population, quality of services, nature of the disease, staff shortages, increase in beds, equipment shortages, tariff changes, referral system, accreditation, major surgeries, and nature of hospital wards/specialties. Solutions proposed included optimizing admission/discharge processes, personnel training, and bed management.
Conclusion: The Health Transformation Plan increased demand but also exacerbated supply-side challenges due to resource shortages and the COVID-19 shock. Strengthening hospital capacity and implementing adaptive managerial interventions—such as workforce planning, process optimization, and resource reallocation—are essential for sustaining the plan’s achievements.
Keywords
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