एडवांटेजेस एंड डिसएडवांटेजेस ऑफ गवर्नमेंट हॉस्पिटल
Answers
Explanation:
pressures especially cost cutting and search for costeffective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing.
Methods:The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis.
Results: Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees’ workload and dissatisfaction.
Conclusion: Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion.
Keywords: Hospital, Downsizing, Downsizing method, Review
Introduction
Hospitals are key actors in national health systems, and consume a large share of spending1. For example in European regions, the hospital sector is consuming 35–70 percent of national expenditures on health care2. Very large sums were spent on construction, maintenance and rehabilitation hospitals around the world annually. Although, appropriate evidences about achieving expected benefits are little2. The World Health Organization has estimated in 1989, it wastes 40 percent of United States' health system resources3. It shows that resources can be achieved through efficiency increasing is very significant3.
Nowadays hospitals face particular challenges and problems in Iran, for example, in the issues of quality, relevancy, and effectiveness as consequences of severely economic disruption4. In the same time, this system allocates more than 50% of total health funds to hospital sector. Hospitals of Iran have more than 130 thousand employees (50% of health staffs) however the low occupancy of hospital beds (54%) in comparison with developed countries (80%-85% bed occupancy)5. It shows the need for proper utilization of limited resources. Furthermore, only 82% of beds in Iran’s hospitals are active5, it means high resources spend on costs, staffing, salaries and maintenance. It might be cost-effective to cut or limit further expansion of hospital beds unless it has been warranted by increased demand5.
It seems necessary to promote efficient management of hospitals by implementing various strategies6. Downsizing is one of strategies. Cameron expresses definition of downsizing: downsizing is a set of activities that reduce the number of employees and results higher efficiency and costs reduction7. Appelbaum and colleagues also argue that downsizing is a step to reduce production costs and staff permanent positions, privatization, or it refers to contracting services and activities8. Downsizing begins in US auto industry following oil crisis in 19739. Organizations has taken downsizing strategy to achieve an appropriate size, reconstruction, adapting to technological advances, specialization in their core of regional hospital in Austria by establishing one equipped center instead of three inefficient centers20 and outsourcing different sections of hospitals in the range of 13.5 to 94.6 percent in Taiwan17.
Excess capacity in the hospitals has become a serious problem in terms of technical, managerial and policy issues similar to all around the world and Iran15.In most of the developing countries including Iran, new hospitals are often constructed with no real assessment. Distributions of hospitals are in the geographical based instead of need based21. Therefore, international experts recommend to stopping hospital beds spreading5 and other interventions22. Hospital sector policy makers are looking for new solutions in response to the growing pressures, especially the lacks of financial resources23. It seems downsizing with different methods is one of these solutions. But, administrative reform has not been done about hospital downsizing in our country24.