Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
Health products safety research center, Qazvin University of Medical Sciences, Qazvin, Iran.
BMC Health Serv Res. 2022 Feb 1;22(1):135. doi: 10.1186/s12913-022-07509-1.
The decision to outsource an activity is one of the most complex organizational decisions. This decision is also influenced by several factors and components. In order to facilitate and optimize it, for the first time in this study, a decision model for outsourcing medical service delivery in public hospitals has been developed.
We conducted this cross-sectional study in 3 stages: 1) We identified the factors affecting the outsourcing decisions, 2) an expert panel identified the influential factors. After standardization, we distributed 220 questionnaires among university staff managers and heads, nursing managers, and managers of the research units, and 3) Structural Equation Model applied to evaluate the relationship between the variables on AMOS22, at 0.05 significant level.
Findings indicated the optimal level of all fit indices. The path coefficient between all identified factors with the outsourcing decision was positive (t > 1.96). Factors ranging from the most effective to least effective included monitoring and control, service type, human resource, economic and financial, executive capability, external environment, and terms and conditions.
The proposed model provides unit evaluation to make the appropriate decision on outsourcing or non-outsourcing. Control and monitoring were the most determining factors. We recommend performing monitoring continuously as a guide and deterrent to error. We also recommend continuous monitoring and control over the quality of outsourced units and stakeholder satisfaction.
将活动外包出去是最复杂的组织决策之一。这个决策还受到几个因素和组成部分的影响。为了促进和优化这个决策，在这项研究中首次开发了一个公立医院医疗服务外包决策模型。
我们分三个阶段进行了这项横断面研究：1）确定影响外包决策的因素，2）专家小组确定有影响的因素。标准化后，我们向大学工作人员管理人员和负责人、护理管理人员以及研究单位的管理人员发放了 220 份问卷，3）在 AMOS22 上应用结构方程模型评估变量之间的关系，在 0.05 的显著水平下。
研究结果表明所有拟合指数的最优水平。所有确定因素与外包决策之间的路径系数为正（t>1.96）。从最有效到最无效的因素依次为：监测和控制、服务类型、人力资源、经济和财务、执行能力、外部环境以及条款和条件。
所提出的模型为单位评估提供了依据，以做出外包或不外包的适当决策。控制和监测是最具决定性的因素。我们建议持续进行监测，作为指导和防止错误的手段。我们还建议对外包单位的质量和利益相关者满意度进行持续监测和控制。
