Comparison of Non-teaching Hospitals and Teaching Hospitals: in Iran as an Integrated Medical Education System and Health Services


teaching hospitals
Systems Integration
Health Systems Agencies
university hospitals


How to Cite

shahidi sadeghi, niusha, & abolghasem gorji, hasan. (2022). Comparison of Non-teaching Hospitals and Teaching Hospitals: in Iran as an Integrated Medical Education System and Health Services. Iranian Red Crescent Medical Journal, 24(7). Retrieved from


Background: Hospitals, like other organizations, are complex social systems influenced by elements such as staff, resources, and structures that work to achieve specific goals. In terms of goals and missions, hospitals are divided into teaching and non-teaching categories. There are many differences in the nature and needs of these two types of hospitals that must be considered for proper operation by policy makers and managers.

Objectives: The present study investigated the comparison of non-teaching and teaching hospital in Iran.

Method: a qualitative study was conducted using semi-structured interviews according to an interview guide with 40 Iranian hospital managers and policy makers through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.

Results: According to the results Main categories extracted as follows: legal and social responsibility, cost-effectiveness and efficiency, supply of resources, empowerment of human capital, goals and mission, external and internal communications, revenue-cost management, organizational structure, customer satisfaction, organizational behavior, clinical and support departments, hospital processes, type and level of services, manpower, performance evaluation, organizing the teaching mission.

Conclusion: complexity and instability of command unity in teaching hospital, understanding the differences of organizational hierarchy, developing a mechanism to cover costs for clients, considering increase the legal and social responsibility of the management team, prioritizing organizational goals, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering the change of individual and group communication, considering change the performance appraisal system and pay for performance were the practical findings that policymakers should be considered in providing the resources and facilities needed for hospitals based on the type of function.




Coid Dr, Davies H. Structural Change In Health Care: What’s The Attraction? Journal Of The Royal Society Of Medicine. 2008;101(6):278-81. doi: 10.1258/jrsm.2008.080107

Silber Jh, Rosenbaum Pr, Niknam Ba, Ross Rn, Reiter Jg, Hill As, Et Al. Comparing Outcomes And Costs Of Medical Patients Treated At Major Teaching And Non-Teaching Hospitals: A National Matched Analysis. Journal Of General Internal Medicine. 2019:1-10.

Czarnecki A, Qiu F, Koh M, Cheskes S, Dorian P, Scales Dc, Et Al. Association Between Hospital Teaching Status And Outcomes After Out-Of-Hospital Cardiac Arrest. Circulation: Cardiovascular Quality And Outcomes. 2019;12(12):E005349.

Kotwal S, Abougergi Ms, Wright S. Differences In Healthcare Outcomes Between Teaching And Non Teaching Hospitals For Patients With Delirium: A Retrospective Cohort Study. International Journal For Quality In Health Care. 2019;31(5):378-84.

Burke Lg, Khullar D, Zheng J, Frakt Ab, Orav Ej, Jha Ak. Comparison Of Costs Of Care For Medicare Patients Hospitalized In Teaching And Nonteaching Hospitals. Jama Network Open. 2019;2(6):E195229-E. doi:10.1001/jamanetworkopen.2019.5229

Valencia V, Arora Vm, Ranji Sr, Meza C, Moriates C. A Comparison Of Laboratory Testing In Teaching Vs Nonteaching Hospitals For 2 Common Medical Conditions. Jama Internal Medicine. 2018;178(1):39-47. DOI: 10.1001/jamainternmed.2017.6032

Cron Dc, Hwang C, Hu Hm, Lee Js, Dupree Jm, Syrjamaki Jd, Et Al. A Statewide Comparison Of Opioid Prescribing In Teaching Versus Nonteaching Hospitals. Surgery. 2019;165(4):825-31.

Naghizadeh S, Sehhati F, Atri Bs, Ebrahimi H, Egdampour F. Assessment And Comparison Of Mothers’satisfaction With Physical Care During Labor, Delivery And Postpartum Care In Teaching And Non-Teaching Maternity Hospitals Of Tabriz. 2011;4(11):129-141. Doi: 10.22038/IJOGI.2013.521

Shahian Dm, Liu X, Meyer Gs, Normand S-Lt. Comparing Teaching Versus Nonteaching Hospitals: The Association Of Patient Characteristics With Teaching Intensity For Three Common Medical Conditions. Academic Medicine. 2014;89(1):94-106. DOI: 10.1097/acm.0000000000000050

Safarani S. Presenting A Management Pattern For Iranian Teaching Hospitals‎. PhD thesis, Tehran: Iran University Of Medical Sciences; 2019. [Persian]

Stephenson-Laws J, Founder JD. Navigating Hospitals: Teaching Hospital vs. Non-teaching, Does it Matter? [Internet]. 2020 [Updated 2020 Oct 18]; Available from:

Lobo MS, Lins MP, Silva AC, Fiszman R. Assessment of teaching-health care integration and performance in university hospitals. Revista de saude publica. 2010;44(4):581-90.

Nuti S, Ruggieri Tg, Podetti S. Do University Hospitals Perform Better Than General Hospitals? A Comparative Analysis Among Italian Regions. Bmj Open. 2016;6(8).

Marandi SA. The integration of medical education and health care services in the IR of Iran and its health impacts. IJPH. 2009;38(Suppl 1):4-12.

Standards and guidelines for assessment and accreditation of teaching hospital. Tehran: Educational department of ministry of health and medical education; 2016 December 27. Report No: MOHME 2928/500/د. [In Persian]

Ali Mohammad Mosadeghrad, Ghasem Janbabai, Behzad Kalantari, Mahya Abbasi, Hamed Dehnavi. Evaluation of efficiency of general hospitals in Iran SJKU. 2021;26(3):151- 169.

Safarani S, Ravaghi H, Raeissi P, Maleki M. Challenges and Opportunities Faced by Teaching Hospitals in the Perception of Stakeholders and Hospital System Managers. Education in Medicine Journal. 2018 Dec 1;10(4).

Souba W, Notestine M, Way D, Lucey C, Yu L, Sedmak D. Do Deans And Teaching Hospital Ceos Agree On What It Takes To Be A Successful Clinical Department Chair? Academic Medicine. 2011;86(8):974-81. doi: 10.1097/ACM.0b013e31822223b2

Doshmangir L, Rashidian A, Jafari M, Ravaghi H, Takian A. Fail To Prepare And You Can Prepare To Fail: The Experience Of Financing Path Changes In Teaching Hospitals In Iran. Bmc Health Services Research. 2016;16(1):1-13.

Najafi Ghezeljeh T, Rezapour A, Sharifi T, Soleymani Movahed M, Teimourizad A, Yousefi Y, Et Al. Analysis Of The Education Costs Of Nursing And Midwifery Students In The Autonomous Hospitals Affiliated To Iran University Of Medical Sciences. Iran Journal Of Nursing. 2019;32(121):15-29. DOI:10.29252/ijn.32.121.14

Epstein Al, Bard Ma. Selecting Physician Leaders For Clinical Service Lines: Critical Success Factors. Academic Medicine. 2008;83(3):226-34. doi: 10.1097/ACM.0b013e3181636e07

Patel Db, Shah Rm, Bhatt Dl, Liang L, Schulte Pj, Devore Ad, Et Al. Guideline-Appropriate Care And In-Hospital Outcomes In Patients With Heart Failure In Teaching And Nonteaching Hospitals: Findings From Get With The Guidelines–Heart Failure. Circulation: Cardiovascular Quality And Outcomes. 2016;9(6):757-66.

Papanikolaou PN, Christidi GD, Ioannidis JP. Patient outcomes with teaching versus nonteaching ‎healthcare: A systematic review. PLoS medicine. 2006; 3(9): e341.‎

Braithwaite J, Westbrook J, Iedema R. Restructuring as gratification. J R Soc Med. 2005; 98(12): 542–544. DOI: 10.1258/jrsm.98.12.542

Yaghoubi M, Javadi M. Health Promoting Hospitals In Iran: How It Is. Journal Of Education And Health Promotion. 2013;2(1):41. doi: 10.4103/2277-9531.115840

Sajadi Hs, Sajadi Zs, Sajadi Fa, Hadi M, Zahmatkesh M. The Comparison Of Hospitals’ Performance Indicators Before And After The Iran's Hospital Care Transformations Plan. Journal Of Education And Health Promotion. 2017;6(1):89. doi: 10.4103/jehp.jehp_134_16

Werner RM, Goldman LE, Dudley RA. Comparison of change in quality of care between safety-net and non-safety-net hospitals. JAMA. 2008; 299(18): 2180-7. doi:10.1001/jama.299.18.2180

Dumont Tm, Tranmer Bi, Horgan Ma, Rughani Ai. Trends In Neurosurgical Complication Rates At Teaching Vs Nonteaching Hospitals Following Duty-Hour Restrictions. Neurosurgery. 2012;71(5):1041-6.

Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, So Far: Four Decades Of Health Policy Reforms In Iran, Achievements And Challenges. Archives of Iranian Medicine. 2019;22(10):592-605. PMID: 31679362

Jagsi R, Lehmann Ls. The Ethics Of Medical Education. Bmj. 2004;329(7461):332-4. doi:

Blumenthal D, Campbell EG, Weissman JS. The social missions of academic health centers. N Engl J Med. 1997; 337(21): 1550-3. DOI: 10.1056/NEJM19971120337211