Background: Hospitals, similar to 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 policymakers and managers.
Objectives: The present study compared issues between non-teaching and teaching hospitals in Iran.
Methods: A qualitative study was conducted using semi-structured interviews according to an interview guide with 40 Iranian hospital managers and policymakers selected through purposive sampling in 2021. Data were analyzed through thematic analysis with an inductive approach using the MAXQDA software (version 10).
Results: According to the results, the main categories of differences between non-teaching and teaching hospitals in Iran were as follows: legal and social responsibility, cost-effectiveness and efficiency, supply of resources, empowerment of human capital, goals and missions, 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, and the organization of the teaching mission.
Conclusion: Practical findings of this study include understanding the complexity and instability of command unity in teaching hospitals, understanding the differences in organizational hierarchy, developing a mechanism to cover costs for clients, increasing the legal and social responsibility of the management team, prioritizing organizational goals, coordinating policy demands with providing resources, funding the teaching mission, organizing multiple supervisory organizations, establishing transparent communication between hospitals and colleges, understanding the complexity of processes, considering the change of individual and group communication, changing the performance appraisal system, and paying for performance. It is suggested that policymakers consider these issues in providing the resources and facilities needed for hospitals based on their function.
Coid DR, Davies H. Structural Change In Health Care: What’s The Attraction? J R Soc Med. 2008;101(6):278-81. doi: 10.1258/jrsm.2008.080107. [PubMed: 18515774].
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. J Gen Intern Med. 2020;35(3):743-52. doi: 10.1007/s11606-019-05449-x. [PubMed: 31720965].
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. Circ Cardiovasc Qual Outcomes. 2019;12(12):1-9. doi: 10.1161/CIRCOUTCOMES.118.005349. [PubMed: 31822122].
Kotwal S, Abougergi MS, Wright S. Differences in healthcare outcomes between teaching and non teaching hospitals for patients with delirium: a retrospective cohort study. Int J Qual Health Care. 2019;31(5):378-84. doi: 10.1093/intqhc/mzy182. [PubMed: 30165567].
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 Netw Open. 2019;2(6):1-14. doi:10.1001/jamanetworkopen.2019.5229. [PubMed: 31173121].
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 Intern Med. 2018;178(1):39-47. doi: 10.1001/jamainternmed.2017.6032. [PubMed: 29131899].
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. doi: 10.1016/j.surg.2018.10.005. [PubMed: 30497812].
Farzianpour F, Foroushani AR, Sadeghi NS, Nosrati SA. Relationship between’patient’s rights charter’and patients’ satisfaction in gynecological hospitals. BMC Health Serv Res. 2016;16(1):1-8. doi: 10.1186/s12913-016-1679-9. [PubMed: 27604496].
Shahian DM, Liu X, Meyer GS, Normand SL. Comparing teaching versus nonteaching hospitals: the association of patient characteristics with teaching intensity for three common medical conditions. Acad Med. 2014;89(1):94-106. doi: 10.1097/acm.0000000000000050. [PubMed: 24280849].
Safarani S. Presenting A management pattern for iranian teaching hospitals. [PhD Thesis]. Tehran: Iran University Of Medical Sciences; 2019.
Stephenson-Laws J, Founder JD. Navigating Hospitals: Teaching Hospital vs. Non-teaching, Does it Matter? 2020. Available from: https://phlabs.com/navigating-hospitals-teaching-hospital-vs-non-teaching-does-it-matter
de Castro Lobo MS, Estellita Lins MP, Moreira da Silva AC, Fiszman R. Assessment of teaching-health care integration and performance in university hospitals. Rev Saude Publica. 2010;44(4):581-90. doi: 10.1590/s0034-89102010000400001. [PubMed: 20676550].
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):1-11. doi: 10.1136/bmjopen-2016-011426.
Marandi SA. The integration of medical education and health care services in the IR of Iran and its health impacts. Iran J Public Health. 2009;38(1):4-12.
Sadeghi NS, Maleki M, Gorji HA, Vatankhah S, Mohaghegh B. Differences and their contexts between teaching and nonteaching hospitals in Iran with other countries: A concurrent mixed-methods study. J Edu Health Promot. 2022;11:1-17. Doi: 10.4103/jehp.jehp_1431_20. [PubMed: 35281395].
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/. available from: https://pe.iums.ac.ir/ [In Persian]
Rezapour A, Foroughi Z, Sadeghi NS, Faraji M, Mazdaki A, Asiabar AS, et al. Identification of the most appropriate variables for measuring the efficiency of Iranian public hospitals: Using Delphi technique. J Edu Health Promo. 2019;8:1-7. doi: 10.4103/jehp.jehp_402_18. [PubMed: 31463325].
Safarani S, Ravaghi H, Raeissi P, Maleki M. Challenges and opportunities faced by teaching hospitals in the perception of stakeholders and hospital system managers. Educ Med J. 2018;10(4):1-13. doi: 10.21315/eimj2018.10.4.2.
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? Acad Med. 2011;86(8):974-81. doi: 10.1097/ACM.0b013e31822223b2. [PubMed: 21694567].
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 Serv Res. 2016;16(1):1-13. doi: 10.1186/s12913-016-1405-7. [PubMed: 27102262].
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 J Nurs. 2019;32(121):14-27. doi: 10.29252/ijn.32.121.14.
Epstein AL, Bard MA. Selecting physician leaders for clinical service lines: critical success factors. Acad Med. 2008;83(3):226-34. doi: 10.1097/ACM.0b013e3181636e07. [PubMed: 18316866].
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. Cardiovasc Qual Outcomes. 2016;9(6):757-66. doi: 10.1161/CIRCOUTCOMES.115.002542.
Papanikolaou PN, Christidi GD, Ioannidis JP. Patient outcomes with teaching versus nonteaching healthcare: a systematic review. Plos Med. 2006;3(9):1-13. doi: 10.1371/journal.pmed.0030341. [PubMed: 16968119].
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. [PubMed: 16319429].
Yaghoubi M, Javadi M. Health promoting hospitals in iran: how it is. J Educ Health Promot. 2013;2(1):1-5. doi: 10.4103/2277-9531.115840. [PubMed: 24251277].
Sajadi H, Sajadi Z, Sajadi FA, Hadi M, Zahmatkesh M. The comparison of hospitals’ performance indicators before and after the iran's hospital care transformations plan. J Educ Health Promot. 2017;6(1):1-5. doi: 10.4103/jehp.jehp_134_16. [PubMed: 29114557].
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. [PubMed: 18477785].
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. doi: 10.1227/NEU.0b013e31826cdd73.
Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, So Far: Four decades of health policy reforms in iran, achievements and challenges. Arch Iran Med. 2019;
(10):592-605. [PubMed: 31679362].
Jagsi R, Lehmann LS. The ethics of medical education.
BMJ. 2004;329(7461):332-4. doi: 10.1136/bmj.329.7461.332. [PubMed: 15297341].
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/NEJM199711203372113. [PubMed: 9366591].