Identification of the Factors Affecting Decision-making, Challenges and Obstacles, and Evaluation Criteria of Hospital Services Outsourcing: A Scoping Review

Extended Abstract

Background
One of the effective methods for providing services is contracting outside organizations and outsourcing services. Service outsourcing has been implemented as one of the most economic methods to increase efficiency and effectiveness; however, it has also caused a major problem for senior managers. Managers often justify outsource services based on its potential for reducing the costs without paying due attention to various aspects of it, while the best approach to the problem is formulating scientific principles and paying due attention to its various aspects, so that it can be employed as a useful tool to save time, cost, quality improvement, and resource release. Therefore, this study aimed to identify the factors affecting the decision-making, challenges and obstacles, and evaluation criteria of the hospital services outsourcing.

Methods
The current study was a scoping review study with an applied purpose, which was conducted based on Arksey and O'Malley protocol to examine the studies published until March 20, 2022. In this study, four databases SID, Magiran, Emerald, PubMed, and Google Scholar search engine were used. To search for studies in the databases, the keyword “outsourcing” was used in combination with other keywords such as “hospital services”, “efficiency and effectiveness”, “health services”, and “private sector”. The research questions for the present study included: what are the factors affecting service outsourcing decisions? what are the challenges and obstacles facing outsourcing? and what are those criteria capable of evaluating the outsourced activity? how? The inclusion criteria of this study were English and Persian original/review articles and case studies. Exclusion criteria were lack of relevance, other languages, as well as the types of study including letters, notes, protocols, and short reviews. After searching the selected databases and reviewing the gray literature, the studies were entered into the Endnote software and duplicates were removed. After removing the duplicates, the titles of the articles were examined by two independent researchers separately. Then the abstracts of the selected studies were reviewed using the inclusion and exclusion criteria; then the full texts of the studies were reviewed and the determined studies were entered into the final analysis. In order to extract the data, a table was designed including the names of the authors, the year of article publication, the country, the type of study, the investigated variable, and the most important findings. Using qualitative analysis and coding approach, the obtained results were analyzed and summarized in the designed tables based on the three main areas of factors affecting decision-making, challenges and obstacles, and outsourcing evaluation criteria.

Results
In the initial search, 1195 articles were found, of which 147 articles were excluded due to duplication and 1096 articles were excluded after reviewing the title and abstract due to lack of relevance and failure to meet inclusion criteria. Finally, 52 articles were selected and their full texts were reviewed, of which 44 were included in the present study. Out of 44 articles, 10 were from other countries and 34 from Iran. Also, 7 articles (15.9%) were in the scope of outsourcing evaluation criteria, 22 articles (59%) were in the scope of factors affecting outsourcing, and 21 articles (47.7%) were in the scope of outsourcing challenges and obstacles. The studies carried out in the field of factors affecting outsourcing decision-making were categorized into four components of the nature of the activity, extra-organizational stimuli, intra-organizational stimuli, and supplier characteristics, which included 9, 15, 19, and 14 sub-components, respectively. The scope of challenges and obstacles of outsourcing was classified into four legal, financial, organizational, and structural management executive components, each of which included 8, 15, 21, and 31 sub-components, respectively. The scope of evaluation criteria was also divided into four categories of financial components, stakeholders, internal processes and growth, as well as learning and innovation, each of which included 10, 7, 11 and 4 sub-components, respectively.

Conclusion
To provide a successful hospital service outsourcing, it was found necessary to pay attention to the factors affecting decision-making and challenges/obstacles facing outsourcing, as well as to develop evaluation criteria based on the obtained sub-components. It was recommended that specific and pre-prepared procedures should be adopted based on each of the areas, components, and sub-components of service outsourcing in order to facilitate the decision-making process and strengthen its implementation. It was also determined necessary to prepare guidelines and lists based on the components and sub-components identified in this study and to provide outsourcing officials with them, so that they were able to properly examine all aspects of outsourcing based on an evidence-based approach. Paying due attention to hospital services was found required for making better decisions.