Comparison of the situation of the outsourced units of Shiraz University of Medical Sciences before and after the outsourcing process revealed that the type of outsourcing in this university was mostly lease, management, and collaboration, any type of which has its own profits and loss based on the type of the service.
The results also revealed that outsourcing of health services based on leasing method is a kind of successful strategy for pharmacies because, in most of the pharmacy units, we experienced the growth of profit and also improvement of access indicator. Tourani et al. found that pharmacy outsourcing at Firoozgar Hospital in Tehran had resulted in cost saving in personnel, medication, and leasing costs. Besides, the number of personnel (as an index for accessibility) was increased from 9 to 14 while their educational level and the number of performed prescriptions were increased. Moreover, the time spent by the manager for managing pharmacy affairs was decreased . A research in the USA showed that outsourcing resulted in decrease in pharmacy cost and number of personnel that saved $59,000 in the first year . As all these study shows, pharmacy costs were decreased after outsourcing which is corresponding with current findings.
In the current research, the only exception from decreasing pharmacy cost was Ali Asghar Hospital’s pharmacy. Studies showed that the governmental sector is lost due to inaccurate expertise rent cost and selection of inappropriate contractor. Due to pharmaceutical sanctions, the contractor is delayed in paying the insurance claims from the insurance companies and is faced with lack of liquidity and lack of supply of the medicine, which finally caused the employer’s dissatisfaction and cancelation of the contract for the next year. Based on Maschuris and Kondylis research in Greece, some factors such as cost of contract (suggested price), quality of services, diversity and range of services, past history, financial state, and also contractor’s reputation should be considered in choosing the contractor by the medical units to fulfill outsourcing goals such as cost savings, patients’ satisfaction, resolution of the lack of fund and staff, and management focus on core activities .
With respect to the service quality indicator in the present study, patient satisfaction, most of the units were in a desirable level and the employer satisfaction from the contractor’s performance was reported in a moderate level.
The study also showed that 40% of the outsourced pharmacies were moderate regarding the quality of service indicators. Mohaghegh et al. revealed that the pharmacies’ outsourcing approach including increase of patient satisfaction may fail even though it promised care improvements; thus, the measures such as clear and comprehensive contracts should be taken, and practical mechanisms such as monitoring and evaluation should be accomplished . One of the factors that could hinder improving customer satisfaction due to outsourcing is the limited number of private suppliers and hence lack of competitive market . Therefore, by considering patient satisfaction in evaluating the outsourced unit performance, it is suggested that in the provision of the contract, patient satisfaction has to be defined as the contractor’s controlling tool, and in the case of low satisfaction, penalty system will be specified, and by emphasizing on performance contract, payment mechanism will be modified in a way that the payments to private sectors in addition to prescription cost will be related to customer’s satisfaction.
In the present research, the outsourced labs had a loss before outsourcing due to low tariffs of lab services, the high cost of consuming materials, and high annual personnel costs. Therefore, the university has used the lease or management outsourcing strategy for outsourcing. In comparison of these two types of outsourcing, the lease outsourcing was more successful because the increase in its profitability was remarkably higher than management outsourcing. Some factors including staff’s low income and benefits compared with the governmental sector, longer working hours, diversity in services, saving raw materials, and patients’ marketing strategy have caused profit for the private sector. Also, in this outsourcing, besides an increase of clients and a decrease in costs, a significant growth was seen in the profit of the private sector.
Omrani et al. showed that after labs’ outsourcing, laboratories income increased 51% due to more customers, longer working hours, not referring to other labs, and diversity in the lab’s experiments . Another study in Iran showed the positive effect of signing a contract in lab leasing to the private sector by comparing income and expenses of these units before and after the contract .
In the management outsourcing of Ghotb Aldin Hospital’s lab, although the goals of outsourcing such as cost saving and prevention of loss have been fulfilled, it is possible to convert this unit to a profitable one by using some solutions such as increase in the service diversity, patient marketing, and leasing outsourcing. Also, in management outsourcing, Dabiran Medical Center’s lab was profitable for the university but it was outsourced to the private sector to improve service access and quality indicators as well as governmental sector obligation to decrease tenure. In this regard, rural per capita amount of insurance was paid to the private sector and the contractor was obliged to deliver high-quality services, attract maximum clients, and pay current fees of the lab. In management outsourcing, even though there were no financial benefits for the government, an improvement in the access to service indicators by using two non-governmental workforces, quick response, and more client attraction was experienced.
In terms of quality of service indicators, the satisfaction indicators were in a desirable level in the outsourced labs. The research in Iran by Omrani et al. showed that responsibility and behavior of the lab’s personnel improved after outsourcing . In order to improve patient and personnel satisfaction, it is suggested to hire specialized workforce and try to decrease medical errors. A study in Arizona revealed that the medical error increased after lab outsourcing. The number of misdiagnosis increased, causing physical and financial problems to the patients due to the use of unprofessional workforce in the labs . Based on the abovementioned results, it is recommended that if the patients’ satisfaction and the service quality are low in the outsourced labs, it is possible to decrease the contractor’s payment as a fine solution.
Findings indicate that from one and three dentistry units that were outsourced by leasing and partnership, respectively, profitability was increased in two partnership outsourcing units (Khonj and Bigherd). Besides, in these two units, accessibility and number of patients were increased and the satisfaction of SUMS and patients’ satisfaction from delivered services were high. In the lease outsourcing of Sede Eghlid Dentistry Center, this unit was profitable for the university before outsourcing. Due to the placement of this unit in a deprived area, the obligation to decrease government tenure, and the absence of appropriate contractor, the university outsourced the unit as a lease unit in order to prevent closure and improve access to service indicators. The condition of this unit in terms of patient satisfaction and employee after outsourcing was in a desirable level.
Finally, the results of the study showed that in most of the outsourced units with the increase in the number of staff in private sector and with the increase in the number of clients, we experienced increase in profitability and reduced costs for the governmental sector; therefore, outsourcing for medical units can be an effective strategy. As several studies revealed, if outsourcing strategy is done by risk and cost assessment along with careful and measured approach, it can be an effective strategy resulting in benefits for management, staff, contractors, patients, and even hospitals [28,29,30]. Moreover, it is suggested that hospitals, especially the governmental ones, can use outsourcing benefits as a strategy for a full-time service and reduction of the human resource constraints, more manager’s effort to hospital management, time-saving, productivity improvement, and staff morale. Also, an outsourcing strategy can be used as an approach to help the hospitals to attract new sources without paying any costs .