Table 3 Characteristic of included studies in the scoping review in the order of publication date

Amiri 1997 [10]

Thesis, autonomization policy

• Investigating the effect of hospital autonomy on performance indicators before and after the implementation of the policy

5 teaching hospitals (Tehran)

• Quantitative (retrospective before-after study)

- Data collection forms (data on performance indicators of 5 teaching hospitals)

- Review of 410 medical records to evaluate the rate of readmissions due to surgical site infections

Jafari 2008 [11]

Article, autonomization policy

• Identifying key organizational dimensions that influence the autonomy of university hospitals and the level of autonomy granted in each dimension

6 hospitals (Tehran)

• Qualitative

- Semi-structured interview with 27 hospital managers

Jafari 2011 [12]

Article, autonomization policy

• Assessing the views of senior managers in selected hospitals on the degree of autonomy granted to the hospitals

6 hospitals (Tehran)

• Qualitative

- 4 initial in-depth interviews and 27 semi-structured interview with hospital managers

Sajadi 2012 [13]

Article, board of trustees policy

• Examining the effect of BT policy on hospital efficiency

1 hospital (Isfahan)

• Mixed method (A quasi-experimental retrospective and qualitative case study)

- Performance indicator data were extracted from the hospital’s statistical information resources

- Interviews with seven experts in the field (three national policymakers, two local managers, and two hospital administrators)

Manavi 2012 [14]

Article, board of trustees policy

• Estimating the financial impact of implementing the board of trustees policy in Iran

Insurance organizations and the MOHME

• Quantitative (cross-sectional, economic analysis)

• Data were extracted by data gathering forms (Insurance organization data, physician’s income, hospital incomes and estimation of total costs)

Gholipour 2013 [15]

Article, board of trustees policy

• Comparing performance indicators of two gynecology hospitals with different organizational governance (budgetary/BT)

2 gynecology hospitals (Tabriz)

• Quantitative, a retrospective longitudinal study

• Study variables included: average length of stay (ALOS), bed occupancy rate (BOR), and bed turnover ratio (BTR). The data were extracted via the hospital information systems (HIS) within the hospitals’ admission and discharge units during the period 2010–2012

Ferdosi 2013 [16]

Article, board of trustees policy

• Evaluating the responsiveness of BT hospitals according to World Bank’s organizational reform model (Preker Model) in Isfahan

2 BT hospital (Isfahan)

• Qualitative

• Semi-structured interviews with top managers of selected hospitals

Ahmadi 2014 [17]

Article, autonomization policy

• Investigating the effect of autonomization policy on patient satisfaction (as an indicator of service quality)

2 autonomous hospitals (Isfahan)

• Quantitative (cross-sectional study)

- Data were collected before and after implementation of the autonomization policy using questionnaires based on SERVQUAL model

Markazi-Moghaddam 2014 [18]

Article, board of trustees policy

• Exploring the obstacles and barriers that lead to the failure of hospital autonomization (BT policy) reform and their mechanisms

All 54-university hospitals that had been granted autonomy in Iran

• Qualitative

- Data collection was done within 2 phases: (1) 276 unstructured questionnaires inquiring key informants of barriers, and (2) 23 semi-structured interviews with key informants.

Meshki 2014 [19]

Article, hospital autonomization policy

• Determining the relationship between the autonomy policy and public hospitals’ performance

5 hospitals (Gilan)

• Quantitative (survey study)

- 48 questionnaire completed by accounting staff, managers, and physicians.

Doshmangir 2015 [20]

Article, autonomization policy

• Developing a policy map that includes important dates and events leading to the policy process milestones

• Understanding intentions and motives of policymakers, general outcomes of the policy, and the reasons behind the perceived failure in achieving the intended objectives

• Drawing broader lessons about the viability of the hospital autonomization policy in Iran

Policy-making institutions in the health sector including Medical Council, the Parliament, medical universities, Vice-presidency for Strategic Planning and Supervision, the Cabinet, MOHME, MOSSW, MPs and related agencies

• Qualitative (retrospective case-study)

- Content analysis of parliamentary sessions’ transcripts, policy documents, gray literature and published papers and articles including 472 policy documents

- 6 interviewees (both exploratory and reflective interviews) and 15 interviewees (reflective interviews) with key informants that were involved in or were affected by the development and implementation of the policy

Doshmangir 2015 [21]

Article, board of trustees policy

• Exploring the perceptions and views of expert stakeholders as to why the BT policy did not achieve its perceived objectives

• Providing an in-depth understanding of the implementation of BT policy in the Iranian health system

Health system experts including policy-makers, healthcare managers, members of selected hospitals’ boards of trustees, and health care providers

• Qualitative

- 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively) and analysis of a comprehensive set of relevant documents

Masoudi Asl 2015 [22]

Article, board of trustees policy

• Comparing performance indicators of two gynecology hospitals with different organizational governance (budgetary/BT)

2 gynecology hospitals (Tabriz)

• Quantitative (cross-sectional and correlation study)

- Five variables of hospital performance (quality management, safety, medical equipment management, and patients and staff satisfaction) was collected during the years 2011 to 2013 using standard lists and questionnaires

Joudaki 2015[23]

Report, corporatization policy

• Comparing corporate hospitals and budgetary hospitals in terms of performance indicators

3 corporate hospitals and 3 budgetary hospitals, all affiliated with the SSO

• Quantitative (cross-sectional retrospective study)

- Data was collected using hospital information system (HIS) and statistical reports sent by corporate hospitals and the Province’s Health Administration

Mehrolhassani 2017 [24]

Article, board of trustees policy

• Determining the allocation of financial resources in one BT hospital

1 teaching hospital

(Kerman)

• Qualitative study-case study

- Review of documents, two in-depth interviews and five focus group discussions with eleven experts). Participants were members of the board of trustees and representatives of the financial department (

Zahmatkesh 2017 [25]

Thesis, hospital autonomization policy and board of trustees policy

• Exploring the extent to which hospital middle managers can exercise autonomy in England and Iran

• Explaining the impact of public management reforms on middle managers and their response to these reforms

2 first-wave applicants for FT status in England, and 2 public hospitals in Iran (Isfahan) that have become BTs

• Qualitative (Comparative case study)

- Face-to-face semi-structured interviews with 45 middle managers

- Observational fieldwork

- Documentary analysis

Jafari 2018 [26]

Article, board of trustees policy

• Identifying the barriers in implementing the board of trustees policy

All Iranian medical sciences universities and hospitals, including 56 hospitals that implemented the BT policy

• Qualitative

- The survey forms were officially mailed to participants. Then, it was followed up by phone calls for further description. The survey form had 2 main questions describing the barriers and proposing the solution

Doshmangir 2019 [7]

Article, hospitals autonomy policy and board of trustees’ policy

• Analytical, sequential and chronological exploration of key historical events, achievements and challenges within the Iranian health system during the past four decades

parliament, the MOHME, the Iranian Health Insurance Organization, the Social Security Organization, the Iranian Academy of Medical Sciences, newspaper and journal articles and social media

• Qualitative document analysis

• Comprehensive document and publications review(Data were collected from various sources mentioned in setting)

Mohammadi 2019 [27]

Article, corporatization policy

• Identifying and explaining the role and importance of factors affecting hospital holding administration (Milad-e-Salamat Institute) in the SSO

Healthcare Holding of the SSO (Milad-e-Salamat Institute)

• Mixed methods (qualitative and quantitative study)

- Literature review and an interview with 15 key informants to identify key factors affecting healthcare holding administration to develop a questionnaire

• Questionnaire completed by 405 staff, line managers, and experts working in the SSO (health management(

Azami_ Aghdash 2019 [28]

Research project, corporatization policy

• Comparing public, private, corporate, and budgetary hospitals in terms of performance indicators

• Qualitative evaluation of the current structure of hospital governance

• Providing a model for reforming the structure of the hospitals affiliated with the SSO

2 corporate hospitals with 5 budgetary hospitals, all affiliated with the SSO

• Mix method (qualitative and quantitative study). Data collected using:

- Input, throughput, and output indicators collected by data collection sheet, HIS, facility-level statistical reports, and medical records

- Likert-based leadership style questionnaire

- Inpatient and outpatient satisfaction survey

- Hospital Survey on Patient Safety Culture

- Semi-structured face-to-face interviews with key informants