This study aims to provide a model for evaluating the outsourcing of educational and medical centers in Qazvin province. For this purpose, we conducted a comprehensive review. We examined the extracted components according to hospital experts to identify and conceptualize the final model. Finally, all experts agreed upon seven dimensions (economic and financial, legal, control and monitoring, service type, the executive capability of the organization, the external environment of the organization and human resources) in the form of 44 components. Then we developed, evaluated and approved quantitative research tools. Finally, we built and modified the model to fit correctly.
Economic and financial factors with a path coefficient of 0.709 directly affect about 70% of outsourcing decision changes. Many studies confirm this finding [14, 16, 18, 19]. This includes freeing up resources to invest in other activities, comparing contractors’ offers, costs during contract execution (inflation, unforeseen costs), service costs, projected financial and budgetary resources, cost-benefit analysis and the projected benefits of services. The most common reason for hospitals to outsource is to reduce costs. Therefore, analyzing the external supplier in terms of economics, service costs, financial feasibility of the contract is important for the organization and prepares health service providers to be more competitive. Meanwhile, the production of services by a contractor who provides only a specific service, occurs more efficiently. Scale savings also occur under these conditions.
On the other hand, according to Dehghanipodeh et al., outsourcing frees up internal resources to spend on more strategic matters. Also, the ultimate goal of outsourcing is to increase profitability, flexibility and reduce the investment risks of the organization. An outsourcing decision is made when the organization is confident that outsourcing will improve its financial status and productivity .
Terms and conditions factors with a path coefficient of 0.643 directly affect about 64% of outsourcing decision changes. Rahman et al. and Raeissi et al. have emphasized the importance of this dimension [3, 14]. This factor includes the transparency and flexibility of the provisions of the contract, the legal validity of the contractor, the laws and regulations of the Ministry of Health and the laws governing the contractor. A contract that sets out conditions such as time, cost, rewards, and risks for both parties creates a secure relationship. In addition to transparency, such a contract should include evaluation indicators and control methods . The contract is best managed and monitored when it pays attention to the details of service levels and metrics based on cost reduction, service delivery, service improvement, and user satisfaction. As a result, it is essential to consider the inclusion of oversight rules in any outsourcing contract.
Monitoring and control factors with a path coefficient of 0.889 directly affect about 88% of outsourcing decision changes. Many studies have pointed out this dimension [16, 22, 23]. This includes monitoring and supervising the strict implementation of contract provisions, focusing on key points of monitoring and evaluating contractors ‘performance, having a valid database for recording contractors’ performance information, defining a structured standard for monitoring and evaluating contractors ‘performance, and managers’ mastery of skills for evaluating the performance of contractors, the ability to measure the continuous improvement of service quality and the ability to measure the satisfaction of other units and the client of the outsourcing target unit’s performance. Service providers must apply their control in both tangible and intangible ways. This control is more severe in the early stages but should generally be continuous. In the further steps, it continues as relationship management. This leads to the correct implementation of the contract and consequently reduces costs (such as evaluation and negotiations costs) and achieves a competitive advantage. In this regard, defining standards, monitoring key points, access to valid data, continuous quality assessment, and satisfaction are necessary [3, 22].
Type of service factors with a path coefficient of 0.758 directly affects about 75% of outsourcing decision changes. Many studies have pointed out this dimension [16, 23,24,25]. This includes the tangibility of the service, the existence of service delivery protocol, the degree of service connection with the client, the degree of interdependence of services, the strategic importance of services, the complexity of processes and the need for service in the mission of the organization. The nature of services such as complexity, structural integrity, required resource capacity, availability of equipment and tools, controllability, and popularity in the organization culture are determining factors [16, 24, 25]. We must first identify the organization’s goals, key capabilities, and main missions to determine the activities that can be outsourced. Any non-core activity can be outsourced. The activities that are the primary mission of the organization are not usually outsourced. Some services inside and outside the organization can better provide efficiency, quality, cost-effectiveness, added value and customer respect.
Executive capability factors with a path coefficient of 0.669 directly affect about 66% of outsourcing decision changes. This includes the support of financial and operational managers, the participation and support of influential people, attention to internal capabilities and key capacities, agility and flexibility of the organization against change, intra-organizational coordination and the extent of conflict of interest. Many studies have pointed to this dimension, including Kavosi et al. . In today’s rapidly changing environment, organizations need to have the necessary flexibility to maintain a competitive position. Because doing all of an organization’s processes internally requires resources, expertise, and attention, often not sufficiently available, outsourcing provides this flexibility. Executive capability to outsource requires the support of managers, participation of all stakeholders, cooperation and coordination of units, and conflict resolution [1, 26,27,28].
The external environment factors with a path coefficient of 0.664 directly affect about 66% of outsourcing decision changes. Many studies have pointed to this dimension [16, 23, 25].. This includes the political, economic and cultural status, the existence of reputable and qualified contractors, the extent to which competitive capacity is achieved, the existence of modern technology, the type of technology and the facilities used by the contractor. Achieving maximum potential benefits and minimum risk requires selecting a qualified supplier [1, 19]: the more suppliers, the less risky the choice. Maintaining a competitive position through outsourcing [16, 19, 23] responds to the rapid growth of technology, the explosion of knowledge, the growing demand of customers, the changing appearance of diseases, the increasing pressures of scarce financial resources, and the achievement of productivity. Equipping the contractor with the latest equipment, facilities, resources, and technology in the world is also necessary [3, 22, 24].
Human resource factors with a path coefficient of 0.732 directly affect about 73% of outsourcing decision changes. This includes training and empowerment of employees, measuring the knowledge and skills of employees, the status of qualified personnel within the organization, coordination of employees and the degree of release of human resources for internal works. Many studies have pointed to this dimension [1, 16, 19]. Whereas processes performed by specialized personnel are more efficient and less risky, outsourcing will take place if the staff’s expertise and skills and the possibility and qualification of training are low. On the other hand, when outsourcing is communicated to employees, there is naturally anxiety, worry, a sense of job insecurity, and consequently a decrease in motivation and performance. In such a situation, creating an outsourcing organizational culture leads to the acceptance of outsourcing, and employees seek their own and the organization’s interests in implementing outsourcing. This culture, along with providing transparent information to employees, strengthens the coordination of internal staff with outsourced staff [26, 27].
The most influential factor in outsourcing health services was monitoring and control (88%). Monitoring and control ensure the fulfilment of obligations at the level of setting standards. Errors in evaluating other factors such as economic and financial factors, selection of the appropriate contractor, type of outsourced service, etc., occur as deviations and problems in the outsourcing process. Therefore, continuous monitoring and control is a factor that allows early detection of errors and even their correction.
Limitations of this study include 1) We made the research tool with the opinions of experts that may lead to mental attitudes and memory biases, 2) Lack of access to some databases in the comprehensive overview section.