Barriers to the Implementation of a Referral System in Hospitals in the Health Reform Plan: Shafa Hospital in Kerman

 Barriers to the Implementation of a Referral System in Hospitals in the Health Reform Plan: Shafa Hospital in Kerman Aidin Aryankhesal 1, 2, Farzaneh Mahmoudi Meymand 3 * 1Department of Health Services Management, School of Management and Medical Information,  Iran University of Medical Sciences, Tehran, Iran 2Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran 3Department of Health Management and Economics, School of Public Health,  Tehran University of Medical Sciences, Tehran, Iran Abstract Background: It is essential to pay attention to the management of the service referral system and identification of the areas that can improve satisfaction and quality of services. The aim of this study was to identify barriers to the implementation of a referral system in hospitals in order to improve the quality of services and patient satisfaction. Methods: This was an applied study in terms of purpose and descriptive - analytic in terms of methodology. We only chose Shafa hospital in Kerman to reach a comprehensive understanding of the issue. Purposeful sampling was done and the data were collected using semi-structured questionnaires that were completed during interviews. The data collection was carried out during three months (August, September, and October 2015). During the study period, 115 referral services for imaging were identified and investigated in the hospital. The answers to open-ended questions were classified after coding and content analysis. Results: In the study, four main themes and 13 sub-themes were identified. None of the patients claimed to pay for hospital’s ambulances and imaging services, and they were not asked to go outside the hospital to receive any health service. The issues of the crowd, delay in service delivery, and the shortage of ambulances in the domain of satisfaction and lack of effective communication in the domain of quality were the main findings of the research. Conclusions: The most important obstacles to implementing the service referral system in the hospital were related to uncertainty, the lack of coordination between different activities, and the human factors. Paying attention to factors such as human and non-human resources, organizational structure, information and communication technology, and development of appropriate indicators for evaluating performance is essential for the success of service chains and quality improvement. Keywords: Hospital Referral Chain; Health Reform Plan; Quality of Care; Satisfaction   Please cite this article as follows: Aryankhesal A, MahmoudiMeymand F. Barriers to the implementation of the hospital services referral chain in the Health reform plan: Shafa Hospital in Kerman. Hakim Health Sys Res 2019; 21(4): 300- 305.   *Corresponding Author: Ph.D. Student in Health Policy, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-3434260086, Email: [email protected]