Explaining Resource Allocation in Board of Trustees Hospitals: A Case Study of Afzalipour Medical Center in Kerman, Iran

Background: The main resources of health care are allocated to hospitals.However, resource bottlenecks are a challenge faced by health systems around theworld, especially in developing countries such as Iran. Inefficiencies in resourceallocation can increase the constraints in double fold. Therefore, the present studywas conducted to determine the allocation of financial resources in one of thehospitals of the board of trustees, Afzalipour Medical Center, Kerman, Iran in2014.Methods: Review of documents, two deep interviews and five focus group discussionswith eleven experts were used to collect data in the present qualitative study.Participants were members of the board of trustees and representatives of the financialdepartment of the hospital. Data were then analyzed using content analysis method.Results: Based on the present study, four main themes and ten sub-themes wereidentified, with main themes including decision-making reference, process, criteriaand factors influencing decision-making. In this regard, there was no clear processand criteria for allocating resources at this center, and allocation of resources wasdone based on a reactive approach, response to critical situations, political currentsand financial bottlenecks. Contrary to the potential capacity of the structure ofboard of trustees, in practice, headship and management played a key role inallocating financial resources.Conclusion: The process of allocating financial resources in the investigatedhospital follows a less rational approach and coincided with the chaos theory andthe garbage can model of decision-making in the governmental bureaucraticstructure. The governmental bureaucratic structure and the board of trusteesstructure (decentralization) in contrast to each other have led to a disorder, wherethe lack of transparency in determining goals, criteria and document performancehave also exacerbated this disorder. In this regard, the oil-related budget hasstabilized the inappropriate allocation of resources.

Keywords:

Resource Allocation , Board of Trustees , Chaos Theory , Garbage Can , Hospital