Trend of Hospital Performance in Northern Iran: A 5-year Assessment Using Pabon Lasso Model

Document Type: Research Paper


1 Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran


Background and Objectives: The large contribution of hospitals to the function and expenditures of the healthsector makes their constant monitoring and evaluation inevitable to improve the overall performance of the health system. Built on that, the present study aimed to evaluate the trend of performance of hospitals affiliated with the public hospitals (in Guilan Province, Iran) affiliated with Ministry of Health and Medical Education (MOHME) using the Pabon Lasso framework.
Methods: All (21) hospitals affiliated to Guilan University of Medical Sciences (GUMS) were monitored within 2010-2015. Data of BOR, BTR and ALS of these hospitals were collected using a form completed by the university’s Office of Vice-chancellor for Clinical Affairs. The Pabon Lasso diagram was set up by dividing the area between BOR (horizontal) and BTR (vertical) axes into four Zones based on the average of BOR and BTR values. A second Pabon Lasso diagram was also set up with the cut-off point being standard average BOR and BTR values as suggested by MOHME. The data of BOR and BTR of the target hospitals were then mapped onto the diagrams.
Findings: The number of hospitals in Zone 1 has decreased from 6 to 3, and the number of hospitals in Zone 3 has increased from 5 to 6 during 2010 to 2015. Based on MOHME’s evaluation criteria, the average BOR of the surveyed hospitals has increased from the moderate level in 2010-2011 to the favorable level in 2014-2015. Moreover, the 5-year average BTR of these hospitals maintains far above the minimum favorable threshold, and the 5-year average ALS of these hospitals falls in the moderate range. In 2014-2015, while 23.8% of the hospitals are located in Zone 3, 71.42% are located in Zone 2, and there is no hospital located in Zone 1.
Conclusions: AOur results suggest that the performance of GUMS hospitals has been on an increasing trend in the recent years. Nonetheless, when considering MOHME’s evaluation criteria, most of the hospitals are still located in the second Zone of Pabon Lasso Model, which corresponds to low BOR and high BTR. This information recommends avoidance of further bed development, and rather using under-utilized beds in high demand healthcare services in order to achieve higher hospital performance in future years