How the service delivery works in the Iranian specialised burns hospitals? A qualitative approach

As burn injuries are a major cause of death and infirmity, successful service delivery is vital in health systems. In Iran, a few specialised burns hospitals (SBHs) located in big provinces provide burn services in which burn patients with more severe conditions are referred to. However, SBHs are faced with several challenges for delivering due treatment for burn patients. So, for the first time in Iran, the main aim of the study was to identify the challenges of delivering burn services in SBHs. For this purpose, we conducted a qualitative study during February 2017 to April 2018. Key informants were purposefully selected and interviewed at national and provincial levels from the Ministry of Health, medical universities, and informants working in eight SBHs. The saturation point was reached at 21 face-to-face semi-structured interviews. A thematic analysis approach was employed to analyse transcribed documents assisted by MAXQDA Plus version 12. Our results reveal four themes and twelve subthemes on the challenges of delivering services in SBHs. Themes and (subthemes) including burn care continuum (preventive care, pre-hospital care, hospital care, follow-up, and home care), regionalisation of burning services (access to other specialties and medical services, access to specialized care in provinces without a SBH, standardised regionalisation system for burn related services (BRSs), costs of providing BRSs (expensive services and supplies and long hospitalisation), and non-compliance with standardised care (guidelines to provide burn care and physical space to provide BRSs). Results suggest that improving BRSs delivery in Iran may be reached by strengthening burn care continuum, regionalising burn care, allocating sufficient budgets to burn services and formulating burn care guidelines. These policy actions can be better addressed via intra-sectoral collaborations.