title: Advantages and disadvantages of different methods of hospitals' downsizing: a narrative systematic review.
abstract: BACKGROUND
  Hospitals as key actors in health systems face growing pres-sures especially cost cutting and search for costeffective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital' downsizing.
  
  
  METHODS
  The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis.
  
  
  RESULTS
  Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees' workload and dissatisfaction.
  
  
  CONCLUSIONS
  Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion.
authors.affiliation: Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Yalda
authors.initials: Y
authors.lastname: Mousazadeh
authors.affiliation: Tabriz Healthcare Management Research Center,Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Jannati
authors.affiliation: Tabriz Health Services Management Research Center, Tabriz University of medical sciences, Tabriz, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Jabbari Beiramy
authors.affiliation: Road Traffic Injury Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Asgharijafarabadi
authors.affiliation: Deputy of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ebadi
keywords: Downsizing; Downsizing method; Hospital; Review