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Background: Teaching hospitals serve as training grounds for students and residents across various specialties, while also providing more complex healthcare services that contribute to research production and advancements in health technologies. Considering all their functions, the efficiency evaluation of these institutions warrants special attention in the literature. This study aims to review the existing literature, identify the main challenges faced by previous studies, and establish new guidelines to address flaws in models assessing teaching hospitals' efficiency. Methods: An integrative review was conducted across five major databases: Springer Link, Scopus, ScienceDirect, Web of Science, and Inderscience. The search yielded 384 records, and after removing duplicates and following PRISMA guidelines, 28 studies were deemed eligible for inclusion. Results: The review reveals a scarcity of evaluation models specifically tailored to teaching hospitals. Data envelopment analysis is the most frequently used method in this field but exhibits several weaknesses. Key challenges identified include the lack of literature on the positive relationship between increased inputs and quality, proving the reliability of DEA, addressing its limitations in handling numerous input and output variables, improving communication with hospital managers, refining the categorization of healthcare professionals, and enhancing the understanding of productivity differences between medical residents and senior physicians. Conclusions: We propose a theoretical framework to guide future studies on the efficiency assessment of teaching hospitals, emphasizing the need for a multidimensional approach. This model should incorporate economic-financial, quality, and educational dimensions, alongside commonly applied dimensions such as healthcare, staff, and physical and technological infrastructure. Moreover, the challenges pointed out based on the integrative review suggest a rich agenda for upcoming studies, encourage the development of management tools to assess efficiency in teaching hospitals and contribute to formulating an agenda to orient public policies related to efficient resource management in teaching hospitals and educational and health systems.
Almeida et al. (Wed,) studied this question.