The relationship between size and performance of primary care organisations in England.
ABSTRACT To examine the relationship between the size and performance of primary care organisations, the effect of and the reasons for mergers.
Data on size, proxy measures of performance and merger intentions for 71 organisations were extracted from telephone and mail surveys of primary care groups and trusts (PCG/Ts).
Of the 22 performance measures examined, only two were significantly associated with size, and over half were not associated with any of the potential explanatory variables. Most organisations (70%) were planning mergers. If all planned mergers take place, the mean size of primary care organisations will double to nearly 200000. The main reasons for mergers were to make better use of resources and for PCGs to become PCTs.
There is little evidence that the performance or efficiency of a primary care organisation is associated with its size. Optimal size may differ for different functions. Mergers are seen as a way of increasing management capacity and may reflect the desire of managers to manage large organisations. There is a risk that larger primary care organisations will recreate hierarchies and lose local ownership and participation.
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ABSTRACT: The ideal population size of healthcare commissioning organisations is not known. To investigate whether there is a relationship between the size of commissioning organisations and how well they perform on a range of performance measures. Cross-sectional, observational study of performance in all 152 primary care trusts (PCTs) in England. Comparison of PCT size against 36 indicators of commissioning performance, including measures of clinical and preventative effectiveness, patient centredness, access, cost, financial ability, and engagement. Fourteen of the 36 indicators have an unadjusted relationship (P<0.05) with size of the PCT. With 10 indicators, there was increasing quality with larger size. However, when population factors including deprivation, ethnicity, rurality, and age were included in the analysis, there was no relationship between size and performance for any measure. There is no evidence to suggest that there is an optimum size for PCT performance. Observed variations in PCT performance with size were explained by the characteristics of the populations they served. These findings suggest that configuration of clinical commissioning groups should be geared towards producing organisations that can function effectively across their key responsibilities, rather than being based on the size of their population alone.British Journal of General Practice 01/2012; 62(594):e46-54. · 1.83 Impact Factor
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ABSTRACT: The aim of the paper is to trace the history and development of performance measurement and management systems in the Italian National Health System (INHS), to identify their key characteristics, and to provide a critical assessment of their implementation. A combination of literature review, action-research and fieldwork conducted over a ten-year period in several Italian health care organizations. Performance management has grown considerably in the INHS over the last 15 years. Explanations for this growth include normative, coercive and mimetic isomorphism, the introduction of quasi-markets, the adoption of DRGs, an increased focus on clinical governance and innovative practices in human resource management. The paper shows how performance management has been implemented in the INHS and why it can still be considered a "work in progress". The introduction of performance management systems has stimulated greater accountability and promoted a more cost conscious culture in healthcare organizations. Nevertheless, there are many problems that remain to be solved if performance management arrangements are to deliver the desired improvements in performance. The paper advocates the need for reduced isolationism and increased international comparison with concomitant evaluative effort.Journal of Health Organisation and Management 02/2008; 22(1):11-22.
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ABSTRACT: Abstract Background. In Sweden and Denmark, clinical dentistry is changing and public dentistry is in transition towards more market orientation. Dentists' overall job satisfaction is important for how public dentistry can fulfil the new expectations from patients, the public and politicians. Objectives. The aim of this study was to investigate what organizational factors were important for publicly employed salaried dentists' overall job satisfaction. Methods. A random sample of active, general dental practitioners (private and publicly employed) was selected in Denmark and in Sweden, and they received a postal questionnaire. The number of questionnaires was 1835 and the response rate was 68% (n = 1226). This study analysed only the publicly employed dentists. The sampling frame for the Swedish dentists was 431, response rate 68.9% (n = 297) and for the Danish ones 194, response rate 81.9% (n = 159). Multivariate regression was used with overall job satisfaction as a dependent variable. Results. Common organizational variables were important. The used model explained between 32% (Sweden) and 39% (Denmark) of the variance in overall job satisfaction. The only significant individual factor was less job satisfaction for Swedish dentists born outside Sweden. An organizational climate characterized by a focus on professional values was associated with job satisfaction in both countries. Among the Swedish dentists, number of colleagues and degree of influence were also important and among the Danish ones sufficient time for patients. Conclusions. Organizational factors had an impact on salaried publicly employed dentists' overall job satisfaction in both countries. The findings may have implications for other Human Service Organizations with employed professionals.Acta odontologica Scandinavica 08/2013; · 1.41 Impact Factor