The Relationship between Size and Performance of Primary Care Organizations in England

National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
Journal of Health Services Research & Policy (Impact Factor: 1.73). 02/2003; 8(1):11-7. DOI: 10.1258/13558190360468173
Source: PubMed


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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    • "Rentsch (1990) using network analysis found that people involved in the same interaction groups attached similar meanings to organisational practices, whereas people attached to different groups attached different meanings to these events. In line with this, it can be argued that greater social interaction between the management team in smaller organisations relative to larger organisations results in greater local ownership and participation (Wilkin et al., 2003). This can be explained by size causing structural complexity (horizontal structural differentiation multiplied by vertical structural differentiation) and thereby creating more bureaucratic organisational layers (Donaldson, 2001). "
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    ABSTRACT: Using data collected in 2004 from 132 Victorian (Australia) public healthcare providers, comprising metropolitan and regional hospital networks, rural hospitals and community health centres, we investigated the perceptions of HRM from the experiences of chief executive officers, HR directors and other senior managers. We found some evidence that managers in healthcare organisations reported different perceptions of strategic HRM and a limited focus on collection and linking of HR performance data with organisational performance management processes. Using multiple moderator regression and multivariate analysis of variance, significant differences were found in perceptions of strategic HRM and HR priorities between chief executive officers, HR directors and other senior managers in the large organisations. This suggested that the strategic human management paradigm is ‘lost in translation’, particularly in large organisations, and consequently opportunities to understand and develop the link between people management practices and improved organisational outcomes may be missed. There is some support for the relationship between strategic HRM and improved organisational outcomes. Implications of these findings are drawn for managerial practice.
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    • "Fulop et al (2002) discuss the failure to achieve the objectives, and the significant disruption to service development, of NHS trust mergers. Wilkin et al (2003) fail to find any basis for assuming that, beyond a certain point, bigger is better when it comes to primary care organisations. Peck et al (2001) are lukewarm about the benefits of health and social care integration. "

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