Introduction In the past few years, many demographic, epidemiological, socio-economic, cultural and technological changes and reduction of resources, have made it necessary to reorganise the health system, shifting the focus... [ view full abstract ]
Introduction
In the past few years, many demographic, epidemiological, socio-economic, cultural and technological changes and reduction of resources, have made it necessary to reorganise the health system, shifting the focus on hospital-based medical practice out into the community.
The process of managerial development of primary care has therefore accelerated significantly also in Italy, particularly in some regions. The tools governing general medical practice have become particularly important, such as to identify elements to improve its effectiveness.
Research questions and method
The main objective is describing the elements of management, organisation and processes, substantially the best practices, leading to the effectiveness of the organisational change toward Health Centre model.
The research methodology used is the business case study (Yin 1994; Stake 1995,1998; Gillham 2001). Six Health Centres in a single region were taken into consideration.
To better understand and analyse the development process, structured interviews were held to key roles in the managerialisation process.
Theoretical foundations for the research
There are some common features on the changes in primary health care and the managerial tools: the first seeks to assess to what extent public programmes of change have achieved their organisational, economic and equity objectives (Wyke et al. 2003; Wilton and Smith 1998, Baker and Hann 2001); a second area aims to measure the dissemination of certain managerial tools and specific organisational solutions in quantitative terms (Wilkin et al. 2002, 2001b; Cavallo, Gerzeli and Vendramini 2001, Baxter, Bachmann and Bevan 2000); a third area on the other hand illustrates how General Practitioners have moved to protect their interests in relation to the introduction of managerial tools in the wider health system (Sheaff et al. 2002, Kay 2001, Sutherland and Dawson 1998); a fourth area analyses whether and how doctors have positively responded to the introduction of reforms which bring with them new managerial tools (Middlemass and Siriwardena 2003, Whynes and Baines 2002).
Rapid reforms supported by law can legitimise formal change but it is necessary to invest in training and dissemination of knowledge, if we want real change (Gillies 1995). The quality of relations between stakeholders, General Practitioners and top managers, is the real pillar for effective introduction of managerial tools (Leese and Mahon 1999, Camp and Tweet 1994). General Practitioners do not put up resistance to the introduction of behavioural requirements, or restrictions, where it is clear that the control system purpose is to facilitate their activities and increase the quality of the service (Jacobs 1998, Vendramini 2002).
The literature leads to some key factors associated to the managerial development of primary care (Jacobs 1998). Their identification is the fundamental element for understanding which of these play an important role.
4. Results
The research concludes by underlining the key relations identified, correlating them to the reference literature and laying the foundations for future research better investigating aspects linked to the efficiency of the analysed processes.
E3 - Health Care Management Reforms – Public Policy, Management and Accountability
