Cheques and challenges: business performance in New Zealand general practice
Richard Greatbanks 1 , Fiona Doolan-Noble 2 , Alex McKenna 11 Department of Management, Otago Business School, University of Otago, Dunedin 9054, New Zealand
2 Rural Aotearoa Research Network, Department of General Practice and Rural Health, University of Otago, New Zealand
Correspondence to: Fiona Doolan-Noble, Rural Aotearoa Research Network, Department of General Practice and Rural Health, University of Otago, New Zealand. Email: fiona.doolan-noble@otago.ac.nz
Journal of Primary Health Care 9(3) 185-190 https://doi.org/10.1071/HC17047
Published: 25 September 2017
Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors.
AIM: To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice.
METHODS: For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data.
RESULTS: All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand.
DISCUSSION: As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of ‘super practices’ based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.
KEYWORDS: New Zealand; general practice; business performance; hybridization tension
References
[1] Billis D. Hybrid organisations and the third sector. Challenges for practice, theory and policy. Basingstoke, UK: Palgrave; 2010.[2] van den Hombergh P, Kunzi B, Elwyn G, et al. High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands. BMC Health Serv Res 2009; 9 118
| High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands.Crossref | GoogleScholarGoogle Scholar |
[3] Rogan L, Boaden R. Understanding performance management in primary care. Int J Health Care Qual Assur. 2017; 30 4–15.
| Understanding performance management in primary care.Crossref | GoogleScholarGoogle Scholar |
[4] Grice N, Wilson J, Foster G, Padgett G. The nature of business planning undertaken by general practitioner fundholding practices in the North West Region. Public Money Manag. 1998; 18 31–40.
| The nature of business planning undertaken by general practitioner fundholding practices in the North West Region.Crossref | GoogleScholarGoogle Scholar |
[5] Majeed FA, Voss S. Performance indicators for general practice. BMJ 1995; 311 209–10.
| Performance indicators for general practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2MzltlWjtA%3D%3D&md5=f2a81472c65d8518d14a8f6324911cd1CAS |
[6] Neely A. Business Performance Measurement. Theory and Practice. Cambridge, UK: Cambridge University Press; 2002.
[7] Bourne M, Neely A, Platts K, Mills J. The success and failure of performance measurement initiatives. Int J Oper Prod Manage. 2002; 22 1288–310.
| The success and failure of performance measurement initiatives.Crossref | GoogleScholarGoogle Scholar |
[8] Bryman A. Chapter 18: Sampling in qualitative research. In: Social Research Methods, 4th edn. Oxford, UK: Oxford University Press; 2012. p. 415–429.
[9] Bryman A. Chapter 20. Interviewing in qualitative research. In: Social Research Methods, 4th edn. Oxford, UK: Oxford University Press; 2012. p. 468–498.
[10] Bryman A. Chapter 2. Social research strategies. Social Research Methods. 4th edn. Oxford, UK: Oxford University Press; 2012. p. 18–4.
[11] Brignall S, Modell S. An institutional perspective on performance measurement and management in the ‘new public sector’. Manage Account Res. 2000; 11 281–306.
| An institutional perspective on performance measurement and management in the ‘new public sector’.Crossref | GoogleScholarGoogle Scholar |
[12] Currie G. The influence of middle managers in the business planning process: a case study in the UK NHS. Br J Manage. 1999; 10 141–55.
| The influence of middle managers in the business planning process: a case study in the UK NHS.Crossref | GoogleScholarGoogle Scholar |
[13] Kath . A worthwhile plan - Business plans help practices focus on their long-term goals. Med J Aust. 2012; 196 2 Available from: https://www.mja.com.au/journal/2012/196/2/worthwhile-plan-business-plans-help-practices-focus-their-long-term-goals cited 15/06/2017.
