A taxonomy of primary health care practices: an avenue for informing management and policy implementation
John Rodwell A B and Andre Gulyas A
+ Author Affiliations
- Author Affiliations
A Faculty of Business, Australian Catholic University, Locked Bag 4115, Fitzroy MDC, Vic. 3065, Australia.
B Corresponding author. Email: john.rodwell@acu.edu.au
Australian Journal of Primary Health 19(3) 236-243 https://doi.org/10.1071/PY12050
Submitted: 26 April 2012 Accepted: 3 July 2012 Published: 15 August 2012
Abstract
Health policy and practice managers often treat primary practices as being homogenous, despite evidence that these organisations vary along multiple dimensions. This treatment can be a barrier to the development of a strong health care system. Therefore, a more sophisticated taxonomy of organisations could inform management and policy to better cater to the diversity of practice contexts, needs and capabilities. The purpose of this study was to categorise primary practices using practice features and characteristics associated with the job satisfaction of GPs. The current study uses data from 3906 GPs from the 2008 wave of the MABEL survey. Seven configurations of primary health care practices emerged from multivariate cluster analyses. The configurations incorporate, yet move beyond, simplistic categorisations such as geographic location and highlight the complexity facing managers and health policy interventions. The multidimensional configurations in the taxonomy are a mechanism for informing health care management and policy. The process of deriving configurations can be applied in a variety of countries and contexts.
Additional keywords: configurations, general practice, health care organisations, health policy.
References
Abt K (1983) Significance testing of many variables: problems and solutions. Neuropsychobiology 9, 47–51.| Significance testing of many variables: problems and solutions.Crossref | GoogleScholarGoogle Scholar |
Access Economics (2002) ‘Primary health care for all Australians.’ (Australian Medical Association: Canberra)
AMWAC (2005) ‘The general practice workforce in Australia.’ Available at http://www.ahwo.gov.au/documents/Publications/2005/The general practice workforce in Australia.pdf [Verified 20 April 2012]
Douglas KA, Rayner FK, Yen LE, Wells NJ, Glasgow NJ, Humphreys J (2009) Australia’s primary health care workforce – research informing policy. The Medical Journal of Australia 191, 81–84.
Duckett SJ (2008) ‘The Australian health care system.’ 3rd edn. (Oxford University Press: Melbourne)
Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 39, 175–191.
| G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Crossref | GoogleScholarGoogle Scholar |
Flocke SA, Litaker D (2007) Physical practice patterns and variation in the delivery of preventative services. Journal of General Internal Medicine 22, 191–196.
| Physical practice patterns and variation in the delivery of preventative services.Crossref | GoogleScholarGoogle Scholar |
Haas JE, Hall RH, Johnson NJ (1966) Toward an empirically derived taxonomy of organizations. In ‘Studies on behavior in organizations: a research symposium’. (Ed. RV Bowers) pp. 157–180. (University of Georgia Press: Athens, Georgia)
Hair JF, Jr, Anderson RE, Tatham RL, Black WC (1995) ‘Multivariate data analysis with readings.’ (Prentice Hall: Sydney)
Harris MF, Proudfoot JG, Jayasinge UW, Holton CH, Powell Davies GP, Amoroso CL, Bubner TK, Beilby JJ (2007) Job satisfaction of staff and the team environment in Australian general practice. The Medical Journal of Australia 186, 570–573.
Harris MF, Jayasinge UW, Chan BC, Proudfoot J, Crookes P, Zwar N, Powell Davies G,, the Team-link Research Team (2011) Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases: a multilevel study. Health Policy (Amsterdam) 101, 140–145.
| Patient and practice characteristics predict the frequency of general practice multidisciplinary referrals of patients with chronic diseases: a multilevel study.Crossref | GoogleScholarGoogle Scholar |
Hills D, Joyce C, Humphreys J (2012) Validation of a job satisfaction scale in the Australian clinical medical workforce. Evaluation & the Health Professions 35, 47–76.
Humphreys JS, Jones JA, Jones MP, Mildenhall D, Mara PR, Chater B, Rosenthal DR, Maxfield NM, Adena MA (2003) The influence of geographical location on the complexity of rural general practice activities. The Medical Journal of Australia 179, 416–420.
HWA (2012) ‘Health workforce 2025.’ (Health Workforce Australia: Adelaide)
Katerndahl D, Parchman M, Wood R (2009) Perceived complexity of care, perceived autonomy, and career satisfaction among primary care physicians. Journal of the American Board of Family Medicine 22, 24–33.
| Perceived complexity of care, perceived autonomy, and career satisfaction among primary care physicians.Crossref | GoogleScholarGoogle Scholar |
Ketchen D, Shook CL (1996) The application of cluster analysis in strategic management research. Strategic Management Journal 17, 441–458.
| The application of cluster analysis in strategic management research.Crossref | GoogleScholarGoogle Scholar |
MacGregor RC, Hyland PN, Harvie C (2009) Do organizational characteristics explain the differences between drivers of ICT adoption in rural and urban general practices in Australia? Australasian Journal of Information Systems 16, 77–78.
Macinko J, Starfield B, Shi L (2003) The contribution of primary care systems to health outcomes within organization for economic co-operation and development (OECD) countries, 1970–1998. Health Services Research 38, 831–865.
| The contribution of primary care systems to health outcomes within organization for economic co-operation and development (OECD) countries, 1970–1998.Crossref | GoogleScholarGoogle Scholar |
McGrail MR, Humphreys JS, Joyce CM, Scott A, Kalb G (2012) How do rural GPs’ workloads and work activities differ with community size compared with metropolitan practice? Australian Journal of Primary Health 18, 228–233.
McKelvey B (1978) Organizational systematics: taxonomic lessons from biology. Management Science 24, 1428–1440.
| Organizational systematics: taxonomic lessons from biology.Crossref | GoogleScholarGoogle Scholar |
Menachemi N, Mazurenko O, Kazley AS, Diana ML, Ford EW (2012) Market factors and electronic medical record adoption in medical practices. Health Care Management Review 37, 14–22.
Meyer AD, Tsui AS, Hinings CR (1993) Configurational approaches to organizational analysis. Academy of Management Journal 36, 1175–1195.
| Configurational approaches to organizational analysis.Crossref | GoogleScholarGoogle Scholar |
Miller D, Friesen PH (1984) ‘Organizations: a quantum view.’ (Prentice Hall: Englewood Cliffs, NJ)
Miller D, Mintzberg H (1983) The case for configuration. In ‘Beyond method: strategies for social research’. (Ed. G Morgan) pp. 55–73. (Sage: Beverly Hills)
Miller WL, Crabtree BF, McDaniel R, Strange KC (1998) Understanding change in primary care practice using complexity theory. The Journal of Family Practice 46, 369–376.
Naccarella L, Southern D, Furler J, Scott A, Prosser L, Young D, Swrissen H, Water E (2008) Primary care funding and organizational policy options and implications: a narrative review of evidence from five comparator countries. The Medical Journal of Australia 188, S73–S76.
Pettigrew AM (1992) The character and significance of strategy process research. Strategic Management Journal 13, 5–16.
| The character and significance of strategy process research.Crossref | GoogleScholarGoogle Scholar |
Schofield DJ, Beard JR (2005) Baby boomer doctors and nurses: demographic change and transitions to retirement. The Medical Journal of Australia 183, 80–83.
Ulmer B, Harris M (2002) Australian GPs are satisfied with their job: even more so in rural areas. Family Practice 19, 300–303.
| Australian GPs are satisfied with their job: even more so in rural areas.Crossref | GoogleScholarGoogle Scholar |
van Ham I, Verhoeven AAH, Groenier KH, Groothoff JW, De Haam J (2006) Job satisfaction among general practitioners. The European Journal of General Practice 12, 174–180.
| Job satisfaction among general practitioners.Crossref | GoogleScholarGoogle Scholar |
Walker J, Hill R, Green L (2000) Tassie’s tele-rrific telehealth network: linking primary health care services for better rural health outcomes. Australian Journal of Primary Health 6, 108–117.
| Tassie’s tele-rrific telehealth network: linking primary health care services for better rural health outcomes.Crossref | GoogleScholarGoogle Scholar |
Warr P, Cook J, Wall T (1979) Scales for the measurement of some work attitudes and aspects of psychological wellbeing. Journal of Occupational Psychology 52, 129–148.
| Scales for the measurement of some work attitudes and aspects of psychological wellbeing.Crossref | GoogleScholarGoogle Scholar |
Williams AP, Vayda E, Stevenson HM, Burke M, Pierre L (1990) A typology of medical practice organization in Canada. Medical Care 28, 995–1004.
| A typology of medical practice organization in Canada.Crossref | GoogleScholarGoogle Scholar |
Wolinsky F (1982) Why physicians choose different types of practice settings. Health Services Research 17, 399–419.
Yan W, Cheng T, Scott A, Kuehnle A, Jeon S-H, Sivey P, Leahy A (2011) ‘MABEL user manual: Wave 2 release.’ (Melbourne Institute of Applied Economic and Social Research, University of Melbourne: Melbourne)
