Elsevier

Health Policy

Volume 48, Issue 2, August 1999, Pages 107-117
Health Policy

An analysis of the effectiveness of Spanish primary health care teams

https://doi.org/10.1016/S0168-8510(99)00036-6Get rights and content

Abstract

One of the main objectives of the managers of public health systems in most developed countries is the modernisation of public services through managerial reforms as a way of resolving the traditional inefficiency of this sector. The objective of this article is to observe how the introduction of one tool traditionally used in the private sector, the organisation of work through teams, can contribute to improved performance in public health services. The study was conducted in the primary health care teams of Navarre, an autonomous region of Spain, where a new model of primary health care, based on teamwork was implanted. We analyse the relationship between team characteristics, team members’ individual features and team performance from a stakeholder approach. We can conclude that teams are a form of organisational design useful for improving performance in primary health care because insofar as they function properly, they achieve greater degrees of job satisfaction for the employees, greater perceived quality by the users and greater efficiency for the Administration.

Introduction

The General Health Act, passed in Spain in 1986, produced, among other reforms, a new model for Primary Health Care based on the principles arising from the Alma-Ata Conference, organised by the World Health Organisation and the United Nations Children’s Fund in 1978 [1]. One of the main changes in this new model was the establishment of what were called primary health care teams (PHCTs), functional units of medical and non-medical professionals who offer integrated health services to a geographical area known as a basic health zone.

A very important difference between this model and the previous one is fundamentally the way the work is organised, in that it is now carried out by teams of professionals and not by individuals as before. This means that each member of the team, following commonly established objectives, participates actively and in co-ordination with the rest of the team according to his/her capacities, field and duties in the programming, execution and evaluation of the activities of the team.

The setting up of work groups is a human resources device whose popularity lies in the idea that this type of organisation heightens the ability to identify and solve problems, and therefore serves to improve the organisation’s performance [2]. The development of work groups has gone through two historical phases of diffusion, as a result of specific historical and social processes [3]. Although the first steps, in the 70s, came about partly as a way of avoiding the negative consequences of Taylorism in productivity, they were later used as a tool to respond to the changing conditions of a market that required rapid, imaginative responses and in which competitiveness was the prime consideration.

On many occasions, teams are considered from a universalistic viewpoint, and they are proposed as a solution to most organisational problems. However, there are more exact models which analyse teams from a contingent point of view, regarding them as adequate when they adapt to concurrent conditions. Contingent models are of the three-phase context-process-result type, derived from traditional socio-psychological models [4]. One of the best known is the Hackman model [5], [6], where the performance of the team depends on the context within which it functions, characterised by factors such as information, remuneration and education. Furthermore, the team’s performance will be the result of its make-up [7].

In this article we shall be studying the relationships between variables of team composition, individual characteristics of team members and team performance from a stakeholder approach. The analysis has been conducted using primary health care teams in Navarre, an autonomous region of Spain. The hypothesis we aim to verify is that an appropriate team design will affect the performance of PHCTs. We have used the Carew, Parisi-Carew, Blanchard and Stoner model [8], [9] of team performance which establishes the characteristics that typify a group of people working together in a team. Team performance is assessed from a stakeholder perspective in which various criteria are considered reflecting, to a greater or lesser degree, the expectations of the different groups (constituencies) related to the organisation [10]. The final objective is to demonstrate that the adequate management of human resources can help to increase performance in this type of organisation.

We also analyse the relationship between some of the individual characteristics of the components of the groups and their design variables with a view to establishing to what extent a certain type of employee influences a team’s performance. In this way, we hope to provide managers with a useful tool when selecting the most appropriate individuals to form a team.

Section snippets

Sample

In Spain, two different types of health system co-exist. In some regions it is INSALUD (National Health Institute), a central government body, that is responsible for the health system, whilst in others it is the autonomous region itself. Navarre has been responsible for its health care system since 1990.

Primary health care services in this region are provided by 53 teams, each one with its assigned basic zone, with an average population of 8777 people per zone. The average number of people

Results

As Table 2 shows only research and type of professional distinguish between team design variables. Personnel that do research feel more pessimistic than others about empowerment and goals. Doctors, paediatricians and social worker are more pessimistic than nurses and administrative personnel about the confidence in the group capacity to overcome obstacles. They feel less flexible too. When the group analysed is the doctor’s group it is possible to observe that resident doctors think about goals

Conclusions

In this article, we have attempted to analyse the relationship between team characteristics and performance in primary health care. We have also studied the relationship between some of the individual characteristics of the team members and team design variables. Our purpose has been to try to show that the performance of public health systems can be heightened by the introduction of managerial reforms. The empirical examination was conducted on 31 PHCTs in Navarre, an autonomous region of

Acknowledgements

The author thanks the comments and suggestions of the anonymous referee.

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