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Challenges in implementing a budget-holding programme for primary care clinics.

N Nirel1, R Gross

  • 1JDC-Brookdale Institute, Jerusalem, Israel.

Health Policy and Planning
|May 7, 1997
PubMed
Summary

Kupat Holim Clalit (KHC) transformed primary care clinics into autonomous budget-holding units. Key factors for successful organizational change include management commitment, clear communication, and staff involvement.

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Area of Science:

  • Healthcare Management
  • Primary Care Innovation
  • Organizational Change

Background:

  • Kupat Holim Clalit (KHC), Israel's largest sick fund, initiated a demonstration program in 1990.
  • The program aimed to transition primary care clinics in the Negev district into autonomous budget-holding units.

Purpose of the Study:

  • To analyze the challenges and lessons learned from implementing a demonstration program for budget-holding primary care clinics.
  • To evaluate clinic staff's perception of the implementation process and their satisfaction with the program.

Main Methods:

  • A four-year longitudinal case study evaluation was conducted.
  • Multiple research tools were employed, including in-depth interviews, a staff survey, and document analysis.

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Main Results:

  • Overall, staff had a positive attitude toward the implementation process.
  • While only 33% were satisfied, 79% preferred the new model over the pre-programme system.
  • Factors influencing satisfaction included intrinsic benefits, perceived fairness, and age.

Conclusions:

  • Successful implementation of organizational change in healthcare requires long-term management commitment.
  • Effective strategies include appointing change agents, establishing formal agreements and communication channels, providing intrinsic benefits, ensuring reliable data, and fostering staff participation.