Self-Assessment Benchmarking as a Quality Management Tool in Primary Healthcare

Abstract

The stated intent of the Conservative government's health service reforms in the 1990s was to reduce waste and inefficiency by introducing market forces and bringing these to bear on both primary and secondary levels of health care. The establishment of the General Practice Fundholder (GPFH) in 1991 was fundamental to these reforms. It was intended to place purchasing power at the most direct point of contact with the patient. It also handed over control of almost £100 million per year of public money to what some commentators considered to be relatively inexperienced fund managers. The structure of this review reflects these concerns and tests the application of Self-Assessment Benchmarking as a quality management tool in the more effective management of primary health care organisations. The first phase of the study reviews the literature on three key interrelated concepts: Benchmarking; Total Quality Management in Healthcare; and Recent Developments in GP Practice Management. The literature review concludes with an attempted synthesis of these concepts in the form of a generic framework for a comprehensive Benchmarking programme for Medical Practitioners that goes beyond conventional practices on the subject. This framework seeks to reflect and capture the range of assumptions and cultural norms that underpin General Practice management together with conventional wisdom on management best practices. The framework is then tested on a sample of twenty-five GP Practice Managers and the whole process is reviewed by means of direct comparison of methods and triangulation of results. The results of the testing and review indicated that the approach taken here does indeed hold considerable promise, but that there needs to be a radical change in attitude towards primary health care management practices for Self-Assessment Benchmarking to become widely acceptable.