Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.
BACKGROUND
Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers.


METHODS
As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services.


RESULTS
Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services.


CONCLUSIONS
Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully.
Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia.
Sara
S
Javanparast
Department of Health Care Management, Flinders University, Adelaide, Australia.
Janny
J
Maddern
Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia.
Fran
F
Baum
Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia.
Toby
T
Freeman
Department of Speech Pathology, Flinders University, Adelaide, Australia.
Angela
A
Lawless
School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ronald
R
Labonté
University of Cape Town, Cape Town, South Africa.
David
D
Sanders
D001315:Australia; D003142:Communication; D018166:Health Care Reform / Q000458:organization & administration*; D006270:Health Facility Administrators; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*
change management; health reform; primary health care