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The purpose of this article is to provide answers to two questions: what has been the impact of nGMS on practice organisation and teamwork; and how do general practice staff perceive the impact?

The article is based on comparative in‐depth case studies of four UK practices.

There was a discrepancy between changes observed and the way practice staff described the impact of the contract. Similar patterns of organisational change were apparent in all practices. Decision‐making became concentrated in fewer hands. Formally or informally constituted “elite” multidisciplinary groups monitored and controlled colleagues' behaviour for maximum performance and remuneration. This convergence of organisational form was not reflected in the dominant “story” each practice constructed about its unique ethos and style. The “stories” also failed to detect negative consequences to the practice flowing from its adaptation to the contract.

The paper highlights how collective “sensemaking” in practices may fail to detect and address key organisational consequences from the nGMS.

The authors' aim was to investigate mechanisms and perceptions of control following the implementation of a new “pay‐for‐performance” contract (the new General Medical Services, or GMS, contract) in general practice.

This article was based on an in‐depth qualitative case study approach in two general practices in England.

A distinction is emerging amongst ostensibly equal partners between those general practitioners conducting and those subject to surveillance. Attitudes towards the contract were largely positive, although discontent was higher in the practice which employed a more intensive surveillance regime and greater amongst nurses than doctors.

The sample was small and opportunistic. Further research is required to examine the longer‐term effects as new contractual arrangements evolve.

Increased surveillance and feedback mechanisms associated with new pay‐for‐performance schemes have the potential to constrain and shape clinical practice.

The paper highlights the emergence of new tensions within and between existing professional groupings.

The purpose of this paper, based on a nation‐wide survey, is to explore how clinical governance managers in the English NHS are seeking to engage with the culture(s) of their organisation to support quality improvement.

All English NHS primary and acute trusts, a total of 325, were contacted for R&D approval between March and September 2006. Clinical governance leads of organisations which gave their approval, 276 (or 85 per cent), were targeted in a nation‐wide postal survey between October 2006 and February 2007. A response rate of 77 per cent was obtained. The questionnaire contained mostly closed questions about the role and importance of culture in clinical governance and the use of tools for culture assessment. The questionnaire was piloted with eight respondents, seven in clinical governance from both primary care and acute trusts, and one from the National Patient Safety Agency. Useful feedback was received from five of the respondents, which was used to revise and refine the questionnaire. Confidence in the reliability and validity of the results is based on a high degree of consistency and similarity in the responses, both with respect to a few questions which were closely related and the two categories of respondents from primary care trusts and acute trusts.

There was found to be clear interest among clinical governance managers in culture renewal and management, in line with the growing national policy interest in promoting culture change as a lever for health system reform. Nearly, all clinical governance managers (98 per cent) saw the need to measure local culture in order to foster change for improved performance; 85 per cent, indicated that culture assessment should satisfy a formative purpose, whereas 64 per cent believed that it should serve summative ends. While nearly all clinical governance managers (99 per cent) acknowledge the importance of understanding and shaping local cultures, the majority are also conscious that there are many challenges to overcome in their efforts to implement and sustain beneficial culture change.

This research highlights the widespread practical interest in assessing and managing local health care cultures to support clinical governance and quality improvement activities. It also highlights the need for culture assessment tools that better reflect the needs and interests of clinical governance managers.

This paper aims to describe the introduction of pay‐for‐performance in New Zealand primary health care; compare this policy development with analogous English initiatives; discuss the risk of unintended, adverse consequences of the New Zealand programme; and consider key lessons for the policy development of pay‐for‐performance in health care.

This article is based on description and analysis of policy developments for performance management in New Zealand and England.

It is not clear that the New Zealand Programme appropriately reflects the values and goals of primary health care providers. It encourages slow, incremental change by paying bonuses to Primary Health Organisations, rather than practices, for meeting targets on a small number of performance indicators. The bonuses account for a tiny proportion of the total income of PHOs and in general are for service improvement rather than to supplement practitioner incomes. It is important to align performance incentives with stakeholders' values and goals.

The paper discusses New Zealand developments in pay‐for‐performance in the context of English policy initiatives and considers lessons for all health systems.

This paper draws on economic theory and empirical evidence in order to explore the role of incentives and information in the successful implementation of the new hospital funding system in the NHS.

The research is based on case studies in two strategic health authorities comprising in‐depth interviews with key stakeholders and analysis of background statistics and documentation.

The structure of tariffs under payment‐by‐results (PbR) provides high‐powered incentives for providers to increase activity because they are rewarded for hospital activity, and payments for increases in activity are made at full average cost. However, there is a danger that hospitals will increase activity beyond affordable levels and possibly induce demand inappropriately.

In future, as PbR is extended, it will be important to monitor its intended and unintended effects. Such evaluation should consider the extent to which commissioners are able to live within their budgets and whether hospitals are engaging in opportunistic behaviour and gaming the new funding system.

This study has shed light on the incentive structure of PbR for NHS organisations and has provided insights for the development of information strategies for providers and commissioners in the NHS market. It also highlights a number of policy issues that need to be addressed as PbR is rolled out nationally as well as several important gaps in knowledge that are in need of more sustained investigation.

The aim of the paper is to trace the history and development of performance measurement and management systems in the Italian National Health System (INHS), to identify their key characteristics, and to provide a critical assessment of their implementation.

A combination of literature review, action‐research and fieldwork conducted over a ten‐year period in several Italian health care organizations.

Performance management has grown considerably in the INHS over the last 15 years. Explanations for this growth include normative, coercive and mimetic isomorphism, the introduction of quasi‐markets, the adoption of DRGs, an increased focus on clinical governance and innovative practices in human resource management.

The paper shows how performance management has been implemented in the INHS and why it can still be considered a “work in progress”.

The introduction of performance management systems has stimulated greater accountability and promoted a more cost conscious culture in healthcare organizations. Nevertheless, there are many problems that remain to be solved if performance management arrangements are to deliver the desired improvements in performance.

The paper advocates the need for reduced isolationism and increased international comparison with concomitant evaluative effort.

This paper aims to analyze the development of “pay‐for‐performance” (P4P) programs implemented by Israel's two largest sick funds, insuring 78 percent of the population.

Analysis of the main features and their evolution over time, the observed outcomes and concerns related to implementing these programs.

Our analysis revealed that although implementation has been successful, both managers and physicians have voiced concerns regarding the effect of measuring clinical performance such as focusing attention on the measured areas while neglecting other areas, and motivating a statistical approach to patient care instead of providing patient‐centered care.

The Israeli case provides an interesting example of nation‐wide, long‐term implementation of the pay‐for‐performance program. Therefore, it provides other countries with the opportunity to assess features that may facilitate successful implementation, as well as highlighting issues related to the outcomes of P4P programs.

Wonders whether companies actually have employees best interests at heart across physical, mental and spiritual spheres. Posits that most organizations ignore their workforce – not even, in many cases, describing workers as assets! Describes many studies to back up this claim in theis work based on the 2002 Employment Research Unit Annual Conference, in Cardiff, Wales.

Scale-ups have a crucial role in our society and economy, are known for their fast growth and high performance and undergo significant organizational change. Research on the organizational elements that ensure scale-ups sustaining high performance is limited. This empirical study aims to investigate the organizational culture in scale-ups using the Competing Values Framework, including the clan, adhocracy, the market, hierarchy cultures and its relation to performance.

Quantitative and qualitative data were collected in five scale-ups. Surveys provided data of 116 employees on organizational culture, assessed using the Organizational Culture Assessment Instrument (OCAI) and perceived performance. The aggregate outcomes and performance measures were analyzed using correlation analysis. Interviews were held with ten top managers and mirrored against the quantitative data.

The results show that top managers and employees have different perspectives on the culture scale-ups are supposed to have. Top managers perceive market culture as more and hierarchy culture as less present in their organizations than employees. The clan and adhocracy culture are positively correlated to performance and are preferred by employees. Market and hierarchy culture types are negatively correlated to performance and are least preferred by employees.

It enables scale-up leaders to specifically intervene when cultural elements are experienced by employees that will not drive performance and fit the high performance and fast-growing scale-up environment.

This study is the first that showed that organizational-wide surveys, combined with in-depth interviews, are suitable for top managers of scale-ups to diagnose the organizational culture and the effect on the organization's performance.