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This paper aims to utilise cultural theory of risk to provide a broad analytic framework for examining how risk is constructed within the dominant discourses around patient safety within the domain of psychiatry. It also seeks to examine notions of blame and to consider the possibility of the creation of a no‐blame culture.

The empirical element of the paper draws on qualitative interviews with a sample of psychiatrists to explore how culture may give rise to different perceptions and responses in respect of “risky behaviour” and “safe practice”.

The paper discusses how psychiatry may be differentiated from other branches of medicine and concludes that the cultural grouping that appears to be most apposite in respect of psychiatrists is the egalitarian culture. However, changes in the NHS are resulting in the imposition of an individualistic culture on the community of psychiatrists with the effect that behaviours are being adopted as measures to avoid potential blame.

The paper finds that if the NHS is to improve patient safety then it must recognise that it is not possible to create a no‐blame culture and, therefore, it is more important to consider which type of culture will impact most positively on patient safety. It appears that psychiatrists are being compelled to adopt an individualistic culture when an egalitarian culture would be more advantageous for patient safety.

In contrast with the methodological individualism of the current safety orthodoxy which interprets risk as an objective and measurable phenomenon, the paper draws on cultural theory of risk to develop a critical perspective on current safety policy and to explore how “risky” and “safe” practices are socially constructed in the context of psychiatry.

The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid to healthcare reform in China as a public policy process, particularly one that is built on policy experimentation.

The viewpoint argues that while recent efforts to understand the impact of reform have brought significant understanding of key issues and processes, such interest tends to focus on pragmatic concerns rather than pose wider theoretical and methodological questions about the nature and pace of reform.

The authors suggest that the lens of public policy is particular relevant and insightful given what has been documented elsewhere regarding China’s unique policy process characterised by “policy experimentation”. The authors discuss how a policy experiment perspective can provide a useful heuristic for understanding healthcare reform in China.

The viewpoint concludes by outlining possible applications of this approach and looks forward at the emerging research agenda in this area.

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.

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.

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 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.

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 aim of this paper is to draw together suggestions for future research from the papers and from the discussion that took place at the workshop.

The suggestions are summarised under four broad themes.

At an international workshop on trust organised by the UK MRC Health Services Research Collaboration there was broad agreement that trust was still a salient issue in diverse health care contexts. The workshop proceedings identified a number of important questions for empirical research and several key conceptual, theoretical and methodological questions relating to trust that need to be addressed in support of or alongside this. The collection of papers in this volume starts to address some of these questions.

Considers trust relations in health care from patient, clinical, organisational and policy perspectives.

Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.

In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.

Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.

These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.

Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.