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There is little evidence that treatment advances have improved the prognosis of heart failure in the community. One explanation is the failure of doctors to undertake necessary prescribing. Reports elsewhere how a modified Delphi approach, based on the RAND Health Services utilisation study method, was used to produce audit criteria for necessary prescribing for systolic heart failure in New Zealand (NZ) general practice. Reports experience of applying these criteria in late 1999 to the medical notes of a random sample of 70 patients with heart failure, as defined by a recorded diagnosis in 30 practices in central Auckland, NZ. Use of the audit criteria was feasible and appears valid, although the methods used to apply them need to be simplified to be of use as a practical means of promoting clinical governance. The small patient sample demands caution in interpreting the results. However, uncommon yet plausible findings, such as the high frequency of ACE inhibitor prescribing for heart failure, deserve further investigation.

Fear is seldom reported in the research literature on barriers to accessing general practitioner (GP) care. One reason may be that some patients are unwilling to admit to fear of this care. This is especially so for patients who, for social, cultural and historical reasons, have a poor sense of self, or do not wish to challenge professionals, or both. In New Zealand, the Maori and Pacific peoples are disproportionately characteristic of these patients and have poor access to GP care, including asthma in children. This paper contributes to the literature on using key informants to interpret another group’s needs, and integrates and adds to known patient attitudes that can hinder access to GP services.

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.

Extensive research towards identifying the attributable cost overrun factors globally has been conducted predominantly from a survey-oriented perspective, which disregard the contextual basis on which these triggers manifest. This study aims to explore the driving factors of cost overrun in highway projects, specific to the Nigerian context.

The research used a context-based approach to seek project stakeholders’ perspectives on the key drivers of cost overrun in highway projects in Nigerian. Semi-structured interviews were conducted with client, contractor and consultant organisations involved in the provision of highway infrastructure projects in Nigeria. The collected data was analysed using a developed coding framework grounded on a case study approach, principles of inductive thematic analysis and saliency analysis to identify the key drivers.

Findings from the analysis identified triggers from macroeconomic, societal, leadership and project management perspectives with synergistic relationships with each other based on prevalence and significance. Among the key triggers is a delay in work progress, political instability, adverse weather, social issues, delay in progress payment to contractors and modification of project scope. In conclusion, the triggers of cost overrun in highway projects are contextually driven by the complex nature of the project management, societal, macroeconomic and leadership triggers specific to the Nigerian context.

The research was limited to only highway infrastructure projects in Nigeria. Furthermore, the findings are based on a small sample size, and thus, caution must be taken before applying the outcome of this study in a generalised way to other contexts.

Practically, the stakeholders i.e. client, contractors and consultants should acknowledge the contextual circumstances in which each of the triggers takes place, which will aid in developing pragmatic measures and make the right decisions towards addressing these triggers during any highway construction project in Nigeria and enhance the chances of project success.

The context-based approach applied in this study is expected to provide a new insight in understanding the triggers of cost overruns, especially in highway projects in Nigeria and indeed other developing countries with similar governance characteristics

Empirical evidence suggests that many triggers influence poor cost performance in highway projects, whereas previous studies about the cost overrun triggers stem from a positivist standpoint supported by conventional statistical techniques, thus disregarding the sophisticated interactions and overall dynamics of the triggers. This study contends for a paradigm shift in investigating and understanding cost overrun triggers by adopting a holistic perspective through the lens of system thinking. This study aims to contend for a paradigm shift in investigating and understanding cost overrun triggers by adopting a holistic perspective through the lens of system thinking.

Semi-structured interviews with industry stakeholders in Nigeria were conducted buttressed by textual data from literature sources and project documents. Data analysis based on a developed data compatible coding framework and causal relations from textual data sources was used to develop a causal loop diagram depicting the interactions of the triggers which were validated by experts.

The analysis of the causal loop diagrams (CLDs) allowed identification of action points used to suggest changes for improved cost-effective highway project delivery. Among the suggested interventions are ensuring the provision of adequate funding prior to contract award will result in timely delivery of projects and indeed delivering key projects at the contractual agreed budget. This can be achieved through ensuring strict adherence to the provisions of Section 4 (2) (b) of the Nigerian Public Procurement Act, 2007 which stipulates that no contract should be awarded if funds are not available from the onset.

The study was limited to only highway infrastructure projects in Nigeria and as such caution must be taken before using the outcome of the study to other context within Nigeria and beyond.

From a practical point of view, the causal model demonstrates that this study is capable of being used to make pragmatic decisions regarding policy leverages about improving cost performance in highway projects provision in the Nigerian highway infrastructure sector of the construction industry. Moreover, it will aid a clear understanding of the key influencing triggers of cost overrun by the relevant stakeholders within the highway sector of the industry.

The hybrid-based approach applied in the development of CLDs in this study is expected to provide new insight into understanding the linkages, interactions, feedbacks and processes among the key cost overrun triggers and suggesting leverages for cost performance improvement within the philosophy of system thinking.

The Maturity Matrix is a tool designed in the UK to assess family practice organisational development and to stimulate quality improvement. It is practice‐led, formative and undertaken by a practice team with the help of trained facilitators. The aim of this study is to assess the Maturity Matrix as a tool and an organisational development measure in European family practice settings.

Using a convenience sample of 153 practices and 11 facilitators based in the UK, Germany, The Netherlands, Switzerland and Slovenia, feasibility was assessed against six criteria: completion; coverage; distribution; scaling; translation; and missing data. Information sources were responses to evaluation questionnaires by facilitators and completed Maturity Matrix profiles.

All practices taking part completed the Maturity Matrix sessions successfully. The Netherlands, the UK and Germany site staff suggested including additional dimensions: interface between primary and secondary care; access; and management of expendable materials. Maturity Matrix scores were normally distributed in each country. Scaling properties, translation and missing data suggested that the following dimensions are most robust across the participating countries: clinical performance audit; prescribing; meetings; and continuing professional development. Practice size did not make a significant difference to the Maturity Matrix profile scores.

The study suggests that the Maturity Matrix is a feasible and valuable tool, helping practices to review organisational development as it relates to healthcare quality. Future research should focus on developing dimensions that are generic across European primary care settings.

Primary care groups are required to demonstrate that patients and the public are involved in the planning, delivery and evaluation of the services they provide. However, a review of the literature suggests that managers' ability will be greatly tested if they are to achieve meaningful progress in this area. Some suggestions are made to assist managers in this important role. In the next issue of MCC, Part 2 reports findings from a locality case study.