| 'We can't get anything done because...': making sense of 'barriers' to Practice-based Commissioning. | |
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MedLine Citation:
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PMID: 19103913 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To investigate the issues raised by participants as 'barriers' to the development of Practice-based Commissioning (PBC) in 'early adopter' sites in England. METHODS: Detailed case studies of five PBC consortia in three Primary Care Trusts (PCTs). Data collection included interviews with a wide range of respondents (46 in total), including general practitioners, PCT employees, Local Authority employees and patient representatives, observation of many different types of meetings (68 in total), and analysis of documents tabled at meetings and circulated at other times. RESULTS: It has been claimed that progress in developing PBC has been slow. Our respondents articulated a number of factors that they felt were holding them back, which could have been identified as 'barriers' preventing change. The issues raised were consistent across our sites (lack of time, resources and personnel, and difficult relationships with the PCT), but observation suggested that these issues arose out of very different organizational 'sensemaking', and as a result the apparent 'barriers' had different meanings in different organizational contexts. CONCLUSION: Weick's concept of 'organizational sensemaking' provides a useful framework within which to explore the problems encountered when implementing policy. Observational methods are a powerful tool in understanding sensemaking. The variations in sensemaking that we observed suggest that the use of 'barrier' metaphors in descriptions of implementation problems risks homogenizing the portrayal of situations that differ greatly in reality. This implies that top-down or centrally driven solutions to such situations will often be inappropriate. |
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Authors:
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Kath Checkland; Anna Coleman; Stephen Harrison; Urara Hiroeh |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of health services research & policy Volume: 14 ISSN: 1355-8196 ISO Abbreviation: J Health Serv Res Policy Publication Date: 2009 Jan |
Date Detail:
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Created Date: 2008-12-23 Completed Date: 2009-04-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9604936 Medline TA: J Health Serv Res Policy Country: England |
Other Details:
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Languages: eng Pagination: 20-6 Citation Subset: H |
Affiliation:
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National Primary Care Research and Development Centre, University of Manchester, Manchester, UK. k.checkland@btinternet.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Attitude of Health Personnel Budgets Contract Services / utilization* Diffusion of Innovation* England Family Practice / economics, organization & administration* Health Plan Implementation* Humans Information Dissemination Interviews as Topic Organizational Case Studies Organizational Innovation Practice Management, Medical / economics, organization & administration* Primary Health Care / economics, organization & administration* Problem Solving Qualitative Research State Medicine / organization & administration* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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