Organizational values in general practice and public involvement: case studies in an urban district

A multiple case study design was used to explore dimensions of organization al values in general practice with respect to developing public involvement . The study was undertaken in an urban district in England with data collec ted through in-depth individual and focus group interviews with service pro viders and service users. Four general practice organizations were randomly selected for study after sorting all in the district according to their re cord of developing involvement activities. The case studies provide evidenc e of how organizational values can differ markedly in general practice in r elation to ideas of public involvement, with consequences for the quantity and quality of activities for involving local people and service users. The differences manifest themselves in the beliefs and attitudes of service pr oviders about the purpose of the organization and the types of relationship s that are appropriate with service users and local people. Service users a ppear to be very perceptive to the underlying ethos and purpose to their pr actice organization and this affects their responsiveness to initiatives fo r their involvement. The dimensions of the different values found in the st udy appear to be essentially the same as a number of established empirical findings of variations in values in general practice: an orientation to a n arrow medical role and to general practice as a business are associated wit h a low valuation of involvement; an orientation to teamwork and to a broad er social role appear more congruent with the development of involvement. P ower is a critical issue in this setting with evidence in the study of the dominance of the medical practitioners in establishing organizational value s and the nature of public involvement activities.