HEALTH-SERVICE REFORM - THE PERCEPTIONS OF MEDICAL SPECIALISTS IN AUSTRALIA (NEW-SOUTH-WALES), THE UNITED-KINGDOM AND NEW-ZEALAND

Objective: To examine the effect of recent healthcare service changes (including significant resource constraint and a greater role for the non-medical manager) in the United Kingdom, Australia and New Zealand on medical specialists' perceptions of their healthcare organisation g oals and service delivery, and their enthusiasm for their work. Design : Postal questionnaire survey, answered anonymously. Participants and setting: Medical specialists employed either part-or full-time in two United Kingdom National Health Service Trusts (one acute, one mental h ealth/community service), an Australian Area Health Service and a New Zealand Crown Health Enterprise in 1995. Main outcome measures: Partic ipants' rating of their knowledge of employers' organisational goals, ability to influence management, perceptions of changes in resources a nd service availability since 1990 and changes in enthusiasm for their work over the past four years. Results: 369 of 521 eligible specialis ts responded (71%); by country-United Kingdom, 123/186 (66%); New Zeal and, 123/160 (77%); Australia, 123/175 (70%). New Zealand specialists were less aware of their employers' organisational goals and had less congruence between these and their own personal goals than United King dom or Australian specialists (P<0.05). Interest in influencing centra l management was similar in the three countries, but Australian specia lists felt management was less likely to follow their advice compared with United Kingdom specialists (P<0.05). New Zealand specialists perc eived that waiting times for non-urgent patients were currently longer than in 1990 compared to United Kingdom specialists (P=0.02). In all three countries, inpatient beds were perceived to be less available th an in 1990, but less so in New Zealand. The ease of replacing equipmen t was better in New Zealand than in Australia and the United Kingdom ( P=0.00001). More than 50% of participants in all three countries (183/ 361; 50.7%) reported that their enthusiasm for their work had decrease d in the past four years. Conclusion: The effects of health service re forms seem to have reduced enthusiasm for work among medical specialis ts in Australia, the United Kingdom and New Zealand.