Rj. Perkins et al., HEALTH-SERVICE REFORM - THE PERCEPTIONS OF MEDICAL SPECIALISTS IN AUSTRALIA (NEW-SOUTH-WALES), THE UNITED-KINGDOM AND NEW-ZEALAND, Medical journal of Australia, 167(4), 1997, pp. 201-204
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.