Designing a Framework for Management in Primary Health Care System Using the New Public Management Approach in Public Health Complex

Abstract

Abstract Introduction: New Public Management (NPM) has been developed as a management approach for improving the efficiency and effectiveness in the public organizations by governments, especially in health sector, using features of the private sector management. Purpose: The purpose of this study is to develop managerial framework for primary healthcare (PHC) based on NPM approach in health complex. Therefore, managerial framework can be good guide for managers in the primary health care organizations. Method and Materials: Qualitative methods and realist review were used to design managerial framework that it were conducted during 2 years ago (2115- 2117) at Tabriz University of Medical Sciences. Participants were experts of health complex managers, health center managers, health policy, economics, management and researchers. A series of semi-structured interviews and focus group discussions (FGDs) and documents analysis were used for collection of data. Finally, framework analysis was used for data analysis. Findings: The results of data analysis (realist review and qualitative data) identified and confirmed the factors affecting the NPM. The results showed that NPM framework have been consisted of 6 elements (managerialism, decentralization, market type mechanism (MTM), performance management and new model of control and discipline and parsimony budgetary process) and implementation procedures of NPM for achieving outcomes (efficiency, effectiveness, quality improvement and customer stratification). Also, the results related to action research study showed that implementation of managerial framework based on NPM approach has created positive changes in assessing framework’ elements for primary health care systems in pilot health complex. On the other hand, using data analysis, three main barriers were identified that include: barriers related to reformers (behavioral and thinking barriers and specialized barriers), Structural-administrative barriers (barriers to bureaucracy, technology barriers, budgeting-financing barriers, barriers to planning and human resource management, and barriers to the performance evaluation system) and environmental barriers (cultural and strategic barriers). Conclusions: This study indicated using the six main elements of NPM can be effective for developing efficiency, effectiveness, quality improvement and customer stratification. Therefore, barriers to NPM must be eliminated and facilitators of NPM must be added to organizations in implementing NPM elements. Also, it is essential to provide political support for this approach.