Governance of primary healthcare practices: Australian insights

Compared to other Organization for Economic Cooperation and Development countries, Australia fell to third in 2010 in terms of health system performance, ranking behind the Netherlands and the United Kingdom. The Australian government believes that primary healthcare practices in particular have not changed sufficiently over time to keep achieving higher levels of performance. One area of concern within healthcare practices is the impact of governance structures on practices’ various performance metrics. Indeed, studies investigating the combination of attributes of high-performing healthcare systems appear to be rare in the literature. This study is a first attempt to address this situation. It reports an exploratory case-based investigation conducted with seven primary healthcare practices in Australia. Its major insights include that higher-performing practices have more hierarchical, complex, but well-defined governance structures. Furthermore, higher-performing practices also appear to be characterized by having a managing general practitioner responsible for the ‘business of the practice.’ Moreover, higher-performing practices seem to be able to produce clearly documented position descriptions indicating explicit duties and lines of accountability for both medical and administrative staff.