From policy to reality: clinical managers' views of the organizational challenges of primary care reform in Portugal

摘要: SUMMARY The primary healthcare reform in Portugal is based on the development of a new management model and clinical governance framework. The objective to strengthen services reduce inappropriate utilization secondary emergency make efficiency gains better control costs. New interventions include introduction system production-based incentives for family health units. This paper presents an initial assessment implementation policies tries explain gap between its expected results what was observed field 5 years later. We used Strengths, Weaknesses, Opportunities, Threats analysis conducted 12 regions, collect perceptions members Clinical Councils Health Centers Groups, responsible reform. looked at dimensions coverage, productivity, technical quality, service quality. It identifies weaknesses human resources (shortages, incentives, team management) lack support from central regional management. There perceived framework as defined by law made available implementation, leading tensions decision makers, managers, professionals. Copyright © 2012 John Wiley & Sons, Ltd.