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      Utilidad del presupuesto y del cuadro de mando integral en la gestión de centros de atención primaria. Impacto sobre la motivación del personal Translated title: Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation

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          Resumen

          Objetivo

          Analizar la utilidad percibida por los gestores de centros de atención primaria respecto a las herramientas utilizadas para su gestión (presupuesto y cuadro de mando integral [CMI]) y su impacto sobre la motivación del personal.

          Diseño

          Estudio cualitativo de casos basado en teoría fundamentada, realizado entre enero y junio de 2014.

          Emplazamiento

          Unidades de Gestión Clínica de Atención Primaria (UGCAP) del Área de Gestión Sanitaria metropolitana de Sevilla.

          Participantes

          Directores de UGCAP y gestores del Área.

          Método

          Los datos se recogieron en 8 entrevistas semiestructuradas mediante muestreo intencional no probabilístico con criterios de representatividad y suficiencia del discurso. Las entrevistas fueron grabadas, transcritas y analizadas mediante códigos in-vivo.

          Resultados

          Ambas herramientas están implementadas en los centros de atención primaria, con usos diferentes. El presupuesto se percibe como una herramienta coercitiva, impuesta para el control del gasto, y poco útil para la gestión diaria. Aunque el CMI es más flexible y permite identificar los problemas financieros y asistenciales del centro, los límites presupuestarios reducen enormemente el margen para implementar soluciones. Además, la política de incentivos es insuficiente, generando problemas de motivación.

          Conclusiones

          Este estudio muestra que las tensiones presupuestarias que afectan a la atención primaria han reducido al mínimo la autonomía de los centros de salud, imponiendo una toma de decisiones centralizada en la que prima el ahorro en costes sobre la calidad asistencial, generando tensiones con el personal. Se plantea la necesidad de incrementar la autonomía de los centros y mejorar el compromiso del personal mediante programas de formación y desarrollo profesional.

          Translated abstract

          Objective

          To analyse the utility perceived by managers of centers of primary care about management tools (budget and balanced scorecard), together their impact on human resources motivation.

          Design

          Qualitative study (case study) based on grounded theory performed between January and June 2014.

          Location

          Units of Clinical Management of Primary Health (UGCAP) in Metropolitan Health Area of Seville, Spain.

          Participants

          UGCAP managers and Health Area (CEO) managers.

          Method

          Data were collected through 8 semi-structured interviews using non-probabilistic intentional sampling with representation and sufficiency criteria of discourse. Interviews were recorded, literally transcripted and analysis through in-vivo codes.

          Results

          Both tools are fully implemented but differently used in primary care centers. Budget is perceived as a coercive management tool, which has been imposed for cost saving; however, it is scarcely adequate for day-by-day management. While balanced scorecard is a more flexible tool that allows identifying financial and welfare problems, budgeting limits heavily reduce the possibility of implementing adequate solutions. The policy of incentives is not adequate either, leading on de-motivation.

          Conclusions

          This study shows that budgeting restrictions have led to a significant reduction in autonomy of Spanish Primary Care centers. Management decision making is much centralised, also focused on cost saving over quality of healthcare. As a result, two needs emerge for the future: increasing centers’ autonomy and improving staff commitment through training and professional development programs.

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          Most cited references34

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          Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012.

          As of 2005, the literature on the benefits of primary care oriented health systems was consistent in showing greater effectiveness, greater efficiency, and greater equity. In the ensuing five years, nothing changed that conclusion, but there is now greater understanding of the mechanisms by which the benefits of primary care are achieved. We now know that, within certain bounds, neither the wealth of a country nor the total number of health personnel are related to health levels. What counts is the existence of key features of health policy (Primary Health Care): universal financial coverage under government control or regulation, attempts to distribute resources equitably, comprehensiveness of services, and low or no copayments for primary care services. All of these, in combination, produce better primary care: greater first contact access and use, more person-focused care over time, greater range of services available and provided when needed, and coordination of care. The evidence is no longer confined mainly to industrialized countries, as new studies show it to be the case in middle and lower income countries. The endorsements of the World Health Organization (in the form of the reports of the Commission on Social Determinants of Health and the World Health Report of 2008, as well a number of other international commissions, reflect the widespread acceptance of the importance of primary health care. Primary health care can now be measured and assessed; all innovations and enhancements in it must serve its essential features in order to be useful. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.
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            The balanced scorecard--measures that drive performance.

            Frustrated by the inadequacies of traditional performance measurement systems, some managers have abandoned financial measures like return on equity and earnings per share. "Make operational improvements and the numbers will follow," the argument goes. But managers do not want to choose between financial and operational measures. Executives want a balanced presentation of measures that allow them to view the company from several perspectives simultaneously. During a year-long research project with 12 companies at the leading edge of performance measurement, the authors developed a "balanced scorecard," a new performance measurement system that gives top managers a fast but comprehensive view of the business. The balanced scorecard includes financial measures that tell the results of actions already taken. And it complements those financial measures with three sets of operational measures having to do with customer satisfaction, internal processes, and the organization's ability to learn and improve--the activities that drive future financial performance. Managers can create a balanced scorecard by translating their company's strategy and mission statements into specific goals and measures. To create the part of the scorecard that focuses on the customer perspective, for example, executives at Electronic Circuits Inc. established general goals for customer performance: get standard products to market sooner, improve customers' time-to-market, become customers' supplier of choice through partnerships, and develop innovative products tailored to customer needs. Managers translated these elements of strategy into four specific goals and identified a measure for each.
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              Use of the balanced scorecard in health care

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                Author and article information

                Contributors
                Journal
                Aten Primaria
                Aten Primaria
                Atencion Primaria
                Elsevier
                0212-6567
                1578-1275
                13 May 2017
                March 2018
                13 May 2017
                : 50
                : 3
                : 166-175
                Affiliations
                [0005]Departamento de Economía Financiera y Contabilidad, Universidad Pablo de Olavide, Sevilla, España
                Author notes
                [* ]Autor para correspondencia. jmramjer@ 123456upo.es
                Article
                S0212-6567(16)30495-4
                10.1016/j.aprim.2017.02.009
                6837067
                28511791
                7f96587a-b22c-47f2-add6-504836819626
                © 2017 Elsevier España, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 5 November 2016
                : 20 February 2017
                Categories
                Originales

                presupuesto,cuadro de mando integral,unidades de gestión clínica de atención primaria,motivación del personal,síndrome burn-out,investigación cualitativa,budget,balanced scorecard,clinical management units of primary health care,staff motivation,burn-out,qualitative research

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