BMJ  2004;329:384 (14 August), doi:10.1136/bmj.38174.496944.7C (published 20 July 2004)

Commentary

Is trust an under-researched component of healthcare organisation?

¹ Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT judith.green@lshtm.ac.uk

The first 150 words of the full text of this article appear below.

The pattern for provision of primary care has changed radically since the early 1980s.¹ The number of small, particularly single-handed, practices has declined rapidly, and most patients now receive a complex, often bewildering, range of primary care services from a large multiprofessional group, rather than seeing their usual general practitioner. This shift has far reaching implications for how professionals work together to provide care and on how that care is experienced by patients. Assumptions that by simply increasing practice size patient care would somehow be improved have been undermined by empirical research on the relations between measures of practice organisation and quality of care. There is no simple relation: larger practices apparently perform better than smaller ones on some indicators of clinical quality of care but worse on factors such as access and continuity.^{2 3} Explaining how organisational factors relate to healthcare outcomes has become a prized, if unattainable, goal for . . . [Full text of this article]

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Rapid Responses:

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