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general practitioners, goal importance, individual performance, Italian National Health Service, knowledge exchange, performance measurement



  1. Cifalino, Antonella
  2. Mascia, Daniele
  3. Vendramini, Emanuele Antonio


Background: In many health systems, general practitioners (GPs) exhibit high levels of isolation and, at the same time, low levels of organizational identification, which can hinder their individual performance. The extant health care literature suggests that the physicians' belief that organizational goals are important, the adoption of performance measurement systems, and knowledge-sharing practices affect their individual performance. Most research has investigated these constructs in isolation, however, rather than explored their collective impact on GPs' individual performance.


Purpose: The aim of this study was to explore how GPs' belief in goal importance, use of performance measures, and knowledge exchange affect their individual performance, here defined as their individual achievement of organizational goals.


Methodology: We developed five hypotheses regarding how GPs' belief in goal importance and use of performance measures may affect individual performance, as well as how knowledge exchange may moderate these relationships. We tested our theoretical conjectures using data collected in a community of GPs in the Italian National Health Service. A survey questionnaire was administered to gather information about the GPs' level of belief in goal importance, use of performance measures, and perception about knowledge exchange in their primary care units. We considered two measures of GPs' individual performance: efficiency and appropriateness of drug prescription. We tested our hypotheses using probit regressions.


Results: Our findings show that perceived importance of organizational goals and use of performance measures have a positive effect on GPs' individual performance. Meanwhile, GPs' use of performance measures moderates the relationship between their belief in goal importance and individual performance. Finally, perceived knowledge exchange moderates the relationships between belief in goal importance/use of performance measures and individual performance.


Practice Implications: Executives could improve GPs' individual performance through interventions that reinforce their belief that organizational goals are important, facilitate a more intensive use of performance measures, and encourage knowledge exchange practices.