The relative importance of leadership and payment system. Effects on quality of care and work environment.

The key question addressed in this study is whether the introduction of stronger financial incentives in health care give rise to such a restrictive context that leadership has only a minor influence? Or is good leadership, on the contrary, important to the achievement of both financial and other goals, regardless of contextual factors? Physicians in one Swedish County Council with performance-based reimbursement and in 10 councils without such a system were studied in a cross-sectional questionnaire study. The result of this study indicates that although contextual factors were of substantial importance there is scope for leaders to act, and their actions make a considerable difference, both for the experience of the work process and for the outcome in terms of work environment and quality of care. A good leadership may be able to shield the health care organisation from unwanted side effects of increased financial pressure.