[Usefulness of the budget and the balanced scorecard in managing Primary Care Centres. Impact on staff motivation].

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.