Analysing programme implementation across districts: a qualitative study of a national falls prevention initiative for older people in New Zealand.

Background: Falls among older people are a major cause of the global burden of disease. This study investigated the implementation of the Falls and Fracture Prevention Programme, a multicomponent population-based intervention, across diverse districts in New Zealand.

Methods: We conducted a comparative case study through 28 semi-structured interviews with programme coordinators and managers across four districts.

Using outcome measures in sub-national level performance management: When and under what circumstances?

There is growing interest in using outcome-based measures in sub-national level health system performance management, particularly in high-income countries. Increasingly, population health indicators used for making international comparisons are being applied at a sub-national level. This study aims to understand whether and under what circumstances population health outcome-based measures can be used for performance measurement and management at the sub-national level health systems.

Implementing new forms of collaboration and participation in primary health care: leveraging past learnings to inform future initiatives.

Introduction Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies.

Violence against healthcare workers in the middle of a global health crisis: what is it about policy and what to learn from international comparison?

Introduction: Violence against healthcare workers is a global health problem threatening healthcare workforce retention and health system resilience in a fragile post-COVID 'normalisation' period. In this perspective article, we argue that violence against healthcare workers must be made a greater priority. Our novel contribution to the debate is a comparative health system and policy approach.

The 2022 restructure of Aotearoa New Zealand's health system: Will it succeed in advancing equity where others have failed?

Aotearoa New Zealand has restructured its health system with the objective of addressing inequitable access to health services and inequitable health outcomes, particularly those affecting the indigenous Māori population. In July 2022, two new organisations were created to centralise planning, funding and provision responsibilities for publicly funded health services in Aotearoa New Zealand. Health New Zealand and the Māori Health Authority have been created to drive transformational change within the national health system and monitor and improve the health and wellbeing of Māori.

Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations.

Objective: To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years.

Design: Observational population-based study over 2008-2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases.

Setting: New Zealand primary and secondary care.

Integrated Care in Aotearoa New Zealand 2008-2020.

Introduction: Ten years ago, progress towards integrated care in Aotearoa New Zealand was characterised as slow. Since then, there has been a patchwork of practices occurring under the broad umbrella of integrated care. These include: collective planning approaches (i.

New Zealand's Integration-Based Policy for Driving Local Health System Improvement - Which Conditions Underpin More Successful Implementation?

Introduction: The System Level Framework (SLMF) is a policy introduced by New Zealand's Ministry of Health in 2016 with the aim of improving health outcomes by stimulating inter-organisational integration at the local level. We sought to understand which conditions that vary at the local level are most important in shaping successful implementation of this novel and internationally significant policy initiative relevant to integrated care.

Strategy And Methods: We conducted 50 interviews with managers and clinicians who were directly involved in SLM implementation during 2018.

Variation in publicly funded bariatric surgery in New Zealand by ethnicity: cohort study of 328,739 patients.

Background: New Zealand health services are responsible for equitable health service delivery, particularly for Māori, the Indigenous peoples of New Zealand. Recent research has indicated the presence of inequities in publicly funded bariatric surgery in New Zealand by ethnicity, but it is unclear whether these inequities persist after adjustment for co-morbidities.

Objectives: To determine whether receipt of publicly funded bariatric surgery varies by ethnicity, after adjustment for co-morbidities.

A survey of the NP workforce in primary healthcare settings in New Zealand.

Aim: The aim of the survey was to describe the demographics, distribution, clinical settings and employment arrangements of the New Zealand nurse practitioner workforce in primary healthcare settings; and organisational factors limiting their practice.

Method: An online survey was developed and sent to all NPs in mid-2019.

Results: The survey was completed by 160 nurse practitioners who worked in settings broadly defined as primary healthcare (response rate 71.

Gaming New Zealand's Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?

Background: Gaming is a potentially dysfunctional consequence of performance measurement and management systems in the health sector and more generally. In 2009, the New Zealand government initiated a Shorter Stays in Emergency Department (SSED) target in which 95% of patients would be admitted, discharged or transferred from an emergency department (ED) within 6 hours. The implementation of similar targets in England led to well-documented practices of gaming.

Ontario and New Zealand Pharmaceuticals: Cost and Coverage.

Ontario is a strong candidate for a comprehensive pharmacare program, given that it has a pre-existing public drug benefit program (the Ontario Drug Benefit Program [ODBP]). This paper outlines strategies from New Zealand's national pharmacare program (the Pharmaceutical Management Agency [PHARMAC]) and compares these strategies to other international examples. It is recommended that the ODBP engage in three strategies currently utilized by the PHARMAC to achieve significant cost savings and create potential to increase their insurance coverage: (i) strict budgeting; (ii) tendering and negotiating; and (iii) reference pricing.

'Complexity-compatible' policy for integrated care? Lessons from the implementation of Ontario's Health Links.

Complex adaptive systems (CAS) theory views healthcare as numerous sub-systems characterized by diverse agents that interact, self-organize, and continuously adapt. We apply this complexity science perspective to examine the extent to which CAS theory is a useful lens for designing and implementing health policies. We present the case of Health Links, a "low rules" policy intervention in Ontario, Canada aimed at stimulating the development of voluntary networks of health and social organizations to improve care coordination for the most frequent users of the healthcare system.

How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand.

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions.

New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when?

Background: In 2009, the New Zealand government introduced a hospital emergency department (ED) target - 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when.

Measuring and managing health system performance: An update from New Zealand.

In July 2016, New Zealand introduced a new approach to measuring and monitoring health system performance. This 'Systems Level Measure Framework' (SLMF) has evolved from the Integrated Performance and Incentive Framework (IPIF) previously reported in this journal. The SLMF is designed to stimulate a 'whole of system' approach that requires inter-organisational collaboration.

Contrasting approaches to primary care performance governance in Denmark and New Zealand.

In high-income countries, the arena of primary health care is becoming increasingly subject to 'performance governance' - the harnessing of performance information to the broader task of governance. Primary care presents many governance challenges because it is predominantly provided by sole practitioners or small organisations. In this article we compare Denmark and New Zealand, two small countries with tax-funded health systems which have adopted quite different instruments for performance governance in primary care.

Health System Regionalization - the New Zealand Experience.

New Zealand's health system has many similarities with Canada, and also has longstanding experience with regionalization of healthcare services. Since 2001, the most important change has been the development of regional primary healthcare organizations funded according to population characteristics. This significant change has created the potential for a more integrated health system.

Comparing the implementation consequences of the immunisation and emergency department health targets in New Zealand.

Purpose Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments. Design/methodology/approach For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation.

Hospital sector choice and support for public hospital care in New Zealand: Results from a labeled discrete choice survey.

This study uses a discrete choice experiment (DCE) to measure patients' preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients.