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Relationships vital to success of Aotearoa’s health system – University of Otago

As Aotearoa New Zealand shifts to a more centralised health system, University of Otago researchers say officials need to ensure policy expectations align and foster environments which support connection and collegiality. 

A new study, published in BMJ Open, investigates how Aotearoa’s four former regional District Health Board (DHB) groupings improved health system integration, health outcomes and equity for their populations.

Researchers interviewed 49 stakeholders in governance-level positions across the regions. From 2011 to 2022, the groups – one in the South Island and three in the North Island – were fundamental to delivering effective integration across tertiary, secondary and primary care.

Lead author Dr Erin Penno, of the Department of Preventive and Social Medicine, says the groups were layered on top of an already complex DHB environment.

“Organisational heterogeneity and tensions between local and regional priorities were key contextual factors,” Dr Penno says.

“So, the regional groups used a combination of ‘hard’ policy and planning processes and ‘soft’, relationship-based mechanisms to improve system integration, population health outcomes and health equity.”

The groups delivered a range of important outcomes, including greater efficiency and consistency of care, a better focus on health equity, a more sustainable and agile workforce, and reinforced a sense of collegiality across the DHB sector, she says.

“Due to the complexity of the situation, working through relationships was fundamental to success.”

The DHB regions were formed in response to concerns about growing costs, clinical sustainability and variations in the availability and quality of care across the health system.

Dr Penno says the current health system reforms seek to address the same issues around fragmentation, consistency, sustainability and equity but go considerably further.

“The reforms see New Zealand move to a model underpinned by regional commissioning with care delivered through local networks of providers, placing renewed emphasis on understanding the systems and processes that drive successful, collaborative models of healthcare delivery.

“Our findings point to the importance of aligning policy expectations and fostering environments which support connection and collegiality across the health system.”

 

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