Shared Governance within the market‐oriented health care system of New Zealand

Abstract

The New Zealand health reforms, announced in 1991 and implemented over the 3-year period 1992-1994, were market-oriented, following a competitive model that had been applied across New Zealand's public sector. Consideration is given to the effects of the health reforms on nursing and midwifery at Capital Coast Health Limited (CCHL), with the introduction of a market/economic model of health care and its accompanying managerialism. The market model, or the economic era of health care, as some describe it, created an environment where nurses felt powerless. All the directors of nursing and on-going hospital educational programs were disestablished in the public sector; nurses were disheartened, confused and lacked representation at senior management. Integral to, and accompanying, corporatization is managerialism. With corporatization, came managers from the non-health care sector who had no understanding of the complexities of health care. Accompanying managerialism is the notion that any able manager was capable of managing any agency, whether public or private. Naturally, there was an underlying conflict between the caring relationships and their related work in the clinical environment, and the desire for efficiency and economy. It seemed that we were dealing with contrasting themes of 'the market' and 'humanity' This led to further confusion and disempowerment, as the dollar gained prominence, for nursing has always been grounded in the 'humanities'. It was into this environment, after 5 years of the health reforms, that a Nurse Executive was appointed and the concept of Shared Governance was introduced. This article describes why Shared Governance was considered an appropriate model to introduce at CCHL, and identifies some of the tangible benefits being realized 18 months post implementation. Discovering that membership in cross-organizational teams provides a mechanism for networking and creating a broader understanding of the organization has been but one of the major benefits.

Impact of MAGNET hospital designation on nursing culture: an integrative review

“…A recent study by van der Voet (2014) found that transformational leadership was dependent on the change approach that is 'planned or emergent' and the existing organisational structure within public organisations. Pragmatically, MAGNET, led by transformational leaders appeared to give nurses more autonomy in their roles and a greater contribution to governance of their work environment (Bamford & Porter-O'Grady, 2000). Leadership providing organisational support was crucial to achieving positive change at all levels within the organisation (Capuano et al, 2005;Kaplan et al, 2014;Mäntynen et al, 2014;Walker et al, 2014;Warren et al, 2016).…”

Transformational leadership and shared governance: an action study

“…Theoretically, these processes were supported by literature addressing transformative leadership (Avolio 1996, Belasco & Stayer 1994, Parry 1996, Parry 1999, the shaping a new culture and structure of governance within the professional workforce (shared governance) (Bamford & Porter-OÕGrady 2000, Kruger-Wilson & Porter-OÕGrady 1999, Porter-OÕGrady 1997 and use of active change and developmental processes (Zuber-Skerritt 1996). The components of the strategy were interactive and progressed over 6 years as a DON and 4 years of study as engaged in a professional doctorate.…”

“…This involved a major paradigm shift and metanoic thinking (Sarros & Butchatsky 1996) which evolved as action processes moved forward to make practice and to make meaning as they embraced the concepts of reconnaissance, planning, implementation and evaluation. The concept of shared governance provided both values (partnership, equity, accountability and ownership) (Bamford & Porter‐O’Grady 2000) and structure as they worked synchronically with the action processes to advance the effectiveness of nursing.…”

Impact of the politics of austerity in the quality of healthcare: ethical advice

“…The management model established in most of the European systems shows a strong link between the biotechnologization of healthcare and the loss of autonomy of practitioners to decide on the type of care given (Doolin & Lawrence, ; Beardwood et al ., ; Molina Mula, ). Some authors such as Banford & Porter‐O'Grady () have proposed governance models shared between public and private management of health systems whereas Barnett et al . () described the resistance of neo‐liberal models to bring about changes in health resource management (González García, ; Blasco Castany, ).…”