The evolution of New Zealand’s health workforce policy and planning system: a study of workforce governance and health reform

Abstract

Introduction While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand’s health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives. Case description New Zealand’s health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations. Discussion and evaluation The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand’s more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care. Conclusion The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

Stakeholders’ Perception of the Palestinian Health Workforce Accreditation and Regulation System: A Focus on Conceptualization, Influencing Factors and Barriers, and the Way Forward

“…All participants highlighted that strengthening HWAR contributes to better health outcomes, increases the quality of services and patient safety, reduces unemployment, enhances resource management, controls fraud and malpractice, and increases overall patient satisfaction and safety with the HS, alongside increased justice in access to healthcare services. This is consistent with regional and international studies [8,10,15].…”

“…Achieving these objectives will require massive investment by both national governments and development partners to provide support, especially to lowincome countries, as well as a more efficient use of resources [14]. There is evidence that disconnecting the workforce from reform policy leads to a range of debilitating effects and the new approach of the workforce policy is integrated and team-based health care [15].…”

Demystifying Case Management in Aotearoa New Zealand: A scoping and mapping review

“…MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions, or products referred to in the content. to be similar in our country but there is minimal NZ workforce data is to confirm this [2,3,11].…”

Governance in health workforce: how do we improve on the concept? A network-based, stakeholder-driven approach

“…In the context of health systems, governance has been characterized as a set of tasks and functions largely established to carry out health ministry goals—essentially driving the direction, type, and accountability of service delivery to improve health system performance Mixed Hazarika [ 7 ] Rules (both formal and informal) for collective action and decision-making among government, providers and beneficiaries that also shape the interactions among them Process-oriented Kaplan et al [ 26 ] The set of rules that define the responsibilities of health system actors, how they operate, and how they relate to one another Process-oriented Kwamie et al [ 17 ] The formal and informal rules which guide behavior Process-oriented Manafi et al [ 20 ] Ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition building, regulation, attention to system design, and accountability Outcome-oriented Milicevica et al [ 18 ] Multi-sector efforts, complex mechanisms and procedures to exercise and mediate the participation of different groups’ rights and interests. Broadly defined, governance shapes the roles, power and interactions among government, providers and beneficiaries Process-oriented Rees [ 19 ] The collection of mechanisms, structures, processes and influences for a system’s oversight, policies, planning and accountability Process-oriented World Health Organization [ 32 ] The ability of individuals, organizations or systems to perform the functions for HRH development effectively, efficiently and sustainably Outcome-oriented …”