Browsing by Subject "Administration"

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BSMC : is there room for me? : an exploration of nursing leadership in primary health care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Auckland, New Zealand
(Massey University, 2012) Calverley, Rachael
The unpredictability of health in a dynamic climate can result in a multiplicity of challenges. Indeed unpredictability has been referred to as the essence of creativity. Strong leadership in healthcare and importantly nursing is crucial to seeking solutions to organizational change especially when decision making will impact on the population’s health. By influencing policy objectives through leadership, nurses have the opportunity to develop strategies that make a difference to future complex problems. With the implementation of the Governments Better Sooner More Convenient (BSMC) policy agenda and principles underway from 2008 onwards, to reframe primary health care services, a series of key principles emerged including: a more personalized primary health care system with services moved closer to home; reduction in demand on hospitals and a package of services centred on integrated family health centres, with nurses taking a key role in shifting services from the secondary to primary care needs of patient support. From seventy health collective submissions positioning themselves to address these principles, nine were selected to move through to the next stage of development. The applications from all of the successful organizations referred to the need for improved multi-professional working and/or the importance of the nursing workforce to the BSMC agenda. Importantly, it would appear that a high quality nursing leadership function within the BSMC health collectives developing BSMC service configurations would be required to meet their goals. The purpose of this study was to explore with nurse leaders how they were able to contribute to these evolving primary health care collectives and changes that influenced the development of new or reviewed services, in addition to gaining insight into their challenges and opportunities as nurse leaders. The literature suggests a move away from the post heroic model of leadership and refers more frequently to coalitions of experts or leaders as a collective intelligence. These emerging characteristics represent a distributed leadership model that is leadership shared across varying people, professions and roles. It is this distributed model of leadership that provided a conceptual framework and a clear point of reference for this study. A qualitative approach derived from an interpretive perspective was the methodology chosen for this research. Eight out of nine potential nurse leaders involved in each of the regional health collectives participated in telephone interviews and communicated with the researcher via email networks. Theme identification was the essential task for the analysis process. Four key themes were identified with subthemes: politicization (power to influence), infrastructure (teams and education/training), coalitions of leaders (communication and relationships) and resilience (battling and visibility). The findings suggest on-going challenges to nurses leading in primary health care which include fragmentation among nurses, variable investment in regional nursing infrastructure, interdisciplinary relationship issues and limited training to develop future nurse leaders. Addressing these results requires clinical, strategic and professional nursing leaders to work within fora that are unified, cohesive and collectively agreed on their purpose.
A case study of the philosophies, policies and practices of educational management at the Church College of New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education at Massey University
(Massey University, 1999) Leqakowailutu, Semiti Koroi
This thesis explores the Educational Management practices at the Church College of New Zealand (CCNZ) in Hamilton. It has examined, analysed and presented answers to the research question which is: How effective is the LDS Church College in following both the philosophies and policies of the LDS Church Board of Education and those of the Ministry of Education in New Zealand?. This college belongs to the Church of Jesus Christ of Latter-Day Saints, a church that is also known as the LDS Church. The research was done through a case study approach because of the need to use a mixture of methods. Some of these methods are personal observation, use of current and historical data, semi-structured interviews, study of relevant records and documents at the Church College, the New Zealand Government through the Educational Review Office (ERO) and from private sources. The thesis initially looks at the Educational Management in general before it examines how management principles are applied at this Church College. I have arranged the various management positions at Church College into three groups. The first group is the Top Management that includes two people, the New Zealand Country Director and the Church College Principal. The second group is the Middle Management consisting of the Deputy Principal, the Assistant Principal, the Director of Finance and the Physical Facilities Director. The third group is the First Line Management that includes the Deans, the Heads of various Academic Departments, two Supervisors at the Physical Facilities Department, the Head Boy & Head Girl and finally, the Dorm Parents. Through interviews, I have examined their areas of responsibility and how they are fulfilling their management roles. While exploring the Church College historical background, I discovered that a number of LDS Church schools were built and operated in New Zealand before the existence of CCNZ. The LDS Church built these earlier schools because of the lack of educational facilities in New Zealand at the time. These schools were eventually closed down when the number of state schools increased to the point where the LDS Church schools were considered by the church leaders to be unnecessary. However, a few years later, the Church Mission President in New Zealand at the time persuaded the church leaders in Salt Lake City to approve the building of another school to be used to educate future church leaders in New Zealand. This was the beginning of the existence of the Church College of New Zealand in Hamilton. This thesis has analysed and produced evidence that the Church College is meeting the initial objectives of educating future church leaders in New Zealand. First, the school is producing the biggest number of full-time missionaries in the country when compared to the numbers from other church units in New Zealand. Second, many of the LDS Church leaders in New Zealand today were educated at Church College. Third, the Maori and Pacific Islands students' exam pass-rates at Church College are much higher than the national figures. The Church College is succeeding in educating their students both spiritually and academically. The balance between these two is creating good leaders in the church and in the society. The 1997 ERO Assurance Audit Report clearly states that the college is meeting its obligation to the Ministry of Education in New Zealand. It is also fulfilling the expectations of the LDS Church Board of Education by teaching religious education on campus. The Church College is successful in educating Maori and Pacific Island students. The exam pass rates for Maori and Pacific Island students are higher at Church College than the national figures. Finally, the management and administration of Church College is of high quality and that they are very effective and efficient in following both the philosophies and policies of the LDS Church Board of Education and those of the Ministry of Education in New Zealand. This conclusion was confirmed by most of the research participants as well as documents from the Educational Review Office.
Challenging Stout : value conflicts in trying to reform the University of New Zealand, 1910-1914 : a thesis presented in partial fulfilment of the requirements for the degree of Master of Management at Massey University
(Massey University, 2001) Park, Nick (Nicholas)
This study looks at the reasons why the University of New Zealand (UNZ), characterized by Beaglehole as an object of "fury, loathing and despair" (1949, p. 1) survived so long, from its founding in 1871 until its dissolution in 1961? The study takes a broad sweep to cover the depth of those reasons. A general answer to the question is that it suited local conditions in New Zealand to create and maintain a university based around a federal, non-teaching, examining model. However, there was a serious challenge to that model mounted in 1911 by the New Zealand University Reform Association (NZURA) and so this study looks in particular at the reasons why that challenge failed. There is a short answer to that question, too. It failed because the institutional authority of the UNZ, and the politicians who supported it, was easily able to drive a wedge through any attempted coalitions that might threaten to dispose of it. The reformers of 1910-14 did not want to destroy the UNZ. They wanted to change it in two respects: they wanted to give what they thought was their rightful place in university governance to professors; and they wanted to give the professors what they argued was their rightful place in teaching and examining their own students as well. However, the UNZ had sufficient confidence and authority to characterise the reformers as destructive of an institution which had served colonial New Zealand well, and which was competent enough to serve the growing Dominion even better. And furthermore, the UNZ had the adaptive capacity to absorb its critics and convert their energies to supporting its subsidiary institutions and serving a common purpose. If it is ever fair to characterize organizations as living organisms it is fair to say that the UNZ showed great vitality and adapted well to local conditions. This study looks at the stories of the UNZ and examines the general questions already suggested, and, in doing so, goes on to tackle other minor questions such as how much the structure of the UNZ owed to the British and the colonial cultures in which it was embedded, and how much the outcomes of 1910-14 owed to the resource dependency of the actors. To answer these questions the study revisits a number of narratives that touch on the UNZ. There are two written histories of the UNZ. The more readable of the two does not provide a complete history for it was published in 1937 by Beaglehole more than twenty years before the university, as he later put it, was finally given a "clump on the head" (Beaglehole in Parton, 1979, p. 253). Beaglehole had deeply committed views about what a university should be, and was strongly of the view that in many respects the UNZ did not measure up to his ideal model. His history is interesting because he was a participant observer in the UNZ and demonstrated strong sympathies towards the reformers. He was a leading figure among the academics who served the UNZ and became one of the most outstanding researchers at the youngest of its Colleges, Victoria University College (VUC). However, he did not take up his position at Victoria before featuring in one of the more outspoken incidents at Auckland University College (AUC) where the weight of power rested with the College Board in stand-offs over academic freedom. The UNZ defended neither academic freedom, nor Beaglehole over the difficulties at AUC and preferred to insist instead on the autonomy of its constituent college to takes its own course of action. Fowlds, the Chairman of the AUC Council at the time, was also a member of the Senate of UNZ so the refusal of the UNZ to act in opposition to AUC probably reflected a view of academic freedom shared by the governing bodies rather than some commitment to principles of autonomy in favour of the subsidiary institution. The bite in Beaglehole's rhetoric and his attitude to the UNZ may have been sharpened by this incident. When he later wrote his essay and mentioned feelings of loathing, fury and despair towards the UNZ he was. I feel sure, expressing his own deeply felt emotions.
Collaborative practice : a practice approach to joint working between agencies providing mental health services : a thesis presented in partial fulfilment of the requirements for the degree of Master of Social Work at Massey University
(Massey University, 2001) Greer, Judith Ann
Collaborative Practice: A practice approach to joint working between agencies providing mental health services This project was undertaken to explore principles important to good collaborative practice and to identify practice guidelines. It explores the "how to do" collaborative practice successfully. The project did not set out to provide solutions to specific situations. It did set out to explore a process which could provide a culture for the collaborative addressing of issues. The proposed approach involved working interactively with key people, trialling a model of collaboration which used the clinical practice of case management and applying this to work between agencies. Through this participative trial key components of collaboration were identified and incorporated into a proposal for future practice. The project methodology used action research.
Early childhood teachers' experiences of leadership development : a thesis presented in fulfilment of the requirements for the degree of Master of Education (Leadership and Administration) at Massey University, Manawatu, New Zealand
(Massey University, 2018) Edwards, Megan Anne (née Shuker)
There are clear links between quality early childhood education (ECE) and positive outcomes for children and increasing research reveals the link between effective leadership of early childhood centres and quality ECE within centres. Development of ECE leaders to support their leadership skills and competencies is essential as a pathway to support quality ECE. The aim of this research was to give voice to teacher leaders in the ECE sector by exploring their perspectives on their own journey into leadership. Surveys and interviews were used to gather data on leader experiences. Data were analysed using descriptive statistics, thematic analysis and a case study approach. Findings indicated that leaders believed they were poorly equipped to take on their leadership role and called for practice-based leadership support that goes beyond a theoretical understanding of leadership. It was also found that ongoing leadership development was largely self-initiated with a clear call for supported networking to create connections between leaders in what has become a highly competitive sector. This research is relevant to the ECE sector because it discusses the experiences of ECE teachers as they enter into leadership roles.
An ethnography of the nursing handover : a thesis submitted in partial fulfillment of the requirements for the degree of Master of Arts in Nursing at Massey University
(Massey University, 2001) Rowe, Wendy Noeline
The purpose of this study was to enable nurses to recognise the significance of their role in delivering the nursing handover, and the impact this has on direct patient care. The aims of the study were: To identify how prepared nurses perceived they were for the next shift at the end of the nursing handover; to describe what nurses identify as important to handover to the nurse on the next shift; and to examine the processes by which nurses deliver the nursing handover. The research question was: Does the nursing handover adequately prepare the nurse for the next shift? This qualitative study using an ethnonursing approach investigated the nursing handover in a large base hospital in New Zealand between the morning and afternoon shifts. Research data were collected during 5 non-participant observations of the nursing handovers between morning and afternoon shifts, and 10 nurses were interviewed using a semi-structured interview schedule. The interview questions emerged from the non-participant observations. The data was analysed using Leininger's 4 phases of ethnonursing. The findings identified that the nurses in the study perceived they were not always adequately prepared during the nursing handover for the next shift. They frequently needed to access further information from a variety of other sources to ensure the provision of safe care to their patients. My observations showed, that the majority of these nurses when handing over recited the list of tasks and procedures they had completed during their shift, rather than prospectively providing the information required by the incoming nurses. The findings also indicated that the nursing handover is still a key component of nursing practice, and serves purposes other than just handing over patient care. It is important for the communication, education and socialisation of nurses.
An evaluation of nursing documentation as it relates to pro re nata (prn) medication administration : a research report presented in partial fulfilment of the requirements for the degree of Master of Nursing in Mental Health at Massey University
(Massey University, 2003) Jenkinson, Frances Heather
Aims of the project: l. To investigate if documentation related to pro re nata (Latin, prn) medication administration by mental health nurses, in a particular Forensic Psychiatry Clinic, in a metropolitan city in New Zealand, complies with the requirements of the National Mental Health Sector Standards (Ministry of Health, 1997), the specific District Health Board's policies, the local policies of the Forensic Psychiatry Clinic, the Code of Conduct for Nurses and Midwives (Nursing Council of New Zealand, 1999) and follows the nursing process. 2. To investigate whether there are any variations in the documentation practices between nursing shifts. Methods: A retrospective file audit was conducted at a forensic psychiatry clinic in a city in New Zealand. Non-random sampling was used. Data was collected from all admissions in 2002 that had prn medication administered during the first four weeks. A document questionnaire was designed to capture the required data to answer the research questions Results: From the sample of 27 files data was collected from up to 170 nursing entries. This was primarily a descriptive and exploratory study. None of the nursing entries met all the requirements of the National Mental Health Sector Standards (Ministry of Health, 1997), company policies, local area policies and/or the Code of Conduct for Nurses and Midwives (Nursing Council of New Zealand, 1999) in relation to nursing documentation. Nearly 47% of the prn medication administered had no documentation, apart from that in the medication-recording chart, to indicate it had been given. Approximately 85% of prn administrations had no evidence of an assessment prior to administration. Where it was documented that a client had requested medication. nearly 82% had no evidence of assessment. A large number of prn medications were administered from prescriptions that did not meet legal or policy requirements. Evidence of planning was lacking in the documentation with nearly 98% of the notes not indicating the rationale for a choice of route of administration where this was permitted on the prescription. No nursing entry offered a rationale for the choice of dose where this was allowed. The name of the medication, dose, route and/or time administered was frequently missing. Of the prn administrations considered for an outcome, nearly 60% had no documented outcome. Little difference was found in the nursing documentation between the shifts. However it was noted that for day and aftenoon shift, the earlier in the shift the medication was administered the less likely there was to be any mention of the medication being administered. Conclusion: The findings established extremely poor documentation practices. The lack of evidence of patient assessment, prior to administration of the medication in the documentation, raises the issue of whether this is being done prior to prn medication administration or simply not being documented. The documentation left questions about decision making in the planning of administration. The large number of medication administrations lacking a documented outcome raises uncertainty about nurses' knowledge of evaluating care, or even whether they are actually evaluating the care given. As a result of these findings, it is recommended that further research in this area be undertaken in New Zealand.
An examination of kaizen drift in Japanese genba : implications for business in the anglosphere : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Business and Administration at Massey University, Manawatu, New Zealand
(Massey University, 2013) Macpherson, Wayne Gordon
In attempting to decode the industrial competitive success of Japan, researchers in the Anglosphere have predominantly identified with the highly visible tools and methods of the quality management philosophy of kaizen. However, due to data collection methodologies and significant cross-cultural limitations kaizen appears to have been largely misinterpreted and misunderstood. This ‘gap’ has resulted in literature riddled with deterministic models of mechanical methodologies promoted to pursue business excellence. Further, there has been a plethora of attempts at transplanting Japan-centric tools and techniques, with little – if any – regard for the country’s individual and indigenous social characteristics. To deepen understanding of kaizen a phenomenological study was conducted in middle-to-large sized industrial companies in Japan to investigate Japanese workers’ perspectives of kaizen. Two parallel and complementary philosophies of the pursuit of business excellence were identified. The Japanese thread explored how Japanese workers acknowledge and exercise kaizen; and, the Anglosphere thread examined how workers in the Anglosphere attempt to adopt and practise kaizen. In the Japanese context, society is identified as being highly bounded with little opportunity for individual creativity. Many Japanese industrial organisations, being active kaizen environments, channel worker creativity and expressions of individuality into bounded environments, or kaizen audiences, providing a counter-point to social and cultural requirements. In addition to Japanese-style management, this has resulted in the production of tangible kaizen tools and methods, as easily identified by Anglosphere researchers and practitioners. The primary contribution to knowledge this research presents is the development of understanding of the utility of the kaizen phenomenon. Kaizen in industrial settings in Japan is found to be both culturally bounded and contextually dependent, and far beyond continuous improvement; differences in the perceptions of older and younger workers are seen to exist as kaizen drifts across generational boundaries; active programmes are maintained to ensure that kaizen remains embedded in both the individual and the organisation; and, the simplistic diffusion of kaizen to Anglosphere organisations is observed to be an unlikely guarantee to sustainable business excellence over the longer term, as it has in Japan. This research reports that the only likely viable means to sustainably diffuse kaizen in Anglosphere domains is for business leaders to return to square one and instil an implicit, comprehensive understanding and appreciation of kaizen; and, acquire and develop recipient-organisation-centric tools and methods. Such a new approach could provide practitioners in the Anglosphere the means to adopt and sustain kaizen thinking and practice, and a gateway to sustainable competitive advantage.
Exploring quality in a university : a critical systems approach : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Educational Studies at Massey University, Palmerston North, New Zealand
(Massey University, 2007) Houston, Donald James
Since the 1990s quality management has been translocated from industry into higher education. However, there is little evidence that improvement in the core functions of universities has resulted. This study adopts a critical systems approach that is grounded in a critique of prevailing models of quality management to explore quality in a university. It examines the potential of Critical Systems Thinking enacted through Total Systems Intervention (TSI) to promote improvement. A case is made for local intervention towards improvement. The thesis is structured around the three modes of TSI, namely Critical Review, Problem Solving and Critical Reflection. A Critical Review of Quality Management suggests that the opposition of academics to quality initiatives in general, and to Quality Management in particular, is rooted in its language and underlying image of organization. This proposition is explored through an analysis of key Quality Management definitions and concepts in relation to the university. The importance of language, metaphors and images of organization are explored. The fitness for purpose of industrial models of quality for universities is challenged. TSI is employed in its Problem Solving mode to describe the quality problem for an academic unit within a university in New Zealand initially from the perspective of its staff and students. For them, the quality problem mainly related to better promoting learning. Analysis and reflection on the problem and context drawing on systems methodologies shaped interventions for improvement. Critical Reflection on a cycle of participative creativity, choice and implementation identified cultural, structural and environmental factors that present threats not only to quality improvement but also to the viability of the unit. The main findings and conclusions question the appropriateness of current models of QM in the university. The thesis demonstrates key systemic problems in higher education; provides a rationale for systemic interventions; identifies pressures that make resistance to systems thinking almost inevitable; and illustrates that TSI is more appropriately used by external researchers than insider researchers. Nevertheless, critical systems approaches, in particular boundary critique, help to structure the problem of improving quality in locally meaningful ways. The challenges of using systems ideas and systems methodologies in the university context, however, are substantial.
Fostering nursing through management : a critical approach : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University
(Massey University, 1993) Russell, Lyneta
This study reveals for critique the philosophical and ideological forces which currently shape the perceptions of a small group of nurse managers in one acute care hospital setting. It has as its aim action to overcome constraints and to realize opportunities in the nurse manager position. Nurse managers assume central ward management and clinical responsibilities. This study describes how they can adjust to changes in these responsibilities within a changing health care structure and at the same time maintain and foster a nursing focus within their work. Using the research methods of critical social science this research explores central themes in the work and world of nurse managers. Through critical dialogue and reflection nurse managers are given opportunities to explore the social, political and historical forces that shape their understanding of their position, and to critique those forces. This critical process assists nurse managers to move towards a new understanding of their position and empowers them towards emancipatory action.
How senior teachers in kindergarten associations in Aotearoa New Zealand, define, understand and enact leadership : a thesis presented in partial fulfillment of the requirements for the degree of Master of Education (Early Years) at Massey University, Manawatū, New Zealand
(Massey University, 2018) Campbell, Gaylyn Joy
Leadership in early childhood education is gaining increased attention as evidence suggests leadership is a key factor in raising the quality of early childhood curriculum provision and learning outcomes for children. The present study examined the way in which one group of positional leaders, senior teachers within kindergarten associations in Aotearoa New Zealand, define, understand and enact leadership. The study was situated within a pragmatic paradigm and was descriptive in approach, offering insight into participant’s beliefs and practices. Employing a survey to gather both qualitative and quantitative data provided an avenue for participants to describe their understanding, practice and enactment of leadership. Qualitative data were analysed thematically with an inductive approach taken to identify patterns of meaning, while simple descriptive statistics were used to summarise and interpret quantitative data such as categorisations and ratings. Findings indicated the leadership role of the senior teacher is characterised by complexity, including the identification of eight key areas of responsibility: curriculum development, collaboration, managing human resources, staff development through the provision of professional development, liaison within and outside of the organisation, oversight across multiple sites, compliance and internal evaluation. Senior teachers’ understanding of leadership as a collaborative, relational endeavor focuses on building the professional capabilities of others, with the intention of strengthening curriculum and pedagogy and thereby influencing outcomes for children. Findings also revealed senior teachers navigate multiple and at times competing demands on their leadership work, exacerbated by the complex external environment within which it is enacted. While leadership was seen to be rewarding and valuable, noted challenges included lack of time, a concentration on compliance and accountability functions, perceived lack of influence on strategic work within their organisations, human resources activities and at times, limited scope to change the practice of others.
Identifying trades tutors' and institutions' perceptions of tutors' roles within the ITP sector : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education in Adult Education at Massey University, Palmerston North, New Zealand
(Massey University, 2008) Pritchard, Christine
Since 1984 tertiary education institutions have been subject to progressive and far-reaching change. Much of this change has been shaped by neo-liberalist agendas which espouse accountability, efficiency, responsiveness, professionalism and managerialism. This thesis looks at how these themes have shaped or influenced managerial and tutorial perceptions of tutors' operational roles, responsibilities and performance within a selection of contemporary Institutes of Technology and Polytechnics (ITP) teaching environments. Analysis of the research identifies that scant or poorly prepared institutional documentation around tutorial roles and responsibilities has contributed to uncertainty or confusion, and consequently to individuals adapting their teaching roles to suit themselves. It has also been identified that managers appointed to the pivotal role of Head of School are stretched in their ability to cope with the demands that are placed on them. This thesis suggests that the increasing responsibilities they carry for managing tutorial staff have contributed to a breakdown in workload planning and performance management processes. Managers acknowledge that further work needs to be done in defining tutors' roles, responsibilities and performance. But such work presupposes the question: how do managers and tutors perceive tutorial roles in today's ITP teaching environment? Research on this key question and associated issues provides the basis for this thesis.
In search of nursing : the long-term impact of the New Zealand health reforms on ward nursing : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Manawatu, New Zealand
(Massey University, 2012) Teekman, Englebert Cornelis
This thesis began with my curiosity about why, despite repeated attention to nurses’ health assessment skills (at undergraduate and professional development level), it has remained an under-utilised skill. A focused ethnography was conducted in six acute wards of a provincial New Zealand hospital. Twelve registered nurses were observed and interviewed in the first phase of the research and multiple additional primary data sources were utilised. Early findings indicated that nurses did not undertake health assessment and raised much broader questions about the nature of ward nursing practice and the amount of control ward nurses have over their work environment and their own nursing practice. The research was extended to include seven stakeholders, senior nurses who had good insight and knowledge of ward nursing practice. A structuration theory lens was applied to assist in the analytic process. The findings of this research reveal the long-term impact of the NZ health reforms on ward nursing practice. The introduction of generic management principles and the continuous restructuring of the health care environment have impacted on nursing practice and reduced nurses’ autonomy. Nurses have come to rely on standardised documented processes to provide essential care, relying significantly less on knowledge of a patient’s actual health status. Much recent local and international quantitative research has revealed a number of concerning findings about the reduced time nurses spend at the bedside, the complexity of nursing work flow, the increase in interruptions, missed nursing care, and the vital role nurses have in preventing many adverse events and unexpected deaths. This thesis provides a rich qualitative understanding of the circumstances behind these quantitative findings and reveals that nurses are now struggling to provide care consistent with the ethos of nursing. I argue that challenging the nature of nurse education will not improve nurses’ ability to deliver nursing care. Instead I argue that the current acute ward environment does not support registered nurses to provide the nature of care for which their education has prepared them.
Inter-district flow transfers : health and economic impacts : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Economics at Massey University, Albany, New Zealand
(Massey University, 2018) Bruce-Brand, Bronwyn
As part of the introduction of the New Zealand Public Health and Disabilities Act in 2000, the introduction of the Population Based Funding Formula led to a change in the flow of funds for transfer patients. Prior to the PBFF, for the years 2000-2003, healthcare events were contracted on a fee-for-service basis and thus were borne by the DHB of treatment. From 2003 onwards, the cost of transfer patients followed the transfer back to their DHB of domicile. This study replicates and extends work done by Shin (2013) in assessing the impacts of this change in funding flows on the level of transfer and patient health outcomes. I use OLS and logistic modelling to empirically assess these effects and draw conclusions as to the effectiveness of the policy change and any potential efficiencies that are gained. I find evidence of a focus in the probability of transfers after the change in funding, where the overall probability of transfer decreases and the probability of transfer to tertiary DHBs increases. Additionally, patient outcomes demonstrate a concentration effect whereby after the policy is implemented, the pool of transfers is less diluted by low severity patient transfers and thus displays poorer health outcomes on average for the transfer group. The concentration of health outcomes suggests that the transfer decision is being considered more carefully now that costs are aligned to the DHB of domicile. A novel addition to this research is the analysis of regional DHB pairs. The analysis of five secondary-to-tertiary transfer flows provides insight into the necessity of a decentralised healthcare system in New Zealand and is mostly consistent with the analysis at the national level. Overall, the introduction of Inter-District Flow transfer funding has increased the efficiency of the transfer mechanism and enabled a more streamlined redistribution of funds to tertiary providers. This is an important finding because it reinforces the necessity of the transfer mechanism, specialist providers and local provision in a healthcare system such as New Zealand’s.
Is participatory governance of relevance to corporate governance? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University
(Massey University, 2008) Penny, Kim
The Grameen Bank, offering neighbourhood-banking services to over five million of the world's most neglected and poor human beings, is perhaps the world's most successful academic-action research project. Now with over five million members, monthly loan dispersal of nearly US$50 million, and constituting over 1% of the Bangladesh GDP. the Grameen Bank started with $25 from Economics Professor Muhammad Yunus' own pocket. There is now no shortage of literature on governments, industries, corporations, organisations and individuals grappling with what governance is and what it means on a day-to-day basis. As the corporate world comes to terms with stakeholder and shareholder involvement in a manner that sometimes appears to be largely rhetorical, in an apparent parallel universe, the discourse of participatory governance is becoming increasingly important for those working in the field of bilateral aid and Non-Government Development Organisations (NGOs). Despite the lack of engagement between those working in these two fields, there appears to be a degree of overlap between these two discourses. It is this possible overlap that underpins the concerns of this thesis. The thesis thus addresses the question: Are there lessons from participatory governance of relevance to the corporate world? If so. what are they? By researching the structure and workings of the governance of the Grameen Bank, it was found that a corporation can prosper using participatory governance, a governance style given the name of participatory corporate governance. This model can assist to create an institutional duality that balances social purpose with the need for positive financial outcomes, further findings show that despite the lack of engagement between the discourses of participatory and corporate governance there does appear to be an overlap in the 'best practice' requirements of each.
Making sense of the Director of Nursing structural positioning in New Zealand public hospitals (2006-2012) : a thesis submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Massey University
(Massey University, 2013) Hughes, Kerri-ann
This dissertation reports on research examining and analyzing nursing leadership structures in New Zealand public hospitals, and in particular, the Director of Nursing (DoN) structural positioning. Leadership in hospital nursing is critical if the profession is to meet the challenges facing health services in the 21st century. The research has been undertaken using case study methodology and focuses on how organizational decision-making structures have impacted on nursing leadership in public hospitals. ‘Sense-making’ has been used as a theoretical construct to understand both the formal and informal structures that influence organizational decision-making. Phase one of the research involved examining twenty District Health Board (DHB) organizational and nursing charts. In phase two and three, the Directors of Nursing (DoNs) and the Chief Executive Officers (CEOs) were surveyed using a series of demographic and qualitative questions to draw out understanding of the Director of Nursing (DoN) role. The research has found that the constructs of power and authority influence the decision making processes at the executive level of the DHB. An analysis of the data indicates that the current structural positioning of the DoN is hindered by the existing dual accountability line reporting structures in DHBs and this is a barrier to alignment with Magnet hospital principles which provide evidence of effective patient outcomes. The focus primarily adopted by District Health Boards on professional line reporting only for nursing is not conducive to achieving effective and safe patient outcomes as it removes authority from the DoN and yet places unrealisticexpectations on accountability of how the DoN can achieve effective and safe patient outcomes within the public hospital setting.
A process evaluation of a shared leadership model in an intensive care unit : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
(Massey University, 2001) Turner, Clare Lynette Eden
Shared leadership has been touted in the United States and United Kingdom as a model of staff management that fosters active involvement of staff, in this case nurses as experienced professionals, in patient management. This study uses process evaluation for the examination of a shared leadership model in an intensive care environment following a period of significant change and restructuring. The model was based on the shared leadership literature (porter-O'Grady, 1992) which focuses on clinical practice as a key accountability and on decentralised clinical leadership at the point of service. The model aligned with the skill acquisition framework used by the employer organisation called the Professional Development Programme (PDP). This programme aims at enhancing the development of expertise in clinical practice and supports the principles of shared leadership. This research study was undertaken to evaluate the process of implementation of the model and to discover whether there is evidence nurse involvement in the management of patient care. The results are based on the responses of 104 registered nurse respondents (56%) working in the intensive care unit of a specialised hospital. Documentation was also examined for evidence of nursing input into indirect patient management process development. The results indicate that nurses are becoming more settled in their working environment and feel more confident in their ability to provide an active role in the management of their patients within a multidisciplinary team.
Realising their governance role : community boards in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Philosophy (Social Policy), Massey University
(Massey University, 1996) Storer, Faye
This thesis explores the governance role of community boards in New Zealand. There has been considerable debate on whether community boards have a meaningful role to play in local government. Critics of community boards argue that if the boards are not given additional functions they should be abolished. However this thesis will attempt to show that community boards already have an important role to play, that of governance. This thesis focuses in particular on the concepts of 'public space', the 'public realm' and 'citizenship'. The mechanisms of participation and consultation are employed to reveal the governance role played by community boards. It is argued that through an appreciation of this governance role, the full potential of sub-local government can be realised.
State practice and rural smallholder production : late-colonialism and the agrarian doctrine in Papua New Guinea, 1942-1969 : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University
(Massey University, 1999) Wright, Huntley Lloyd Rayne
This study shows why and how late-colonial state practice in Papua New Guinea became synonymous with the development of a centrally regulated scheme of rural household production. It is suggested that the origins of the scheme lie not in its supposed pre-adaptiveness to previously existing ('non-capitalist') social relations, nor in its external, 'subsidising' effect on capital accumulation. Rather, its origins lie in the changing politico-economic realities of post-Second World War global capitalism and the corresponding shift to social trusteeship which, in transmitting metropolitan ideas on 'full employment' to the colonies, sought to reconcile indigenous welfare with expanded rural commodity production. Key objects of analysis include the late-colonial state, the household labour process and the agrarian doctrine of development. It is argued that a serious weakness in much of the literature on Papua New Guinea is the tendency to conflate the distinction between immanent and intentional development, so that the negative dimension implicit in the latter is excluded from discussion. Whereas the immanent implies an unintentional process, unfolding outside the regulatory capacity of the colonial state, the intentional refers to the conscious application of state power to ameliorate the negative consequences explicit in the former - poverty and the emergence of a relative surplus population. The present study seeks to recapture the negative dimension of the late-colonial intent to develop in Papua New Guinea. It is argued that the post-war ascendancy of household production is given in the formation of an agrarian doctrine which, in positing the middle peasant as a developmental ideal, sought to use state policy to check landlessness by recasting the capital-labour relation in agriculture. The intent was to regenerate the 'old' within a welfarist agenda defined in opposition to the "landless proletariat". Securing this process was a fundamental shift in the relationship between the colonial state and international capital. In the period 1919-1939 the movement of capital was essentially spontaneous, albeit subject to regulatory controls on land and labour. However, for the period under consideration the "order of intervention was reversed". Reflecting a major increase in power and capacity, the colonial state "assembled capital" to be superintended as part of the Administration's plan for expanding indigenous commodity production. It is in this recasting of late-colonial state practice that the dominance of household production is situated.
Where we are and how we got here : an institutional ethnography of the Nurse Safe Staffing Project in New Zealand : a thesis in fulfilment of the requirements for Doctor of Philosophy, Massey University, School of Nursing, College of Health, Manawatu, New Zealand
(Massey University, 2019) McKelvie, Rhonda
Frontline nurses in New Zealand hospitals still work on short-staffed shifts 18 years after they began to express concerns about unsafe staffing and threats to patient safety. The Nurse Safe Staffing Project and its strategies (Escalation planning and the Care Capacity Demand Management Programme) were designed to address the incidence and risks of short-staffing. After a decade, these strategies are yet to yield tangible improvements to frontline nursing numbers. Using institutional ethnography, I have charted a detailed description and analysis of how aspects of the strategies of the Nurse Safe Staffing Project actually work in everyday hospital settings. Competing institutional knowledge and priorities organise what is happening on short-staffed shifts, and nurses are caught in the crossfire. The central argument throughout this thesis is that nurses’ vital situated knowledge and work are being organised by and overridden in this competitive institutional milieu. I show how what actually happens is consequential for nurses, patient care, and staffing strategies. This analytical exploration contributes knowledge about nurses’ situated and intelligent compensatory work on short-staffed shifts, how this knowledge is displaced by abstracted institutional knowledge, and the competing social relations present in environments where nurse-staffing strategies are negotiated.