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Item Alignment of big data perceptions in New Zealand healthcare : a thesis presented in partial fulfilment of the requirement for the degree of Doctor of Philosophy in Management at Massey University, Albany, New Zealand(Massey University, 2019) Wannitilake Mudiyanselage, Kasuni Gayara WeerasingheThe growing use of information systems (IS) in the healthcare sector, on top of increasing patient populations, diseases and complicated medication regimens, is generating enormous amounts of unstructured and complex data that have the characteristics of ‘big data’. Until recent times data driven approaches in healthcare to make use of large volumes of complex healthcare data were considered difficult, if not impossible, because available technology was not mature enough to handle such data. However, recent technological developments around big data have opened promising avenues for healthcare to make use of its big-healthcare-data for more effective healthcare delivery, in areas such as measuring outcomes, population health analysis, precision medicine, clinical care and research and development. Being a recent IT phenomenon, big data research has leaned towards technical dynamics such as analytics, data security and infrastructure. However, to date, the social dynamics of big data (such as peoples’ understanding and their perceptions of its value, application, challenges and the like) have not been adequately researched. This thesis addresses the research gap through exploring the social dynamics around the concept of big data at the level of policy-makers (identified as the macro level), funders and planners (identified as the meso level), and clinicians (identified as the micro level) in the New Zealand (NZ) healthcare sector. Investigating and comparing social dynamics of big data across these levels is important, as big data research has highlighted the importance of business-IT alignment to the successful implementation of big data technologies. Business-IT alignment is important and can be investigated through many different dimensions. This thesis adopts a social dimension lens to alignment, which promotes investigating alignment through people’s understanding of big data and its role in their work. Taking a social dimension lens to alignment fits well with the aim of this thesis, which is to understand perceptions around the notion of big data technologies that could influence the alignment of big data in healthcare policy and practice. With this understanding, the research question addressed is: how do perceptions of big data influence alignment across macro, meso, and micro levels in the NZ healthcare sector? This thesis is by publication with four research articles that answer these questions as a body of knowledge. A qualitative exploratory approach was taken to conduct an empirical study. Thirty-two in-depth interviews with policy makers, senior managers and physicians were conducted across the NZ healthcare sector. Purposive and snowball sampling techniques were used. The interviews were transcribed verbatim and analysed using general inductive thematic analysis. Data were first analysed within each group (macro, meso, and micro) to understand perceptions of big data, then across groups to understand alignment. In order to investigate perceptions, Social Representations Theory (SRT), a theory from social psychology, was used as the basis for data collection. However, data analysis led to the decision to integrate SRT with Sociotechnical Systems Theory (SST), a well-known IS theory. This integration of SRT with SST developed the Theory of Sociotechnical Representations (TSR), which is a key theoretical contribution of this research. The thesis presents the concept and application of TSR, by using it to frame the study’s findings around perceptions of big data across macro, meso and micro levels of the NZ healthcare sector. The practical contribution of this thesis is the demonstration of areas of alignment and misalignment of big data perceptions across the healthcare sector. Across the three levels, alignment was found in the shared understanding of the importance of data quality, the increasing challenges of privacy and security, and the importance of new types of data in measuring health outcomes. Aspects of misalignment included the differing definitions of big data, as well as perceptions around data ownership, data sharing, use of patient-generated data and interoperability. While participants identified measuring outcomes, clinical decision making, population health, and precision medicine as potential areas of application for big data technologies, the three groups expressed varying levels of interest, which could cause misalignment issues with implications for policy and practice.Item Breaking bad news about cancer : the experiences of patients, patients' family/whānau members and healthcare professionals : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2020) Matthews, TamyraBreaking bad news is a reality of medical practice in oncology, and can be a challenging task for those receiving and delivering the news. For patients and their family members, ‘bad news’ is understandably accompanied by strong emotions and ongoing implications for their lives as they adjust to the news. For healthcare professionals (HCPs), there are numerous variables to consider and balance when having these difficult conversations, as well as managing the personal impact. The current study aims to explore the subjective experiences of patients, patients’ family/whānau members, and HCPs when bad news was delivered to patients about their cancer within the surgical departments of MidCentral District Health Board. The study is designed to allow multiple perspectives to be gathered and compared, and recommendations for practice to be made that align with the goals of those involved in the project’s inception, as well as attend to the underrepresentation of family members’ perspectives and New Zealand-based data in the literature. To achieve this, the current study utilised a qualitative approach with the epistemological and methodological basis informed by interpretative phenomenological analysis. The study also included a consumer perspective with the involvement of the Otaki advisory group to guide how the study was conducted and provide feedback on the study outcomes. Data was collected through semi-structured interviews with 10 patients, 6 family/whānau members, 5 surgeons, and 6 nurses. Interviews were analysed in two ways: by participant group (i.e., patients, family members, and HCPs) and by ‘linked case’ (i.e., direct comparisons of the perspectives of all those involved in the same patient’s case of breaking bad news). The findings are presented as a series of superordinate and subordinate themes. The group-based analysis highlighted that patients understood their bad news experiences through the lens of their health beliefs and expectations of care, the relational and support needs they, and others, had during and following the encounter, and the ongoing shifts in perspective and priorities they experienced. Family members identified the patient as the focus of care, but also acknowledged their need for support in order to cope. HCPs recognised that breaking bad news was challenging based on the variation between instances of breaking bad news and patients’ needs, organisational constraints they had to work under, and the personal toll this task could take. The linked case-based analysis demonstrated that the receivers of bad news have a range of emotional and informational needs and that HCPs and family members fulfil important roles in accurately meeting patients’ needs. Four conclusions can be drawn from the study as a whole about the process of breaking bad news. Firstly, there is variability in the situations, delivery approaches and needs of those involved in breaking bad news, requiring a flexible and tailored approach. Secondly, establishing an interpersonal connection between the deliverer and receiver of bad news is a central part of the process. Thirdly, breaking bad news is a challenge for all and receiving support in order to cope, is paramount. Lastly, there is a shared responsibility across healthcare organisations, training providers, HCP teams, and individual HCPs to make this process go as well as possible for all those involved. The current research makes an important contribution to understanding that, without doubt, breaking bad news is a complex process for those delivering and receiving the news, and improvements in this area require careful consideration, prioritising and resourcing as part of delivering effective cancer care.Item New Zealand's food system is unsustainable : a survey of the divergent attitudes of agriculture, environment and health sector professionals towards eating guidelines : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand(Massey University, 2019) Jones, RebekahBackground: The United Nation’s (UN) Sustainable Development Goals (SDG) address the adverse health and environmental changes associated with changes in the food and nutrition system. In one of its many sustainable development initiatives, the Food and Agriculture Organisation of the UN (FAO) has called for sustainable diets, which align with SDG 2, Zero Hunger, and SDG 12, Sustainable Consumption and Production. The inclusion of sustainability characteristics in New Zealand’s (NZ) eating and activity guidelines (EAGs) would contribute to directly addressing the SDGs and lead to achieving sustainable diets. This study aimed to evaluate the agreement among sectoral professionals of including sustainability characteristics within the guidelines. Methods: Professionals within the agriculture, environment and health sectors were invited to complete an online survey to establish agreement with sustainability characteristics. Opinion and attitude questions were completed using a 5-item Likert scale. One-way ANOVA analyses were conducted to compare the level of agreement with the inclusion of sustainability statements of the three professional sector groups. A one-way ANCOVA analysis was undertaken to detect a difference in means of the sectoral levels of agreement whilst controlling for covariates. Post-hoc tests were used to determine where the significant differences in opinion lay between the sector groups. Results: Overall, 298 (65% female) respondents completed the survey from the agriculture (37%), environment (22%) and health (41%) sectors. Two-thirds (66%) of respondents were over 35 years and 90% had a tertiary education. Two-thirds (63%) of respondents disagreed with the statement that NZ’s current food system is sustainable; sector respondents from health (77%) and environment (78%) had greater disagreement than agriculture (35%) (P = 0.00). Overall, 77% of respondents agreed that sustainability characteristics should be included in guidelines; with greater agreement from health (90%) and environment (84%) versus agriculture (58%) (P = 0.00). Five sustainability characteristics received unanimously high levels of agreement (> 90%) for inclusion: dietary diversity (97%), sustainable seafood (90.8%), to limit processed foods (90.7%), reduced food waste (95.3%) and sustainable lifestyle behaviours (97.2%). Agreement for eight sustainability characteristics was higher for health and environment versus agricultural sector (P < 0.05). There was relatively lower level of agreement from all three sectors, particularly environmental (68.7%), to consume recommended serves of dairy products. Only 38.5% of all respondents agreed with the inclusion of “organic food produce”. Respondents who agreed with the inclusion of sustainability characteristics were more likely to be familiar with the EAGs and to agree NZs current food system is unsustainable. Conclusion: Professionals from the agriculture, environment and health sectors of New Zealand largely support the inclusion of sustainability characteristics within NZ’s EAGs. However, there are areas of divergence that need to be addressed for their successful development and implementation.Item What makes a moving and handling people guideline work? : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Manawatū, New Zealand(Massey University, 2018) Lidegaard, MarkMoving and handling of people (MHP) is a major reason for developing musculoskeletal disorders (MSD) in the healthcare sector worldwide. To reduce MSD from MHP, many national and state level guidelines targeting MHP have been developed. However, little is known about their impact on injury claims rates, how they are intended to work, if intended users are aware of and use them, which parts of the guideline are being used, and how they are implemented. Therefore, the overarching goal of this thesis was to contribute to understanding what makes a MHP guideline work. It was addressed by examining the effects of introducing the New Zealand Accident Compensation Corporation ‘Moving and Handling People: The New Zealand Guidelines’ (MHPG), using a mixed-methods approach in five sequential studies. An analysis of claims data (Study 1) showed that MHP related claims rates declined before, but increased after the introduction of the MHPG. A study of the MHPG programme theory (Study 2) showed that key actors for implementation were MHP coordinators, H&S managers, and therapists. The developers argued for implementing a multifaceted MHP programme where implementation of organisational systems should create the foundation for implementing the core components. A questionnaire analysis (Study 3) showed that a high proportion of MHP coordinators, H&S managers, and therapists were aware of the MHPG, while a high proportion of therapists used it. In contrast, fewer carers were aware of and used it. A second questionnaire analysis (Study 4) showed that more key actors were familiar with and used the core components compared to the organisational systems. A low proportion of actors experienced change after use. Case studies (Study 5) showed that organisational motivation to implement a MHP programme was initiated by MHP related staff injuries. The implementation process was gradual, changing MHP practices during multiple steps, and dependent on a dedicated person to drive implementation. This thesis shows that making a MHP guideline work requires a dedicated actor, with support from management, to facilitate implementation and organisational changes needed. However, many contextual factors affect implementation, ranging from national, e.g. legislation and policies, to individual level, e.g. individuals conducting MHP.Item Medical misadventure, legislation, reporting, and injury prevention : an evaluation of the process of ACC's reporting of medical error findings with regard to injury prevention : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Policy at Massey University(Massey University, 2003) Ralph, Lisa TatianaThis research investigated and evaluated the reporting process with regard to medical error as under the Accident Rehabilitation Compensation Insurance Act (1992) and the impact of that process with regard to the prevention of injury. It considers: (a) whether the legislation is consistent with regard to the aim of the prevention of injury; (b) the outcomes of the reporting process in terms of injury prevention; (c) if anything else could be done in terms of injury prevention. Under the Accident Rehabilitation and Compensation Insurance Act (1992) the Accident Compensation Corporation (ACC) was specifically required to 'report the circumstances [of the injury] to the appropriate body with a view to the institution of disciplinary proceedings, and to any other body that may be appropriate' if the Corporation was satisfied that negligence or inappropriate action had caused personal injury (ARCI Act, 1992). Reporting of medical error by health professionals is one mechanism available to the ACC to prevent injury. Reporting to bodies such as the Health and Disability Commissioner's (HDC) office and organisations responsible for the registering of health professionals can result in changes which minimise the re-occurrence of the medical error. This research is based on a formative policy evaluation. It seeks to improve ACC's medical error reporting process and employs the methodological tools of document research and case studies. The study is based on a random selection of sixty claims accepted on the basis of medical error under the Accident Rehabilitation and Compensation Insurance Act (1992). The process of data analysis was informed by grounded theory in that four analytical categories established were based on similarity of content, according to their injury prevention outcome. The key findings of this evaluation resulted in recommendations which relate to improving the ACC's medical error reporting process. These may be of interest to those working in the area of policy development and/or process improvement, with regard to the reporting of medical error for the purpose of injury prevention. It is clear that there is a need for further research into the outcome of injury prevention initiatives undertaken by professional bodies and for the uptake of injury prevention initiatives by the ACC and the HDC's office.Item Kia taupunga te ngākau Māori : anchoring Māori health workforce potential : a thesis presented for the degree of Doctor of Philosophy, Māori Studies, Massey University, Palmerston North, New Zealand(Massey University, 2006) Gillies, AnnemarieIn New Zealand Māori are under-represented in the workforce across multiple sectors. This thesis explores this incongruity with regard to Māori health. A Māori perspective and philosophical foundation formed the basis of the methodological approach, utilising a case study research design to inform the study. This provided the opportunity to explore Māori health workforce development initiatives and their potential to contribute to improvements and gains in Māori health. It was important that this work take into account social and economic factors and their impact on health, as well as the varying political climates of market oriented reform and a fiscal policy focus, because it has not only challenged Māori health development but also provided opportunities for increased Māori involvement and participation in health and New Zealand society. Therefore the thesis, while focused on health takes cognisance of and, coincides with the capacity and capability building efforts that have been a feature of overall Māori development, progress and advancement. In the context of this thesis Māori health workers are seen as leaders within their whānau, hapū, iwi, and Māori communities. Consequently a potential workforce that is strong and powerful can lead to anticipated gains in Māori health alongside other Māori movements for advancement. The potential cannot be under-estimated. This thesis argues that there are critical success factors, specific determinants, influencing Māori health workforce potential, and that these success factors have wider application. Therefore, as this thesis suggests Māori workforce development, especially in relationship to the health workforce, is dependent on effective Māori leadership, the application of Māori values to workplace practices, levels of resourcing that are compatible with training and development, critical mass, and targeted policies and programmes.