A single case study : an evaluation of the impact of the implementation of the primary health Care strategy on the primary health care nursing workforce in Tairawhiti : a thesis presented in total fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Manawatu, New Zealand

Abstract

In December 2000 the New Zealand Health Strategy was released closely followed by the Primary Health Care Strategy in February 2001. The Primary Health Care Strategy pledged a significant paradigm shift in health service funding and delivery and primary health care nurses were considered crucial to implementation. The intent of this study is to investigate the impact of implementation of the Strategy on primary health care nursing in Tairawhiti. Tairawhiti District Health Board (TDH) and the two Primary Health Organisations (PHOs) were central to the analysis.

For my overarching research framework I employed a qualitative interpretive design informed by constructionism. The diffusion of innovation theory seeks to explain how, why, and at what rate new ideas are spread through cultures and provided the theoretical lens to collect the data and analyse the findings. Using a single instrumental case study design, data were collected from multiple sources including relevant policy documents and strategic plans as available on the TDH, Ngati Porou Hauora and Turanganui PHO websites. Qualitative data were obtained using in-depth individual interviews with managers at middle and senior levels at TDH and the two PHOs. Focus groups were held with primary health care nurses.

The study concludes that investment in and the effective deployment of primary health care nurses in Tairawhiti did not occur as anticipated. A key finding was the lack of a whole of system strategic approach and poor diffusion processes meant widespread service change was undermined. The study also found that the Strategy met with multiple sources of resistance across the health sector, further exacerbated by existing structural barriers in the health system. This study brings together an increased understanding of the complexities that continue to disable a true primary health care approach and consequently restrict the potential gain the nursing workforce offers.