Research and development in health service management : a study of innovation in New Zealand acute health care enterprises : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Health Management at Massey University

Abstract

As of 1 July 1993, the New Zealand Government has extensively reformed its health care industry along the lines of managed competition. Amongst other objectives, the reforms were designed to encourage innovation in health service delivery. Innovation is preceded by research and experimental development (R&D). When considered in the context of a service industry such as health, innovation arises from health service management R&D. Health service management R&D encompasses all R&D that improves the efficiency and effectiveness of health service delivery. The purpose of this research was to establish the capability and extent of R&D in health service management within New Zealand acute health care enterprises during the fiscal year, 1 July 1992 to 30 June 1993, i.e. the year immediately prior to the reforms becoming operational. Case study research was then conductcd to describe the parameters of health service management R&D in practice. This thesis focuscd on R&D as an indicator of innovativeness within the New Zealand health industry, innovation being a prerequisite for competitive advantage and business success/survival. The research design was triangulation. A full population survey of 31 acute health care enterprises was conducted in the first instance, using a survey questionnaire based on the internationally accepted OECD framework for conducting such surveys. The response rate was 29 percent. Only one out of nine respondents conducted any health service management R&D, conducting five R&D projects in total and that organisation subsequently gave permission for the case study research to proceed, waiving its right to anonymity. The organisation was the Wellington Area Health Board and the R&D involved the development of a perinatal management information system- PIMS. The research for this innovation began in the early 1980's, taking a decade to bring into operation. The case study documents that history, illustrating the realities of innovating in an industry undergoing constant change due to environmental forces impacting on it. It also demonstrates the behaviour of an intrepreneurial knowledge worker, Professor Prof. John Hutton, of the Wellington School of Medicine, who joined forces with an entrepreneurial private company of software application developers, Terranova Pacific Serv ices Ltd. Together they championed the idea to the point of successful innovation. The survey questionnaire highlighted a paucity of health service management R&D being conducted plus identified perceived barriers to innovation and imitation. More importantly, it identified a serious shortage of employees among the responding organisations who had the expertise to conduct such R&D i.e., post-graduate qualifications in health service management. This input deficiency must affect R&D outputs and should be further researched.