Strategic and operational management principles on integrated coordinated healthcare in New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies (Management), Massey University, New Zealand
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2024
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Massey University
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Background - Globally the health system burden has been rising due to increasing populations and complexity of health status, as well as resource and infrastructure pressures. To address this, the World Health Organisation Strategy has encouraged health economies worldwide to embed Integrated Coordinated Healthcare (ICH) services. Aligned with this, New Zealand (NZ) has progressively introduced system-wide initiatives supporting ICH design and implementation at each tier of the health system. Aims and objectives – This research explored management principles involved with ICH service delivery at each tier of the NZ health system, to understand how organisations have applied theories in practice, to improve efficiency and effectiveness of service delivery and support sustainability. Methodology – This research took an interpretivist position and followed inductive methodology to investigate how management principles for ICH have evolved with the contributions of stakeholders. This research obtained qualitative data via purposive and snowball sampling, to request participants take part in semi-structured interviews and complied with ethics by gaining participants informed consent and ensuring their privacy. The findings reflected common themes across interviewees and were categorised using an iterative coding process for each participants’ responses. Their themes were compared to literature. Bias is an inherent limitation for this type of study, though mitigations were taken to reduce this. Key findings and conclusions – The findings added to the body of knowledge for ICH management principles. As the strategic level, they indicated that ICH is beneficial for the sustainability of the NZ health system, if service objectives are aligned with strategic government initiatives. At the sector level the findings outlined that partnering shares risk and benefit between the funder and suppliers to incentivise goal congruence in achieving social good objectives. In contrast, conditional contracts enable the funder to manage competition objectively, to equitably reward suppliers. The findings contrast ICH operational management approaches to achieve efficiency and effectiveness. They pose the view that for complex patient groups and ICH service pathways, integration should be implemented with coordination of assessments, policies, and information systems across multiple suppliers. They posit that ICH designs for patient groups whose service use is largely unaffected by complexity other than their health condition, can feasibly achieve integration within clinics delivering multi-disciplinary services. The findings further indicated ICH designs must incorporate meaningful monitoring supported by collaborative processes to ensure stakeholders embed continuous improvements. The findings also demonstrated that building trust is key for engaging with suppliers, particularly for Māori and ICH services. Contribution - The key management principles for ICH are themed around connectivity and contextual factors, governance and equity, and collaboration and trust. ICH designs should include realistic measures to monitor performance and quality, and categorise complexity, enabling organisations and funders to assess the relative impact of improvements on health outcomes. Incorporating these management principles into designs should support the efficiency and effectiveness of ICH services in practice.