Abstract
IntroductionWhile considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand’s health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives.Case descriptionNew Zealand’s health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations.Discussion and evaluationThe case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand’s more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care.ConclusionThe case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.
Highlights
While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform
The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is better placed to plan for a future of integrated and team-based health care
Reflecting re-centralisation, this consolidation was seen as a means to mitigate Health Workforce New Zealand (HWNZ)’s slow goal achievement progress, for while HWNZ was successful in health workforce intelligence gains, it was less successful at addressing workforce problems, creating a clear strategy and future pathways and providing sector leadership
Summary
The sequence of oscillating reforms created a number of issues for New Zealand’s health workforce. HWNZ’s application of design thinking in its workforce planning affords a possibility to support wider health policy implementation [57], through the emphasis on patient-centred care throughout the WSFs and the proposed use of plasticity models to assist with improved deployment of PC teams. Does this approach break with workforce planning’s limiting connection with the present’s institutional norms and infrastructures [12], it more readily aligns workforce planning with the New Zealand health strategy’s commitment to a more integrated care system [19]. While this shift within New Zealand’s health planning and policy agencies would be desirable [72], it will likely take some time
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