New Zealand Health System Research Articles

A self-assessment maturity matrix to support large-scale change using collaborative networks in the New Zealand health system

BackgroundA maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care.MethodsThe aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Māori Health Strategy and Policy team.ResultsThe maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Māori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders’ responsiveness to improving Māori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government’s treaty with Māori, the indigenous people of NZ.ConclusionsThrough a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally.OtherThis study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

The place of rural hospitals in New Zealand's health system: an exploratory qualitative study.

In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for Māori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system. A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants' views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method. Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, 'Our place and our people', reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital's response. Local services were provided by small, adaptable teams across broad scopes and blurred primary-secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, 'Our positioning in the wider health system', related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being 'at the end of the dripline'. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them. This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Māori.

Parental vaccine hesitancy among former refugees in New Zealand

Immunisation is one of the most effective public health measures to prevent and control infectious diseases. But for vaccinations to work, very high vaccine compliance is needed both amongst the general population and subgroups. Vaccine hesitancy (VH) — delay or refusal of vaccines — is an important factor underpinning low vaccination uptake around the world and in New Zealand (NZ). Previous VH studies have focused on the general population and evidence on subgroups, such as refugees, is limited. I have conducted a cross-sectional study among former refugee parents with a child under 16 years old. I used the Parental Attitudes about Childhood Vaccines (PACV) questionnaire in four languages (English, Arabic, Somali and Oromo). The rate of VH and the association between VH and sociodemographic factors was examined. This presentation will report key findings of the study. Of 178 participants, 29 (16.3%) were vaccine hesitant. The greatest concerns about childhood vaccines were side effects, general safety and efficacy (vaccine might not work well). Three in four parents reported that their child(ren) had up-to-date vaccination status. Parents with lower educational achievement were more hesitant to vaccinate than those with higher educational achievement. Caregivers who used unofficial sources of vaccine information were more hesitant to vaccinate than those who used official sources of vaccine information. The rate of VH among former refugees was less than that of the host population, yet more refugee parents delayed and refused vaccines than the host population, which may be explained by issues with accessibility and understanding of the NZ health system. VH among former refugees is influenced by modifiable factors (education and source of information); therefore, health and vaccine literacy tailored to former refugee parents’ needs in a manner that addresses their concerns is required to reduce VH and improve uptake.

Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients

ObjectivesChronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality, particularly for Māori, which places a large burden on the New Zealand (NZ) health system....

Wide-ranging impacts reported by NZ cancer survivors: is supporting cancer survivor resilience a health sector role?

Cancer survivor numbers are on the rise but little is known about New Zealand (NZ) survivors' experiences with management of cancer-related impacts and vulnerability. This study explored the experiences and resilience of NZ cancer survivors and the experiences of healthcare practitioners who work with cancer survivors. There is a focus on indigenous Māori survivors. This study used qualitative methods to explore survivors and healthcare practitioners' views on cancer-related impact and management strategies. Two focus groups were conducted with mainly colorectal cancer survivors residing in the central regions of NZ. There was one Māori-only group (n=6 participants) and one multicultural group (n=18 participants). The Māori-only focus group was purposefully organised to provide a culturally safe setting for the research. In addition, 12 in-depth interviews were conducted with healthcare practitioners between October 2011 and March 2012. Wide-ranging survivorship impacts were described by survivors across physical, emotional, spiritual and social domains. Shame resilience and relationships, particularly with healthcare practitioners, were indicated as useful supports. Healthcare practitioners' time constraints and role priorities were identified as barriers to their ability to provide survivorship support. This study generated qualitative data on survivorship impacts and components of survivor resilience in NZ. It also provided insights into the need for better strategies and pathways to help the NZ health system be more responsive to both Māori and non-Māori survivors. Survivor impacts create vulnerabilities that are experienced and described differently by individuals and groups in NZ. Tailored survivor support that can enhance resilience and support relationships is needed in NZ.

The prevalence of human papillomavirus in oropharyngeal cancer in a New Zealand population.

BackgroundThe incidence of oropharyngeal cancer (OPC) in New Zealand (NZ) has more than doubled over the last 14 years with 126 cases in 2010. Overseas studies have shown that human papillomavirus (HPV) plays a significant role in the development of these cancers. However, the role of HPV in OPC and the burden on the NZ health system is unclear.AimThe aim of the study was to determine the prevalence and the genotypes of HPV associated with OPC in New Zealand.MethodsIn this study, 621 OPC were identified from cancer registry data from 1996–98, 2003–05, and 2010–12. Biopsies of 267 cases were then retrieved from laboratories throughout New Zealand. p16 immunohistochemistry and a human beta globin PCR were performed on all specimens. HPV genotyping was performed on all beta globin positive specimens using real-time PCR with melt analysis.ResultsUsing a p16/PCR algorithm, 77.9% (95% CI: 71.1–83.5%) of cases were attributable to HPV. Of these, 98.5% were HPV 16 positive. There was also one case each of HPV 33 and 35. The percentage of HPV positive cases increased from 61.9% (95% CI: 40.9%– 79.2%) in 1996–98 to 87.5% (95% CI: 79.8%– 92.5%) in 2010–12. Results from the multivariable model, adjusted for sex and ethnicity found statistically significant associations between HPV positivity and timeframe (OR: 5.65, 95% CI: 2.60–12.30, 2010–12 vs 1996–98), and between HPV positivity and patient age (OR: 0.55, 95% CI: 0.33–0.99, ≥61 years vs ≤60 years).ConclusionsThis data is consistent with data from other developed countries showing an increase in cases of HPV positive OPC in New Zealand, and the majority of cases being attributable to HPV 16. These results support the recent inclusion of males into the nationally funded immunization schedule for Gardasil® 9.