Central Leadership, Gover nance, and
Regional Cooperation in Implementing
the National Health IT Plan
Presented By: Nouran...
OUTLINE
Objective

Explore and examine key issues around the
implementation of the New Zealand National Health IT
Plan.

B...
BACKGROUND
The leadership and strategies for eHealth implementation in New
Zealand have gone through changes over the past...
BACKGROUND
National Health IT Plan
Implementation

+

Regionalisation
k
REGION

DHBS

NORTHERN

MIDLAND

Waikato
Bay of Pl...
METHOD

Objective

Explore and examine key issues around the implementation of the
New Zealand National Health IT Plan.

•...
METHOD
Initial list of 32 individuals
Initial list of 32 individuals
meeting criteria
meeting criteria
INTERVIEW SCHEDULE
...
FINDINGS

• Discussion about the NHITP and different aspects of its
implementation
• Changes in some topics and manner of ...
FINDINGS
CENTRAL LEADERSHIP
• Unanimous that the NHITB and/or Graeme Osborne and Tony
Cooke were instrumental in the shift...
FINDINGS
GOVERNANCE
• Regionalisation of the 20 DHBs, governance
structures (and the lack thereof) a growing
subject matte...
FINDINGS
REGIONAL COOPERATION
– the impact on decision-making
Regionalisation was described as a way to
“centralize where ...
DISCUSSION

• “We need evolution not revolution”
• Consensus an issue  With NHITB & NHITP that
consensus could be reached...
DISCUSSION
• NHITB has set out to do is no small feat
• Regionalisation, a step forward
• IT governance in the health sect...
IMPLICATIONS

• Clear that a key set of issues affecting implementation
• Come a long way in using IT in healthcare, still...
Thank you for your attention!
n.ragaban@auckland.ac.nz
NouranARagaban

Questions?
References
•

•

•
•
•
•

•
•
•

Ministerial Review Group. Meeting the challenge: Enhancing sustainability and
the patient...
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Central Leadership, Governance, and Regional Cooperation in Implementing the National Health IT Plan

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University of Auckland

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Central Leadership, Governance, and Regional Cooperation in Implementing the National Health IT Plan

  1. 1. Central Leadership, Gover nance, and Regional Cooperation in Implementing the National Health IT Plan Presented By: Nouran Ragaban, PhD Candidate Academic Supervisors/co-authors: Dr. Karen Day, Dr. Martin Orr 28 November 2013 @2pm
  2. 2. OUTLINE Objective Explore and examine key issues around the implementation of the New Zealand National Health IT Plan. Background – Why conduct this research? Method – How was the objective achieved? Findings Discussion Implications – Implications and take away points
  3. 3. BACKGROUND The leadership and strategies for eHealth implementation in New Zealand have gone through changes over the past few years. 2005 1991/ 1996 Health Information Management and Technology/WAVE Advisory Board Health Information Strategy Action Committee (HISAC) National Health IT Board (NHITB) Working to Add Value through E-information (WAVE Report) Health Information Strategy- New Zealand (HIS-NZ) National Health IT Plan 2001 = Impact on the health sector landscape 2010
  4. 4. BACKGROUND National Health IT Plan Implementation + Regionalisation k REGION DHBS NORTHERN MIDLAND Waikato Bay of Plenty Lakes Tairawhiti Taranaki CENTRAL Capital & Coast Hutt Valley Wairarapa Mid-Central Whanganui Hawkes Bay SOUTHERN Source: health.govt.nz Northland Auckland Waitemata Counties Manukau Nelson Marlborough Canterbury West Coast South Canterbury Southern
  5. 5. METHOD Objective Explore and examine key issues around the implementation of the New Zealand National Health IT Plan. • Participant Criteria: – Have been historically involved in eHealth policy in New Zealand – having contributed to the shaping of the NHITP, and/or – involved in the implementation of key eHealth initiatives Source: uib.no
  6. 6. METHOD Initial list of 32 individuals Initial list of 32 individuals meeting criteria meeting criteria INTERVIEW SCHEDULE   Exploring the NHITP Reference First I woulddid you discuss the the National HealthPlan: Group like to hold when National Health IT IT Plan 1.What role 8 Individuals development in 2009-2010 (if different from your was in current role)? 2.What level of involvement did you have in the development of the National Health IT Plan? what were responsibilities, what factors influenced your decisions 3.In what ways do you think the NHITP (positive and/or negative) contributed to the implementation of eHealth in New Zealand? what evidence is there to support the positive or negative effect, what would you do differently 30 Interviewees 30 Interviewees • 30-90 minute interviews – One-on-one (two over the phone) – Detailed notes taken – Analyzed for themes Source: aerva.com
  7. 7. FINDINGS • Discussion about the NHITP and different aspects of its implementation • Changes in some topics and manner of discussion based on the phase of NHITP implementation • A set of themes emerged, three of which are discussed here: Central Leadership Governance Regional Cooperation
  8. 8. FINDINGS CENTRAL LEADERSHIP • Unanimous that the NHITB and/or Graeme Osborne and Tony Cooke were instrumental in the shift of direction in the sector NHITB was described as necessary for the healthcare sector as it “couldn’t sustain duplication of services, procurement, [and] IT.” “There’s an acceptance that change is a risk but standing still is even riskier. Where we’re willing to lead is where we get the best value.” Source: technet.microsoft.com In comparison to prior national implementation the NHITB was more “engaging” and allowed for more “collaborative development” seeking greater sector involvement.
  9. 9. FINDINGS GOVERNANCE • Regionalisation of the 20 DHBs, governance structures (and the lack thereof) a growing subject matter • A “shift that has made progress,” early interviewees agreed with that sentiment • Lack of clear governance structures was highlighted Source: gurucul.com • Being able to learn from one another was when the discussions shifted toward the pros and cons of regional cooperation “There needs to be on-going governance [and] a two-way conversation” Necessary to “run regional governance on top but still have investments remain local.”
  10. 10. FINDINGS REGIONAL COOPERATION – the impact on decision-making Regionalisation was described as a way to “centralize where [the sector] must and distribute where they can” in order to “mobilize capability better.” DHBs within each region had to cooperate with one another because as one interviewee so bluntly put it, “[we are] short of money and workforce and we need to simplify and establish a foundation as a region.” Source: oxfamblogs.org • Although progress seen, some statements aligned with one interviewee: accompanying regionalisation, “local investment in IT slowed up” • Slower decision-making was indicated
  11. 11. DISCUSSION • “We need evolution not revolution” • Consensus an issue  With NHITB & NHITP that consensus could be reached (to a degree) • Complexity of the sector and the divergent needs of the services within it • Need for clear structures so that the nature of the distributions could be better understood
  12. 12. DISCUSSION • NHITB has set out to do is no small feat • Regionalisation, a step forward • IT governance in the health sector is a topic with fuzzy boundaries • Accompanying structural changes to drive the Plan’s implementation • Clarification in the governance space Source: dilbert.com
  13. 13. IMPLICATIONS • Clear that a key set of issues affecting implementation • Come a long way in using IT in healthcare, still things to be done • Define a functional framework • DHB understanding of their role and responsibilities when coordinating and consolidating Photo source: lonelyplanet,com; travelphotoadventures.com
  14. 14. Thank you for your attention! n.ragaban@auckland.ac.nz NouranARagaban Questions?
  15. 15. References • • • • • • • • • Ministerial Review Group. Meeting the challenge: Enhancing sustainability and the patient and consumer experience within the current legislative framework for health and disability services in New Zealand. Wellington: Ministerial Review Group, 2009. Office of the Auditor-General. Performance audit report: Progress with priorities for health information management and information technology. Wellington: Office of the Auditor-General, 2006. Health Information Strategy Action Committee. Health Information Strategy for New Zealand 2005. Wellington: Ministry of Health, 2005. Creswell, J. W. Research Design: Qualitative and Quantitative Approaches. Thousand Oaks: Sage, 1994. Berman P. The study of macro and micro implementation. Public Policy 1978: 27: 157-184. Meier KL, O’Toole Jr. LJ, and Crotly SN. Multilevel governance and organizational performance: Investigating the political-bureaucratic labyrinth. Journal of Policy Analysis and Management 2004: 23(1): 31-47. Hurley J. Regionalization and the allocation of healthcare resources to meet population health needs. Healthcare Papers 2004: 5(1): 34-39 Harper P. Procurement processes costing DHBs dearly. The New Zealand Herald 2010. Milner M. Delivering improved outcomes from ICT investment in health. Panel discussion: Health Informatics New Zealand Conference 2012.

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