This document summarizes a presentation on central leadership, governance, and regional cooperation in implementing New Zealand's National Health IT Plan. Key findings from 30 interviews with stakeholders involved in eHealth policy and implementation in New Zealand are discussed. Central leadership provided by the National Health IT Board was seen as instrumental in shifting the sector's direction. Regional cooperation also helped by centralizing some functions and distributing others. However, accompanying the regionalization was a lack of clear governance structures and slower decision-making. Defining functional frameworks and roles could help address these issues and further implementation efforts.

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Thank you for your attention!
n.ragaban@auckland.ac.nz
NouranARagaban
Questions?

15. References
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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.