ORCID Profile
0000-0001-6100-090X
Current Organisation
The University of Auckland
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Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-052209
Abstract: To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years. Observational population-based study over 2008–2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases. New Zealand primary and secondary care. All children aged 0–4 years enrolled in the PHO Enrolment Collection from 2008 to 2018. ASH. Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables. The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
Publisher: Emerald
Date: 28-06-2021
DOI: 10.1108/JHOM-10-2020-0417
Abstract: In 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited. We develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF. Policy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis . When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably. This article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health. This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.
Publisher: Ubiquity Press, Ltd.
Date: 23-04-2021
DOI: 10.5334/IJIC.5602
Publisher: Ubiquity Press, Ltd.
Date: 2021
DOI: 10.5334/IJIC.5679
Location: Germany
No related grants have been discovered for Pushkar Raj Silwal.