NAVIGATING THROUGH A RURAL HEALTH CARE SERVICE DELIVERY IN NEW ZEALAND: AN ACTION RESEARCH STUDY

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NAVIGATING THROUGH A RURAL HEALTH CARE SERVICE
DELIVERY IN NEW ZEALANDAN ACTION RESEARCH STUDY
Andrea M Corbett, RN, MPhil (Nursing), Senior
lecturer, Western Institute of Technology at
Taranaki, New Zealand. PhD candidate, Monash
University, Victoria, Australia
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New Zealand in relation to Thailand in the world
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The New Zealand Health Service

• Established in 1938
• climate of welfarism
• Cataclysmic change
• July 1, 1993
• Out with benevolent welfarism
• In with profit making philosophy

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A decade of endless change began

• Strategic policy documents released

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The purpose of the study . . .

• Using Action Research --
• To understand the conditions that
• created hardship for rural dwelling
• New Zealanders.

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Causes of morbidity and mortality

• Cardiovascular disease and other
• lifestyle illnesses
• asthma
• diabetes
• congestive heart failure

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Consumers responsible for own health

• Inequality and inequity of health service
  availability is unacceptable
• Stated in---
• The New Zealand Health Strategy, 2000
• The Primary Health Care Strategy, 2001
• The NZ Disability Strategy, 2001
• Health of Older People Strategy, 2002
• The Health and Independence Report, 2003

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• I was alone, but deep inside I could not accept
  that majority views must be right, accepted or
  adhered to simply because of the majority status.
  I recognised that we should not leave a paradigm
  unchallenged simply because it is dominant

Zuber-Skerrit Farquhar, 2002, p103
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The studys aims were to . . .

• Develop a seamless service delivery model for
  use in the rural sector that would permit
  community access to health care that traversed
  hospitalisation through discharge and the home
  management phases.

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Inclusion/exclusion criteria . . .

• Inclusion
• All persons over age 15
• Physical disability
• Exclusion
• Children (those under 15 years of age)
• Intellectual disability

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Profile of Taranaki and the District Health Board
which was the location of the study

• Area 7273 square kilometres
• Population 107,200 as at June 2007
• 1488 staff 310 beds Taranaki Base Hospital
• 39 beds Hawera Hospital 50 k south
• 213,952,000 budget for 2005 financial year

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Funding of health services . . .

• TDHB principle supplier of primary and
  secondary services
• Monies from Vote Health fixed budget
• Accident Compensation and Rehabilitation
  Corporation (ACC)
• Funds all services to injured (including
  visitors to New Zealand)

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Recruitment of participants . . .

• Through liaison person within key identified
  service provider organisations
• Information sheet passed on by liaison
• Consent form signature obtained by researcher

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Diversity of participants . . .

• 23 enrolled
• 15 management 18 designated health
  professionals
• Nurses
• Physiotherapists
• Social workers
• Occupational therapists
• Podiatrist
• Speech language therapist

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Data collection began with . . .

• Modified Delphi technique
• one-on-one interviews
• anonymous and confidential
• interviews transcribed
• member checking process
• Analysis

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Thematic analysis using template . . .

• Six a priori themes identified . . .
• Patient and family education
• Agency interface
• Team functioning
• Discharge planning
• Discipline role
• Funding issues

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Rationale for using template analysis

• Understanding is only possible because of,
• not in spite of, preunderstandings derived
• from the interpreters (researcher) initial
• situation.

Rabinow Sullivan (1987)
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Further data collection and analysis

• Followed with . . .
• Focus Group discussions
• which identified four key areas
• functioning of the team
• issues around staffing
• coordination of care
• matters relating to discharge

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Final conclusions from analysis came after . . .

• Large participant discussion groups
• Need for coordinated and uninterrupted delivery
  of services not disputed
• Meeting long term personal health and disability
  needs greatest challenge for acute care service
  providers

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What is lacking in service delivery?

• A continuum of management from
• moment of acute admission to hospital
• through to and beyond discharge.
• Secondary health service stops at the hospital
  door.

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Greatest challenge facing New Zealands health
services?

• Meeting the complex needs of the rapidly
  increasing numbers of the over 65s
• significant co-morbidities
• long term duration
• many with disabilities

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Some of the issues found by the study . .

• The sheer number of agencies operating
• No compatible operating IT systems
• Duplication of services
• Competition between agencies
• Lack of funds to provide services
• Lack of personnel to provide services
• No overall coordination of services

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A suggestion solution from the study. . .

• Appoint a service coordinator who would transcend
  both primary and secondary care boundaries to
  oversee and coordinate service delivery that the
  patient requires.
• Need to develop a clinical pathway.

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The view from my classroom Mt Egmont/Mt Taranaki,
New Zealand
THANK YOU