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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.

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand’s four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989‐1991) with planning and purchasing located at “home” in local areas and closely aligned with service provision; a competitive internal market system (1993‐1996) which separated planning and purchasing from service provision; a centralised system with a “headquarters” controlling planning and purchasing (1997‐1999) while maintaining the distance from provision; and the district health board system currently under development (1999‐) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand’s experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.

This chapter examines why managed clinical networks are an appropriate approach to sustainable healthcare, and discusses the conditions for the effectiveness of these multi-stakeholder, clinician-led modes of organizing. It describes the development of a national clinical network to achieve system-wide improvement in the provision of publicly funded cardiac surgery services in New Zealand, and the subsequent evolution of a broader network encompassing the whole cardiac care patient pathway.

The case study of the two cardiac clinical networks focuses on the emergence and evolution of the networks over a four-year period from 2009. Data were collected from interviews with key stakeholders of both networks and from internal and published documentary evidence. Analysis of the case study is informed by network theory and prior studies of managed clinical networks.

Progress made towards the achievement of the goals of the initial cardiac surgery network encouraged a broadening of focus to the entire cardiac care pathway and the establishment of the national cardiac network. An important benefit has been the learning and increase in understanding among the different stakeholders involved. Both clinical networks have demonstrated the value of clinician engagement and leadership in improving the delivery of health services, and serve as a best practice model for the development of further clinical networks for health services that require a national population base.

The case study analysis of the two cardiac clinical networks identifies five mutually reinforcing themes that underpin network effectiveness: network structure, management and governance, and internal and external legitimation. These themes encompass a number of factors suggestive of successful managed clinical networks, and offer insights into the use of such networks in organizing for sustainable healthcare.

The purpose of this paper is to discuss the engagement of Pacific peoples in mental health services in Aotearoa New Zealand and Pacific strategies for suicide prevention.

This qualitative study involved 22 interviews with Samoans who had made a suicide attempt and/or had suicide ideation, were engaged in a mental health service.

Narratives of mental health services and suicide prevention focused on issues of cultural competency, the importance of family involvement, dichotomous views of western and traditional beliefs around mental illness and the unsuccessful engagement of Pacific youth.

This research argues that cultural considerations for Pacific communities are of paramount importance if mental health service engagement and developments towards Pacific suicide prevention strategies are to be effective.

The purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and alternatives to seclusion.

A questionnaire was circulated to mental health inpatient staff. Data from the Ministry of Health for seclusion numbers and rates for Ma¯ori and non-Ma¯ori were also collected.

The major barriers to reducing the use of seclusion related to staffing issues, a lack of management and medical support, and physical characteristics of the facility. Data from the Office of the Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion events, the number of patients secluded, and the percentage of total patients secluded. However, the percentage of Ma¯ori secluded compared to the total number of patients secluded showed little change from 2007 to 2013.

Further analysis of the nurse’s responses showed that four of the six least-used strategies incorporated Ma¯ori cultural approaches. The authors surmise that an inability to provide culturally sensitive care, either through staffing or education factors, may be implicated in the lack of change in the seclusion rates for Ma¯ori. This may also be pertinent to seclusion rates for indigenous peoples in other countries.

The COVID-19 pandemic and its related economic meltdown and social unrest severely challenged most countries, their societies, economies, organizations, and individual citizens. Focusing on both more and less successful country-specific initiatives to fight the pandemic and its multitude of related consequences, this chapter explores implications for leadership and effective action at the individual, organizational, and societal levels. As international management scholars and consultants, the authors document actions taken and their wide-ranging consequences in a diverse set of countries, including countries that have been more or less successful in fighting the pandemic, are geographically larger and smaller, are located in each region of the world, are economically advanced and economically developing, and that chose unique strategies versus strategies more similar to those of their neighbors. Cultural influences on leadership, strategy, and outcomes are described for 19 countries. Informed by a cross-cultural lens, the authors explore such urgent questions as: What is most important for leaders, scholars, and organizations to learn from critical, life-threatening, society-encompassing crises and grand challenges? How do leaders build and maintain trust? What types of communication are most effective at various stages of a crisis? How can we accelerate learning processes globally? How does cultural resilience emerge within rapidly changing environments of fear, shifting cultural norms, and profound challenges to core identity and meaning? This chapter invites readers and authors alike to learn from each other and to begin to discover novel and more successful approaches to tackling grand challenges. It is not definitive; we are all still learning.

In 1993 the Ministry of Education in New Zealand identified health education, jointly with physical education, as one of the seven essential learning areas of the country’s national curriculum. This article takes a critical look at some of the emerging issues during the construction and implementation of the new curriculum. Consultation is one of the vital ingredients for successful curriculum construction. It might reasonably be assumed that the views and opinions of children and young people would be sought, and that their issues and concerns might be taken into account during the process. Indications are that this does not happen; this article addresses the question of whose knowledge and what knowledge counts. The new curriculum identifies health with physical education as a single learning area. The author considers that it would be more suitable to position health with social studies, as the two subject areas have more complementary similarities between goals, processes and content.

This paper seeks to describe the New Zealand Ministry of Health District Health Board (DHB) Mental Health Service Profile, which for the first time compares performance on a number of quality indicators for the populations of 21 DHBs.

The background, theory and development of the Ministry of Health Mental Health Directorate DHB Mental Health Service Profile (Profile) is discussed and example pages from the Profile are included

The DHB Profile overcomes the problem of setting arbitrary benchmarks by using the range of current practice across the sector. The profile demonstrates that certain levels of performance can be achieved and, given a better understanding of the long‐term client group, is potentially a very powerful tool for encouraging improved service delivery. Improved data quality is also likely to be a spin‐off from the use of the Profile in the sector.

Having key DHB mental health quality information in one place and being able to compare individual DHB performance with minimum, medium and maximum values for all DHBs are a significant step to improving information use and understanding DHB service and quality issues.