Health Discourse, Policy and Management Challenges: a decade of New Zealand health service developments

Aim: The paper analyses a decade of change in discourse and health policy in New Zealand that has underpinned health system paradigms. It discusses how performance indicators were shifted fundament-ally and how this impacted on the work of managers, with a focus on workforce management and relationships with communities. Paradigms reviewed: The paper begins by briefly summarising the market reforms as a context, and then discusses a transitional period when a public service ethos was re-introduced, characterised by incoherence in its objectives. A return to a population and health outcomes focus followed, requiring collaboration and a population health and primary health focus. The associated strategies and their commitment to service delivery are threatened as ageing of the health professional workforce and shortages lead to difficulties in recruitment, a growing reliance on overseas graduates and industrial unrest. Conclusions: Discourse and policy impact on the day-to-day work of managers, who need to respond to new performance requirements and priorities and to privilege different relationships and ways of operating. The consequences of health policy change on the work and priorities of managers, particularly when there are fundamental shifts in underlying discourse and paradigms, is seldom a consideration in health sector change.