Overwriting New Public Management with New Public Governance in New Zealand's approach to health system improvement
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 28 June 2021
Issue publication date: 13 October 2021
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.
Keywords
Acknowledgements
This research (specifically, research into the formulation and implementation of the System Level Measures Framework was funded by University of Auckland's Faculty of Medical Science (Faculty Research Development Fund).
The authors would like to thank Viola Burau (University of Aarhus) for her contribution to the conceptualisation of New Public Governance. We would also like to thank Laura Wilkinson-Meyers’ for her contribution to research design and data collection, and Kate Young and Reuben Ayeleke for their contributions to the analysis of interview data. Finally, we would like to thank all our participants for their time their insights into the development and implementation of the SLMF.
Citation
Tenbensel, T., Silwal, P. and Walton, L. (2021), "Overwriting New Public Management with New Public Governance in New Zealand's approach to health system improvement", Journal of Health Organization and Management, Vol. 35 No. 8, pp. 1046-1061. https://doi.org/10.1108/JHOM-10-2020-0417
Publisher
:Emerald Publishing Limited
Copyright © 2021, Emerald Publishing Limited