Academic journal article Australian Health Review

An Evaluation of New Zealand's Iterative Workforce Service Reviews: A New Way of Thinking about Health Workforce Planning

Academic journal article Australian Health Review

An Evaluation of New Zealand's Iterative Workforce Service Reviews: A New Way of Thinking about Health Workforce Planning

Article excerpt


Countries are confronted by a mismatch of health service demand, workforce supply, and affordability.1-5 More appropriate workforce planning is required to meet the challenges facing the health workforce, from both the demand side (e.g. ageing population, increasing chronic disease, increasing comorbidities) and workforce side (e.g. difficulties recruiting and retaining staff, staffturnover, ageing workforce).1-11

Health Workforce New Zealand (HWNZ) was established to provide national leadership on the development of its country's health and disability workforce. To ensure New Zealand's healthcare workforce was fit for purpose, HWNZ initiated an iterative Workforce Service Review (WSR) process12 within 14 topic specific areas: aged care, anaesthetics, diabetes, youth health, eye health, gastroenterology, mother and baby, mental health, musculoskeletal, palliative care and rehabilitation. The WSR process was designed to develop a vision of the relevant health service and workforce for 2020, and possible models of care that were patient-centred and teambased.


The evaluation aimed to identify what makes theWSRsprocesses work for whom, and in what circumstances. Four WSRs (eye health, palliative care, anaesthesia and aged care) were selected based on their diversity (not representativeness), and as they provided rich insights into WSR implementation processes conceptually and operationally. Two evaluation questions were posed:

(1) What theory (assumptions) underpins how the WSRs are supposed to work?

(2) What contextual factors (enablers and barriers) influence the way theWSRshave been implemented and hence work or not work?

A realist evaluation approach was used as we sought to discover what WSR mechanisms worked for whom, and within which contexts.13 The ultimate goal of a realist evaluation is to examine the interplay between mechanisms and contexts to understand why an intervention works or not, what effects it has, and how what works can be transferred to other contexts. The evaluation had two phases. Phase 1 involved the development of a program logic model14 (a visual representation of the assumptions or theories underpinning how the WSRs were supposed to work, i.e. the context, inputs, activities, and outputs required to achieve intended outcomes) utilising literature and WSR documentation. Phase 2 involved semi-structured interviews with key informants fromHWNZand members of the four WSRs.HWNZ and WSR members were emailed information about the evaluation, a consent form, and an invitation to participate in a semistructured interview. The interview guidelines were based on three conceptual models: realist evaluation;13 program logic;14 and relational coordination15. Interviewees participated in either face-to-face or telephone interviews at convenient dates and times. Interviews ranged from 25 to 69 min, and were audiorecorded and transcribed.

Analysis followed an interpretive approach using an inductive process to code the data into broad categories and then into key emergent themes. Ethics approval was obtained from the University of Melbourne Human Research Ethics Committee. ID: 1135304.1

Participant profiles

A total of 16 key informants participated in the evaluation. These were threeHWNZstaff, threeHWNZboard members, threeWSR lead clinicians, two WSR project managers and four members of WSRs.


This section provides insights from the context-based evaluation into the assumptions underpinning the WSRs, the implementation of the WSRs, and the designated support system for the WSRs.

Theory underpinning how the WSRs work

The WSR processes were based on the theory that a clinician-led think-tank inductive process was essential to develop a creative innovative vision for 2020, new service configuration and new workforce models. Interviews confirmed that the WSR process was a successful way to facilitate new ways of thinking and working:

'The purpose is to challenge people to actually think on their feet a bit. …

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