Category | Issue | Phase 1 | Phase 2 | Phase 3 | ||
---|---|---|---|---|---|---|
Pre mid-1980s | Mid-late 1980s | Mid-late 1990s | Early-mid 2000s | Late 2000s on | ||
Implications of reforms for the workforce and service delivery | Focus | Centralised planning | Neglect | Markets | Asserting control | Rethinking |
Workforce governance responsibility | Department of Health | No identifiable organisation | Regional entities Employer-led | Ministry and various advisory entities | HWNZ, a dedicated HWP agency | |
Impacts of reforms on policy and governance | Pre reform | Loss of structures and knowledge Use of advisory committees | Dispersal of governance to smaller operational entities | Fragmentation Duplication and ineffective responses | Consolidation Improved data management and integration Longer planning horizons | |
Implications for governance and planning | Planning practice | Medical manpower based | None observable | Employer-led planning, based on operational needs | Data gathering and situation analysis | Some planning re-centralisation Provide sector leadership Wider view of the planning function |
Planning concerns | Mal-distributions, Unsustainable delivery paradigms | Increasing visibility of workforce problems | No wider or longer view Shortages Rising dependence on overseas professionals and workers | Poor industrial relations Planning inefficiencies Data gaps | Incorporating the new vision Introducing team-based care Resistance to change Conservatism | |
Implications for methods | Principal methods | Stock and flow models Estimation of doctor numbers | No data available | Demand driven modelling Headcount based modelling | Aggregated demand models Improved data collection begins | Design thinking and workforce intelligence approach—integrated quantitative and qualitative data to meet future care scenarios and team-based workforces |