Vision and strategy in healthcare; valuable tools or redundant phrases. A case-study in Waikato District Health Board around leadership in older person health

Abstract

Background: It has been over a decade since the launch of the „Health of Older People Strategy‟ in May 2002. Aimed at ensuring older New Zealanders participate to their fullest ability in decisions about their health and wellbeing and in family, whanau and community life, the strategy also stated older people would be supported by co-ordinated and responsive health and disability support programmes. To date, there is little evidence to suggest the strategy has achieved its objective. In the last three years, health service for older people have focussed on primary care, with health professionals at all levels left without a clear sense or vision as to how this focus relates to the initial Health of Older People Strategy. This thesis, focussing on the 2002 Health of Older People Strategy, explores how strategies and visions are identified, developed and implemented across the leadership continuum and suggests opportunities to improve the implementation of the strategy. Objective: To explore how the vision for maximising the health of older people in New Zealand was developed, and how it is being implemented at both strategic and operational levels. Participants: Interviews were held with key individuals across the multiple levels of policy and leadership: Ministry of Health (n=2); District Health Board (DHB) governance (n=2); DHB executive management (n=4); as well as focus groups with DHB operational management (n=3); Service delivery (n=4); and consumers (n=3). Methods: This thesis adopts a qualitative research approach using information gained from semi-structured interviews with participants and analysis using a general inductive enquiry, whereby transcripts were transcribed and major themes elicited. Findings: All participants acknowledged the strategy and identified its over-arching focus of enabling older people to participate to their fullest ability in decisions about their health and wellbeing. Whilst all participants admitted they had not reviewed the strategy since its inception, they felt strongly that it remained relevant and applicable and that the vision and objectives were appropriate in the current environment of population growth and fiscal constraint. Conclusion: The implementation and delivery against the Health of Older Persons objectives showed evidence of „burn out‟ of staff to the multiple strategies and focus by various governments. In terms of vision setting, the general view was that whilst people acknowledged the vision for older persons health, it was not a critical factor impacting on their day-to-day activities. What was important to all levels was the recognition that the growth in population of older people needed to be reflected in the provision of future services and the voice of the service providers and users needs to be heard in this planning process.