Overwriting New Public Management with New Public Governance in New Zealand's approach to health system improvement

Abstract

<jats:sec><jats:title content-type="abstract-subheading">Purpose</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Design/methodology/approach</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Findings</jats:title><jats:p>Policy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would <jats:italic>supplement</jats:italic> existing performance management (NPM) practices, to create a superior synthesis<jats:italic>.</jats:italic> When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should <jats:italic>supplant</jats:italic> performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Research limitations/implications</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title content-type="abstract-subheading">Originality/value</jats:title><jats:p>This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.</jats:p></jats:sec>