Peter Carswell

Religion and entrepreneurship in New Zealand

Purpose - The purpose of this paper is to examine the relationship between religion and entrepreneurship and whether religious practice impacts on how individuals view the individual and societal contribution of business enterprise. As ethnic diversity is increasing within the Western world, so too is the religious mix of value systems and religious belief systems that come with such diversity/religions. Paralleling increasing diversity is the decreasing participation rates in the traditional Christian churches. The paper questions the impact of this changing religious mix on entrepreneurial participation and perception. Design/methodology/approach - A total of 2,000 randomly-selected New Zealanders were telephone-surveyed to measure their perceptions of individual and societal impacts of entrepreneurial participation and religious practice. Findings - The findings indicate that increasing ethnic diversity and associated religious value systems are certainly not going to negatively reduce the business start-up rate. If anything, the start-up rate may be enhanced. Originality/value - The paper shows that the value that New Zealand society places upon entrepreneurship is not diminished by the increasing religious diversity in the country.

Health equity in the New Zealand health care system: a national survey

IntroductionIn all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable.MethodsA national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes.ResultsSurvey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations that conventional practitioners find hard to reach, despite recognized needs, are often underserved. Nurses and community health workers carried a disproportionate burden of care. Cultural and diversity training is not a condition of employment.ConclusionsThere is a struggle to put equity principles into practice, indicating will without enactment. Equity is not addressed systematically below strategic levels and equity does not shape funding decisions, program development, implementation and monitoring. Equity is not incentivized although examples of exceptional practice, driven by individuals, are evident across New Zealand.

Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project

Objective: Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in New Zealand were selected and validated.

Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol

BackgroundIn May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a performance measure has the potential to see improvements in the wider health system. However, the imposition of targets may have significant adverse consequences. There is little empirical work examining how the performance of the wider hospital system is affected by such a target. This project aims to answer the following questions: How has the introduction of the target affected broader hospital performance over time, and what accounts for these changes? Which initiatives and strategies have been successful in moving hospitals towards the target without compromising the quality of other care processes and patient outcomes? Is there a difference in outcomes between different ethnic and age groups? Which initiatives and strategies have the greatest potential to be transferred across organisational contexts?Methods/designThe study design is mixed methods; combining qualitative research into the behaviour and practices of specific case study hospitals with quantitative data on clinical outcomes and process measures of performance over the period 2006-2012. All research activity is guided by a Kaupapa Māori Research methodological approach. A dynamic systems model of acute patient flows was created to frame the study. Consequences of the target (positive and negative) will be explored by integrating analyses and insights gained from the quantitative and qualitative streams of the study.DiscussionAt the time of submission of this protocol, the project has been underway for 12 months. This time was necessary to finalise both the case study sites and the secondary outcomes through key stakeholder consultation. We believe that this is an appropriate juncture to publish the protocol, now that the sites and final outcomes to be measured have been determined.

Organisational culture: an important concept for pharmacy practice research

Throughout the developed world, community pharmacy is under considerable pressure to play a greater part in delivering effective primary health care. The requirement to adopt new roles continues to challenge community pharmacy and drive change. The factors that determine the ability of community pharmacy to effectively deliver services for health gain are complex and include; policy, professional, financial and structural elements. There is also evidence to suggest that organisational culture may influence the effectiveness of an organisation. In order to address this there is a need to understand the dimensions of organisational culture that lead to successful implementation of the change necessary for community pharmacy to become a more effective primary health care organisation. In this commentary, we introduce the concept of organisational culture, outline two frameworks for studying culture, and argue the benefits of pursuing an organisational culture research agenda for the evolution of pharmacy practice and research.

Patterns of collaboration in complex networks: the example of a translational research network

BackgroundThis paper examines collaboration in a complex translational cancer research network (TRN) made up of a range of hospital-based clinicians and university-based researchers. We examine the phenomenon of close-knit and often introspective clusters of people (silos) and test the extent that factors associated with this clustering (geography, profession and past experience) influence patterns of current and future collaboration on TRN projects. Understanding more of these patterns, especially the gaps or barriers between members, will help network leaders to manage subgroups and promote connectivity crucial to efficient network function.MethodsAn on-line, whole network survey was used to collect attribute and relationship data from all members of the new TRN based in New South Wales, Australia in early 2012. The 68 members were drawn from six separate hospital and university campuses. Social network analysis with UCInet tested the effects of geographic proximity, profession, past research experience, strength of ties and previous collaborations on past, present and future intended partnering.ResultsGeographic proximity and past working relationships both had significant effects on the choice of current collaboration partners. Future intended collaborations included a significant number of weak ties and ties based on other members’ reputations implying that the TRN has provided new opportunities for partnership. Professional grouping, a significant barrier discussed in the translational research literature, influenced past collaborations but not current or future collaborations, possibly through the mediation of network brokers.ConclusionsSince geographic proximity is important in the choice of collaborators a dispersed network such as this could consider enhancing cross site interactions by improving virtual communication technology and use, increasing social interactions apart from project related work, and maximising opportunities to meet members from other sites. Key network players have an important brokerage role facilitating linkages between groups.

Leadership in complex networks: the importance of network position and strategic action in a translational cancer research network

BackgroundLeadership behaviour in complex networks is under-researched, and little has been written concerning leadership of translational research networks (TRNs) that take discoveries made ‘at the bench’ and translate them into practices used ‘at the bedside.’ Understanding leaders’ opportunities and behaviours within TRNs working to solve this key problem in implementing evidence into clinical practice is therefore important. This study explored the network position of governing body members and perceptions of their role in a new TRN in Sydney, Australia. The paper asks three questions: Firstly, do the formal, mandated leaders of this TRN hold key positions of centrality or brokerage in the informal social network of collaborative ties? Secondly, if so, do they recognise the leadership opportunities that their network positions afford them? Thirdly, what activities associated with these key roles do they believe will maximise the TRN’s success?MethodsSemi-structured interviews of all 14 governing body members conducted in early 2012 explored perceptions of their roles and sought comments on a list of activities drawn from review of successful transdisciplinary collaboratives combined with central and brokerage roles. An on-line, whole network survey of all 68 TRN members sought to understand and map existing collaborative connections. Leaders’ positions in the network were assessed using UCInet, and graphs were generated in NetDraw.ResultsSocial network analysis identified that governing body members had high centrality and high brokerage potential in the informal network of work-related ties. Interviews showed perceived challenges including ‘silos’ and the mismatch between academic and clinical goals of research. Governing body members recognised their central positions, which would facilitate the leadership roles of leading, making decisions, and providing expert advice necessary for the co-ordination of effort and relevant input across domains. Brokerage potential was recognised in their clearly understood role of representing a specialty, campus or research group on the governing body to provide strategic linkages. Facilitation, mentoring and resolving conflicts within more localised project teams were spoken of as something ‘we do all the time anyway,’ as well as something they would do if called upon. These leadership roles are all linked with successful collaborative endeavours in other fields.ConclusionsThis paper links the empirical findings of the social network analysis with the qualitative findings of the interviews to show that the leaders’ perceptions of their roles accord with both the potential inherent in their network positions as well as actual activities known to increase the success of transdisciplinary teams. Understanding this is key to successful TRNs.

Who are the key players in a new translational research network

BackgroundProfessional networks are used increasingly in health care to bring together members from different sites and professions to work collaboratively. Key players within these networks are known to affect network function through their central or brokerage position and are therefore of interest to those who seek to optimise network efficiency. However, their identity may not be apparent. This study using social network analysis to ask: (1) Who are the key players of a new translational research network (TRN)? (2) Do they have characteristics in common? (3) Are they recognisable as powerful, influential or well connected individuals?MethodsTRN members were asked to complete an on-line, whole network survey which collected demographic information expected to be associated with key player roles, and social network questions about collaboration in current TRN projects. Three questions asked who they perceived as powerful, influential and well connected. Indegree and betweenness centrality values were used to determine key player status in the actual and perceived networks and tested for association with demographic and descriptive variables using chi square analyses.ResultsResponse rate for the online survey was 76.4% (52/68). The TRN director and manager were identified as key players along with six other members. Only two of nine variables were associated with actual key player status; none with perceived. The main finding was the mismatch between actual and perceived brokers. Members correctly identified two of the three central actors (the two mandated key roles director and manager) but there were only three correctly identified actual brokers among the 19 perceived brokers. Possible reasons for the mismatch include overlapping structures and weak knowledge of members.ConclusionsThe importance of correctly identifying these key players is discussed in terms of network interventions to improve efficiency.

Understanding Evaluation Influence within Public Sector Partnerships: A Conceptual Model.

The importance of evaluation use has led to a large amount of theoretical and empirical study. Evaluation use, however, is still not well understood. There is a need to capture the complexity of this phenomenon across a diverse range of contexts. In response to such complexities, the notion of “evaluation influence” emerged. This article presents a theory of evaluation influence within public sector partnerships. An analysis of key concepts is used to develop propositions about the relationships between evaluation attributes, partnership functioning and characteristics, partnership evaluation behavior, individual characteristics, contextual factors, and evaluation influence. The model highlights the complexities of evaluation influence and identifies a range of factors that evaluators can consider in practice. The model also extends on existing theories of evaluation influence in considering the role of individual characteristics, stakeholder evaluation behavior, and partnership contexts.

Describing the organisational culture of a selection of community pharmacies using a tool borrowed from social science

Objective of the study To describe the dimensions of organisational culture within a selection of community pharmacies. Setting Community pharmacy in the New Zealand primary care sector which is partially government funded and currently undergoing major reform. Community pharmacy is under pressure to take on new roles, integrate within the wider primary care team and deliver the expectations of contemporary health policy. Method The mixed methods approach of concept mapping was undertaken with 10 representatives from six community pharmacies selected as case sites. The process was split into three parts (a) face to face brainstorming to generate statements describing culture, followed by (b) statement reduction, piloting and approval of statement list by participants, followed by (c) sorting the statements into ‘like’ groups. Multidimensional scaling analysis of participant sorting allows the development of discrete clusters of statements that describe aspects of organizational culture. Results A set of 105 statements were generated at the brainstorming meeting. Eight clusters of organisational culture resulted from participant sorting: leadership and staff management; valuing each other and the team; free thinking, fun and open to challenge; trusted behaviour; customer relations; focus on external integration; providing systematic advice; embracing innovation. Conclusion Community pharmacy is under pressure to take on new roles and deliver and there is some evidence organisational culture of pharmacy may be a barrier. Our paper outlines the development of a survey instrument for describing organisational culture through Concept mapping, a tool borrowed from social sciences. This tool can be used for exploration of aspects of culture that may be important in the change management process for improving the effectiveness of community pharmacy as expected by contemporary primary health care policy.