Robin Gauld

Do they want it? Do they use it? The ‘Demand-Side’ of e-Government in Australia and New Zealand

Abstract Drawing on 435 telephone interviews in Australia and 498 in New Zealand, this paper investigates the ‘demand’ side of e-government. That is, we examine the use of and support for e-government measures. Whilst respondents were generally supportive of e-government on a number of measures, we find that the majority were reluctant to use some of the more sophisticated ‘transactional’ e-government measures, and less than half had even visited a government website. High users of information and communications technologies (ICT) were more likely to use e-government measures, and are more positive towards e-government in general across several measures. Similar to a number of U.S. studies, we find a ‘digital divide,’ where older age, and less education were associated with lower ICT and e-government use and support. Income level was not a statistically significant predictor in all cases however, and gender was not significant for e-government support.

Public sector information system project failures: Lessons from a New Zealand hospital organization

Abstract Information system (IS) project failures are so common as to be almost expected by planners. There is an expanding literature on IS project failures including both theory and case studies. This literature, however, is largely derived from private sector IS failures, despite the fact that the likelihood of failure appears higher in the public sector. This article seeks to fill the public sector case study void. It details the failure and abandonment of a large New Zealand public hospital IS development. The case corroborates findings from the private sector literature, namely that ill-planned and managed, large and multifaceted projects are more likely to fail and that contextual issues are highly influential. It also shows how much more complex project commissioning and development is in situations of public governance where political and organizational elements come to the fore. Finally, the article offers lessons for public sector IS planners.

Use of the internet for health information: A study of Australians and New Zealanders

This article presents descriptive data from surveys that probed the use of health information by Internet users in Australia and New Zealand. Using this data, the article also contributes to understanding of factors associated with a series of Internet health information use outcomes. Four hundred six respondents (151 Australians; 255 New Zealanders) had used the Internet for health information and were asked about emailing doctors, Internet searching, taking Internet information to the doctor and perceptions of Internet information reliability. Regression analyses were conducted to examine associations between key outcomes and independent variables. A bootstrap procedure was performed to select variables used in logistic regression models. Fifty-two percent of health Internet users had emailed their doctor. Few significant differences between Australian and New Zealand responses were found. Internet use for health information was below levels found in North American and European studies, but there was similar prevalence of emailing and presenting Internet information to doctors. Emailers were more likely to believe this improved communication with doctors (OR = 3.59; 95%CI 1.95, 6.61). Frequent Internet searchers were more likely to take Internet information to their doctor (OR = 2.41; 1.47, 3.92), and believe the Internet to be a more useful information source (OR = 2.47; 1.22, 5.03). Females were less likely to email their doctor (OR = 0.47; 0.26, 0.85). More educated respondents were more likely to email their doctor (OR = 1.99; 1.16, 3.39) and to check website credentials (OR = 2.61; 1.53, 4.43). This study suggests that there is a digital divide among health care Internet users. It shows that, for males, email could have health care advantages. Doctors may need to develop strategies to deal with patients presenting with Internet information, including how to source information and check its credibility.

The clinical governance development index: results from a New Zealand study

Background Clinical governance is seen as pivotal to improving healthcare quality, yet there are few available tools for tracking progress on its implementation. With this in mind, the authors developed a Clinical Governance Development Index (CGDI) designed to track performances between healthcare organisations and over time. Methods A survey on implementation of government policy on clinical governance was sent to 3402 New Zealand public hospital specialists. Responses to seven survey items were weighted and combined to form the CGDI. Final scores for each of New Zealands 21 District Health Boards were converted to percentages. Results The mean CGDI score was 47.3%, with significant differences in performances across the 21 District Health Boards (F(20, 1178)=3.233, p=0.0000). Scores were higher in boards where respondents perceived governing boards and management worked to support clinical leadership. Conclusion The CGDI offers a simple method for measuring the extent to which a healthcare organisation is working to develop clinical governance. Its use in New Zealand provides a baseline for tracking clinical governance over time. The CGDI could be easily adapted for use in other healthcare systems.

Quality of generic medicines in South Africa: Perceptions versus Reality - A qualitative study

BackgroundGeneric Medicines are an important policy option allowing for access to affordable, essential medicines. Quality of generic medicines must be guaranteed through the activities of national medicines regulatory authorities. Existing negative perceptions surrounding the quality of generic medicines must be addressed to ensure that people use them with confidence. Campaigns to increase the uptake of generic medicines by consumers and providers of healthcare need to be informed by local norms and practices. This study sought to compare South African consumers’ and healthcare providers’ perceptions of quality of generics to the actual quality of selected products.MethodsThe study was conducted at the local level in three cities of South Africa: Johannesburg, Durban and Cape Town. Purposive sampling was used to recruit consumer participants (n = 73) and random sampling used to recruit healthcare providers from public and private sectors (n = 15). Data were obtained through twelve focus group discussions with consumers and semi-structured interviews (n = 15) with healthcare providers in order to gain familiarity with perceptions of quality. One hundred and thirty five products comprising paracetamol tablets (n = 47), amoxicillin capsules (n = 45) and hydrochlorothiazide tablets (n = 43) were sourced from public and private sector healthcare providers. These products were subjected to in vitro dissolution, uniformity of weight and identity (Fourier Transformed Infrared Spectroscopy) tests using prescribed methods from the British (2005) and United States Pharmacopeias (2006).ResultsRespondents described drug quality in relation to the effect on symptoms. Procurement and use behavior of healthcare providers was influenced by prior experience, manufacturers’ names and consumers’ ability to pay. All formulations passed the in vitro tests for quality.ConclusionsThis study showed clear differences between perceptions of quality and actual quality of medicines suggesting deficiencies in public engagement by government regarding the implementation of generic medicines policy. Implementation of generic medicines policy requires the involvement of consumers and healthcare providers to specifically address their information gaps and needs.

Is Public Trust in Government Associated With Trust in E-Government?

The term e-government describes the use of information and communications technology, particularly the Internet, for the delivery of public services. As governments invest in e-government, there is only limited knowledge of the extent of public trust in the new electronic modes of delivery; we also know little about whether there is any relationship between trust in government and trust in e-government. This article reports on research designed to probe this issue. Drawing on survey data from Australia and New Zealand, a series of hypotheses are tested pertaining to relationships between public trust in government and e-government, in the use of information and communications technology and trust in e-government, and support for e-government investment and development. Trust in government was found not to be correlated with trust in facets of e-government service provision but was associated with support for e-government investment. More intensive Internet users were more likely to trust e-government services.

New Zealand's post-2008 health system reforms: Toward re-centralization of organizational arrangements

The election of a centre-right government in 2008 has spawned a series of ongoing reforms to the structures for governing New Zealands health system. These mainly involve creation of a series of new national agencies designed to stimulate national coordination and centralization of some planning and service delivery functions along with performance improvements in specific areas, namely quality, information technology, service efficiency, reduction of administrative costs, and comparative-effectiveness research. This brief article provides an overview of the post-2008 reforms. It notes that, while there appears to be agreement within the health system that the reforms are moving in the right direction, the new institutional arrangements are perhaps overly complicated.

Scorecards for health system performance assessment: The New Zealand example

OBJECTIVE To develop a national scorecard for assessing health system performance derived from routine data. METHODS We drew upon national and international data to develop benchmarks for health system performance, then applied basic ratio scores to compare New Zealand performances to the benchmark. 64 indicators were included in four assessment categories: healthy lives, quality, access, and efficiency. In a fifth category, 27 of these indicators were used to score health system equity. Indicator scores in each category were then averaged to give a health system score out of 100. RESULTS New Zealands health system achieved an overall score of 71 out of 100. The system scored relatively well on quality and efficiency, but poorly on equity despite considerable government investment in reducing inequalities. CONCLUSIONS The scorecard offers a useful method for combining a range of data to give an overall picture of health system performance, highlighting strengths, weaknesses and areas for improvement. This initial study provides a baseline for assessing New Zealands performance over time and, where data permit, a template for other countries to follow.

The unintended consequences of New Zealand's primary health care reforms.

In 2001, the New Zealand government commenced a program to reform the organization of publicly funded primary care services. While there have been several positive results of this reform, including the reduction of patient co-payments and the extension of the range of primary care services, the governments program was a hastily implemented attempt to place primary care, the delivery of which is dominated by private doctors, under firm state control. It was also an attempt to override preexisting arrangements. As such, the government succeeded in its goal of establishing new primary health organizations (PHOs), but there were also significant unintended consequences. As detailed in this article, these consequences include (1) the creation of a labyrinthine funding and organizational system with a variable capacity to deliver on the governments reform objectives, (2) an increase in the power and scope of preexisting doctor organizations combined with a government unable to wrest control over the setting of patient co-payment levels, and (3) an emerging lack of clarity about future directions for the primary health care sector.

Are New Zealand's new primary health organisations fit for purpose?

Attempts to make New Zealands health care more equitable have resulted in rapid change. But the reforms are largely untested and their effects difficult to predict