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Purpose: Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries' successful strategies, unresolved questions and recommendations to enhance self-direction globally. Design/methodology/approach: The findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand. Findings: In all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction. Practical implications: The results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction. Originality/value: This international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators. [ABSTRACT FROM AUTHOR]

Purpose – The introduction of competitive tendering and contracting and a lack of transparent funding processes has seen a move towards greater contestability of services in the nongovernment organization (NGO) sector. To ameliorate this situation requires a sound understanding of knowledge management (KM) practices. However, not all NGOs have been equally successful at embracing KM principles. The purpose of this paper, therefore, is to explore the KM challenges faced by New Zealand NGOs in the health and disability sector.Design/methodology/approach – Using qualitative research methods, specifically interpretive case study research, the authors studied the KM practices of nine NGOs in the health and disability sector in New Zealand. Qualitative data were obtained from documents and semi-structured interviews following a dramaturgical approach.Findings – The findings suggest many barriers to successful implementation of KM in NGOs; some of the most important ones being related to organizational structure and culture. Specifically, tensions between local and national organizational branches, difficulty integrating volunteers and complex funding arrangements are key challenges faced by NGOs in the health and disability sector.Originality/value – Existing literature suggests that volunteer turnover is a serious impediment to successful KM implementation. The authors' research suggests that volunteer integration, more so than turnover, is an issue. The research also reports on an underlying tension between commercialization and the inherent service culture of the sector. This paper makes recommendations for improved volunteer management and suggests that there is a clear opportunity for better KM systems and practices in the NGO sector. [ABSTRACT FROM AUTHOR]

Purpose - Public sector organisations have to respond to calls for accountability from both funders and recipients of the services, as well as report on operations within constrained financial resources. Given the absence of profit motives and the difficulties of performance assessment in public sector organisations, the purpose of this paper is to consider the role of benchmarking as a tool to help overcome some of the problems of performance assessment in the public sector. Design/methodology/approach - A review and discussion of current and recent trends and approaches in public sector benchmarking in New Zealand. The difficulties of establishing meaningful benchmarking exercises are discussed in relation to management accounting's approach to management control systems. Findings - In New Zealand, the pharmaceutical management agency (PHARMAC) is responsible for obtaining the best health outcomes that are reasonably achievable through the use of pharmaceuticals for eligible people, within the funding provided. The concepts discussed in the paper are applied to PHARMAC as an illustration. Proposes that a combination of internal benchmarking, process benchmarking and increased public documentation will enhance reporting systems in any public sector organisation. Practical implications - The methodology should facilitate organisations' responses to calls for accountability, from a diversity of interested parties. Originality/value - Highlights the role of benchmarking as a tool to help overcome some of the problems of performance assessment in the public sector. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the conditions and processes affecting the operation of an audit committee within the context of a New Zealand district health board (DHB). Design/methodology/approach – The methodology used in this paper was exploratory and qualitative, including the analysis of secondary data and semi-structured interviews. Findings – Using the New Zealand Auditor-General's best practice guidelines for a public sector audit committee as a benchmark, the paper finds that the DHB rates moderately well in terms of "effectiveness potential". However, factors are identified concerning the audit committee members' independence, competence, tenure, and remuneration, which impinge upon the overall effectiveness of the audit committee. Despite apparent shortcomings in these areas, the informal networks between audit committee members and management serve to maximise the "realisation" of what potential effectiveness exists. As a result, the audit committee is perceived by its stakeholders (management, auditors, and committee members) as being a valuable tool to assist the DHB board in achieving proper governance. Practical implications – There are no specific regulatory or legislative requirements for establishing audit committees in the New Zealand public sector. The findings from this paper may be useful to public sector entities that are considering establishing an audit committee and to entities, including the one in this paper, that wish to improve the effectiveness of their existing audit committees. Originality/value – Most studies of audit committees to date have focuses on corporate sector entities; this is the first qualitative paper of an audit committee of a public sector entity in New Zealand. [ABSTRACT FROM AUTHOR]

The adoption of DRG coding may be seen as a central feature of the mechanisms of the health reforms in New Zealand. This paper presents a story of the use of DRG coding by describing the experience of one major health provider. The conventional literature portrays casemix accounting and medical coding systems as rational techniques for the collection and provision of information for management and contracting decisions/negotiations. Presents a different perspective on the implications and effects of the adoption of DRG technology, in particular the part played by DRG coding technology as a part of a casemix system is explicated from an actor network theory perspective. Medical coding and the DRG methodology will be argued to represent "black boxes". Such technological "knowledge objects" provide strong points in the networks which are so important to the processes of change in contemporary organisations. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the indicators of quality in care for people working and living in aged residential care (ARC) settings.Design/methodology/approach This research was conducted using an ethnographic design in two distinct ARC facilities in a New Zealand city, a large facility with residential, dementia and hospital level care, and a small family owned facility providing residential care only. In total, 50 hours of observational data were collected, and semi-structured interviews were conducted with 21 people, including managers, careworkers, nurses, family members and residents. These data were thematically analysed using the constant comparative method.Findings The main indicators of quality for staff, family and residents included: a home-like, friendly and safe environment; good medical and personal care; respect for the residents; and good staff. Participants also acknowledged the need for adjustments by residents to living in aged care; and the challenges of caring for increasingly frail residents.Originality/value Findings support the growing recognition of a need for resident-centred approaches to ARC that are reflected in government policy and regulatory apparatus. Managers in ARC facilities must balance adherence with health and safety standards, and providing an environment where their residents can enjoy a meaningful life that has purpose and value. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to identify innovations and lessons learned from interviews with members of the multidisciplinary healthcare team who participated in the response to the 22 February earthquake, affecting the Canterbury region of New Zealand's South Island. Design/methodology/approach – Narratives from individual staff members who were associated with the Christchurch Hospital Emergency Department response were recorded and analysed. This data, together with other contextual documents have been used to identify the responses of healthcare workers to an unexpected natural disaster. Perspectives were sought from a range of individuals, including allied health professionals, social workers, Maori health workers, orderlies, medical and nursing staff. Findings – The individual as well as the organisational responses to the earthquake events are significant, and need to be considered in relation to future planning and responses. In particular, the importance of encouraging and supporting a culture which values innovation and responsiveness was identified. While specific, practical responses to the earthquake disaster are noted, it is also important to acknowledge the implication for individuals of an acute, unanticipated event. Research limitations/implications – The findings from this study have the potential to illuminate possible responses in other crisis situations, and to guide the development of targeted support measures in response to disaster events. Originality/value – Little documentation has occurred to date relating the experiences of health care responders who are not only reacting to a natural disaster, but are also part of it. This is a unique and valuable perspective that has relevance within a number of settings. [ABSTRACT FROM AUTHOR]

Provides an explanation and understanding of developments in casemix and related information systems at a large regional hospital in the center of the North Island of New Zealand. Use of accounting techniques to influence decision makers both within and outside the health institutions; Detailed description of events at the research site.

New Zealand is a country of many cultures and ethnicities. With a growing Asian community, cultural capability of the mental health workforce is essential to ensure that Asians have equity in access to appropriate and high quality services. Literature indicates a growing need to develop resources and enhance knowledge on cultural competence to assist health service providers to address the needs of people from diverse backgrounds. Yet, at what stage of training and/or practice are health professionals gaining access to this knowledge?Consultation with local health services and tertiary education institutions revealed a gap in the knowledge of Asian mental health being taught in the curriculum of students undertaking training to become health professionals. Further research indicated a need and desire from tertiary institutions to have access to Asian mental health material for both enhancing students' learning, and promoting the concept of continuing education following graduation. As a result, an interactive, self-administrative CD-rom comprising three modules: self-reflection; Asian philosophies; and clinical issues was compiled.Early feedback indicates that the CD-rom has tremendous potential in terms of applicability to enhancing current curriculum and for teaching students skills such as accessing articles and web based resources, valuable for the purposes of continuing education. Continuing education with regards to cultural competence is not just for qualified health professionals but needs to be integrated as part of students training as health practitioners, in order to ensure health care providers are able to provide effective and culturally responsive services. [ABSTRACT FROM AUTHOR]

The article studies the transformation of social systems in health organizations in New Zealand, and the way in which accounting systems are an integral part of the challenge to extant structures of signification, legitimation and domination. It examines the points at which accounting and medical practices have come face to face. It treats accountancy as part of wider social practices, and call on Giddens's structuration theory to help better understand the ways in which accountants and their practices are implicated in certain social reforms. By categorizing various modes or types of social change, and providing analytical means of clarifying social systems, Giddens's structuration theory is enabling of empirical study. Accounting systems contribute to the binding of time and space in some circumstances, yet can play a part in major discontinuities and disruptions to institutionalized procedures and practices in other circumstances. Increasingly there is an acceptance that accounting cannot be understood as an autonomous sphere of activity, but needs to be seen as part of a complex series of political, economic, and organizational contexts in which it operates.

The article examines the move towards a commercialized, economically driven, health sector in New Zealand. Reforms involve extensive organizational rearrangements and the creation of profit-driven businesses in place of public hospitals. These institutional rearrangements involve the fabrication of new ways of accounting. Attempts to understand the processes involved in the development of information technologies before they become accepted "facts" of organizational life. The fabrication of new technologies cannot be understood as an autonomous sphere of activity, but has to be understood as part of a complex series of political, economic and organizational contexts. Accountants are viewed not as mere technicians reporting on what is, but as active agents contributing to change. Accounting often acts as an arbiter in social conflict. Nowhere is this more evident than in the way it is being called upon to assist in the implementation of clause 25 of the Health and Disability Services Bill, which requires hospitals in New Zealand to act as competitive profit motivated commercial enterprises while at the same time meeting unspecified social obligations. The creation of a pseudo-market for health services presents a challenge not only for accountants, but also for all New Zealand citizens. The outcomes of the radical reforms are uncertain and some fear that the massive restructuring is in the form of an experiment. It is based on an ideology lacking empirical support.

The effectiveness of the reforms of the health sector in New Zealand will depend on the development of new accounting and information systems. The reforms have been rapid and significant. Increasing attention is being given to the development of costing and budgeting as a part of the reform process. Focuses on the organizational strategies in implementing such reforms. Although the progress has been significant, problems of implementation and change of organizational culture remain. [ABSTRACT FROM AUTHOR]