Leading Health Workforce Change: Insights from Experience
New Zealand has unique legislation that allows for the government to plan for, and to provide for, the health and wellbeing of its population. The pressures to continue to do so are enormous. This thesis describes the work undertaken within Counties Manukau District Health Board (DHB), with an intention to align the Allied Health workforce to an organisational strategy of providing services based within localities. This first required me, in my role as the Director of Allied Health, to gain a deeper understanding of Allied Health and, in turn, to gain greater insight into the process of change. By seeking clarity on these two points and deploying an action spiral methodology, there was the ability to progressively seek to understand how change could effectively be enacted within the organisation. While this was initially within the Allied Health professions, the organisational context led to the action spiral cycles encompassing the broader workforces involved in providing services to localities. Over time all four localities, identified within Counties Manukau DHB, progressed through the action spiral cycles in seeking to more explicitly align the healthcare workforces to their locality. As the action spiral cycles wound up, a fundamental question remained unanswered as to whether actual change had been affected. This was evaluated using an inductive thematic qualitative analysis. Seven key themes were identified: (1) Engagement, how the employed change framework engaged the staff; (2) Process, the strengths and issues of the process deployed; (3) Change, how the change framework did and did not enable change to occur; (4) Ways of working, what arose as a part of the process to challenge to facilitate changes to patterns of working; (5) Porosity of professional boundaries, how the process enabled more in the way of cross boundary working between some, but not all professions; (6) Managing change within a team, the benefits and challenges that arose; (7) Broader context, how the change framework enabled contribution to broader organisational change and/or how it potentially still remained separate. The qualitative analysis detailed the effectiveness of the process and highlighted how ultimately it did not result in sustained change. Taking these key lessons learnt into account there has been the ability to develop a workforce change framework that considers the key theories and philosophies of change and integrates the specific lessons learnt. Potentially the greatest lesson that has come out of this process is the impact that it has had on myself as a leader of change. Understanding the non-linearity of change and the multiple tensions involved in a process of change has, I believe, placed me with a much greater understanding of change, and a responsibility to ensure I do something about it.