Managing Service Delivery in Health Sectors

The report provides a holistic purview of the health care system in New Zealand, emphasizing on the organization Stoddard Road Medical Centre (SRMC) and its patient care providence. It covers the national and regional health hierarchy, revenue and cost, workforce, and future issues.

Running head: MANAGING SERVICE DELIVERY IN HEALTH SECTORS
Topic- Managing service delivery in health sectors
Student name
University name
Author notes

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SUMMARY
The report is based on three major sections in regard to health care providence in New Zealand.
The sections include structure, revenue and workforce. Each section is sub divided into different
parts to add to the effectiveness of the paper. The organization Stoddard Road Medical Centre
(SRMC) is chosen for the paper and its patient care providence is explained with various
theoretical and graphical supports. National and regional health hierarchy is considered for the
paper and governmental intervention in fund collection and fund allocation is also focused upon.
ACC and other insurance agencies were included to have a clear understanding of the cost drives
in the country in areas of healthcare. Professions like GPs, nurses and assistant health providers
were considered to emphasis on work conditions and work roles. Future issues that are likely to
crop up are also discussed to have a holistic view of the service delivery management in health
sectors in New Zealand.

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TABLE OF CONTENTS
INTRODUCTION.......................................................................................................................................4
PURPOSE AND CONTEXT...................................................................................................................4
BACKGROUND OF CHOSEN ORGANIZATION...............................................................................4
FINDINGS AND ANALYSIS....................................................................................................................5
SECTION 1 STRUCTURE.....................................................................................................................5
DETERMINING THE POSITION OF SRMC IN NEW ZEALAND NATIONAL HIERARCHY
AND REGIONAL HEALTH SYSTEM..............................................................................................5
FOUR THEORIES RELATED TO THE ORGANZIATION AND FOUR EXAMPLES OF EACH
THEORY.............................................................................................................................................7
EVALUATION OF HOW SRMC FITS WITH WHOLE NEW ZEALAND SYSTEM...................10
INTEGRATED CARE PROVIDANCE............................................................................................11
SECTION 2 REVENUE AND COST...................................................................................................11
REASONS FOR NEW ZEALAND GOVERNMENT COLLECTING REVENUE.........................11
FUNDING TRIANGLE: THIRD PARTY STAKEHOLDERS, PATIENTS AND CARE
PROVIDERS.....................................................................................................................................12
IDENTIFICATION AND ANALYSIS OF FUNDING STREAM....................................................13
THREE MAJOR COST DRIVERS...................................................................................................13
SECTION 3 WORKFORCE.................................................................................................................14
THREE PROFESSION IN SRMC....................................................................................................14
JOB DESIGN APPROACHES IN SRMC.........................................................................................15
JOB DESIGN AND SRMC...............................................................................................................15
FUTURE ISSUES.............................................................................................................................16
CONCLUSION.........................................................................................................................................17
REFERENCES..........................................................................................................................................18

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INTRODUCTION
PURPOSE AND CONTEXT
Health care service industry is one of the most developing industries in recent times. New
Zealand has one of the most comprehensive health care system in the world which is basically
developed on the inbuild need of the Kiwis to examine that every resident there gets a ‘fair go’
health providence in their life (Abdelhak, Grostick & Hanken, 2014). The core purpose of the report
is to provide a holistic purview of the health care system in New Zealand. Heavy government
subsidies provide great benefit of public health care services and service is either free of cost or
of very low cost (Batalden et al., 2016). Government involvement is also emphasized in this report
and how it provides funding for service care in health organizations is also explained.
There are main three sectional heads which provide a synopsis of prevalent health care system,
governmental support, theories of health care, integrative care and revenue considerations. The
final section includes explanation of various health professions, job descriptions and some issue
that might be faced by the health practitioners in future. For the report work the primary
healthcare service organization Stoddard Road Medical Centre is chosen. A brief introduction of
the organization is provided in the next section.
BACKGROUND OF CHOSEN ORGANIZATION
The organization Stoddard Road Medical Centre (SRMC) emphasis on the words ‘you and your
health’. Here best expertise on knowledge, skill and experience is used to impart the best service
to the patients and to their families (Stoddard Road Medical Centre - General Practice in Mt Roskill,
Auckland, 2019). It is the ultimate destination of quality health care and is pioneer in general
health practices (GP services). And 365-day online health service accessibility is provided to
patients to have a complete updated information about their health. The hospital is situated in
Auckland one of the most popular town of New Zealand. Expert nurse services are also
available for health screening and vaccination services (Nurse Services - Stoddard Road Medical
Centre, 2019). Other than health service check-up facility it also has its own pharmacy and
laboratory for testing sample results. The organization has been awarded with the prestigious
ProCare’s award of ‘Practice of the year’ in recent times.

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FINDINGS AND ANALYSIS
SECTION 1 STRUCTURE
DETERMINING THE POSITION OF SRMC IN NEW ZEALAND NATIONAL
HIERARCHY AND REGIONAL HEALTH SYSTEM
NATIONAL HEALTH HIERARCHY
In order to understand the position of SRMC in healthcare system it is important to understand
the National Hierarchy in the country. Along with that the regional health system need to be
understood as well. The National Hierarchical framework is shown in the diagram below.
(Mills, 2014).
In the National Hierarchy of health services first and foremost the annual work agreement is
assigned by the Central Government to the Ministry of Health (MOH). The Health ministers then
work as per the MOH guidelines (Baum, 2016). The policies are all set up to devise the quality
health care services to the entire community and for that reason there are 20 District Health
Boards under Minister of Health. Private health providers, NGOs and DBH providers work
Central Government
Health Minister
Ministry of health
District Health Board (DHB-
20)
Auckland DHB
Private/NGO providers/Public/ DHB
providers arms
SRMC (primary) and Auckland City Hospital
Service agreements

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together to support the responsibilities of DHBs. The primary health care level includes private
hospitals, laboratories, pharmacies, public hospitals for direct care providence, and other public
health service providers as well (Betancourt et al., 2016). The organization Stoddard Road Medical
Centre (SRMC) has direct contract with the Auckland District Health Board in providing quality
health care to the patients. The position of SRMC is provided in the national hierarchy and it is
one of the primary health care providers in the country.
REGIONAL SYSTEM OF HEALTH CARE
In order to support the functions of the National Hierarchy the Regional health system is
developed in the country. The regional health care system deals basically with the primary,
secondary and tertiary service levels. The chosen organization SRMC is one of the best primary
level service care providers in the country. Here quality care is provided to patients in areas of
GP, online service care and nurse caring (Free et al., 2013). Registered nurses are only considered
for providing support to patients in areas of vaccination and general health screenings. Report
preparation and checking the same is another job of the nurses. Free checkup for children below
14 years is facilitated. Moreover the 365 days and 24*7 days online service help patients have
the updated health information about their concerns (Drummond et al., 2015). The organization
support secondary and tertiary health cares by system of referral and are referred to the Auckland
City Hospital in emergency situations. Added to all these, SRMC has its own pharmacy and
laboratory for on time delivery of medicines and diagnostic reports to the patients (Healthcare
Services in New Zealand | New Zealand Now, 2019). The regional system of healthcare including
SRMC is provided in the diagram below.

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(Ginter, Duncan & Swayne, 2018)
FOUR THEORIES RELATED TO THE ORGANZIATION AND FOUR
EXAMPLES OF EACH THEORY
The four theories incorporated in this report are Bureaucratic theory, institutional theory, system
theory and resource dependency theory. Each is elaborated below with supporting examples.
Bureaucratic theory
Max Weber the father of Bureaucracy, propounded this theory in the year 1905. In bureaucratic
organizational structure rules, standard procedures, responsibility, division of labor, professional
hierarchy and impersonal employee interaction are the main characteristic features. It supports
large organizational having higher number of employees (Ginter, Duncan & Swayne, 2018).
Organizational power can be of three types traditional, charismatic and legal. Principle of
established jurisdiction is the underlying law and in such organizational staff selection and
promotion is supported only on the basis of qualification. Here standard of quality care is
maintained by controlled supervision and well-developed line of command (Hirshon et al., 2013).
The top management provides a descending scale of functional operation and every employee
need to abide by the set-up principles and procedures. Large organizations are benefitted by
Tertiary health care provider
(Auckland City Hospital)
Secondary health care
provider (Auckland City
Hospital)
Primary health care service
provider
(SRMC)

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consistent employee behavior, reduced chance of conflicts and optimum human resource
optimization by providing specialist job roles. The major characteristics of bureaucracy include,
Simple division of labor
Well defined tasks
Clearly defined chain of command
Clear and formal staff selection on basis of qualification and expertise
Well defined set of rules and regulations
Uniform application of rules irrespective of staff diversity
Career orientation support to expert professionals like managers.
Supporting example
In SRMC every staff need to follow some pre-defined set of rules and regulations. Only expertise
staffs are hired (registered nurses) so that quality are is provided to the patients (Nurse Services -
Stoddard Road Medical Centre, 2019). Chain of command is well balanced where support workers
follow the command of the nurses, the nurses in turn follow the command of the line managers
and they in turn follow the top management guidelines.
Institutional theory
The main idea of this theory is that every organization follow the stakeholders’ guidelines and
their operation is based on the hierarchical framework set up by the stakeholders. The
organization that best fits the environment gains in productivity as well. Success factor is
influenced largely by social environments (Kim, Farmer & Porter, 2013). In New Zealand almost
all health service providers fulfil their stakeholders’ interests and also governmental rules and
regulations to encourage easy funding and uphold the good market reputation.
Supporting example
In SRMC the governmental health guidelines are followed and health care is provided as per the
requirements of the patients. It is very flexible to change needs and try to uphold its dignity and
reputation in all situations. Hygiene is one of the major concerns here and patient safety is
emphasized upon the most (Kringos et al., 2013). Qualified and experienced registered nurses and
expert staffs work here to provide quality care and look after the patient safety needs at large.

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System theory
This theory helps in illustrating the relationship in between the organization and the departments.
All concerned departments are interdependent and work with each other to add to the ultimate
success of the organization. Quality care in health organizations are provided by the interaction
of three basic component support of input, process and output.
(Kringos et al., 2013)
Systems are basically of two types,
Open system- here changes in government rules and regulations, environment and technological
changes directly affect the organization.
Closed system- here the outer changes cannot affect the organization and its functions remain
unaltered.
Supporting example
SRMC is basically an open system organization where main departments like GP service, Nurse
service and Online service are interdependent and work together to assure quality care
providence to patients (Levesque, Harris & Russell, 2013). The organization is also flexible to
policy changes in governmental health regulations and is updated to the latest health regulatory
framework (Krumholz, 2014).
Resource dependency theory
InputProcessOutput

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This theory basically defines the importance of resources to an organization. No healthcare
provider can survive on its own and requires resources to support its existence. Resources can be
either financial funds or can be human resources and care providers (Mills, 2014). Organizations
can also have strategic alliance with other similar organizations to control uncertainty and future
contingencies. Reasons can be either resource instability and operational complexity.
Supporting example
SRMC is a primary health care provider and it has alliance with Auckland City Hospital to refer
emergency cases when required. It is also dependent on governmental aids to support lower fee
and free check-up programs for the patients.
EVALUATION OF HOW SRMC FITS WITH WHOLE NEW ZEALAND
SYSTEM
Bureaucracy Pyramid position System type (open/closed)
In SRMC all professionals
and support staffs follow the
principles of bureaucracy and
the laws and regulations of
the organization. Here line of
command is clear and
consistent. Top management
commands to the line
mangers, they command to
the professionals, then nurses
are commanded and then
support staffs are to follow
the former’s command (Nurse
Services - Stoddard Road
Medical Centre, 2019). Nurses
are only assigned to perform
their own job role of
SRMC is a primary health
care provider in Auckland,
NZ. It has GP support,
Registered nurse support and
online service support. Basic
care is provided to all age
groups and it is free for
children under 14 years of
age. In case of emergency
patients are referred to
Auckland City Hospital to the
earliest.
SRMC is an organization
having open system of
functions. That is, SRMC
gets affected by changes in
governmental rules and
regulations and other
environmental and
technological advancements
(Raghupathi & Raghupathi,
2014). In the year 2007 the
pay rate of the health care
staffs increased and this
caused financial issue in
SRMC and the top
management was to decide
upon the new salary structure
and find alternative fund

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vaccination and health
screening. They have no
connection to management
duties and responsibilities.
collection methods to meet
the financial contingencies.
INTEGRATED CARE PROVIDANCE
To provide better and quality health care New Zealand government decided upon the idea of
integrated care to all communities. Here primary, secondary and tertiary care providers are
directly interlinked and have the same mission and vision statement for providing quality are and
support overall patient wellness (Stoddard Road Medical Centre - General Practice in Mt Roskill,
Auckland, 2019). Integration can be organizational, normative, systematic, functional, financial
and clinical. In SRMC normative and clinical integration is predominant. Here health providers
share same philosophy of providing quality care to patients and meet the safety needs and dignity
of patients.
Both horizontal and vertical integration care is provided in SRMC.
Horizontal integration- Horizontal clinical integration is provided at SRMC where all GPs,
nurses and support staffs work together for the same cause of patient care.
Vertical integration- SRMC is a primary care provider and it refers patients to Auckland City
Hospital for secondary and tertiary treatment services.
SECTION 2 REVENUE AND COST
REASONS FOR NEW ZEALAND GOVERNMENT COLLECTING REVENUE
Government plays an important role in tax collection and revenue generation in NZ. Major
portion of health care sector is dependent on tax collection and statistics show that almost 25% of
total revenue collected is spend on health care sectors (Stoddard Road Medical Centre - General
Practice in Mt Roskill, Auckland, 2019). The DHBs distribute the money to the respective health
organizations as per requirement.
There are a number of reasons for government involvement in revenue collection in the country,

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To provide quality care treatment by involving third parties which in turn reduces
financial burden on the common people
Ensuring equality and equity in fund allocation and community service care
Making optimum resource accessibility to rural and under privileged areas in areas of
health care
FUNDING TRIANGLE: THIRD PARTY STAKEHOLDERS, PATIENTS AND
CARE PROVIDERS
Communal health care service is provided by the concept of funding triangle comprising of
people, care providers and third-party involvement. Two organizations play major role in
revenue collection namely ACC and Ministry of Health. Appropriation budget planning is
supported by PBFF method for equal distribution of funds. DHBs collect the funds and then
money goes to primary, secondary and tertiary levels (Stoddart & Evans, 2017). NGOs and private
fund providers also take part in service contribution. A number of insurance companies fund
patient treatment coverage and support health care funding.
(Valentijn et al., 2013)
IDENTIFICATION AND ANALYSIS OF FUNDING STREAM
The money distribution flowchart is shown below.
PEOPLE/PATIENT
THIRD PARTY FUNDERS
CARE PROVIDERS

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Central Government
Appropriation
Minister of health (Vote health)
Ministry of health
PBFF
Auckland district health board
Service agreement
Stoddard Road Medical Centre (SRMC)
Health care services
New Zealand population
Tax payment
Central government
(Mills, 2014)
THREE MAJOR COST DRIVERS
The age and life style of people impact the revenue and cost generation in NZ. Most of
the people are educated and have higher health consciousness. Aged people are more
prone to health issues complications and need increased primary care. SRMC provide
primary are and its online service help aged community to have an updated health
information about their lives.
Advancements in technology increase self-care and patients demand the best specialized
treatment alternative available which is also costly in comparison to general treatment.
 ACC
 Private health insurance
companies
 Disability support bodies
 Charitable trusts

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The increased pay rate for health care staffs in the year 2007, forced health organizations
to restructure the employees’ salary structures and this is another major drive for cost
changes (Kim, Farmer & Porter, 2013).
Apart from these, general maintenance cost of water supply and electricity and laboratory costs
for chemicals and apparatus equipment and also supplier demands change every year and this
affects the overall organizational costing.
SECTION 3 WORKFORCE
THREE PROFESSION IN SRMC
The three main professions provided by SRMC includes GPs, Registered nurses and health care
assistants.
General practitioners (GPs)
All Doctors of SRMC have special General Practice training. Specialty training and preventive
care training is provided to them to take care of patients and solve complex health issues.
Patients are encouraged to consult the same doctor for the issue so that consistency in treatment
is maintained. The GPs provide services like urgent care, wound and injury care, suturing, driver
medicals, insurance medicals, travel medicine, family planning, skin consultation, minor
surgeries, Aclasta infusions, primary option for acute care (POAC), repeat prescriptions and
home visits as well (GP Services - Stoddard Road Medical Centre, 2019).
Registered nurses
Most of the nurses here are registered under the nursing policies. The major service provided by
them include vaccination (both funded and non-funded), health screening, travel vaccine,
diagnostic test results and other nurse services like ECG recording, ear syringing, blood pressure
and cholesterol check, diet planning, diabetes advice, sexual health advice and other
cardiovascular risk assessments (Nurse Services - Stoddard Road Medical Centre, 2019).
Health care assistants or support workers
They support the nurses and doctors in their jobs like bookkeeping, data recording, equipment
supplies etc. Moreover, the online service portal for patients called Health 365 also provide

15HEALTH SECTOR SERVICES
support to the main patient care providence by increased service accessibility (Stoddard Road
Medical Centre - General Practice in Mt Roskill, Auckland, 2019).
JOB DESIGN APPROACHES IN SRMC
The GPs are available all days except for Sunday which is a holiday. All GPs are available
during the working hours from 8am to 6 pm (GP Services - Stoddard Road Medical Centre, 2019).
Emergency facility is also supported as per patient need.
Registered nurses work in rotational shifts where the shift coordinator roaster their shifts. But
their expertise area remains unchanged.
The support workers and health care assistants are few in number and so work in flexible job
hours to reduce monotony of work and provide support during peak hours.
JOB DESIGN AND SRMC
Job enrichment
Here extra responsibility is added with the job role. The GPs along with their general practice
sessions include motivating patients and supporting them in leading healthy life. They can
prescribe diet chart if required which is not included in medication (Kim, Farmer & Porter, 2013).
The nurses can provide free medical samples to motivate the patients to visit them in future. The
support staffs can provide quality hospitality so that patients find the quality difference in health
care.
Job rotation
The nurses and support staffs have job rotation and flexible shifts so that they remain active and
provide their best quality care to the patients. Employee management becomes easy and cost
effectiveness is increased in SRMC.
Job enlargement
Nurses are provided with extra works to be done by the GPs to increase their expertise and
knowledge of patients. This at times may cause conflicts among staffs.
Multitasking

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Multitasking is supported SRMC and both GPs, nurses and support staffs are trained to improve
their work efficiency so that limited number of employees can meet the situational demand when
required.
FUTURE ISSUES
Most of the nurses in NZ is aging and thus the increased need for new young and
specialized nurse are required and hospitals in order to meet the demand are recruiting
nurses lacking field knowledge and experiences. This will reduce the quality of care
providence. Also, nurses are migrating to other countries to find more balanced job and
their increased turnover is creating health care issues in NZ (Ginter, Duncan & Swayne,
2018).
Support staffs are not expertise in their fields and this will hamper the quality care
providence and improved technological effect will be seen in their work when they will
lack knowledge of operating new equipment and care quality will reduce considerably.

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CONCLUSION
It is evident that New Zealand Government is dedicated to provide quality care to the people and
community of the country. A number of regulatory bodies are there to support the financial
contingencies in health sector and every professional here try to deliver their best to impart
quality health care to the patients. To sum up it could be said that the service delivery
management in health sector in the country is well defined and health sector will show
considerable growth in future times.

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