Centralised control and devolved responsibilities: personal experiences of senior health executives on the implementation of the area health management model in New South Wales, 1990-1999

Abstract

Objective: This study explored the impact of the implementation of an area health management model (AHMM) on senior health executives in New South Wales between 1990 and 1999. Setting: Healthcare reform has been a global phenomenon and its negative effects on senior healthcare managers have been confirmed by empirical studies. In New South Wales (NSW), Australia, a major structural reform was the introduction of an AHMM in 1986. Design: Qualitative methods were used to capture the personal experiences and views of senior health executives to the implementation of the AHMM. Thirteen senior executives employed by NSW Health between 1990 and 1999 were selected to participate in open-ended telephone interviews. The results were grouped into four common themes. Results: Participants acknowledged that the area health management model had the potential to produce positive outcomes. However, they considered most of the potential benefits were not achieved due to shortcomings with the implementation process. These shortcomings included inadequate resources, insecurity and instability of senior management positions, control from central office and constant and powerful political influences. The study also found that the benefits documented in NSW Health annual reports between 1990 and 1999 did not reflect the views of its senior health executives. Conclusion: During the introduction and implementation of a major healthcare reform in New South Wales between 1986 and 1999, barriers created by the 'system', centralised management processes and political influences within the Department for example, prevented the realisation of its potential benefits.