Service management: New Zealand's model of resource management

The health system in New Zealand, which in many respects is similar to that of the United Kingdom NHS, is currently undergoing massive change. In 1989 fourteen area health boards were formed, each board being accountable to the minister of health for achieving health goals and providing comprehensive health services for its defined population. This process has been assisted by the promulgation of a set of national health goals and a national health charter. Within area health boards the principle of general management is being implemented. Organisational structures are moving away from hospitals to services in a process which is being called service management which may be defined as the decentralisation of general management to the clinical workface. Similar in many respects to the resource management initiatives in the NHS it brings together medical, nursing and business management at the operational level with one person being accountable for the achievement of quality of care objectives within a budgetary framework. Budgetary restraints in excess of 10% have been achieved in the last 12 months partly through the service management process. Service management is seen to be a major paradigm shift in health services organisation and could be of international significance in its potential for achieving medical accountability for cost containment and quality assurance, and for coordinating care across agency and disciplinary boundaries.