Implications of policy and management decisions on hospitals: a New Zealand viewpoint

In New Zealand, the effect of resource constraint operates at two levels. In the macrocosm of national politics, there is a tectonic collision between two plates--social equity and a fiscal constraint on government expenditure. In the hospital, these forces are reflected in the frustration of the staff who cannot deliver that which they are trained to deliver, in the distress of those who cannot obtain the care they have been told they need and in the stress on management pushed by forces it cannot control. If there is to be resolution, there must be change on all three fronts--the expectations of professionals and users alike--and the approach of management. Perhaps the needed change in management could be the key to change in the expectations of the other two parties.