Shared Governance within the market-oriented health care system of New Zealand

The New Zealand health reforms, announced in 1991 and implemented over the 3-year period 1992-1994, were market-oriented, following a competitive model that had been applied across New Zealand's public sector. Consideration is given to the effects of the health reforms on nursing and midwifery at Capital Coast Health Limited (CCHL), with the introduction of a market/economic model of health care and its accompanying managerialism. The market model, or the economic era of health care, as some describe it, created an environment where nurses felt powerless. All the directors of nursing and on-going hospital educational programs were disestablished in the public sector; nurses were disheartened, confused and lacked representation at senior management. Integral to, and accompanying, corporatization is managerialism. With corporatization, came managers from the non-health care sector who had no understanding of the complexities of health care. Accompanying managerialism is the notion that any able manager was capable of managing any agency, whether public or private. Naturally, there was an underlying conflict between the caring relationships and their related work in the clinical environment, and the desire for efficiency and economy. It seemed that we were dealing with contrasting themes of 'the market' and 'humanity' This led to further confusion and disempowerment, as the dollar gained prominence, for nursing has always been grounded in the 'humanities'. It was into this environment, after 5 years of the health reforms, that a Nurse Executive was appointed and the concept of Shared Governance was introduced. This article describes why Shared Governance was considered an appropriate model to introduce at CCHL, and identifies some of the tangible benefits being realized 18 months post implementation. Discovering that membership in cross-organizational teams provides a mechanism for networking and creating a broader understanding of the organization has been but one of the major benefits.