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ABSTRACT
The majority of research into Managed Clinical Networks (MCN) has been undertaken in large countries; little is known about the implementation of MCNs in small countries. Using a prospective, longitudinal, qualitative method, this three-year case study explored the development and implementation of a New Zealand palliative care MCN, particularly focusing on the establishment, mid-point, and completion time points. The analysis showed throughout the three years, the MCN failed to implement the guiding principles of MCNs. This may have been influenced by the small county context where clinicians and health provider organizations know each other well and compete for government-allocated resources and other funding (e.g. grants and donations). MCNs remain widely supported as a tool to achieve clinical representation in governance, particularly where change is needed to support equitable service delivery. However, it is possible in small country settings that MCNs require a different approach to leadership and development to achieve effective governance and implementation.
Acknowledgements
We acknowledge the New Zealand Ministry of Health. We also acknowledge the support and contribution of the Central Region Managed Clinical Network, the contributing District Health Boards, Primary Health Organizations and other stakeholders.
Disclosure statement
No potential conflict of interest was reported by the authors.
Additional information
Notes on contributors
Eileen McKinlay
Eileen McKinlay Associate Professor, Department of Primary Health Care and General Practice, University of Otago Wellington. Eileen is a nurse by background and has worked clinically in cancer and palliative care. Her research interests include palliative care, health service models, interprofessional education, and interprofessional collaboration.
Jo Esplin
Jo Esplin Principal, Sapere Research Group, Auckland. Jo specializes in non-clinical service evaluations for community-based service improvements, across the wider health, social, and disability sectors. Jo is an early childhood teacher by background and holds an MBA from Otago University. Her research interests focus on people who are disadvantaged or in vulnerable positions, for any number of reasons. She works across Government, public and private sectors.
Christine Howard-Brown
Christine Howard-Brown Director, Phoenix Productions Limited, a consulting company providing service development, evaluation, and research services. Christine has a nursing and business management background and holds a PhD. Her research interests include primary care, aged residential care, traumatic brain injuries, spinal cord injuries, health service models, and integrated care.
Jo Smith
Jo Smith Principal, Sapere Research Group, Wellington. Jo is an economist specializing in applied research and analysis. She has extensive experience in designing and undertaking evaluations of programmes and services, for clients in the public, private, and not-for-profit sectors.
Lynn McBain
Lynn McBain Associate Professor and Head of the Department of Primary Health Care and General Practice, University of Otago Wellington. Lynn is a General Practitioner. Her research interests include palliative care, the patient decision making about medicines and investigations, health service delivery models, use of big data, medical education.