Tim Tenbensel

Publications (20) View all

• Article: How not to kill the golden goose: Reconceptualising accountability environments of third-sector organisations

  Tim Tenbensel, Judith Dwyer, Josee Lavoie
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  ABSTRACT: For third-sector organizations (TSOs) that deliver publicly funded health and commu- nity services, accountability practices are predominantly shaped by the imperatives of government funders. However, the ensuing public management accountability regimes can undermine TSO responsiveness to com- munities, align poorly with imperatives of professional staff, create high transaction costs and threaten TSO sustainability. Public management literature lacks an ade- quate framework for conceptualizing TSO accountability. We outline a conceptual fra- mework – the ‘ triskele ’– for analysing accountability tensions experienced by TSOs that could assist funders and other stakeholders with the difficult task of design- ing more workable and meaningful account- ability regimes for all stakeholders.
  Public Management Review 04/2013; · 0.92 Impact Factor
• Article: Health reform in New Zealand: short-term gain but long-term pain?

  Toni Ashton, Tim Tenbensel
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  ABSTRACT: Following a period of quite radical structural reform during the 1990s, health reform in New Zealand is now more incremental and often 'under the radar' of public scrutiny and debate. However, many changes have been made to the roles and functions of key agencies and this could have a profound effect on the direction and performance of the public health system. In particular, the objective of reform at the national level has shifted away from improving population health and reducing health disparities towards improving the performance of service providers. This article describes some of the reforms that have been introduced in recent years and discusses some implications of these changes. We argue that policy settings that are concerned only with getting the right services to the right people at the right time are inherently short-sighted if they fail to tackle the long-term causes of increasing demand for future health services.
  Expert Review of Pharmacoeconomics & Outcomes Research 10/2012; 12(5):579-88.
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  Available from: Tim Tenbensel

  Article: Comparing health policy agendas across eleven high income countries: islands of difference in a sea of similarity.

  Tim Tenbensel, Samantha Eagle, Toni Ashton
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  ABSTRACT: Does the way in which health systems are financed influence whether health policymakers are more or less interested in accessible and equitable health services? Are social democratic governments more interested in primary health care reform than conservative governments? Have particular domains of health policy really become more important over the past decade across a range of countries? In this exploratory article, we investigate the similarities and differences in patterns of attention in health policy in eleven high income countries using data from the Health Policy Monitor database from 2003 to 2010. Our study suggests significant 'islands of difference' in an overall 'sea of similarity' between the health policy agendas of the selected countries. The key findings are: (i) that improving population health outcomes is more likely to be on the agenda under tax-based systems and when centre-left parties are dominant in government; (ii) health systems funded through social insurance are more preoccupied with efficiency and cost-containment than tax-funded systems; (iii) the political complexion of governments is not a major factor shaping health policy agendas; and (iv) since 2003 there has been an increasing interest in initiatives that address public health concerns, access and equity, and population health outcomes.
  Health Policy 05/2012; 106(1):29-36. · 1.51 Impact Factor
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  Available from: Tim Tenbensel

  Article: Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol.

  Peter Jones, Linda Chalmers, Susan Wells, Shanthi Ameratunga, Peter Carswell, Toni Ashton, Elana Curtis, Papaarangi Reid, Joanna Stewart, Alana Harper, Tim Tenbensel
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  ABSTRACT: In May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a performance measure has the potential to see improvements in the wider health system. However, the imposition of targets may have significant adverse consequences. There is little empirical work examining how the performance of the wider hospital system is affected by such a target. This project aims to answer the following questions: How has the introduction of the target affected broader hospital performance over time, and what accounts for these changes? Which initiatives and strategies have been successful in moving hospitals towards the target without compromising the quality of other care processes and patient outcomes? Is there a difference in outcomes between different ethnic and age groups? Which initiatives and strategies have the greatest potential to be transferred across organisational contexts? The study design is mixed methods; combining qualitative research into the behaviour and practices of specific case study hospitals with quantitative data on clinical outcomes and process measures of performance over the period 2006-2012. All research activity is guided by a Kaupapa Māori Research methodological approach. A dynamic systems model of acute patient flows was created to frame the study. Consequences of the target (positive and negative) will be explored by integrating analyses and insights gained from the quantitative and qualitative streams of the study. At the time of submission of this protocol, the project has been underway for 12 months. This time was necessary to finalise both the case study sites and the secondary outcomes through key stakeholder consultation. We believe that this is an appropriate juncture to publish the protocol, now that the sites and final outcomes to be measured have been determined.
  BMC Health Services Research 02/2012; 12:45. · 1.66 Impact Factor
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  Available from: Tim Tenbensel

  Article: A successful mix of hierarchy and collaboration?: Interpreting the 2001 reform of the governance of the New Zealand public health system

  Tim Tenbensel, Nicholas Mays, Jacqueline Cumming
  Policy & Politics 01/2011; 39(2-39):239-256. · 0.70 Impact Factor