Robin Gauld

• PhD
• Professor at University of Otago

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-govern...

Objective To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic. Data Sources and Study Setting Administrative patient‐level data between 2017 and 2020 of eight high‐income countries:...

Background For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet needs for pri...

Introduction Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs. Me...

Objectives In Aotearoa New Zealand (NZ), integration across the healthcare continuum has been a key approach to strengthening the health system and improving health outcomes. A key example has been four regional District Health Board (DHB) groupings, which, from 2011 to 2022, required the country’s 20 DHBs to work together regionally. This research...

Background: The New Zealand (NZ) Pae Ora (Healthy Futures) health reforms came into effect in July 2022 with the establishment of Health New Zealand (HNZ) (Te Whatu Ora) and the Māori Health Authority (MHA) (Te Aka Whai Ora) – the organisations charged for healthcare provision and delivery. Given these changes represent major health system reform,...

Background For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet need for prim...

Transformative artificially intelligent tools, such as ChatGPT, designed to generate sophisticated text indistin- guishable from that produced by a human, are applicable across a wide range of contexts. The technology presents opportunities as well as, often ethical and legal, challenges, and has the potential for both positive and negative impacts...

Transformative artificially intelligent tools, such as ChatGPT, designed to generate sophisticated text indistinguishable from that produced by a human, are applicable across a wide range of contexts. The technology presents opportunities as well as, often ethical and legal, challenges, and has the potential for both positive and negative impacts f...

Transformative artificially intelligent tools, such as ChatGPT, designed to generate sophisticated text indistinguishable from that produced by a human, are applicable across a wide range of contexts. The technology presents opportunities as well as, often ethical and legal, challenges, and has the potential for both positive and negative impacts f...

Introduction: While the general principles of healthcare quality are well articulated internationally, less has been written about applying these principles to rural contexts. Research exploring patient and provider views of healthcare quality in rural communities is limited. This study investigated what was important in healthcare quality particu...

Aim: Physician multi-site practice (PMP), or dual practice, is commonplace worldwide. Since the mid-2000s, the Chinese government has issued a series of laws and regulations to promote PMP with a goal of improving access to high-quality medical services. However, PMP is widely conducted illegally in China, i.e., without official registration of pra...

Background Primary care in Aotearoa New Zealand is largely delivered by general practices which are heavily subsidised by government. At least seven models of primary care have evolved: Traditional, Corporate, Health Care Home, Māori practices, Pacific practices, and practices owned by Primary Health Organisations/District Health Boards and Trust/N...

Background Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into different models of primary care. We describe nurse work in relation to these models of care; populations wit...

Purpose This article reviews New Zealand's journey through managing Covid-19. It provides a chronological overview of key developments. The article analyses the impacts of Covid-19 on business and society and offers lessons for others from the New Zealand case. Design/methodology/approach The article draws on various sources, primarily media piece...

What makes business research seemingly irrelevant outside of the closed circle of academia? This question has been discussed and debated in various forms in academic circles. Concerns such as increased relevance, access, and better communication are routinely touted as the way forward. However, these recommendations are often targeted towards resea...

Objectives: To explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ). Design: Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation sci...

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Objectives Aotearoa New Zealand has demonstrable maternal and perinatal health inequity. We examined the relationships between adverse outcomes in a total population sample of births and a range of social determinant variables representing barriers to equity. Methods Using the Statistics New Zealand Integrated Data Infrastructure suite of linked a...

Purpose Quality improvement is an international priority, and health organisations invest heavily in this endeavour. Little, however, is known of the role and perspectives of Quality Improvement Managers who are responsible for quality improvement implementation. We explored the quality improvement managers’ accounts of what competencies and qualit...

Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Austral...

Purpose The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of...

Objective To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs i...

Objective Effective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare...

Objective The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. Data Sources We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the Interna...

Objective: This study explores variations in outcomes of care for two types of patient personas-an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. Data sources: We used individual-level patient data from 11 health systems. Study design: We compared inpatient mo...

Objective This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. Data Sources We used individual-level patient data from five care settings. Study Design We compared utilization and spending of an older person aged older than 65 years for 365 days befor...

This study investigates the quality of reporting around the spending related to the use of external consultant and contractors in New Zealand's 20 District Health Boards (DHBs). We make use of the publicly available annual reviews conducted by the New Zealand Parliament Health Select Committee (HSC) as well as DHB data which were retrieved using Of...

Objective Little is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients’ rural or urban location using general practice data. Design Secondary...

The challenges facing Quality Improvement Managers (QIMs) are often understood and addressed in isolation from wider healthcare organisation within which quality improvement initiatives are embedded. We draw on Stafford Beer's Viable System Model (VSM) to shed light on how the viability of quality improvement depends on the effective functioning of...

Background: Birthing outcomes in New Zealand are demonstrably inequitable based on governmental reports and research. However, the last Ministry of Health maternal satisfaction survey in 2014 indicated that 77% of women were satisfied or very satisfied with care. This study used data from the maternal satisfaction survey to examine aspects of inequ...

Using an online panel, we surveyed a representative sample of 500 each in Australia and New Zealand during July 2020, in the middle of the Covid‐19 pandemic. We find trust in government has increased dramatically, with around 80% of respondents agreeing government was generally trustworthy. Around three quarters agreed management of the pandemic ha...

In Australia and New Zealand (ANZ), clinical academics are an important part of the workforce needed to deliver social and economic returns from health and medical research investment. This review aims to examine the extent and nature of the empirical evidence base addressing the development of the multi-professional clinical academic workforce in...

New Zealand’s dual public-private health system allows individuals to purchase health services from the private sector rather than relying solely upon publicly-funded services. However, financial boundaries between the public and private sectors are not well defined and patients receiving privately-funded care may subsequently seek follow-up care w...

Alliance governance is a form of governance developed in industry settings and more recently applied to healthcare. The core idea behind alliance governance is to involve the many stakeholders in the system to collaboratively develop a joint programme that promotes integrated and whole of a systems approach to care. Little is known about the model...

Using an online panel, we surveyed a representative sample of 500 each in Australia and New Zealand during July 2020, in the middle of the Covid-19 pandemic. We find trust in government has increased dramatically, with around 80% of respondents agreeing government was generally trustworthy. Around three quarters agreed management of the pandemic ha...

Purpose Integrated care presents health workforce planners with significant uncertainty. This results from: (1) these workforces are likely in the future to be different from the present, (2) integrated care's variable definitions and (3) workforce policy and planning is not familiar with addressing such challenges. One means to deal with uncertain...

While lean thinking has been used in healthcare for almost two decades, its efficacy has been debated extensively by researchers and practitioners alike. This ongoing debate is largely due to the varied results of its implementation; and resistance to change is considered to be the primary reason behind this variation. This study adopts an institut...

Purpose: The work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017. Design/methodology/approach: Three questions were included in a national New Zea...

Purpose The purpose of this paper is to identify and describe the international and New Zealand (NZ) evidence for models of integrated ambulatory care and describe key implementation issues and lessons learnt. Design/methodology/approach A scoping review was conducted for published and grey literature on integrated care. Publications from 2000 to...

Background: A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constit...

Background Aotearoa New Zealand’s (NZ) socialised health system offers free maternity midwifery-led services in a women-centred model of care. While person-centredness is promoted as a means to provide better care outcomes, including better ‘satisfaction’ with care, maternity outcomes in NZ are not equitable. Aims/Objects Our objective was to ex...

Background: Community/consumer health councils (CHCs) are a relatively new phenomenon in New Zealand. CHCs are usually established within district health boards (DHBs) to help address gaps in community engagement in the health sector. Little is known about the establishment, structure, roles and functioning of these councils. Aim: To undertake a...

Clinical governance is a key policy and organisational foundation for health care quality improvement. This study sought to measure progress with clinical governance development from the perspective of practicing medical professionals in the New Zealand public health system. A short fixed-response survey, with questions derived from a government po...

Purpose Healthcare alliances are a mechanism for developing collaborative and integrated care governance and service delivery arrangements. Yet is not known how widespread alliance arrangements are in Organisation for Economic Co-operation and Development (OECD) countries, how alliances function or how effective they are. The purpose of this paper...

Background: The purpose of this review was to examine the literature for themes of underlying social contributors to inequity in maternal health outcomes and experiences in the high resource setting of Aotearoa New Zealand. These 'causes of the causes' were explored and compared with the international context to identify similarities and New Zeala...

Social audit is a mechanism used to hold frontline health service providers accountable. Using the case of the social audit process in Dang District, Nepal, this study explored the role of social audit in facilitating direct accountability between service providers and community. This relationship was summarised by three elements: information/data...

Objectives Healthcare organisations are increasingly required to undertake transformational change in response to epidemiological and demographic changes, and rapid healthcare technological advances. However, transformational change is notoriously complex and challenging. This article presents a checklist that identifies key components of successfu...

What can the Statistics New Zealand Integrated Data Infrastructure tell us about maternity health inequity in Aotearoa New Zealand? Background: Aotearoa New Zealand’s socialised health system offers free maternity care led by midwives. Yet, large maternal health inequities exist with over-representation of Māori and Pacific women in maternal morta...

Introduction Achieving effective integration of healthcare across primary, secondary and tertiary care is a key goal of the New Zealand (NZ) Health Strategy. NZ’s regional District Health Board (DHB) groupings are fundamental to delivering integration, bringing the country’s 20 DHBs together into four groups to collaboratively plan, fund and delive...

The 2018 year signalled the 80th anniversary of the Social Security Act 1938. In order to implement this legislation, a historic compromise between the government and the medical profession created institutional arrangements for the New Zealand health system that endure to this day. The 2018 year also marked the commencement of a Ministerial review...

Hospitals in the Asia‐Pacific today face the ‘triple aim’ challenge, proposed by the Institute for Healthcare Improvement, of how to improve quality of care and population health, while at the same time controlling healthcare costs. Yet, pursuing these challenges in combination is presently a remote prospect for many hospitals and, indeed, in a maj...

Objectives To explore the process of implementation of an online health information web-based portal and referral system (HealthPathways) using implementation science theory: the Consolidated Framework for Implementation Research (CFIR). Setting Southern Health Region of New Zealand (Otago and Southland). Participants Key Informants (providers an...

Purpose: The purpose of this paper is to identify five quality improvement initiatives for healthcare system leaders, produced by such leaders themselves, and to provide some guidance on how these could be implemented. Design/methodology/approach: A multi-stage modified-Delphi process was used, blending the Delphi approach of iterative informati...

Purpose In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgement...

Aim: The Population-Based Funding Formula (PBFF) has a significant impact on health funding distribution between New Zealand's 20 district health boards (DHBs) yet is subject to little independent oversight or public scrutiny. There has been widespread dissatisfaction among DHBs with the allocation process; however, there are limited formal avenue...

Abstract Aotearoa New Zealand has a socialised health care system with a uniquely structured, free maternity care scheme, yet large inequities exist in maternal health. There is over-representation of Māori, and Pacific women in maternal mortality and morbidity statistics and patient experience is also rated poorly by these groups. This presentati...

Concerns over New Zealand's health workforce sufficiency, distribution and sustainability continue. Proposed solutions tend to focus on supplying medical professionals to meet predicted numbers or to resolve distributional problems. This is despite quantitative forecasts being known to have poor reliability. A recent study on New Zealand's health w...

Objective: To establish aspirational 'gold standards' for a suite of System-Level Measures (SLMs) being used by Counties Manukau Health (CM Health), a New Zealand (NZ) District Health Board. Design: This study employed a multi-stage, multi-method modified Delphi consensus process. Setting: The Delphi consensus process involved virtual (email)...

Health workforce planning aims to meet a health system’s needs with a sustainable and fit-for-purpose workforce, although its efficacy is reduced in conditions of uncertainty. This PhD breakthrough article offers foresight as a means of addressing this uncertainty and models its complementarity in the context of the health workforce planning proble...

Future health systems will be required to accommodate changing social and treatment environments along with new and not-before-contemplated health care roles. Thus, health workforce planning is likely to benefit from improved problem identification, response formulation and data and methods that provide deeper understandings of socially influenced...

The health professional workforce in high-income countries is trained and organised today largely as it has been for decades. Yet health care professionals and their patients of the present and future require a different model for training and working. The present arrangements need a serious overhaul: not just change, but disruption to the institut...

Background: Community participation has been recognised as one of the key components for the successful implementation of primary health care (PHC) strategies, following the 1978 Declaration of Alma-Ata. In low- and middle-income countries (LMICs), HFMCs are now widely considered as a mechanism to increase community participation in health through...

Purpose Clinical governance is an important foundation for a high-performing health care system, with many countries supporting its development. Clinical governance policy may be developed and implemented nationally, or devolved to a local level, with implications for the overall approach to implementation and policy uptake. However, it is not kno...

Although the rapid increase in population ageing observed across the globe poses significant challenges to the sustainability of health systems it has been paralleled by an exponential growth in health technologies. This article reviews the literature surrounding health technologies and explores how the future of ageing and health care could be sha...

Background: Despite some empirical findings on the usefulness of citizen's charters on awareness of rights and services, there is a dearth of literature about charter implementation and impact on health service delivery in low-income settings. Objective: To gauge the level of awareness of the Charter within Nepal's primary health-care (PHC) syst...

Purpose The purpose of this paper is to review and discuss the effects of the introduction of lean into healthcare workplaces, phenomena that have not been widely investigated. Design/methodology/approach The paper draws on discussions and findings from the literature. It seeks to bring the few geographically dispersed experiences and case studies...

Objectives This article focuses on the results of evaluations of two business plans developed in response to a policy initiative which aimed to achieve greater integration between primary and secondary health providers in New Zealand. We employ the Consolidated Framework for Implementation Research to inform our analysis. The Better, Sooner, More C...

Background Multimorbidity is a major issue for primary care. We aimed to explore primary care professionals’ accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery. Methods Qualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealand’s Otago region. Thematic...

Aims: In this pilot study, the primary aim was to compare four potential methods for undertaking a national survey of unmet secondary healthcare need in New Zealand (one collecting data from GPs, and three from community surveys). The secondary aim was to obtain an estimate of the prevalence of unmet secondary healthcare need, to inform sample siz...

Purpose – The purpose of this paper is to investigate the contextual factors contributing to the sustainability of healthcare quality improvement (QI) initiatives. Design/methodology/approach – Themes from semi-structured interviews with international healthcare leaders are compared with Kaplan and Provost et al.’s (2012) model for understanding su...

Clinical leadership has been on the New Zealand policy agenda since the launch of the 2009 In Good Hands report, yet performance in supporting its development has been variable. The 2016 New Zealand Health Strategy renews the emphasis on clinical leadership, but with few details for what this is, what the expectations are and how clinical leadershi...

Public spending on external consultancies, particularly within the health sector, is highly controversial in many countries. Yet, despite the apparently large sums of money involved, there is little international analysis surrounding the scope of activities of consultants, meaning there is little understanding of how much is spent, for what purpose...

Purpose - The purpose of this paper is to outline the theory and practice of governance for integrated care, using the case of New Zealand's healthcare alliances. Design/methodology/approach - This is descriptive analysis. Findings - Alliance governance provides considerable scope for bringing health professional together to focus on whole system a...

Information technology is perceived as a potential panacea for healthcare organisations to manage pressure to improve services in the face of increased demand. However, the implementation and evaluation of health information systems (HIS) is plagued with problems and implementation shortcomings and failures are rife. HIS implementation is complex a...

Background Despite abundant literature on the different aspects of health care complaint management systems in high-income countries, little is known about this area in less developed health care systems and most research to date has been conducted in hospital settings. This article seeks to address this gap by reporting on research into complaint...

Background Enhancing the use of evidence in policymaking is critical to addressing the global burden of nutrition-related disease. Whilst the public health nutrition community has embraced evidence-informed policymaking, their approach of defining relevant evidence and evaluating policy has not brought about major shifts in policymaking. This artic...

Purpose The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes. Design/methodology/approach The paper draws from a larg...

Introduction: The impact of orthodontic treatment on oral health-related quality of life (OHRQoL) in adolescents being treated in orthodontic practices has not yet been explored longitudinally. The aim of this cohort study was to describe the changes in both malocclusion and OHRQoL with orthodontic treatment. Methods: One hundred seventy-four pa...

New Zealand’s healthcare system is, like most, in a continual process of restructuring and change. While the country has endured several major system-wide changes in recent decades, more recent change has been incremental and evolutionary. Current changes are in response to a set of challenges, which are not unique to New Zealand. This article over...

This article argues that New Zealand (NZ) could be an important case for drawing health system reform lessons from for the English National Health Service. Reasons for this are outlined, including the close similarities between the two countries and their health systems. The article describes the diverging health reform agendas of conservative gove...

The English NHS is of significance among health policy observers around the globe for various reasons. The NHS is particularly noteworthy for the fact that, for many, it represents the high-income world’s best attempt to have built and maintained a ‘national’ health system with a focus on universal access to care that is free at point of service. T...

Introduction The English NHS is of significance among health policy observers around the globe for various reasons. The NHS is particularly noteworthy for the fact that, for many, it represents the high-income world's best attempt to have built and maintained a ‘national’ health system with a focus on universal access to care that is free at point...

This book provides an in-depth analysis of the NHS reforms ushered in by UK Coalition Government under the 2012 Health and Social Care Act, arguably the most extensive reforms ever introduced in the NHS. Contributions from leading researchers from the UK, the US and New Zealand examine the reforms in the contexts of national health policy, commissi...