Te mana whakahaere, te whaiora Māori : change management and Māori health development : a study on the management of Māori health strategies in a changing health sector from the 1991 health reforms to the year 2001 : a thesis submitted for the degree of Doctor of Philosophy in Social Science, Massey University, Palmerston North, January 2002

Abstract

Two themes form the basis of this thesis. One is Maori health development, and the other is Māori health management or, in particular, the management of health sector change by Māori health professionals. Both themes are inextricably linked. One is about definitions of Maori progress and is focussed on health gains. The other is about process. Although both are examined in the context of positive development and differing perspectives, this research is essentially about Māori health management strategies, or processes through change for achieving best outcomes for Maori health service delivery. This thesis is primarily focussed within the time span 1991 to 2001, though there are speculations that go beyond that period of time. For convenience sake, the focus period for this thesis is continuously referred to as 'the 1990s'. In 1991 the National Government introduced a series of significant health reforms which accelerated a privatisation trend, making the health sector more accountable in business and commercial terms. Democratic control of hospital boards was replaced by appointed boards with business objectives, thus forming a market place within the health sector. This transformation was justified by the needs for efficiency, cost containment and accountability to consumers but in the process it increased the growing importance of management through social policy reform.