CARACTERISTICAS DE USUARIOS:

Participants were asked to identify how the performance of Māori mental health providers is measured by the Crown or funder and whether the performance of Māori mental health providers should be measured in the same way as mainstream services.

Respondents noted that there are several ways of measuring the performance of Māori mental health providers, some of which are more formal than others. For example performance can be assessed through the contracts providers have with funders; through performance monitoring returns; or through an audit process, where part of that process involves talking to clients and observing the provider in their day to day work (KI02:5).

There’s a standard contract and all they do is underneath the standard contract,

they put this stuff [points to Nationwide Mental Health Service Framework

2001]. So in here you’ve got a description of what you have to provide for a residential service. And all they do is they take that out, put it into the contract and they might put some more detail in there and then that ... forms the contract. And then ... for each of those services you’ve got a measurement.

KI13:8

I mean ultimately it’s the DHB ... who are responsible for ... that sort of quality control or contract compliance. And ... we’re only just entering ... the arena of

quality control basically. I mean, we’ve had it in the hospitals for a while under accreditation, we’ve had it in ... the residential care area, beds, you know? Like inpatient beds if you like ... So all of the rest homes and stuff like that are going through that ... but eventually it will roll out to all of the primary care sector and other providers. And so this ... is the first time that there has been a DHB

external audit ... of Māori providers. They’ve had other audits through various,

... other contract funders but ... we’re just starting to get our heads around what

all of this means really. And its had huge implications for our Māori provider

network because its shown up quite a few gaps in service delivery and contract

compliance. KI11:3

Some respondents noted that Māori tend to take a more outcomes-focused approach to service delivery, whereas funders are more concerned with outputs.

I mean all they collect is quantitative data. They do not collect qualitative data. Now for our own Trust we collect qualitative data here, because we need to know whether we are actually making a difference to people’s lives or whether we are just mechanically going about delivering a service because if that’s what

we’re doing there’s no point in us being here. KI20:2

The difference in emphasis between a focus on outcomes and one on outputs may result in Māori mental health providers appearing to have “failed” in delivering on their contracted outputs.

Contracts have an expectation of output … You’re a successful provider if your

output is this high in numbers ... Whereas ... Māori often fail in their contracts

because they have an inherent interest in outcome and are outcome focused.

However, if you are outcome focused for Māori then you’re gonna cost

somebody mega bucks. And if you cost someone mega bucks even though you’ve got a hundred percent effectiveness in your outcome, you are a failure in the eyes of the contractors because you got a hundred percent success rate in terms of maybe ten whaiora when the contract expects you to have forty outputs.

KI12:5

One respondent was very concerned at the funders’ reliance upon, and seemingly inappropriate use of, audits to track the performance of Māori mental health providers,

rather than regular performance monitoring and monitoring of progress against a contract.

The trouble is many Māori NGOs in particular, are very concerned about the

number of audits they face compared with non-Māori, they have two, three, four

times a year. Ridiculous. See one of the things that the system has failed on is the distinction between ... normal performance monitoring of the contract and the function of audit. They’re entirely different things. What we tend to do in the health sector, in the past anyway, is to use the audit as both ... it’s an examination of your ... total activity ... and whether or not it fulfils whatever criteria that you’ve set for an organisation of that sort. The ... performance monitoring is something to do with the contract itself, ‘a’ contract, whether or not you’re actually providing what was expected within that contract. It’s very

specific. KI05:20

Less formal measures were also identified and include the profile of the provider in the community and what is said of providers by their peers.