Cuestionario

The Voices in Chapter Six provide insight into how the Steering Committee established themselves as a team and how they approached the planning and achievement of required tasks.

Steering Committee meeting times were central to the establishment of relationships between members. The way of conducting business at Steering Committee meetings reflected a climate of valuing all contributions, tolerance of knowledge deficits, support for personal learning, inclusiveness and decision-making by consensus. Everyone’s contribution was valued and expectations of individual members differed depending on their knowledge and time availability. Decision-making at meetings, made by consensus, often took some time. The demands of DHB timeframes or deadlines did not deter this consensual decision-making process. The agenda item “Matters arising from the minutes of the previous meeting” was frequently used by members to raise whatever they wished, irrespective of whether it was an item from the previous minutes or on the current agenda. On these occasions, and throughout the meeting, there were often lengthy deviations from the agenda.

Steering Committee members all managed the tension between achieving the commonly shared project goals of PHO establishment while also attending to their individual stakeholder and personal interests. This was evidenced by changing power relationships both within the Steering Committee membership and between the Steering Committee as a whole and stakeholders external to the Committee, depending on the issue being addressed. The roles and professional relationships which the health professionals on the Steering Committee, the MIPA Advisor and Funding Division representatives had separate from the PHO planning process provided these groups with a platform to exclude the legitimised planning structures and processes set in place by the Steering Committee. Iwi and community representatives were marginalised on these occasions. This emphasised the synergies established between the traditional holders of power: the professional and “expert” stakeholders. It could be argued that time constraints, along with skill and

knowledge deficits, necessitated this approach for completion of some tasks. Baum (1990) acknowledges that while individual health professionals are open to changing their mode of practice, they often maintain and promote their power and privilege and that: “Experts should be able to make their area of knowledge understandable to the non-expert.” (ibid., p. 149). The impact of constantly changing roles and power relationships observed within the Steering Committee added to the complexity of achieving the task of PHO establishment for committee members. The perception of the role and value of community representative input into this project was diminished on occasions when dominant stakeholder needs (e.g. those of GPs and the DHB) became a priority. This was especially difficult for the community representative Chairperson, whose responsibility it was to ensure that the Steering Committee conducted its business in an open and inclusive fashion. Despite this the Voices in Chapter Six reflected a sense of trust within the Steering Committee and a commitment to determining the “ways of doing” that best suited the needs of the Steering Committee members.

Three significant events were identified by different Steering Committee members as contributing to the strengthening of relationships within the Committee and the formation of a cohesive team. The first was the decision made by the Committee to undertake the planning themselves rather than contract the Grafton Group to lead the project. The cost to secure their services was one issue, however, equally important were the observations made of the degree of community inclusiveness the Grafton Group allowed when managing the Health Services Review:

And my perspective of the consultation with the health facility [Health Services Review] was that if that had been me involved in the actual organizing of that, I would have actually had those groups together that they consulted with instead of getting just the information that was perceived to be important.

Steering Committee Chairperson, from interview 18 August 2004 This perception of “consultation” fits with Arnstein’s (1969) description of consultation where individuals “… lack the power to insure (sic) that their views will be heeded by the powerful.” (p. 217) and reflects what she describes as tokenism. While the Steering Committee was aware PHO establishment was a huge task for which they did not have all

necessary expertise, the importance of maintaining “a degree of citizen power” (ibid.) outweighed the challenges that self-management would bring (refer to Figure 2.1).

Engaging the MIPA to take responsibility for the administrative functions gave the health professionals on the Steering Committee the assurance that local control would be achieved. Community representatives supported this local solution. At this early stage of planning they had not experienced or considered the impact on planning of the MIPA’s and GP’s vested interests or their desire to maintain the status quo. Establishing a model of partnership which would enable meaningful community participation across power structures is essential if community representatives are to contribute effectively to planning and decision-making.

The second significant event which contributed to developing a sense of team was the process experienced when gaining approval for the PHO Establishment Plan. As the Steering Committee Chairperson described at an interview:

I think it [the Steering Committee] did [gel] after our first proposal was knocked back.

18 August 2004 The Committee went on to prepare a revised plan which was accepted by the DHB. Findings highlighted the superior knowledge community representatives had of the positive contribution community participation can make to health service planning.

The third event was the decision made by the Steering Committee to delay merging with the Kere Kere Healthy Communities Network. The Steering Committee Iwi Representative II gave his perspective:

And I think when everything got to the stage where it was decided that the Kere Kere group may need to follow their own pathway and that we be left to follow ours … . And I think that was the moment we sort of suddenly decided - yes we are a group, we are a PHO, and we are ready to do this now.

From interview, 2 September 2004 Some perceptions about the development of team cohesiveness were linked to specific events, however, this iwi representative also aligned his perception to the level of comfort

or perception about being successful in achieving the desired outcome for the PHO establishment project. The determination to achieve the agreed outcome contributed to the cohesiveness within this group and thus acted as a motivator for success.

In reality relationships within the Committee were managed at a number of levels depending on the issue being addressed. A cohesive conciliatory Steering Committee team was evident when all committee members were in agreement and vested interests were not an issue. On other occasions the traditional health professional / bureaucrat alliance which excluded community and iwi representatives was apparent. When the Funding Division placed demand on the health professionals to change they aligned themselves with the community and iwi representatives, who invariably supported the health professional position. The decision made regarding the mix of health professionals and community representatives on the PHO inaugural Board highlights this. While community representatives had constituted the majority on the Steering Committee the balance on the Board was in favour of health professionals by six to four. The community representatives supported this decision.