Respondents were asked a series of questions designed to discover the origins of New Zealand’s mental health performance measurement framework, including how the measures were developed, whether there are differences in how performance is
measured at a central government level and how the performance of Non-Governmental Organisations (NGO), such as Māori mental health providers, is measured.
Very few key informants were able to discuss with certainty the derivation of the New Zealand’s mental health performance measurement framework and even fewer commented on performance measurement at a central government level compared with the performance measurement of NGOs. However one respondent was able to outline the performance measurement framework in use in the mental health sector in some detail. That informant noted that the origins of the current system have as much to do with key people working in the health sector, as with specific windows of opportunity that arose during periods of health reform.
I actually think a lot about the process was about key people who really wanted mental health to get its place in the sun. The key processes around that like the Mason Report etc. So that I’m not sure whether we would say the government intended to set out to develop the mental health sector or the mental health performance measures. I think it has related hugely to some very key players who believed in the sector and unfortunately some crises that ... helped their lobbying perhaps. So from that it was saying ‘well how will we know we’ve made a difference? How will we know, we’ve made progress? If the Government is going to invest additional money, what information will the Government get back to justify that expenditure?’ So ... I think that’s actually
been quite a robust process overall. KI03:2
It became clear through this interview that measuring performance in the mental health sector occurs at a number of levels and for a range of reasons. At one level the Government is concerned with tracking how the money appropriated to the sector is being spent. This is the input focus.
It’s a very input-based system and to a degree I can absolutely understand and accept why that happened when I look at ... the Health Funding Authority. Their desire was to see how ... performance against the Blueprint could be tracked and the best way to see that was to see people on the ground, able to deliver the services. So it was something that was very important for that time.
At another level, the Government as the funder is concerned with ensuring Māori mental health providers comply with their contractual obligations and deliver what they have been paid or funded to do.
Some of the other ... reporting requirements that are in contracts ... may not actually relate to anything and nobody does anything with it. They are mainly ... contractual requirements and there may be some other things ... a lot about numbers, a lot about volumes, FTEs, staff, what their qualifications, whether they’re clinical or non-clinical. The narratives, any narrative reports are very
important to check them out. KI03:6
At yet a third level the Government is concerned that all mental health providers, including Māori mental health providers, are delivering a high quality service. The quality audit is the main tool employed for this purpose.
... [providers] would be measured during an audit programme and we’ve had over the past two years audit programmes that I think would now have included
all of our community Māori mental health providers and a good deal of other
non-Māori providers to say ‘at a quality level, are you meeting the terms of
your contract, can you describe to us that you’re indeed a kaupapa Māori
service?’ KI03:5
Audits include a range of quality measures; however, one respondent noted that these measures are very generic and based on western concepts and values.
The performance measures are ... generically based, so ... they’re measured on the clinical component quite strongly, the management component, and the management component is using western paradigms not, it doesn't account for any kind of indigenous management practices. And the other one would be the sort of HR, financial areas and then there’s these sort of add on cultural components which are more around things like ... ‘How’s the provider implementing the Treaty of Waitangi?’ But there's nothing behind that that says these are the components that must be demonstrated. It’s just a broad question because I don't think they know either. And you might get also things like
‘How’s the provider involving whānau? What are the relationships between the
remember much about Māori models ... in terms of delivering the service, but I would say that ... the cultural component is probably like about 10% and then
the rest is mostly mainstream sort of indicators. KI09:5
The same respondent indicated that one of the government’s key concerns in terms of provider performance was managing risk:
Risk is a biggy ... mitigating risk, yeah. That’s a big one and that’s probably ... public pressure that brings that about ... especially around issues to do with homicide or suicide or serious assaults and that sort of interface between justice and ...[the] court ... Mental health would be one of the few areas where that
interface is so close. KI09:2