Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand.
BMJ Open. 2022 Oct 31;12(10):e065635. doi: 10.1136/bmjopen-2022-065635.
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).
Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory-the Consolidated Framework for Implementation Research.
Southern health region of NZ (Otago and Southland).
Eleven key informants (Alliance Leadership Team members and senior health professionals) who were involved in the development and/or implementation of the strategy.
The large number of strategy action plans and interdependencies of activities made implementation of the strategy complex. In the inner setting, communication and relationships between individuals and organisations were identified as an important factor for joint and integrated working. Key elements of a positive implementation climate were not adequately addressed to better align the interests of health providers, and there were multiple competing priorities for the project leaders. A perceived low level of commitment from the leadership of both organisations to joint working and resourcing indicated poor organisational readiness. Gaps in the implementation process included no detailed implementation plan (reflected in poor execution), ambitious targets, the lack of a clear performance measurement framework and an inadequate feedback mechanism.
This study identified factors for the successful implementation of the PCSS using an alliancing approach in Southern NZ. A key enabler is the presence of a stable and committed senior leadership team working through high trust relationships and open communication across all partner organisations. With alliances, partnerships and networks increasingly held up as models for integration, this evaluation identifies important lessons for policy makers, managers and services providers both in NZ and internationally.
通过联盟治理，探索新西兰南部卫生区（南岛和奥塔哥）初级和社区保健策略（新的护理提供模式）的实施过程。
进行了定性半结构化访谈。采用实施科学理论——实施研究综合框架，对框架指导的快速分析进行了指导。
新西兰南部卫生区（南岛和奥塔哥）。
11 名主要信息提供者（联盟领导小组成员和高级卫生专业人员），他们参与了该战略的制定和/或实施。
大量的战略行动计划和活动的相互依存关系使得该战略的实施变得复杂。在内部环境中，个人和组织之间的沟通和关系被确定为联合和综合工作的一个重要因素。积极的实施氛围的关键要素没有得到充分解决，以更好地协调卫生提供者的利益，并且项目领导者有多个相互竞争的优先事项。两个组织的领导层对联合工作和资源配置的承诺程度低表明组织准备不足。实施过程中的差距包括缺乏详细的实施计划（反映在执行不力）、雄心勃勃的目标、缺乏明确的绩效衡量框架和不完善的反馈机制。
本研究使用联盟方法在新西兰南部确定了成功实施 PCSS 的因素。一个关键的促成因素是存在一个稳定且坚定的高级领导层团队，通过在所有合作伙伴组织之间建立高度信任的关系和开放的沟通来开展工作。随着联盟、伙伴关系和网络越来越被视为整合的模式，这项评估为新西兰和国际上的政策制定者、管理者和服务提供者提供了重要的经验教训。
