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This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

This research began a journey towards improved maturity around data quality management in New Zealand health care, where total data quality management is 'business as usual" institutionalised into the daily practices of all those who work in health care. The increasingly information intensive nature of health care demands a proactive and strategic approach to data quality to ensure the right information is available to the right person at the right time in the right format, all in consideration of the rights of the patient to have his/her health data protected and used in an ethical way. The work extends and tests principles to establish good practice and overcome practical barriers. This thesis explores the issues that define and control data quality in the national health data collections and the mechanisms and frameworks that can be developed to achieve and sustain good data quality. The research is interpretive, studying meaning within a social setting. The research provides the structure for learning and potential change through the utilisation of action research. Grounded theory provides the structure for the analysis of qualitative data through inductive coding and constant comparison in the analysis phase of the action research iterative cycle. Participatory observation provided considerable rich data as the researcher was a member of staff within the organisation. Data were also collected at workshops, focus groups, structured meetings and interviews. The development of a Data Quality Evaluation Framework and a national Data quality Improvement Strategy provides clear direction for a holistic and 'whole of health sector' way of viewing data quality, with the ability for organisations to develop and implement local innovations through locally developed strategies and data quality improvement programmes. The researcher utilised the theory of appreciative enquiry (Fry, 2002) to positively encourage change, and to encourage the utilisation of existing organisational knowledge. Simple rules, such as the TDQM process and the data quality dimensions guided the change, leaving room for innovation. The theory of 'complex systems of adjustment' (Champagne, 2002; Stacey, 1993) can be instilled in the organisation to encourage change through the constant interaction of people throughout the organisation.

Treating chronic health conditions consumes a significant portion of the health care resource. Two–thirds of UK hospital admissions consist of people with chronic conditions (Singh, 2005). To date, health management has tended to focus on service redesign, rather than focusing on the patients, as a way to facilitate improved outcomes and control costs. Typically, these management approaches are premised on the patient as a consumer/end user. An alternative view to the patient being a consumer is that of the patient being a co–producer of the service. Co–production recognises the client (patient) as a resource, in that value cannot easily be created or delivered, unless the patient actively contributes to the service (Alford, 1998). Patients gain health value when they are well and are independent of the health care system and its costs. Health care organisations gain economic value, when chronic patients require less health care. This thesis examines co–production, in the context of contemporary patient involvement and heath services management. ‘Knowing the People Planning’ (KPP), an innovative health management method, is evaluated for its patient management co–production potential. KPP is based on ten key features of service provision. Four of the key features relate to the patient, whilst the remaining six features relate to the organisation. It is the management of these patient and organisation features that better facilitates chronic long-term mental health patients as co–producers. The empirical findings, from this evaluation of KPP provide evidence for the efficacy of co–productive health management theory and practice. Patient health value and health care organisation economic value are created, when both the organisation and the patient co–produce the health service. KPP was initially implemented by eight of New Zealand’s 21 District Health Boards. Socio-ecological action research methodology was used to evaluate KPP — by taking a ‘people-in-environments’ approach. The evaluation covers fourteen action research cycles for 2,021 chronic long-term patients over four years. Measurements include the amount of time these long-term patients spent in hospital and employment rates. The integration of the action research cycles, using the socio-ecological method supported the generation of (what I have called) ‘co–productive health management theory’. Analyses of secondary data, across organisational and patient domains, supplement the action research findings, in order to assess for confounding factors. The organisation outcomes relate to costs and staff turnover. Patient outcomes relate to service utilisation measures, for approximately 60,000 adult patients per year, who access New Zealand’s secondary mental health services. A pivotal finding of this research was that, as the rate of patients with treatment plans increased from 50% to 90%, inpatient bed use decreased by 26%. However, increased funding for mental health services had only a minor impact on decreasing inpatient bed use. Patient employment rates increased, whilst the number of patients who required access to general practitioners and changes to their housing situation, decreased. The patient management co–production view offers a significant opportunity for health care managers and researchers to significantly improve both patient and organisation value. Co–production views the patient as a resource, who contributes to her/his health outcome, rather than a person who simply consumes services. The better patients can co–produce their health outcome the better their health, and the lower their demand for health services.

Workflow in healthcare, particularly for the shared and coordinated management of chronic illnesses, is very difficult to model. It is also difficult to support via current Clinical information Systems and current information technologies. This dissertation contributes significant enhancements to the current methodologies for designing and implementing workflow Management Systems (WfMSs) suitable for healthcare. The contribution comprises three interrelated aspects of workflow system architecture as follows:- Firstly, it shifts the emphasis of workflow modelling and enactment to a focus on goals, and the monitoring and facilitation of their achievement. Secondly, it introduces the concept of self-modifying workflow in the context of health care planning, whereby explicit tasks in the goal-based care plan are devoted to assessing and modifying downstream workflow. Thirdly, this dissertation proposes methodologies for identifying and dealing with tasks which overlap, subsume or interfere with other tasks elsewhere in a given workflow. / PhD Doctorate

Immersed in a context of constrained health resources, nurse managers are at great risk of the experience and negative consequences of values clashes and ethical conflict, such as burnout and attrition. Replicating a qualitative descriptive study previously conducted in Canada (Gaudine & Beaton, 2002) this research is aimed at increasing knowledge of the experience of nurse managers’ ethical conflict with their health care organizations in New Zealand. Semi-structured interviews were used to gather data from eight nurse managers in New Zealand, which was analyzed using a general inductive approach to qualitative research. The experience of advocating for values that may be shared by both nursing and the health care organization, such as safety, teamwork and quality patient care, were revealed in the conceptual category of Nursing Management Advocacy. As with their Canadian study counterparts, Isolation was revealed as a key factor that made the experience of ethical conflict worse and involves the social experiences of silencing, employment barriers and invisibility. Support describes the factors that mitigated the experience of ethical conflict and involves personal, professional and organizational support, and are likewise similar to the experiences of Canadian nurse managers. The Bottom Line describes a focal point of the experience of ethical conflict where the health care organizations predominantly fiscal bottom line was confronted and challenged by nurse managers, and where the nurse manager might reach their own bottom line and choose to leave the organization. Being and Becoming Nursing Leaders describes the outcomes of ethical conflict for nurse managers who were not only transformed into nursing leaders, through learning, reflection, and growth but also counted the costs of nursing leadership. This study concludes that supportive colleagues, organizational structures and culture are essential to mitigating the experience of ethical conflict and isolation which nurse managers encounter. The study also concludes that reducing isolation and supporting nurse managers will ensure that nursing values are appropriately represented and articulated in the health care organization’s decision making systems and processes.

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.