How health care is best provided remains topical, contentious, and political. Debates continue over funding allocation and the weighting placed on preventive, curative, institutional and community services. Such debates were evident in 1973 when a new Federal Labor Government began to reform Australia's health system by implementing a national Community Health Program policy. Implementation led to the establishment of community health centres and multi-disciplinary teams. Studies have generally concluded that community health centre teams have ???failed??? to achieve the goals of this policy. This study sought to answer one broad question. How was the community health program policy implemented, in what context did this event occur, what processes were used and why, and how did generalist community nurses participate? This case study of the Hunter Region, New South Wales, between 1974 and 1989, was based on data collected from four sources: over five hundred documents and archives, including relevant literature, epidemiological studies, centre records, official government and newspaper reports; 69 in-depth interviews with practitioners and administrators; and participant observation. The findings revealed that implementation was hindered by political, administrative and professional impediments. However, practitioners established and provided a broad range of relevant new services by changing the way they practised. Generalist community nurses worked with non-government, private and public organisations offering health, educational and social services. As boundary riders they filled structural holes and created social capital. Conclusions drawn were first, that context strongly influenced how public health policies were implemented and the services offered by different discipline groups. Second, teamwork would have been improved had pre-service health professional education fostered a common understanding of the aim of health care and the broader determinants of health. Third, a preventive orientation needed reinforcing via an organisational context, administrative processes, ongoing learning opportunities and leadership. Fourth, generalist community nurses??? commitment to a preventive approach was embedded in a growing understanding of people's circumstances and health problems. Finally, while policy implementation was constrained in the Hunter Region during the study period it achieved what its architects intended, that is, a broader mix of accessible services, and collaboration between organisations and groups as the boundaries that maintained their separation were bridged.
| Identifer | oai:union.ndltd.org:ADTP/282048 |
| Date | January 2006 |
| Creators | Schulz - Robinson, Shirley, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. School of Public Health and Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Shirley Schulz - Robinson, http://unsworks.unsw.edu.au/copyright |
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