Consumer involvement in health service decision making under the Health Services Amendment Act 2004 NSW
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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- Internationally, there has been growing interest by governments in consumer involvement in all areas of decision making over the last three decades. Consumer involvement has been seen as a method to address rising public concern over accountability, democracy and governance issues. In relation to health services, consumer involvement has also been driven by the concept of patient-centred care. The aim here is to improve the safety and quality of health services by being responsive to individual patient demand. In order to address accountability, democracy and governance concerns, most jurisdictions have enacted legislation mandating that citizens be appointed to health service governance and/or advisory committees. Evaluations suggest that this method of involvement is largely unsuccessful. Outcomes that are more successful have been achieved through projects measuring patients’ experiences of health services. Mirroring international developments, the New South Wales (NSW) parliament enacted the Health Services Amendment Act in 2004. This Act imposed a statutory duty upon area health services (AHSs) to establish area health advisory councils (AHACs), made up of consumers and clinicians, who advise the area chief executive on health service decision making. The recency of the legislation means that there is a lack of research on the NSW model. The enactment of the NSW legislation raises several issues worthy of research. Firstly, is the new legislative framework for consumer involvement consistent with the theoretical aims and regulatory responses to those aims of consumer involvement in health service decision making? Secondly, are there new and emerging aims in NSW Health that are not in existing models and literature? Thirdly, how are stakeholders using and negotiating the aims and regulatory responses in NSW? Fourthly, how can the aims and regulatory responses, and tensions between them, inform the regulation, implementation and practice of consumer involvement? These issues form the research questions for this thesis. This study has analysed a variety of data including legislation, policy documents and grey literature from jurisdictions with similar system of health service delivery to NSW in order to ascertain the aims, and regulatory responses to those aims, of consumer involvement in health service decision making. In addition, 76 semi-structured interviews have been conducted with various stakeholders associated with the Health Services Amendment Act 2004 NSW. Data were analysed using semantic discourse analysis (Iedema 2003; Iedema, Mallock, Sorensen, Manias et al. 2008). Based upon this analysis, the argument advanced in this thesis is that the Health Services Amendment Act 2004 NSW has failed in its stated aim of increasing consumer involvement in health care decision making. The main proposition advanced in support of this thesis is that the Health Services Amendment Act 2004 fails to facilitate and link with patient experience-based activities, currently emerging as the primary building block for increasing consumer involvement in health service decision making. Considerations to inform the future regulation of consumer involvement are submitted.
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