Electing New Zealand's Health Governors: Do elected board members have the appropriate knowledge, skills and experience to govern district health boards?

Abstract

The manner by which a health system is governed impacts upon the delivery of health services. New Zealand has a decentralised health system featuring twenty district health boards (DHBs) that are responsible for ensuring the provision of regional health services. Each DHB is governed by a board typically comprised of four appointed board members and seven elected board members. Appointed board members are selected by the government, and must be deemed to have the appropriate knowledge, skills, and experience. On the other hand, elected board members are chosen by the public in triennial DHB elections. Aside from some statutory disqualifiers, there are no prerequisites to standing in these DHB elections.

Objectives: This dissertation contributes to the debate on whether elected board members have the appropriate knowledge, skills, and experience to govern DHBs. This dissertation describes the past experiences of elected DHB board members and identifies which of these past experiences are associated with successful candidacy. This dissertation also explores whether elected and appointed DHB board members perceive that they have the appropriate knowledge, skills, and experience to govern DHBs.

Methods: The past experiences of elected DHB board members were assessed through an analysis of the candidate profiles submitted prior to DHB elections. Then, the association between these past experiences and the outcome of DHB board candidacy was studied through logistic regression. Finally, all current DHB board members were invited to participate in a short survey focused on DHB governance.

Conclusions: According to their candidate profiles, elected DHB board members have a range of past experiences, with the most common being past DHB board membership. Of the past experiences identified, past DHB board membership, past service as an elected representative, and experience as a doctor or a nurse were associated with increased odds of success in at least two of the past three DHB elections. Conversely, past experience in both health and non-health related business and management was associated with decreased odds of success in at least one of the past three DHB elections. Regarding the perceptions of current DHB board members, most elected and appointed DHB board members perceive themselves to have the appropriate knowledge, skills, and experience to govern DHBs. Some appointed DHB board members are, however, sceptical of the competence of their colleagues, particularly those that are elected DHB board members.