Between reform and reality: institutional logics of data and digital in New Zealand’s health system transformation
DOI:
https://doi.org/10.47989/ir31iConf64137Keywords:
Health data, Health policy, Institutional logicsAbstract
Introduction. We report on an investigation into the strategic role of data in improving health equity during Aotearoa New Zealand’s 2019–2025 health reforms, using institutional logics to uncover stakeholder differences and barriers.
Method. Semi-structured interviews were conducted with fourteen professionals involved in the strategic use of health data and technology. Participants included government IT/data policy leads, senior IT/data leaders, Māori data governance experts, general practitioners, and IT health industry representatives.
Analysis. We identified a framework of eight institutional logics shaping stakeholders’ visions of data ideals: public good/equity logic, bureaucratic logic, market logic, professional logic, innovation logic, indigenous sovereignty logic, liberal-individual rights logic, and national sovereignty logic.
Results. Tensions between differing logics surrounding the ideal role of data in system reform help explain implementation challenges. These included balancing individual and collective data sovereignty and contrasting views on ownership of patient data as a public, commercial or professional good.
Conclusion(s). Whilst national shared systems have potential to increase equity through improved data flow, key implementation issues can be explained by a legacy of health data power struggles embedded in different institutional logics, intensified by fragmentation and underinvestment. Adaptive governance is needed to balance logics in delivering the vision for transformation.
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