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Reducing health inequalities has been part of the New Zealand government's agenda since the early 1990s. As a result, interventions have been implemented nationally with the explicit goal of reducing health inequalities. This paper describes findings from a comparative case study of two community-based interventions - carried out in different New Zealand communities. Complexity theory was used as an analytic tool to examine the case data, and provided a systematic way in which to explore 'local' issues by taking a 'whole system' perspective. The findings showed that two important influences on the successful implementation of the interventions were the existence and capacity of local organisations and their relationships with government agencies. The analysis provided a dynamic picture of shared influences on the interventions in different communities and in doing so offered insight into intervention effectiveness. It is argued in this article that, for examining intervention effectiveness, it is essential to have a theoretical understanding of the behaviour of the complex system in which they are implemented. This theoretical understanding has implications for the appropriate design of interventions to reduce health inequalities, and in turn should lead to more meaningful ways to evaluate them. [ABSTRACT FROM AUTHOR]

To explore the attitudes of clinicians working in New Zealand publicly funded hospitals towards prioritizing patients for elective surgery, and their reported use of clinical priority assessment criteria (CPAC).A cross-sectional study using a postal questionnaire. The questionnaire drew on themes identified from an earlier qualitative study. Questions were closed and information was sought about perceptions of the need to prioritize patients, effective ways of doing so and the use of CPAC.New ZealandA national sample of cardiologists, cardiac, general and orthopaedic surgeons, and registrars.Three hundred and thirty-two clinicians responded to the survey (74.1%). Respondents generally agreed that a nationally consistent method of prioritizing patients for surgery was required but felt their clinical judgement was the most effective way of prioritizing patients. Current CPAC were considered to be administrative tools and there was marked variation in their reported use. Consistent use of CPAC using the constructs provided was more likely to be reported by cardiac specialists than general or orthopaedic surgeons. Other features of the hospital system in which surgeons worked also had a major impact on access to elective surgery.Clinicians recognized the need for a nationally consistent method of prioritizing patients. Although most did not consider current CPAC were effective in achieving this, many felt there was some potential in further development of tools. However, further development is problematic in the absence of objective measures of need and ability to benefit. [ABSTRACT FROM AUTHOR]