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Purpose: The purpose of this paper is to lay out how advanced practitioner development occurs in New Zealand primary health care settings. The paper specifically focuses on mechanisms occurring across policy creation and in practice leading to successful role development., Design/methodology/approach: The authors applied a realist approach involving interviews, document review and field log observations to create refined theories explaining how successful development occurs., Findings: Three final mechanisms were found to influence successful advanced practitioner role development: engagement in planning and integrating roles; establishing opportunities as part of a well-defined career pathway; and championing role uptake and work to full scopes of practice., Research Limitations/implications: This research focuses on one snapshot in time only; it illustrates the importance of actively managing health workforce change. Future investigations should involve the continued and systematic evaluation of advanced practitioner development., Practical Implications: The successful development of advanced practitioner roles in a complex system necessitates recognising how to trigger mechanisms occurring at times well beyond their introduction., Social Implications: Potential candidates for new roles should expect roadblocks in their development journey. Successfully situating these roles into practice through having a sustainable and stable workforce supply provides patients with access to a wider range of services., Originality/value: This is the first time a realist evaluation has been undertaken, in New Zealand, of similar programmes operating across multiple sites. The paper brings insights into the process of developing new health programmes within an already established system.

Institutional entrepreneurs are vital for facilitating non-incremental health policy change in complex institutional settings where established traditions and practices carry considerable weight. This paper describes a comparative case study of health policy-making which shows that Kingdon's Multiple Streams Framework for non-incremental policy change requires enhancement to explain results in policy-making in two Westminster unitary majoritarian jurisdictions. The most similar systems comparative study found that historical, rational choice, organisational and discursive institutionalist approaches explained the policy change and variation observed better than agency-based approaches did. However, institutional entrepreneurs were important in both cases. Differences in coordinative discourse help to explain the differences in degree of change achieved in each case study and highlight the importance of discursive institutionalist approaches in bridging institutional and agency-based approaches. [ABSTRACT FROM AUTHOR]

Background: In order to profile the health services research community in Australia and New Zealand and describe its capacity, a web-based survey was administered to members of the Health Services Research Association of Australia and New Zealand (HSRAANZ) and delegates of the HSRAANZ's Third Health Services Research and Policy Conference. Results: Responses were received from 191 individuals (68%). The responses of the 165 (86%) who conducted or managed health services research indicated that the health services research community in Australia and New Zealand is characterised by highly qualified professionals who have come to health services research via a range of academic and professional routes (including clinical backgrounds), the majority of whom are women aged between 35 and 54 who have mid- to senior- level appointments. They are primarily employed in universities and, to a lesser extent, government departments and health services. Although most are employed in full time positions, many are only able to devote part of their time to health services research, often juggling this with other professional roles. They rely heavily on external funding, as only half have core funding from their employing institution and around one third have employment contracts of one year or less. Many view issues around building the capacity of the health services research community and addressing funding deficits as crucial if health services research is to be translated into policy and practice. Despite the difficulties they face, most are positive about the support and advice available from peers in their work settings, and many are actively contributing to knowledge through academic and other written outputs. Conclusion: If health services research is to achieve its potential in Australia and New Zealand, policy-makers and funders must take the concerns of the health services research community seriously, foster its development, and contribute to maximising its capacity through a sustainable approach to funding. There is a clear need for a strategic approach, where the health services research community collaborates with competitive granting bodies and government departments to define and fund a research agenda that balances priority-driven and investigator-driven research and which provides support for training and career development. [ABSTRACT FROM AUTHOR]