Health managers influencing equitable outcomes

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Josephine Davis
1 June 2022
Bulletin 14

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Health managers influencing equitable outcomes

Managers within healthcare provider services are vital to leading activity that reduces bias and promotes achieving equity of outcomes for communities and populations.1 Furthermore, health managers have significant influence in directing strong organisational policy, staff development, audits, programme focus, and funding to reduce risk for populations who carry the highest burdens of morbidity and premature death.

Implementing change

Opportunities exist within current government-funded programmes to prioritise efforts to obtain equitable outcomes for populations with the poorest health. Care Plus is an example of a specific programme that is available nationally2. With both intention and attention, Care Plus funding can be prioritised to make positive change for Māori, who carry the greatest avoidable chronic disease burdens in New Zealand.3

Regular audits can help shed light on gaps in prescribing and treatments, and support the provision of equitable access to medication and diagnostics for Māori and Pacific peoples. When considering timely access to medications, which door is the right door? How does your organisation ensure that any door is the right door, especially for people who have infrequent or intermittent access – those who do not have transport, or have difficulty connecting with healthcare providers due to their hours of work or not having a telephone? What funding mechanisms can be used to ensure provision of timely prescriptions and medication dispensing to these people?

Leading by example

Racism, in its many forms, is known to have profound negative impacts and directly contributes to health inequities in New Zealand.4 By having clear anti-racist policy and a focus on positive outcomes for defined populations embedded in organisational process, managers can direct behaviours that foster equity. Regular and ongoing staff development is required to build organisational and individual culturally safe practice.

Teamwork vital for equitable outcomes

Equity of access to medications is thought to sit within the clinical scope of practice, however, a whole-of-team approach is required to be intentional about improving equitable medication access and by proxy, patient outcomes. Building trust and nurturing relationships begins with the first point of contact.

Genuine management guidance is crucial to actively reduce bias and improve the health experience for individuals, whānau, and our communities. This is particularly important in the current primary healthcare context of staff shortages, provider and patient wariness caused by COVID-19, and the resulting reduced in-person access to health services.


  1. Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health 2019;18(1):1–17.
  2. Ministry of Health NZ. Care Plus. Updated June 2021 (accessed May 2022).
  3. Ministry of Health. Health Loss in New Zealand: A report from the New Zealand Burden of Diseases, Injuries and Risk Factors Study, 2006–2016. Wellington: Ministry of Health. 2013.
  4. Talamaivao N, Harris R, Cormack D, et al. Racism and health in Aotearoa New Zealand: a systematic review of quantitative studies. NZMJ 2020;133:1521.



Josephine Davis (Ngāpuhi), MN, nurse practitioner, co-leader National Nurse Practitioner & Enrolled Nurse Workforce Programme, School of Nursing, University of Auckland.