Ngā ara hou ki te ora | New pathways to wellbeing

Modelling healthcare delivery and optimising for wellbeing, justice, equity, and efficiency.

The need and impact

Equitable access to healthcare services, and timely transition to the next level of care for those patients who need it are essential for health and wellbeing, and primary health care is the foundation for health services. Persistent failures to provide such access, not least “…the Crown’s failure to provide primary health care to Māori consistent with the principles of Te Tiriti o Waitangi…” requires critical attention.

How can we best improve healthcare, given that budgets are constrained? How can we improve equity of access to healthcare? What are the best measures of success for our healthcare services?

The changing demographic profile of GPs gives added urgency to this future planning. The Royal New Zealand College of General Practitioners workforce survey for 2017 reported that 47% of respondents planned to retire within the next 10 years.

This project identifies measures of success for the provision of primary and emergency health care services, which are the first points of contact to health care services for most patients, and develops ways in which resource allocation can be adjusted to improve those measures of success. We work with St John’s Ambulance, Emergency Departments at Auckland, Waitemata, and Waikato DHBs, and GP networks as well as groups of patient stakeholders.

The project delivers case study examples to illustrate the tools and methods that will be developed in the course of the project, providing a resource for stakeholders seeking to develop and improve primary care access. The work on performance measures and incentives will influence policy.

The approach

This project will develop mathematical modelling, simulation, and optimisation methods and tools, grounded in both mainstream and Māori conceptual frameworks. These will support capacity provision, allocation, and deployment decisions, for primary and emergency services, both in longer term capacity provision, and shorter-term capacity allocation. A central part of this project will be to determine desirable outcomes for these services, and measures of success in their delivery, that are appropriate for Aotearoa New Zealand.

Research aims

  • What are desirable outcomes for Primary and Emergency services? What should we optimise?
  • Māori worldviews prioritise aspects of wellbeing differently from non-Māori and need to inform our models and optimisation.
  • What is the right structure for these services? How can the delivery structure assist in improving access?
  • What are the right incentives? As an example, the quality of healthcare provision is often measured by reporting the percentage of patients waiting longer than a target time. This has potential to create undesirable side effects.
  • How are outcomes best measured? The choice of performance indicators can have a strong effect on system behaviour.
  • What data are available to assist decision making? What still needs to be gathered?


  • Associate Professor Ilze Ziedins (Project Lead)
  • Associate Professor Krushil Watene
  • Associate Professor Cameron Walker
  • Dr Marama Muru-Lanning
  • Associate Professor Michael O’Sullivan