Health Policy 93 (2009) 118–127 Contents lists available at ScienceDirect Health Policy journal homepage: www.elsevier.com/locate/healthpol Implementing new modes of governance in the New Zealand health system: An empirical study Pauline Barnett a,* , Tim Tenbensel c , Jacqueline Cumming b , Clare Clayden b , Toni Ashton c , Megan Pledger b , Mili Burnette b a Health Sciences Centre, University of Canterbury, Christchurch, New Zealand b Health Services Research Centre, Victoria University of Wellington, New Zealand c School of Population Health, University of Auckland, New Zealand article info Keywords: Health system governance Health reform abstract Health governance internationally has become more complex, with both hierarchical and network modes of governance explicitly represented within single public systems. Objective: To understand the implementation of new modes and mechanisms of gover- nance under New Zealand health reforms and to assess these in the context of international trends. Research methods sought data from key groups participating in governance policy and implementation. Methods included surveys of board members (N = 144, 66% response rate), interviews with chairs (N =14) and chief executives (N = 20), and interviews with national policy makers/officials (N = 19) and non-government providers and local stakehold- ers (N = 10). Data were collected over two time periods (2001/2002; 2003/2004). Analysis integrated the findings of both qualitative and quantitative methods under themes related to modes and mechanisms of governance. Results indicate that a hierarchical mode of governance was implemented quickly, with mechanisms to ensure political accountability to the government. Over the implemen- tation period the scope of decision-making at different levels required clarification and mechanisms for accountability required adjustment. Non-government provider networks emerged only slowly whereas a network of statutory health organisations established itself quickly. Conclusion: The successful implementation of a mix of governance modes in New Zealand 2001–2004 was characterised by clear government policy, flexibility of approach and the appearance of an unintended network. In New Zealand there is less tendency than in some other some other small countries/jurisdictions towards centralisation, with local elections and community engagement policies providing an element of local participa- tion, and accountability to the centre enhanced through political rather than bureaucratic mechanisms. © 2009 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Health Sciences Centre, University of Can- terbury, PO Box 4800, Christchurch 8104, New Zealand. Tel.: +64 3 364 3692; fax: +64 3 364 2490. E-mail addresses: pauline.barnett@xtra.co.nz, pauline.barnett@canterbury.ac.nz (P. Barnett). 1. Introduction In the New Zealand public health system, governance has reflected international trends in New Public Man- agement (NPM). Initially NPM governance models were characterised as maintaining accountability through strong agency relationships and corporatised and quasi-market 0168-8510/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2009.06.004