The impact of the rural hospital medicine vocational scope on the Hokianga Health service

Introduction and Aim Rural Hospital Medicine was recognised in New Zealand as a vocational scope of medical practice in 2008. The intention was to provide recognised standards of training and professional development for doctors working in rural hospitals and to encourage quality systems to become established in rural hospitals. Hokianga Health is an integrated community owned health service including a hospital in the far north of New Zealand, serving a rural Māori community. The aim of this thesis was to explore the impact of the Rural Hospital Medicine scope at Hokianga Health. Methods A case study design using qualitative methods comprising a document analysis and interviews was chosen. A thematic analysis of key documents tracking change and development at Hokianga Health was undertaken. Twenty-six documents (ten internal and sixteen external to Hokianga Health) were included. Eleven individual semi-structured interviews were undertaken with past and present employees of Hokianga: eight were medical practitioners, three were senior non-medical staff. The interview explored the participant’s view of the Rural Hospital Medicine scope of practice. Interviews were recorded and transcribed. Thematic analysis of the interviews was undertaken. The two data sources were analysed separately followed by a process of convergence and corroboration of findings. Results Before 2008 there was a mismatch between the scope of medicine practiced at Hokianga and available medical training and professional development programmes: the hospital aspect of practice fell outside the General Practice scope. This created a vulnerability for individual practitioners and the hospital service. The Rural Hospital Medicine scope brought a specific focus to hospital practice and thus validation of this aspect of the medical practitioners’ work. The Rural Hospital Medicine and General Practice scopes together provided the right fit for medical practice at Hokianga. The strengthening of clinical practice and improved scope of services resulting from the alignment with Rural Hospital Medicine and the associated rural hospital regulatory policy, systems and processes, strengthened clinical safety and thus the viability of the hospital service. The Rural Hospital Medicine movement also strengthened Hokianga Health’s external strategic alliances helping to create a sense of belonging, and facilitating alignment with the changing external regulatory environment including nomenclature. Challenges resulting from the Rural Hospital Medicine scope at the individual practitioner level mirrored those at the health service level: rural practitioners and the rural hospital service attempting to deliver to regulatory systems and processes that had not been set up with their scope of practice and model of care in mind. Conclusions The new vocational scope of Rural Hospital Medicine enabled the strengthening of both clinical practice and wider quality systems and standards at Hokianga Hospital, thus meeting the intentions of the new scope. In highlighting wider challenges to rural health the study supports the notion that New Zealand implements a process of rural health impact assessment. Though focused on one rural health service, findings are applicable to other rural health services in New Zealand and internationally.