Hospital Restructuring: Patient Outcomes and Nursing Workforce Implications




Health Research Council of New Zealand


Peter Davis, Roy Lay-Yee


University of Auckland: Alastair Scott

University of Otago: Robin Gauld


This study aimed to evaluate the impact of various reforms in the 1990s on the hospital sector, specifically looking at issues of:

  • Bed supply – what was the scale of reduction?
  • Bed closures – what was the impact on patterns of care?
  • Activity – was throughput diminished?
  • Vulnerable groups – was their access reduced?
  • Quality of care – were patient outcomes compromised?

Our role came later in the project and was analytical in focus. Performance measures were derived from the National Minimum Data Set (NMDS) and linked mortality data from the New Zealand Health Information Service (NZHIS) – a total of 34 secondary or tertiary public hospitals were involved, with nearly 7 million records.


Hossain M, Graham P, Gower S, Davis P (2003). Hierarchical generalised linear models with time-dependent clustering: assessing the effect of health sector reform on patient outcomes in New Zealand. Health Services & Outcomes Research Methodology 2003(4): 169–186.

Davis P, Lay-Yee R, Scott A, Gauld R (2008). Do hospital bed reduction and multiple system reform affect patient mortality? A trend and multi-level analysis in New Zealand over the period 1988–2001. Medical Care 45: 1186–1194.