Media analysis of the DHB modelLocal media and local government

Grant Hannis, Beth Houston, Dale Pfeifer

Paper presented by Grant HannisDecember 2004Jeanz conference seminar

What I will cover

• Context for the study• Media and public officials• The DHB model• Research method• The relationship between the media and the DHBs - interviews• Media depictions of DHBs – content analysis• Conclusions

Context

• Three-year study led by HSRC (Victoria University), funded by Ministry of Health, HRC, etc.• Whole process of establishment and running of DHBs• This seminar is a report of work in progress, indicative results

Media and public officials

• Fourth Estate – the most important of all• Debates in fourth estate more comprehensive than debates in Parliament itself• Local govt - frequently few public observers but local govt reporters attend and report

Media and public officials

• Although many commentators interested in media/govt interface, frequently little detail on how exactly this interface operates• Notable exception is Dunn (1969)

Media and public officials

• “Most people, if they have given any thought to the matter at all, instantly recognize that they obtain most of their information about public affairs from the newspaper. They do not have to talk directly with public officials, moreover, to know that policy makers view the press as important.” (1)

• Dunn interviewed media and officials in Wisconsin

Media and public officials

• Media actively engage with policy process: highlight issues, watchdog• Officials regard media as way of informing public, watchdog, and informing officials

Media and public officials

• Officials criticise media for emphasising conflict, lacking objectivity (prefer negative stories), lack of technical/in-depth knowledge• Others have investigated more fully media’s role as watchdog.

Media and public officials

• Public watchdog: In many studies public officials express disdain at the effectiveness of media scrutiny: - Media interested in short term, sensationalism, conflict • Media reps often concede these points, acknowledging need to sell papers and lack time and technical skills

Media and public officials

• Studies often find local community newspapers less likely to feature conflict – create sense of community, boosterism, social position of editor

Media and public officials

• So, what role does NZ news media and officials believe media should play in media/public officials interface?• Is media coverage negative? Conflict-oriented? Lack technical knowledge?• Are there difference in coverage between large and small papers?• Look at these questions with regard to DHBs

The DHB model

• From the late 1930s, NZ’s health care system has been predominately publicly funded.• Up to the 1970s, public hospitals run by hospital boards, by the 1980s elected Area Health Boards established throughout country to provide health care in their areas.• Abandoned in early 1990s in favour of funder-provider split: 4 regional health care authorities (later amalgamated into 1) purchased health care.• This system later abandoned in favour of DHBs, under Public Health and Disability Act 2000

The DHB model

• Central govt establishes over-arching health strategies and objectives• 21 DHBs established (began operation 1 July 2001) to purchase and arrange health in geographic areas• Each DHB governed by 11-person board (4 Govt appointed, rest elected by local community). Elections held during local govt elections every 3 years.

The DHB model

• Each DHB has range of objectives, most notably:- Promote and protect public health- Reduce health disparities- Foster community participation in healthcare provision

• Each DHB must produce a strategic plan and annual plan, to promote health of community, and must seek public input in that process.

• Clearly, media can have a role in this process, as (1) conduit for information to and from DHB, and (2) public watchdog.

Research method

• Our research looks at two DHBs: - Large urban: Capital & Coast (Wellington and Kapiti Coast) - Smaller rural: Tairawhiti (Gisborne) • large urban, smaller rural contrast- Interviews with media and DHB officials, content analysis

Research method

• Interviews conducted in second half of 2004. Spoke to health reporters, editors and DHB chief executives.

• With content analysis, we looked at 11 newspapers: - Wellington large dailies: Dominion, Evening Post- Wellington communities: Cook St News, Independent Herald, Porirua News, Western News, Contact, Kapi Mana News, Kapiti Observer- Gisbrone large daily: Gisborne Herald- Gisborne community: The Bulletin

Period covered: 1 June 2001 to 31 May 2002, covers election and issuing of strategic and annual plans (end of 2001). 380 daily stories, 132 community stories (unit of measurement: one paragraph).

The relationship between media and DHBs – interviews

• What is newsworthy about DHBs? -Media says it will report: good or bad news, consultation (eg, hospital open day, new technology, poor treatment of patients, new proposals)- “What’s the local angle? “Importance to local community?”- DHBs want media to report: health promotion (Smokefree, breastfeeding), safety info (whooping cough vaccines), voice of people (where is money going?).

The relationship between media and DHBs - interviews

• How does the interface work?

- Media: Reporters attend launches, use press releases, read newspapers and listen to radio!, monitor news elsewhere in NZ (matchers), lobbied by health officials (Annette King based in Wellington).

- DHBs: In Gisborne, reporters do attend meetings (“congratulate”, election meeting and 10 showed up), reprint or process press releases (angles, benchmarks, photo ops), matchers. Media seeks conflict. DHBs acknowledge media is very influential – letters to editor, phone calls to CEO. The Artery.

The relationship between media and DHBs - interviews

• Can the relationship be improved?

-Media: Sometimes officials won’t go on the record (eg, criticising working conditions). Sometimes struggle with technical aspects of DHBs (healthcare, budgets) so need more training and resources. Usually, DHBs comms people approachable but busy so can be unavailable.

-DHBs: Tairawhiti says newspapers too soft – don’t dig deeply eg where money is going! Because of lack of resources, family-owned newspaper

Media depictions of DHBs – content analysis

• Is coverage negative, emphasising conflict and poor performance?

Media depictions of DHBs – content analysisCommunities and dailies – mostly neutral

Communities and dailies tone

16%

20%

64%

Negative

Positive

Neutral

Media depictions of DHBs – content analysisCommunities more positive – boosterism? Promoting local area? Close to people involved?

Dailies tone

19%

16%

65%

Negative

Positive

Neutral

Communities tone

10%

28%

62%

Negative

Positive

Neutral

Media depictions of DHBs – content analysis• What do papers cover? Any differences in coverage?

• Themes (based on actual splits in coverage):

Election

Management neutral

Management negative

Management positive

Health outcomes negative

Health outcomes positive

Consultation negative

Consultation positive

Lobby groups

Reducing inequalities

Govt interventions

Media depictions of DHBs – content analysis

• Election figures highly; management near half; consultation only 14% and often negative; reducing inequalities small

Dailies and communities themes

24%

24%

15%

10%

2%

4%

2%

6%

8%

1%

4%

Election

Management neutral

Management negative

Management positive

Health outcomes negative

Health outcomes positive

Consultation negative

Consultation positive

Lobby groups

Reducing inequalities

Govt interventions

Media depictions of DHBs – content analysis

• Positive management: - “Funding for a new hospital for Wellington, including the construction and refurbishment of facilities at Wellington, Porirua and Paraparaumu, was announced by the Ministry of Health last week…’This is the news Wellington has waited 30 years for’”.

• Neutral management:-“If Mrs King and Dr Cullen sign off the plan by the end of the year, construction of the regional hospital should start in the middle of next year and be finished in late 2005.”

• Negative management:- “Following a heated public backlash culminating in a petition with more than 15,000 signatures and a seven-week consultation period the board decided in September to retain the beds.”

Media depictions of DHBs – content analysis

• Negative consultation: - “widespread disquiet over the choice of the site for the hospital”

- “Expert planning advice for Wellington's new regional hospital cost more than $ 3 million”.

Media depictions of DHBs – content analysis• Very similar story with dailies; but communities lots more election coverage and positive consultation news

Dailies themes

19%

28%

18%

10%

2%

4%

1%

4%

8%

1%

5%

Communities themes

38%

14%6%10%

1%

5%

4%

13%

6%

2%

1%Election

Management neutral

Management negative

Management positive

Health outcomes negative

Health outcomes positive

Consultation negative

Consultation positive

Lobby groups

Reducing inequalities

Govt interventions

Media depictions of DHBs – content analysis• Examples of positive consultation news:-“strong and well-developed lobby to the strategic plan around the need for services responsive to young people”- “the expectation is that ‘the public will go to the meetings and tell the representatives about gaps in services. We want to know the consumers’ perspective’. - Election stories:- “Stand and make a difference in the health and wellbeing of our community”-“Voters seeking to make an informed choice will have 2550 words of profiles to get through when voting packs arrive later this month”.- “I intend being an outspoken consumer voice, placing emphasis on socially and financially responsible policies for the board”

Conclusions

• Role played by media- News media says will report news – tautological! Good news/bad news – does much thought go into this?- DHBs want news media to largely be information channel, but even DHB surprised at lack of media questioning. - Resources an issue (time, technical skills), not likely to change soon.

Conclusions

• Nature of coverage- Overall, 2/3rds of coverage neutral, but communities tend to be more positive (safer? Closer to people involved?)- Overall, lot of election coverage, but neutral. Management also major, but again largely neutral or positive. Consultation only 14% and reducing inequalities 1%- Compared to dailies communities do more election coverage and consultation

Conclusions

• Theory and earlier studies supported. Questionable the extent of media watchdog role; especially communities. Resources? Skills? Nature of local papers?

Media analysis of the DHB model

Discussion…