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Celebrating 30 years of health services research

Issue date:
Dr Jackie Cumming

Recently we sat down to chat with Dr Jackie Cumming, who is celebrating 30 years of health services research. 

Jackie began working with Te Hikuwai Rangahau Hauora | the Health Services Research Centre at Victoria University of Wellington | Te Herenga Waka, since its formation in 1993, and was director from 2001 to 2019. She took early retirement in 2020 but continues to work with the centre and other colleagues, and to supervise PhD students. She has researched the effects and efficacy of numerous government health reforms during this time, and mentored many students, yet she remains as passionate today about her and her team’s work as she did when she first started her research career.

HRC: For those who might not be familiar with the term, what does health services research involve?

Jackie: The term health services research can be looked at in three parts. First, it can focus on the delivery of services to improve people’s health. Here, we’re interested in not only the difference that a treatment or service has on people’s health, but the experiences of those people who are receiving and delivering the service, and how we can improve the delivery of services to better meet everyone’s needs. The other part that often gets lost in the terminology involves looking at the health system itself. How, for example, is the system as a whole working to achieve its goals of improving people’s health, being equitable and managing limited resources efficiently? The third part relates to methodology and methods – health services researchers can bring their skills to a huge range of research questions in health. 

HRC: How did you get into this area of research?

Jackie: I came into this field of research from a background in economics and public policy. I was working at the Department of Health in the early 1990s when the government at the time was reforming the health system, including changing the way that user charges worked in primary care. When Te Hikuwai Rangahau Hauora | the Health Services Research Centre was established, its initial focus was to investigate whether these health reforms were working or not, and that was something I was eager to know. I began at the centre as a research fellow and later went on to get my PhD. For the whole time I worked at the centre, and to this day, I’ve received funding from the Health Research Council, either as a lead researcher or as part of a project with others, and that’s something I’m incredibly grateful for. When I started, I never envisaged that I would still be here 30 years later!

HRC: What health reforms have you been involved in researching over the years? 

Jackie: We’ve worked on five major health reforms (and tweaks within each of those). I began by researching the 1990 health reforms, which included the establishment of Regional Health Authorities (RHAs). Other reforms have included the replacement of the RHAs with a centralised Health Funding Authority, the establishment of the district health boards (DHBs), the introduction and implementation of the Primary Health Care Strategy, and the setting up of the current health system model. I’ve also been involved in projects looking at specific aspects of health services, such as financing, access, and service integration. 

HRC: How influential has the centre’s research been?

Jackie: I think our research over the past 30 years has helped change people’s thinking about how likely it is that health reforms themselves will make a difference, and what it takes to improve the system’s performance. For example, our work on district health boards was important to understand the strengths and weaknesses of that system, while our primary healthcare research has been aimed at understanding what supports positive change. 

It’s important to do this type of research so we have a clear idea of what the goals are of any health reform and how these goals are tracking; if the government is doing what it said it was going to do (and if not, why not?); what things we are improving on – and what we need to do better. Linking back into the policy environment enables us to have the biggest impact as this ensures that the research is known and understood and can therefore influence what’s going on. 

Health equity has been a huge focus for the centre – how equitable is our funding for health services in terms of who gets what services, and where these services are located – as well as the effectiveness of different models of primary healthcare services. These are incredibly important questions to answer. I’ve learned so much about Māori health and the importance of honouring Te Tiriti o Waitangi, and I’m grateful to my wonderful Māori colleagues for their support. I’ve also been working with some dedicated Pacific colleagues on Pacific health issues, including integration of services for people using many services, and COVID-19. 

HRC: What have you enjoyed most about this area of research?

Jackie: I’ve been incredibly lucky to meet and work with many amazing people across different parts of the health system from policy to those working on the ground delivering the health services and those using those services. I’ve also been privileged to supervise PhD students on various research projects. I’ve seen 24 students successfully complete their PhDs since I got my own in 2003. It’s so rewarding to watch people grow during their studies, and their research is important to our understanding of specific parts of the health system. 

Another thing that was unexpected was how much researchers and policymakers in other countries like Australia, Canada, and the United Kingdom want to know about how things work and change in Aotearoa New Zealand. We’re seen as an important source of ideas and knowledge. As a result of this, we’ve been able to build strong relationships with some amazing international researchers.

HRC: What change would you like to see in health services research going forward?

Jackie: I haven’t found it easy over the past 30 years, with ups and downs in funding and projects, and colleagues coming and going. I’d really like to see a greater focus on supporting research careers, recognising that people don’t just work on projects, they work on building a body of knowledge and research methods expertise over time. This would also have the advantage of supporting researchers to keep strong relationships with policymakers at all levels.