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In 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited.

We develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF.

Policy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis. When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably.

This article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health.

This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.

The study aims to estimate the prevalence of workplace bullying, personal and work-related impacts, reporting practices for bullying, and the reasons for not reporting bullying incidents in the New Zealand pharmacy sector.

An online survey was conducted among registered pharmacists and pharmacist interns in New Zealand from June to August 2020. The questionnaire comprises both close-ended and semi-structured free-text questions. Goldberg’s 12-item General Health Questionnaire (GHQ-12) assessed the respondents’ general psychological health status, and a 22-item Negative Acts Questionnaire-Revised (NAQ-R) was used to estimate bullying prevalence together with the self-rated/self-labeled questions. The qualitative information obtained from the free-text responses was used to support and elaborate on the quantitative results.

The self-labeled prevalence of workplace bullying was 36.9%, with almost 10% reporting it occurring almost daily to several times per week. The 54.7% prevalence based on the NAQ-R assessment compares well with the prevalence of witnessing the incidents (58.5%). Psychological distress symptoms were experienced by 37.1% in pre-COVID and 45.3% during COVID-year 1. Supervisors or direct managers were the commonest perpetrators (32.7%). Only 28.8% of those who experienced bullying had reported the incidents formally.

This study is cross-sectional, and the relationships indicated are bi-directional. The consistency of the results is reassuring, however inferring causality of effect is challenging. Future studies and analyses should focus on this. This study suggests that in the pharmacy environment bullying from the top is reasonably prevalent, is not commonly reported and requires the design and implementation of prevention and management strategies that take into account and mitigate these bullying factors. Professional pharmacy leadership organizations, National Health Authority and Pharmacy regulators could play a significant role in awareness and training to reduce bullying with the development and promotion of strategies to curb it and improve reporting.

This is the first paper to describe the prevalence and impact of workplace bullying, and the practices of reporting bullying incidents in the New Zealand pharmacy sector. Based on empirical evidence, pharmacists represent a small share of total healthcare workforce, yet the overall prevalence of bullying is consistent with professions with much larger numbers such as medicine and nursing.