A Round Peg in a Square Hole: Changes in a Rural Health Service

The cultural partnerships which have been formed as a result of the decision to restructure a rural health service are discussed here. Previously, some aged care services and allied health staff in hospitals were responsible to the medical superintendent, and community health services answered to hospital chief executive officers in each location. The organisational principles, key elements of the structure, and changes in management are analysed using change management and primary care literature. The changes have been implemented within the context of several health cultures, which are often not only different by definition, but are also in direct competition with each other. Twelve months after restructuring the service, staff have responded positively to the changes so that now a partnership exists between management and staff. It is clear, however, that primary socialisation had made it difficult for the system to cope with these changes. Funding of primary health care remains an issue, and although there is an increasing reliance by medical services on the primary health care service system, there has not been a corresponding shift in resources. Changes have been significant at the local level, although much remains to be resolved before the health service becomes a health promoting service rather than a medically dominated sickness service.