Clinical Practice Framework


The Treaty of Waitangi is acknowledged widely as a platform for building partnerships between mainstream health providers and Iwi Maori Hauora. The principles of Partnership, Participation and Protection are renowned in health service delivery as a pathway forward. Te Tai Tokerau PHO have introduced an enhanced practice engagement framework by extending the common three P’s to include a new ‘P’ trio – focusing on People, Places and Processes.

Over the years, health services have focused heavily on improving service and population capability. This development is reflected in cultivating a range of service supports, such as Staff competence, to targeted programs of activity through to data capture and evaluation. Within Whanau and community, building capability is found in strengthening access, education opportunities, healthy living supports and a host of other building blocks.

Despite this capability development, poor health outcomes for northlands rural population have persisted. Poor health outcomes for Maori relate to cardiovascular disease, Rheumatic fever, Cancers, Gout, Chronic Respiratory disease, Sudden Infant Death Syndrome, Mental health issues, Suicide.  We challenge the notion that the more important capability development is the one targeted at connection, between People, Places and Processes.

Disparity in Life Expectancy:


New Zealand


Non Maori


Non Maori












These demographics within Northlands rural population remain a key driver for reducing health inequalities for Maori by improving relationships between mainstream health services and Iwi Maori health providers and  to create bridges for improved collaboration and effective health service delivery.

A bridge could be used as a metaphor for describing the connection between the population and health services. The goal of service delivery is to focus on influencing every relationship positively, to ‘create and facilitate opportunities that allow processes of connection to occur’ – (Whanau ora).

‘The New Zealand Medical Association  #Statement for Best Practice when providing services to Maori’, strongly advocates that improved engagement with Maori improves trust in therapeutic relationships, where the practitioner gains increased information and is able to negotiate differences better, through improved communication. The patient in turn has improved satisfaction of service, is more compliant with treatment, ensuring better health outcomes. The People, Places and Processes framework offers a  challenge at the interpersonal level, calling for genuine, authentic therapeutic relationships to assist the breakdown of barriers to service.

This paradigm shift focuses on People, developing robust interactions and the culturally relevant platform on which these interactions occur. Engagement progresses to deliver the RIGHT services in a variety of accessible and appropriate settings for the whanau, utilising Processes to enhance engagement and improve health outcome.

It is on this point that Te Tai Tokerau PHO emphasises Building Relationships through the People Places and Processes framework. Secondly it is Maintenance of Relationships, to improve and sustain relationship capability. In metaphorical terms it is a test of how well the bridge remains in tact over extended periods of time, affected by tidal challenges and other environmental impacts. In real terms it is overcoming silo practices and fragmentation with a thrust towards seamlessness and ‘whanau ora’.