Why effective pathology leadership matters, lessons from New Zealand

New Zealand’s pathology services face significant challenges including fragmented governance, workforce shortages exacerbated by pay inequities and low domestic training, outdated infrastructure, and the need for unified national leadership and strategic planning. Recent progress has been marked by collaboration between New Zealand Institute of Medical Laboratory (NZIMLS), Health NZ, and the Ministry of Health aiming toward national governance and improved service delivery. SelectScience^® speaks to Terry Taylor, past president of the NZIMLS Council to find out more. Taylor is a specialist medical laboratory scientist with over 30 years of experience in hematological malignancy diagnostics and autoimmune immunology at Dunedin Hospital. He is recognized nationally and internationally for expertise in clinical flow cytometry and active advocacy for pathology workforce wellbeing, sector stability, and infrastructure investment.

SelectScience: What do you see as the biggest challenges currently facing pathology services in New Zealand?

Terry Taylor: Undoubtedly not having true national operational governance is a huge barrier. Currently New Zealand (NZ) has no formal governance, leadership and control over publicly funded Pathology services. Unbelievably we still operate under an adhoc historical fragmented setup that relies on a mix of public and private providers who basically do whatever they deem appropriate for their own business and separate funding models.

For a country with just over 5 million people to have a provider setup that has a mixed model of service delivery with no significant formal oversight and control from the government organization that provides the Pathology funding is simply beyond belief.

Publicly funded pathology is not a license to print or waste public money. NZ is in the grips of a very tough and demanding financial environment. Undoubtedly there needs to be the realization that our future structure needs to encompass service consolidations and big decisions around what is publicly funded and what isn’t. Plus, where our specialist service centers are and how best to juggle this expertise. In my mind, the funding landscape is outdated and ineffective and we need a full reset to put in the most effective national model of service provision. Politically this is difficult ground but the risk of doing nothing is now out in media constantly for everyone to see.

Priorities for the pathology workforce

SelectScience: How has your work with the NZIMLS Council and the Ministry of Health helped shape national pathology policy?

Terry Taylor: Since the formation of the national health entity Health NZ Te Whatu Ora (HNZ) in 2022, HNZ have effectively taken over the operational governance of publicly funded health care and the Ministry of Health Manatū Hauora (MOH) taken up a non-operational and stewardship role.

Before 2022 the MOH did oversee almost all health issues and the NZIMLS was proactively involved with meeting, advocating and working with the MOH during the difficult Pandemic period and the early stages of the national health reform process. The NZIMLS had to proactively create a niche for oversight of Pathology to address the inherent engagement and governance neglect that the sector was facing. I will stipulate the challenge in this way, not everyone involved in Pathology service delivery in those early days wanted our professional voice anywhere near the prevailing narrative. Stakeholders at that time were very happy with the financial windfall from having little oversight control and professional input in Pathology services. Those of us with a patient and workforce view of course were very aware of the rumblings that would all bubble to the surface with vengeance as predicted over 2024 and 2025.

In short all of our persistent meetings and discussions with both MOH and HNZ leadership have seen incorporation of many of our initiatives into significant national health plans and documentation. However as explained above, we simply do not have the national leadership and governance control to drive these changes into true Pathology service and workforce strategy.

That is a massive frustration for people like me who sit in rooms with health leaders and politicians frantically nodding when I talk about the positive potential of incorporating foundation priorities and strategies for our national service provision.

Future proofing the pathology workforce

SelectScience: What are the key priorities for stabilizing and future proofing the pathology workforce?

Terry Taylor: The first priority is recognition of the need for planning and ring-fenced funding to incorporate a long-term workforce plan that sees our universities, training institutions and operational providers and with clear pathways and responsibilities. The reoccurring theme is ad hoc setups without any national oversight or long term direction.

We simply must train our own people first and foremost. Medical laboratory science as a profession has the lowest uptake of Māori and Pacifica practitioners for a start. Due to the traditional low pay across many of our lab providers there is always the big temptation to go ‘shopping’ overseas for cheaper alternatives to keep services running. This is a fraught situation which has amplified our national predicament. Our training institutions are suffering, and the workforce mix regards experience and specialists has left significant vulnerabilities across many of our laboratories.

We have lost more than our share of experienced older and talented young practitioners to other industries and vocations plus to Australia and wider afield. All due to the lack of direction, certainty and questionable provider policies regarding pay and work conditions.

Without doubt the successful gender inequality pay equity claims that were settled for the publicly controlled laboratories back in 2023 is a massive issue. More than half of our laboratory workers earn up to 30% less than those who benefited from the 2023 settlement. Remembering these workers all do the same roles but are paid significantly less. In 2025 we now have what is effectively a two-tier system depending on whether you are in a public or private laboratory. Remember that the outsourcing contracts that regions operate under mean in many parts of NZ there is no choice of hospital laboratory provider to work for. It will undoubtedly be the first task of any future national governance leadership and structure to address this disparity.

Infrastructure investments for pathology

SelectScience: What infrastructure investments are most urgently needed to support pathology

Terry Taylor: Most of our hospital laboratories are in desperate need of facility upgrades. The days of shunting laboratories to the furthest away space that no one else wants are well over. I have consistently lobbied and pushed for a national plan regarding laboratory upgrades and new builds. There is now a national infrastructure emphasis and planning within HNZ and it is pleasing to see this commitment spreading into our sector.

It hasn’t been easy but the debacle over the Dunedin hospital rebuild ‘forgetting’ to allocate a fit for purpose Pathology laboratory has helped us in this space. This was one example of how media coverage helped to get us in the door about these issues.

One of the positive changes that has come from our past ad hoc laboratory service consolidations has been this. Many of our regional centers now only have one hospital laboratory which is effectively a one stop shop. All hospital and community Pathology services from across those regional and urban centers are consolidated into one service. This instantly curbs duplication and ensures no more staffing double-ups. Once we are all under the same governance and leadership (wishful thinking), the expectation is that this will happen across the remaining regional centers that still provide separate hospital and community Pathology services. Talking to health and political leadership regards this also sees nodding and acknowledgment that this is a good idea!

Lessons for other pathology leaders and healthcare systems

SelectScience: What three key lessons can other pathology leaders and healthcare systems learn from the challenges faced by New Zealand pathology services?

Terry Taylor: Pathology services are critical to a functioning health system. This criticality needs to be matched by our direct involvement within national operational health leadership. Strong consistent leadership and governance will ensure that service provision, workforce stability and development and most importantly of all, patient outcomes are positively impacted.

Unfortunately, in NZ, it has taken a pandemic followed by amplification of historical service and workforce issues that have caused angst at the highest level of health and political leadership, to promote change.It may seem very simple for system and strategy people like me to fix but there are many competing distractions and interests that will consistently block any progress. Collaboration but most importantly, persistence is key. Don’t ever give up, think about why and who we need to positively change things for. Change takes time, and patience is a great virtue. I have outlasted 7 health Ministers, 3 Prime Ministers, and numerous top health leaders. I know this means something when I turn up each time to sit and talk in those big rooms.

I turn up in meetings with our most recognizable political and health leadership with the support and voice of our team of 4000. This is an honor, not a right of passage, respect and trust is earned, not taken for granted. Being honest, engaged and passionate about our wonderful profession must be pitched at every corner. Your rhetoric simply cannot change. I represent the most brilliant minds, technical expertise and compassionate practitioners we have in health, they do things that need to be preached and celebrated. I get emotional when I talk about why we need to treat these people better and enable them to create systems that will make a real difference to their communities.

My final word is this. I have lobbied and advocated for nearly 10 years to get National Pathology leadership and governance in NZ. Just last week, the National Clinical Pathology Advisory group is almost in place. After that……. I would love to say finally true National Pathology Governance for NZ is coming.