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Commercial Macro Framework, a case study in Health New Zealand – Te Whatu Ora
Author: Claire Cilliers
Supervisors: Ruth Myers Henk Roodt
6 September 2025
Cilliers, C. (2025). Commercial Macro Framework, a case study in Health New Zealand – Te Whatu Ora [Master's thesis, Otago Polytechnic]. Research Bank. https://doi.org/10.34074/thes.7126
Abstract
This thesis presents the development, application, and evaluation of the Commercial Macro Framework (CMF), a practice-informed tool designed to enhance commercial decision-making. The CMF was initially conceived and emerged in response to my own professional experience, where I observed a gap in structured business proposal processes within my organisation. Inconsistent processes, unclear expectations, and limited collaboration between clinicians and the business frequently resulted in inefficiencies, misaligned priorities, and missed opportunities for the economic deployment of resources to drive meaningful change.
This study takes place in the public health system of New Zealand in Health New Zealand - Te Whatu Ora (Health NZ). Health NZ is the government agency responsible for administering and delivering public health services. Funded by taxpayers, the system, regardless of social demographics, aims to provide equitable healthcare to all New Zealanders. Drawing on a practice-led inquiry approach, I developed a transferable CMF to provide a consistent structure and flexible guide for the development of business proposals. While the initial aim was to sense check the CMF with senior stakeholders, it quickly gained traction in the broader environment, far beyond its original scope. These opportunities included a national investment case for a Hyper Acute Stroke Service (HASS), rural service development, and an international presentation.
This transition from theoretical concept to a widely applied, real-world tool was an unexpected but positive development, confirming the relevance of the CMF’s adaptability and scalability. Throughout this work, I observed how the CMF acted as both a technical instrument and a relationship buttress. It supported cross-disciplinary engagement, enabling what I have come to term “meeting of the minds” between the commercial side of health (the business), where I practice, and clinicians. The CMF also provided a reference point that allowed both parties to bring their expertise to the work at hand without compromising their perspectives. Through its structured yet flexible design, the framework facilitated deeper inquiry, clearer alignment, and improved overall quality of business proposals.
In practical terms, the CMF supported stakeholders in maintaining focus, staying the course, on complex, interdependent business and clinical components without losing sight of broader strategic goals. It improved confidence in decision-making processes, ensuring proposals were credible, coherent, and aligned with clinical aspirations and organisational targets.
Visual tools used in the phases proved particularly effective in creating a shared understanding and encouraging reflection, an unanticipated but valuable finding that reinforced the function of design thinking in planning within the sector. Importantly, the CMF supported the development of stronger relationships and greater mutual respect between professional groups. It legitimised different ways of thinking, reduced ambiguity, and offered a framework for co-developing solutions in a complex system that is often fragmented.
Clinicians, in particular both nationally and internationally, responded positively, expressing interest in using the CMF more broadly across the healthcare sector. Their unsolicited engagement and enthusiasm demonstrated a clear appetite for more structured and collaborative approaches to service development and evolution. This unexpected momentum suggests that the CMF is more than a local tool.
Keywords
Commercial Macro Framework tool, health sector management, business proposal development, practice-informed, Health New Zealand, public health services
Licence
A copy of the thesis is publicly available under a Creative Commons Attribution Non-Commercial No Derivatives licence CC BY-NC-ND 4.0 International license
This licence applies except where otherwise indicated, especially for images.
